Radiation Medicine

High-dose-rate (HDR) brachytherapy combined with hormonal therapy (HTx), without the addition of external beam radiation therapy (EBRT) for high-risk prostate cancer was evaluated retrospectively. Between May 1995 and April 2002, 35 patients with prostate cancer [Stage≥T2b (UICC 1997) or tumor grading=3 or prostate-specific antigen (PSA) level≥20 ng/mL] were treated with HDR brachytherapy combined with HTx. Most patients (74%) had two or more of these factors. All patients received Iridium-192 HDR brachytherapy with a total dose of 54 Gy/9 fractions/5 days (48 Gy/8 fractions/5 days for the first 6 cases) in one implant session. The median neoadjuvant HTx [luteinizing hormone-releasing hormone (LH-RH) agonist and antiandrogen] period was 7 months. The median adjuvant HTx (ATH) (LH-RH agonist) period was 40 months, and median follow-up was 57 months (range, 23–117 months). The 5-year actuarial biochemical control, local control, and disease-free rates were 62%, 96%, and 76% respectively. No patients experienced local and/or regional relapse without distant progression. The 5-year actuarial cause-specific survival and overall survival rates were 89% and 87%, respectively. The acute and late toxicity were moderate and well tolerated. HDR brachytherapy plus long-term HTx is at least as effective as conventional EBRT plus long-term HTx.

Gastric cancer metastatic to skeletal muscle is an unusual entity. Surgery, systemic chemotherapy, or radiotherapy to the metastatic mass can be treatment options for achiving palliation. Case Report: A patient with multiple skeletal muscle metastases that occurred during follow-up after gastrectomy and adjuvant chemo-radiotherapy is reported. Magnetic resonance imaging (MRI) demonstrated soft-tissue masses involving the posterior right paralumbar and posterior left paradorsal muscles. Biopsy showed metastatic infiltrating adenocarcinoma. The patient did not respond to palliative chemotherapy. Palliative radiotherapy was administered to the painful mass. Based on this case, the diagnosis of muscle metastases and treatment options for palliation are discussed.

We present a case of right intracystic carcinoma of the breast. An 83-year-old woman was seen at our hospital with a growing bulky mass in the right breast for the last 2 years. Whole-body fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG-PET/CT) was performed 15 days after mammography (MMG). 18F-FDGPET/CT showed a right bulky cystic mass and intense FDG uptake in the intracystic nodules as well as in the adjacent extracystic lesion and the underlying pectoralis major muscle. It suggested tumor invasion of the pectoralis major muscle. Right mastectomy combined with partial resection of adherent pectoral muscle was performed. The main cystic lesion was diagnosed to be solid-papillary carcinoma, but the area of the pectoralis muscle was diagnosed to be a “foreign body” inflammation. It was thought that the compression related to MMG and core needle biopsy induced an injury in the bulky breast mass with leakage of contents into adjacent tissue, resulting in the foreign body inflammation. In conclusion, the coexisting foreign body inflammation was responsible for a false-positive 18F-FDG-PET/CT scan in the current case.

The aim of this study was to assess the variation of probe rotation angles for detecting a single needle using sagittal images of transrectal ultrasonography (TRUS). A phantom study was performed. One needle was inserted through each of 10 holes of the template, and variations in the probe rotation angles for detecting the needle were measured. The mean variation of probe rotation for detecting a single needle was 17.0° (range 4°–25°). Slightly broader variation was seen for the needle in holes farther away from the probe. Probe rotation angles for detecting a single needle displayed considerable variation. Seed locations recognized on sagittal imaging by TRUS are thus indeterminate, and real-time dose calculations using TRUS for 125I seed implantation should be used with care.

We have performed pelvic magnetic resonance imaging (MRI) in patients undergoing breast cancer surgery before and after adjuvant drug therapy. Our purpose was to detect any radiographic uterine changes induced by various types of adjuvant therapy on pre- and postmenopausal patients by evaluating prospectively performed MRI. Between September 2004 and December 2007, a total of 41 women with breast cancer (11 premenopausal, 30 postmenopausal) were enrolled. All underwent MRI of the pelvis before and after drug therapy, and uterine changes were evaluated. Postoperative drugs used were selective estrogen receptor modulators (SERMs) including tamoxifen and toremifene (n = 18), aromatase inhibitors (n = 13), and anticancer drugs (n = 10). Only the postmenopausal patients receiving SERMs showed a significant increase in endometrial thickness: from 2.4 ± 0.4 mm before therapy to 4.5 ± 2.6 mm after therapy (P = 0.0485). No statistically significant endometrial change was evident in postmenopausal patients treated with aromatase inhibitors (P = 0.573) or anticancer drugs (P = 0.754). Also, in premenopausal patients treated with SERMs or anticancer drugs, the change in endometrial thickness was not statistically significant (P = 0.958, 0.370). This prospective study using MRI has demonstrated that uterine changes associated with adjuvant drugs for breast cancer occur exclusively in postmenopausal patients receiving SERMs.

The purpose of this prospective study was to perform quantitative multidetector computed tomography (MDCT) analysis of pulmonary solid nodules using three parameters (long-short ratio, compactness, and intranodular CT number) and to evaluate the usefulness of each parameter in the differentiation of the nodules. Seventy solitary pulmonary nodules with a long axis length of 5–30 mm were examined using one multidetector CT (MDCT) system and one three-dimensional (3D) system, and the findings regarding the three parameters were statistically analyzed among five diseases (hamartoma, organizing pneumonia, adenocarcinoma, squamous cell carcinoma, and metastasis). The long-short ratio of the pulmonary nodule showed no significant differences among five diseases. The compactness showed significant differences (P < 0.05) in five pairs of diseases. Intranodular CT number showed significant differences (P < 0.05) in three pairs of diseases. Our results are insufficient for the complete differentiation of pulmonary solid nodules. However, among the three parameters, compactness and intranodular CT number contribute somewhat to the differentiation of pulmonary nodules.

The purpose of this study was to evaluate the frequency of tracheobronchomalacia (TBM) associated with pulmonary emphysema with paired inspiratory-expiratory multidetector computed tomography (MDCT) using a low-dose technique. This study included 56 consecutive patients (55 men, 1 woman; mean age 68.9 years) with pulmonary emphysema who had undergone paired inspiratory-expiratory CT scanning with a low-dose technique (40 mA). All images were retrospectively examined by two thoracic radiologists in a blinded fashion. The diagnosis of TBM was based on the standard criterion of >50% reduction in the cross-sectional area of the tracheobronchial lumen at the end-expiratory phase. A mild TBM criterion of >30% reduction was also reviewed. All patients underwent pulmonary function tests. The relation between the forced expiratory volume in 1 s (FEV1.0%) and TBM was statistically analyzed. Four (7.1%) and eight (14.3%) patients were diagnosed as TBM based on the standard and mild criteria, respectively. In four patients, the percentages of luminal narrowing were 63.4% and 51.2%, respectively for tracheomalacia and 59.2% and 62.0%, respectively, for bronchomalacia. The FEV1.0% values between patients with and without TBM showed no statistical difference. The incidence of TBM associated with pulmonary emphysema was 7.1% with the standard criterion. It is possible that TBM has been underdiagnosed in a number of patients with pulmonary emphysema.

Four-dimensional (4D) radiotherapy, in particular respiration gating for the treatment of lung tumors, is gaining popularity. Its utility for other sites, however, has not been investigated fully. The purpose of this study was to see whether 4D therapy is feasible for liver tumors. Six patients (five with hepatomas and one with metastatic liver tumor) had a fiducial, gold marker 1.5 mm in diameter implanted in the vicinity of their liver tumors. The inner and external (i.e., upper abdominal wall) respiratory movements were simultaneously recorded using a real-time tumor-tracking radiotherapy system and respiration monitor equipment applied to the mid to upper abdomen. The fluctuations from the baseline position of liver tumors were small; the mean absolute value was 3.92 ± 1.94 mm. The mean right-left, anteroposterior, and craniocaudal total movements were 4.19 ± 2.46, 7.23 ± 2.96, and 15.98 ± 6.02 mm, respectively. The phase shift was negligible. Liver tumors may be suitable for respiration-gated radiotherapy, and they may become curable with 4D radiotherapy.