Radiology and Oncology最新文献

Background: In patients with rectal cancer, daily fluctuations in rectal volume often lead to large deformations of the target volume that cannot be corrected by adjusting the radiation couch. The main aim of the study was to determine the deviation of all three thirds of the rectum from the reference position and to determine whether these deviations are influenced by the alignments to the bony structures (the sacrum) and the posterior rectal wall.

Patients and methods: The conduct of the study was divided into review of the database, contouring of the anatomic structures on the cone-beam computed tomography (CBCT) images, data collection of the deviations and data output, with the alignment to the bony structures (the sacrum) - and the alignment to the posterior rectal wall performed separately.

Results: Fifty preoperatively irradiated patients were included in the study. The analysis revealed statistically significant differences in terms of alignment to the bony structures for different variations of the rectal thirds in the anterior (+), posterior (+), posterior (-), left (-), right (+) and right (-) directions. With regard to the alignment to the posterior rectal wall, the analysis showed statistically significant differences for different variations of the rectal thirds in directions anterior (+), posterior (+), posterior (-), left (-), right (+), right (-) and bone (+). (The positive value (+) means that the rectum was larger and the negative value (-) means that the rectum is smaller than in the reference position of the CT simulator images.).

Conclusions: The position of the rectal thirds changes daily in alignment with the bony structures (the sacrum), and in alignment with the posterior rectal wall.

Background: The subventricular zone (SVZ), the brain's largest neural stem cells reservoir, plays a critical role in glioblastoma development and progression. This study aims to investigate the association between MRI features and SVZ contact in IDH-wild-type glioblastoma, as well as their prognostic significance to guide personalized diagnosis and treatment.

Patients and methods: We retrospectively analyzed the MRI and clinical data of 371 patients with IDH-wild-type glioblastoma from The Cancer Imaging Archive. Tumors were classified into SVZ contact and non-contact group based on the spatial relationships between contrast-enhanced lesions and the SVZ on T1C imaging. Group differences were analyzed, and survival outcomes were assessed using Cox regression and Kaplan-Meier analyses.

Results: SVZ contact was observed in 64.4% of patients, these patients exhibited significantly shorter overall survival (OS) compared to the SVZ non-contact group (11.0 vs. 17.5 months, p < 0.001), larger tumor size (5.07 vs. 3.31 cm, p < 0.001), and higher rates of crossing the midline (11.7% vs. 0%, p < 0.001). They also showed higher rates of cystic lesions and necrosis. Cox regression confirmed SVZ contact as an independent predictor of poor OS (p = 0.027), alongside multifocal lesions and age. OS significantly differed by SVZ contact regions (p < 0.001), with temporal horn contact linked to longer OS and body contact to shorter OS.

Conclusions: SVZ contact is an independent prognostic factor for OS in IDH-wild-type glioblastoma, they exhibit larger tumor size, higher rates of crossing the midline, and multifocality. Prognostic differences among SVZ contact regions warrant further investigation to explore the role of their distinct microenvironments.

Background: Surgery followed by chemoradiotherapy (CRT) with temozolomide is the standard treatment for glioblastoma patients. But, the time between surgery and CRT is still a controversial issue. This study investigated the impact of delay in CRT after surgery on overall (OS) and progression-free survival (PFS).

Patients and methods: Patients aged ≥ 18 years with IDH-wild type glioblastoma, who received 60 Gy concomitant CRT with temozolomide were included in the study. Exclusion criteria include patients who underwent biopsy only, had an Eastern Cooperative Oncology Group (ECOG) performance status > 1, or presented with multicentric tumors. The interval between surgery and CRT was categorized according to 42 days, and delays after this point were defined as delayed treatment initiation. Statistical analyses included Kaplan-Meier survival analysis and Cox regression models.

Results: The median OS for the regular and delayed groups was 18 and 19 months, and the PFS was 11.8 and 14.6 months, respectively. Delayed patients showed better PFS, but no statistically significant difference was found between the groups in terms of OS and PFS (p = 0.149, p = 0.076). In multivariate analysis, ECOG performance score 1 and subtotal resection were associated with poor prognosis for both OS and PFS (for OS p = 0.031, p < 0.001; for PFS p = 0.038, p = 0.029). When the time from surgery to CRT was analyzed according to the extent of surgery, no significant difference was observed in OS and PFS (p = 0.068, P = 0.057).

Conclusions: Our findings showed that delays of more than 42 days in adjuvant CRT did not affect OS or PFS. However, further studies are needed to evaluate the effects of delayed adjuvant therapy in patients with subtotal resection.

Background: Epicardial adipose tissue (EAT) is a biologically active visceral brown adipose tissue, which is irregularly distributed across myocardium. It has emerged as a potential modifiable cardiometabolic biomarker in adults, demonstrating pro-inflammatory properties with involvement in subclinical atherosclerosis. The increased thickness of the inner two layers of the carotid artery wall (intima and media) in childhood can pose as a risk of the development of atherosclerotic disease and its complications in adult life, representing additional potential biomarker. The purpose of our study was to evaluate a relation between EAT volume (EATV) and carotid intima-media thickness (cIMT) in children and adolescents who have been diagnosed with primary arterial hypertension (AH), utilizing magnetic resonance imaging (MRI).

Patients and methods: The study included 72 children and adolescents, half of them had an established diagnosis of primary AH and the other half were matched healthy controls. The EATV and cIMT measurements were compared between the two groups and correlated with clinical, anthropometric and functional parameters.

Results: Children diagnosed with AH exhibited a significantly higher EATV (16.5 ± 1.9 cm³ vs. 10.9 ± 1.5 cm³; t = -13.815, p < 0.001) and higher cIMT (0.7 [0.2] mm vs. (0.4 [0.1) mm]; U = 54, p < 0.001) compared with their healthy counterparts. EATV demonstrated a significant correlation with cIMT.

Conclusions: Increased EATV and cIMT were found with MRI in hypertensive children compared to their healthy counterparts. EATV demonstrated a stronger association with hypertension than cIMT. EATV emerged as an independent predictor of cIMT.

Background: The aim of the present study was to assess a diagnostic potential of stem cell markers NANOG and SOX2 for classifying cervical squamous intraepithelial lesions (SILs)/cervical intraepithelial neoplasia (CIN).

Patients and methods: NANOG and SOX2 expression was evaluated immunohistochemically on 40 patients: in 10 cases each of low-grade SIL (LSIL), high-grade SIL/CIN, grade 2 (HSIL/CIN 2), HSIL/CIN, grade 3 (HSIL/CIN 3), cervical squamous cell carcinoma (CSCC) and their adjacent non-dysplastic squamous epithelium. In addition, human papillomavirus (HPV) genotyping and immunohistochemical staining with p16 and Ki-67 were done. NANOG and SOX2 expression was compared between squamous lesions and controls and between squamous lesions by multiplying staining intensity (SI) by the percentage of positive cells (P) and by multiplying SI by the thickness of staining in epithelium (T) to calculate SI x P and SI x T score.

Results: NANOG and SOX2 expression gradually increased from non-dysplastic squamous epithelium via LSIL and HSIL to CSCC. Expression of NANOG and SOX2 was higher in LSIL compared to controls (P < 0.05 for NANOG Si x P and Si x T scores and SOX2 SI x T score) and lower compared to HSIL (P < 0.05 for all SI x P and SI x T scores). HSIL/CIN 3 showed higher SOX2 expression than HSIL/CIN 2 (P < 0.05 for SI x P and SI x T scores).

Conclusions: Contrary to p16, NANOG and SOX2 could be effective for distinguishing LSIL from non-dysplastic changes. NANOG and SOX2 could be surrogate markers for differentiating LSIL from HSIL. Moreover, SOX2 could be helpful for distinguishing HSIL/CIN 2 from HSIL/CIN 3. Further studies with larger numbers of patients and molecular insights are needed.

Background: In recent years, various gene therapy strategies have been developed for cancer treatment. One of these strategies is electroporation-based delivery of therapeutic transgenes - gene electrotransfer (GET). Electrochemotherapy and GET have been combined in several contemporary preclinical and veterinary studies. In most cases, two different pulse protocols are used, each for a specific treatment. The aim of our current study was to test whether the standard pulse protocol used in daily clinical practice for electrochemotherapy can also be used for effective GET.

Materials and methods: Experiments were performed in vitro in a tumor (B16F10) and two normal tissue cell lines (C2C12 myoblasts and L929 fibroblasts). Four different GET protocols, three using monopolar electric pulses and one bipolar electric pulses, were tested for the GET of plasmid DNA, which codes for green fluorescent protein in vitro. In addition, two GET protocols were chosen for in vivo tumor and muscle transfection.

Results: Two GET protocols using monopolar electric pulses of different voltages delivered at 1 Hz transfected B16F10 tumor cells significantly better than normal cells. GET4 protocol, which uses monopolar electric pulses at 5 kHz, again transfected the B16F10 tumor cells significantly better, but the difference to the C2C12 myoblast cells was not significant. Compared with other GET protocols, GET3 using bipolar electric pulses at 1 Hz was significantly less effective. Both the GET2 (1 Hz) and GET4 (5 kHz) protocols resulted in similar tumor transfection efficiencies, whereas only the GET4 protocol was effective for muscle transfection in vivo.

Conclusions: Our study demonstrated the efficient transfection of tumors and muscles with the GET4 pulse protocol, which is used clinically for electrochemotherapy. The use of this protocol could enable simultaneous electrochemotherapy and GET of the therapeutic gene in one session, which will significantly shorten the procedure and thus will be more tolerable for patients.

Background: Selecting the most suitable skeletal remains for genetic analysis is challenging due to the variable DNA yield across different bone types and within individual bones. Compact bone typically preserves DNA longer, whereas cancellous bones, such as those in the hands and feet, often contain higher DNA quantities. This study aimed to incorporate dual-source computed tomography (DSCT), a technique frequently utilized for assessing bone density in living subjects, into targeted DNA sampling for dry, skeletonized remains by mapping compact and cancellous regions within six small skeletal elements.

Materials and methods: A total of 137 bones were analysed using an imaging protocol specifically adapted to highlight the skeletal structure of small bones. This tailored protocol involved meticulous calibration of imaging parameters. Anatomical landmarks for six distinct elements were identified, and regions of interest were selected for bone density measurement in Hounsfield units (HU).

Results: Among 461 assessed regions, 312 (68%) were classified as compact bone, and 149 (32%) as cancellous bone. Given the abnormal distribution of data, statistical differences were evaluated using 95% confidence intervals, with significance indicated by non-overlapping intervals. The analysis revealed statistically significant differences between compact and cancellous bone, as well as within each type across different bones.

Conclusions: DSCT proved effective in mapping the internal structure of six small skeletal elements in dry, skeletonized remains, underscoring significant intra-bone variability in density. The findings illustrate DSCT's substantial potential for enhancing DNA sampling in forensic and paleogenetic studies, setting the stage for future research advancements.

Background: The aim of the study was to evaluate gender-specific differences in the quality of life (QoL) and late effects among colorectal cancer patients during the first two years after treatment, to inform and improve long-term follow-up care and clinical management strategies.

Patients and methods: A total of 239 colorectal cancer patients were included, 56% males and 44% females, mostly in the age range 60-69 years. They were treated at the Institute of Oncology Ljubljana, during the time period from 1^st September 2023 to 1^st May 2024. In addition to demographic data, we included clinical data on disease and outcomes collected using the standardized quality of life questionnaires of European Organization for Research and Treatment of Cancer (EORTC) named EORTC QLQ-30 and EORTC QLQ-CR29 for colorectal cancer, respectively.

Results: Females were more likely to experience emotional problems (p = 0.002), higher levels of fatigue (p < 0.001), insomnia (p = 0.015), nausea and vomiting (p = 0.007), which may also be associated with poorer appetite in females. Males reported better body image than female (p = 0.047), lower levels of anxiety (p = 0.029), less frequently reported perceived weight loss or gain (p = 0.010). Male reported more stool frequency (p = 0.045), and also had more sever dysuria compared to female (p = 0.008).

Conclusions: The results provide the opportunity to improve the clinical management of long-term follow-up and care planning, taking into consideration the gender-specific needs of colorectal cancer survivors.

Background: Microvascular invasion (MVI), particularly its severity, correlates with prognosis in hepatocellular carcinoma (HCC), however, it remains uncertain which imaging traits are associated with MVI grades. Predicting MVI status precisely pre-surgery assists clinicians in making optimal treatment decisions.

Patients and methods: 213 HCC patients with surgically confirmed were assigned into three groups based on the severity of MVI (M0, M1, and M2). Clinical and imaging features were compared between each group. Univariate and multivariate analyses were used to identify the significant variables associated with MVI severity. Subsequently, nomograms were constructed to estimate MVI and its M2 grade by crucial factors. Nomograms were assessed for accuracy, clinical value, and efficacy using the area under the curve (AUC), calibration curve, and decision curve analysis (DCA).

Results: Four factors associated with MVI (P < 0.05) were related, including non-solitary growth types, no/mini enhanced mode, peritumoral enhancement on arterial phase, and peritumoral hypointensity on hepatobiliary phase. Only the ratio of the maximum and minimum tumor diameter (Max/Min-R), confluent multinodule growth type, and non-washin/washout enhanced modes of those MVI-positive patients showed a strong correlation with M2 grade. The areas under the receiver operating characteristic (ROC) curves were 0.885 (95% confidence intervals [CI]: 0.833-0.937) in identifying MVI and 0.805 (95% CI: 0.703-0.908) in predicting its M2 grade, respectively. The nomograms demonstrated a high goodness-of-fit and clinical benefits in DCA and calibration curve.

Conclusions: Enhancement modes and tumor growth patterns of preoperative MRI were independent risk factors of MVI severity, which were valuable for facilitating individualized decision-making.

Background: The quality of life of patients undergoing oncologic treatment has become an important issue in recent years. Owing to potential mutilation following surgery for vulvar cancer, more conservative approaches have evolved with the integration of new local ablative therapies, such as electrochemotherapy. The aim of this study was to determine the quality of life of women with vulvar cancer recurrence treated with electrochemotherapy for nonpalliative purposes.

Patients and methods: Eleven patients with vulvar cancer recurrence were treated with electrochemotherapy from July 2020 to December 2023. Patients completed different questionnaires: the EuroQol - 5 Dimension (EQ-5D), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Vulva Cancer 34 (EORTC QLQ-VU34) and visual analog pain scale (VAS) before and one, three and six months after electrochemotherapy. As a control group, fifteen patients with vulvar cancer recurrence treated with wide local excision completed the EORTC QLQ-C30 and VAS questionnaires before surgery and three and six months after surgery.

Results: No significant differences in EQ-5D scores were found between quality of life before electrochemotherapy and at each follow-up visit. A comparison of the EORTC QLQ-C30 scores between the electrochemotherapy and surgery groups showed a significant difference in physical functioning, fatigue, insomnia, and global health status three months after the procedure and in role, cognitive, social functioning and appetite loss six months after the procedure, all of which were in favor of the electrochemotherapy group. The EORTC QLQ-VU34 questionnaire showed improvements in urinary symptoms and symptoms related to scarring and mutilation of the external genitalia in the electrochemotherapy group. The VAS score did not differ significantly between the electrochemotherapy and surgical groups.

Conclusions: The study showed that the quality of life after treatment with electrochemotherapy is better in some segments than after surgical treatment.