The role of quantitative diffusion-weighted imaging in characterization of hypovascular liver lesions: A prospective comparison of intravoxel incoherent motion derived parameters and apparent diffusion coefficient.

BACKGROUND: The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown. PURPOSE: The purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM). METHODS: Seventy-four prospectively enrolled patients (21 IMC, and 53 HLM) underwent 1.5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0-800 s/mm2). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver reliability was tested using a intraclass correlation coefficient. ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS: The interobserver agreement was good for ADC (0.802), and excellent for D, D*, and ƒ (0.911, 0.927, and 0.942, respectively). ADC, and D values were significantly different among IMC and HLM (both p < 0.05), while there was no significant difference among these lesions for ƒ and D* (p = 0.101, and p = 0.612, respectively). ROC analysis showed higher diagnostic performance of D in comparison to ADC (AUC = 0.879 vs 0.821). CONCLUSION: IVIM-derived parameters in particular D, in addition to ADC, could help in differentiation between most common hypovascular malignant liver lesions, intrahepatic mass-forming cholangiocarcinoma and hypovascular liver metastases.

Statement to an Insufficient Systematic Review on Viscum album L. Therapy.

BACKGROUND: Up to 88% of oncological patients apply complementary therapies and up to 77% apply complementary mistletoe therapy in the context of integrative oncological approaches. An evidence-based consultation of oncological health professionals regarding complementary therapies used in Germany is missing. Therefore, a new S3-Guideline for Complementary Medicine in the Treatment of Oncological Patients is under development and is anticipated to be finalized in November 2020. It will be based on evidence-based publications and systematic reviews on complementary therapies in oncology. A recently published two-part systematic review on mistletoe treatment in oncology has been reevaluated. METHODS: The latest published systematic two-part review on mistletoe has been systematically proofread and checked in compliance with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) tool. RESULTS: The here discussed two-part review is incomplete, lacks sound accuracy including insufficient assessment of the risk of bias, and contains imprecise statements. In addition, it does not sufficiently comply with the Cochrane Handbook for Systematic Reviews of Intervention and the AMSTAR 2 tool. CONCLUSION: In view of the approaching release of a new guideline in the field of complementary therapies in oncology, the present statement draws attention to a lack of profound methodology of conductance of a recently released systematic review on mistletoe. In consequence, a comprehensive overview of published mistletoe studies, i.e., a meta-analysis with a sound methodology of conductance, is necessary.

Iscador Qu inhibits doxorubicin-induced senescence of MCF7 cells.

Chemotherapy in patients with inoperable or advanced breast cancer inevitably results in low-dose exposure of tumor-cell subset and senescence. Metabolically active senescent cells secrete multiple tumor promoting factors making their elimination a therapeutic priority. Viscum album is one of the most widely used alternative anti-cancer medicines facilitating chemotherapy tolerance of breast cancer patients. The aim of this study was to model and investigate how Viscum album extracts execute additive anti-tumor activity with low-dose Dox using ER + MCF7 breast cancer cells. We report that cotreatment of MCF7 with Viscum album and Dox abrogates G2/M cycle arrest replacing senescence with intrinsic apoptotic program. Mechanistically, this switch was associated with down-regulation of p21, p53/p73 as well as Erk1/2 and p38 activation. Our findings, therefore, identify a novel mechanistic axis of additive antitumor activity of Viscum album and low dose-Dox. In conclusion, ER + breast cancer patients may benefit from addition of Viscum album to low-dose Dox chemotherapy due to suppression of cancer cell senescence and induction of apoptosis.

Treatment of a Patient with Abdominal Aortic Aneurysm and Hepatocellular Carcinoma.

BACKGROUND: The surgical tactics in cases of abdominal aortic aneurysms (AAA) and intra-abdominal malignancy are not uniform in the literature and are still a matter of debate. In this case report, we present a patient with coexisting AAA and primary liver cancer managed by simultaneous open AAA repair and liver resection After laparotomy and intraoperative liver ultrasonography that confirmed resectability of the tumor, aneurysm repair was performed with aorto-aortic tube grafting after interrenal cross-clamping Radiofrequency-assisted liver transection was performed to complete an anterior anatomic resection of liver segments VI and VII. The postoperative course was uneventful and the patient was discharged on a postoperative day 10. METHODS: This was prospective follow up of one patient. RESULTS: The patient is free from disease at 18-month follow-up. CONCLUSIONS: The best treatment strategy for patients with AAA and malignant disease is still not clearly defined. Strategy selection is made individually according to the risk of rupture of AAA, general condition of the patient, experience of the teams that should perform the procedure and estimated life expectancy after resection of malignant disease.