Clinical Results of Transarterial Radioembolization (TARE) with Holmium-166 Microspheres in the Multidisciplinary Oncologic Treatment of Patients with Primary and Secondary Liver Cancer.

Holmium-166 microspheres are used for the transarterial radioembolization (TARE) treatment of primary and secondary liver cancers. In this study, its efficacy regarding local tumor control and integration into the oncological treatment sequence of the first 20 patients treated in our institution were examined. A total of twenty-nine 166Ho-TARE procedures were performed to treat hepatocellular carcinoma (HCC, fourteen patients), metastatic colorectal cancer (mCRC, four patients), intrahepatic cholangiocarcinoma (ICC, one patient), and hemangioendothelioma of the liver (HE, one patient). In eight patients, 166Ho-TARE was the initial oncologic treatment. In patients with HCC, the median treated-liver progression-free survival (PFS), overall PFS, and overall survival after 166Ho-TARE were 10.3, 7.3, and 22.1 months; in patients with mCRC, these were 2.6, 2.9, and 20.6 months, respectively. Survival after 166Ho-TARE in the patients with ICC and HE were 5.2 and 0.8 months, respectively. Two patients with HCC were bridged to liver transplantation, and one patient with mCRC was downstaged to curative surgery. In patients with HCC, a median treatment-free interval of 7.3 months was achieved. In line with previous publications, 166Ho-TARE was a feasible treatment option in patients with liver tumors, with favorable clinical outcomes in the majority of cases. It was able to achieve treatment-free intervals, served as bridging-to-transplant, and did not prevent subsequent therapies.

Flowability, Tear Strength, and Hydrophilicity of Current Elastomers for Dental Impressions.

This study investigates 2 polyethers (PE), 2 polyvinylsiloxanethers (VXSE), and 10 polyvinylsiloxanes (PVS), seven of which had a corresponding light-body consistency and seven of which had a corresponding heavy-body consistency. Each light-body elastomer underwent a flowability test using the shark fin method 20, 50, and 80 s after mixing. The tear strength test DIN 53504 was used after setting the time (T0). Next, 24 h later (T1), hydrophilicity testing was used with static contact angles in water drops during polymerization (20, 50, and 80 s, as well as after 10 min). The heavy-body elastomers underwent shark fin testing with a corresponding light-body material at 50 and 80 s after mixing. The results of light-body testing were combined in a score to describe their performance. The highest differences were detected within flowability in shark fin heights between PE and a PVS (means of 15.89 and 6.85 mm) within the maximum tear strengths at T0 between a PVS and PE (3.72 and 0.75 MPa), as well as within hydrophilicity during setting between VXSE and a PVS (15.09° and 75.5°). The results indicate that VSXE and novel PVS materials can significantly compensate shortcomings in PE towards tear strength and hydrophilicity, but not flowability.

First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases.

PURPOSE: Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. METHODS: We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as "Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)". RESULTS: ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. CONCLUSION: To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.

Comparison of subjective evaluation versus objective algorithm in the interpretation of follow-up FDG-PET/CT scans after radiochemotherapy in head and neck cancer patients.

AIM: Retrospective evaluation of serial FDG-PET/CT scans in head and neck squamous cell cancer (HNSCC) patient's follow-up after primary radiochemotherapy (RCTx), to assess the diagnostic accuracy of an experienced observer vs. an objective classification compared to standard clinical follow-up examinations. METHODS: Sixty-nine patients with locally advanced HNSCC were included, who received curative RCTx. Follow-up included serial FDG-PET/CT at the following time intervals t1: ≤ 270 d, t2: 271-540 d, t3: > 540 d after curative RCTx. The likelihood to detect local recurrences, nodal and distant metastases were compared between (i) experienced observer, (ii) an objective classification system by Zundel et al. 25, and (iii) routine clinical follow-up examinations. RESULTS: Twenty-two local recurrences, 7 nodal and 17 distant metastases were recorded during the follow-up. The diagnostic accuracy for local recurrence of the experienced observer vs. objective classification was 78 % vs. 77 % for t1, 83 % vs. 79 % for t2 and 100 % vs. 84 % for t3.The classification (ii) and the conventional follow-up (iii) resulted in a relatively high amount of equivocal findings reducing the diagnostic accuracy. CONCLUSION: Evaluation of FDG-PET/CT by an experienced observer in follow-up of HNSCC patients after curative RCTx resulted in the highest diagnostic accuracy in comparison to an objective classification and to routine clinical examination.HNSCC is a malignant tumor with a high likelihood of recurrence, especially in the first two years after curative RCTx. Early detection of recurrence is of high clinical importance, since there are several effective second line therapies that may have curative potential in some patients.

Calibration and cross-laboratory implementation of scintillating screens for electron bunch charge determination.

We revise the calibration of scintillating screens commonly used to detect relativistic electron beams with low average current, e.g., from laser-plasma accelerators, based on new and expanded measurements that include higher charge density and different types of screens than previous work [Buck et al., Rev. Sci. Instrum. 81, 033301 (2010)]. Electron peak charge densities up to 10 nC/mm2 were provided by focused picosecond-long electron beams delivered by the Electron Linac for beams with high Brilliance and low Emittance (ELBE) at the Helmholtz-Zentrum Dresden-Rossendorf. At low charge densities, a linear scintillation response was found, followed by the onset of saturation in the range of nC/mm2. The absolute calibration factor (photons/sr/pC) in this linear regime was measured to be almost a factor of 2 lower than that reported by Buck et al. retrospectively implying a higher charge in the charge measurements performed with the former calibration. A good agreement was found with the results provided by Glinec et al. [Rev. Sci. Instrum. 77, 103301 (2006)]. Furthermore long-term irradiation tests with an integrated dose of approximately 50 nC/mm2 indicate a significant decrease of the scintillation efficiency over time. Finally, in order to enable the transfer of the absolute calibration between laboratories, a new constant reference light source has been developed.

Erratum: Primary choriocarcinoma of the liver: a rare, but important differential diagnosis of liver lesions.

[This corrects the article DOI: 10.1093/jscr/rjy068.].

Primary choriocarcinoma of the liver: a rare, but important differential diagnosis of liver lesions.

The case of a 64-year-old man with spontaneous acute abdominal bleeding is presented. Under suspicion of an atypical hepatocellular carcinoma an extended left hemihepatectomy was performed. Histological diagnosis after surgical therapy revealed a primary hepatic choriocarcinoma. During follow-up within 5 months several metastases were detected. Because of the number and localization of the metastases, there was no further curative surgical option and palliative systemic chemotherapy was initiated. Primary choriocarcinoma of the liver is an important differential-diagnosis in hypervascularized lesions of the liver. This tumor-entity is highly aggressive, with rapid tendency for metastatic spreading. This correlates with the poor prognosis of 12 months after tumor-detection.