Prognostic analysis of radiation-induced liver damage following carbon-ion radiotherapy for hepatocellular carcinoma.

BACKGROUND: Radiation-induced liver damage (RILD) occasionally occurs following carbon-ion radiotherapy (CIRT) for liver tumors, such as hepatocellular carcinoma (HCC), in patients with impaired liver function disease. However, the associated risk factors remain unknown. The present study aimed to determine the risk factors of RILD after CIRT. METHODS: We retrospectively analyzed 108 patients with HCC treated with CIRT at the Osaka Heavy Ion Therapy Center between December 2018 and December 2022. RILD was defined as a worsening of two or more points in the Child-Pugh score within 12 months following CIRT. The median age of the patients was 76 years (range 47-95 years), and the median tumor diameter was 41 mm (range 5-160 mm). Based on the pretreatment liver function, 98 and 10 patients were categorized as Child-Pugh class A and B, respectively. We analyzed patients who received a radiation dose of 60 Gy (relative biological effectiveness [RBE]) in four fractions. The median follow-up period was 9.7 months (range 2.3-41.1 months), and RILD was observed in 11 patients (10.1%). RESULTS: Multivariate analysis showed that pretreatment Child-Pugh score B (p = 0.003, hazard ratio [HR] = 6.90) and normal liver volume spared from < 30 Gy RBE (VS30 < 739 cm3) (p = 0.009, HR = 5.22) were significant risk factors for RILD. The one-year cumulative incidences of RILD stratified by Child-Pugh class A or B and VS30 < 739 cm3 or ≥ 739 cm3 were 10.3% or 51.8% and 39.6% or 9.2%, respectively. CONCLUSION: In conclusion, the pretreatment Child-Pugh score and VS30 of the liver are significant risk factors for RILD following CIRT for HCC.

Carbon-ion radiotherapy for oligometastatic liver disease: A national multicentric study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS).

Reports on the therapeutic efficacy and safety of carbon-ion radiotherapy (C-ion RT) for oligometastatic liver disease are limited, with insufficient evidence. This study aimed to evaluate the clinical outcomes of C-ion RT for oligometastatic liver disease at all Japanese facilities using the nationwide cohort data. We reviewed the medical records to obtain the nationwide cohort registry data on C-ion RT between May 2016 and June 2020. Patients (1) with oligometastatic liver disease as confirmed by histological or diagnostic imaging, (2) with ≤3 synchronous liver metastases at the time of treatment, (3) without active extrahepatic disease, and (4) who received C-ion RT for all metastatic regions with curative intent were included in this study. C-ion RT was performed with 58.0-76.0 Gy (relative biological effectiveness [RBE]) in 1-20 fractions. In total, 102 patients (121 tumors) were enrolled in this study. The median follow-up duration for all patients was 19.0 months. The median tumor size was 27 mm. The 1-year/2-year overall survival, local control, and progression-free survival rates were 85.1%/72.8%, 90.5%/78.0%, and 48.3%/27.1%, respectively. No patient developed grade 3 or higher acute or late toxicity. C-ion RT is a safe and effective treatment for oligometastatic liver disease and may be beneficial as a local treatment option in multidisciplinary treatment.

Radiographic predictive factors for 10-year survival of removable partial denture abutment teeth: Alveolar bone level and density.

PURPOSE: To determine postoperative periodontal and radiographic factors that predict the survival rates of abutments of removable partial dentures (RPDs). METHODS: Patients who wore RPDs for > 10 years and received supportive periodontal therapy were included. Periodontal examinations and radiographic assessments were conducted on 83 abutment teeth in 35 patients at baseline, and five years after RPD insertion. In addition to conventional factors, such as tooth mobility at 5 years, radiographic factors, such as the crown-root ratio (ΔCR ratio) and gray-level changes reflecting changes in alveolar bone density (ΔABD), were evaluated. The impact of the covariables on the 10-year survival of abutment teeth was estimated using a multivariate Cox regression model, considering multicollinearity. RESULTS: Patients were classified as having A2-B2 (45.7%) and B3-C2 (54.3%) tooth loss, according to the Eichner classification. A probing depth ≥ 4 mm, tooth mobility ≥ grade 1, and CR ratio ≥ 1 were found in 30.1%, 33.7%, and 51.8% of abutment teeth, respectively. The 10-year survival rate of abutment teeth was 86.7%. Multivariate analysis showed that the 10-year survival of abutment teeth was significantly associated with root canal treatment (P = 0.045, hazard ratio [HR] = 1.23), the 5-year ΔCR ratio (P = 0.022, HR = 3.20), and ΔABD on the edentulous side of the abutment teeth (P = 0.047, HR = 1.08). CONCLUSIONS: In addition to root canal treatment, changes in the CR ratio and radiographic alveolar bone density at five years predicted the long-term survival rate of RPD abutments.

Long-term observation of periodontal condition following placement of removable partial dentures with rigid retainers and major connector in patients with/without diabetes: A retrospective study.

PURPOSE: This retrospective study evaluated the periodontal tissues of the abutment teeth of removable partial dentures (RPDs) with rigid retainers and major connectors in patients with and without type 2 diabetes mellitus (T2D). METHODS: A total of 313 patients who had been treated with RPDs, including rigid retainers and major connectors, were divided into two groups: T2D and non-T2D. The periodontal parameters and radiographic bone heights of the abutment teeth were evaluated at baseline and at a 5-year examination during supportive periodontal therapy (SPT). For patients with accessible standardized radiographs, bone density was analyzed based on the gray level (GL) using digital subtraction radiography (n = 83). RESULTS: Overall, 739 abutment teeth (86 in the T2D group) of 235 patients (25 in the T2D group) were analyzed, and 95.0% (94.2% in the T2D group, and 95.2% in the non-T2D group) were maintained. The mean probing pocket depth significantly increased in both groups (p < 0.001). There were significant changes in the radiographic bone height (p = 0.038) and GL on the side of the denture base area (p = 0.048) in the T2D group compared to those in the non-T2D group. CONCLUSION: Regardless of T2D, RPDs with rigid retainers and major connectors could prevent the progression of periodontal disease and successfully maintain most of the abutment teeth during 5-years of SPT. However, T2D may be significantly associated with loss of bone height reduction and density on the side of the denture base area.

Effect of night dentures on tooth mobility in denture wearers with sleep bruxism: A pilot randomized controlled trial.

PURPOSE: The purpose of this study was to investigate the inhibitory effect of night denture (ND) placement on abutment tooth mobility in removable partial denture (RPD) wearers with sleep bruxism (SB). METHODS: The participants were selected from RPD wearers diagnosed with SB using BiteStrip® and randomly allocated to one of the following groups: with ND placement or without ND placement (intervention or control group, respectively). The mobility of the RPD abutment tooth was measured using Periotest® at baseline (T0) and at 1 (T1), 3 (T3), and 6 months (T6). BiteStrip® scores were recorded at T0 and T6. Intragroup comparisons of the Periotest® value (PTV) were performed using analysis of covariance. Intergroup comparisons of PTV and BiteStrip® scores were performed using the linear mixed model and Wilcoxon signed-rank test, respectively. Intragroup comparisons of BiteStrip® scores were performed using the Mann-Whitney U test. RESULTS: At T6, the PTV in the intervention group was significantly lower than that in the control group (p=0.004). PTV was significantly lower at T6 than that at T0 in the intervention group (p=0.030), while PTV was significantly higher at T6 than that at T0 in the control group (p=0.007). There was no significant difference in the BiteStrip® score between the two groups. The BiteStrip® score at T6 was significantly lower than that at T0 only in the intervention group (p=0.011). CONCLUSION: ND placement might inhibit the increase in mobility of RPD abutment teeth and be effective in protecting them in RPD wearers with SB.

Assessment of Daily Replanning and Geometrical Variation of High-dose-rate Brachytherapy for the Prostate.

BACKGROUND: The present study aimed to estimate geometric changes in applicators and prostate over 3 days in patients with high-dose-rate brachytherapy (HDR-BT) and to assess the need for daily replanning. PATIENTS AND METHODS: This study retrospectively investigated 18 patients who underwent HDR-BT as monotherapy from February 2016 to October 2018. RESULTS: Without replanning, the planning target volume coverage significantly worsened on day 2 (p<0.001) and day 3 (p=0.003). The minimum dose distributed to the highest irradiated rectal volume of 5 cc became significantly higher on day 2 (p=0.02), and the maximum dose distributed to the urethra became significantly higher on day 2 (p=0.01). CONCLUSION: Conformal, high-dose delivery of HDR-BT is impaired without replanning not only on the second day but also on the third day. Daily replanning is required for achieving accuracy of HDR-BT.

Influence of retainer and major connector designs of removable partial dentures on the stabilization of mobile teeth: A preliminary study.

The purpose of this study was to investigate the influence of retainers and major connector designs on the stabilization of remaining mobile teeth using removable partial dentures (RPDs). We prepared experimental RPDs with several retainer designs and major connectors for lower Kennedy class I models. The simulated RPD insertion and removal test was conducted and retentive force and mobility of mobile remaining teeth with and without RPD placement were measured throughout a simulation test. Regardless of reduction of retentive force, the placement of RPDs using cast clasps and/or lingual plates resulted in reduced mobility of the remaining teeth than use of wrought wire clasps and/or lingual bars. The results suggested that cast clasps and lingual plates are effective for the stabilization of mobile, remaining teeth. Additionally, the stabilizing effect of RPD on abutment teeth was not diminished, despite decreases in retentive force.

Total care system for maintaining a comfortable prone position after vitreoretinal surgery.

A care system to maintain a comfortable prone position after vitreoretinal surgery was developed. Four positions and face-down gear including a TV-watching table were prepared in patients' rooms. Patients could take one position and then change to another position actively as desired. Thirty-nine patients used this system for 4 days after vitreoretinal surgery with intravitreal gas injection. Patients rated the system on a questionnaire. Patients who used the TV-watching table expressed more satisfaction than the patients who did not use it. Also, patients' active selection of various prone postures was important physically and mentally.