Radiology and Oncology最新文献

Background: Basal cell carcinoma (BCC) is a cutaneous malignancy that typically appears in sun-exposed areas. We analyzed data from the Insp-ECT registry of all patients affected by BCC in the head and neck region. The aim of this study was to evaluate the safety and efficacy of electrochemotherapy (ECT) on a 5-year basis.

Patients and methods: A cohort of 132 patients was included. They were treated by ECT according to the current Standard Operating Procedures. The median age was 74 years (range 41-93). There was a median of 1 nodule per patient (range 1-7), and the median size of the lesions was 1.4 cm (range 0.5-5.0 cm).

Results: Patients tolerated ECT well, and 96% agreed to repeat it if needed. The side effects were mild and temporary. All patients achieved a complete clinical response after 1 to 3 ECT sessions. During the first year of follow-up, 4 (3%) patients experienced recurrence, which was treated (2 with ECT, 1 with surgery, and 1 with a combination of ECT and surgery), after which they remained free of disease until the end of follow-up at 5 years. Five patients reported recurrence thereafter and were treated according to their condition. At the 5-year follow-up, the disease-free survival (DFS) rate was 92% (95% confidence interval [CI]: 87%-96%). At that time, 3 patients were alive with disease (2%), and 124 patients were free of disease (98%).

Conclusions: This study shows the feasibility and efficacy of ECT treatment in elderly patients with BCC tumors in aesthetically and functionally sensitive areas, with negligible toxicity. Comparable efficacy to other treatment modalities was demonstrated at 1 year and 5 years of follow-up in terms of DFS.

Background: On imaging, malignant breast masses are commonly associated with spicules. To the best of our knowledge, the clinical significance of such spiculae has not been previously studied, and no surgical guidelines are available for the management of mammographically detected spiculations.

Patients and methods: Between April 2018 and December 2019, all consecutive breast-conserving surgery -patients with invasive malignant lesions, who required intraoperative radiological breast specimen assessment with tomosynthesis, were retrospectively included in this analysis. The tumors were classified into two groups: those with spiculated margins as the dominant feature, and those with other distinct morphological characteristics. Spicule visualization, length, and distribution were evaluated in both groups using pre- and intraoperative imaging and compared with the histopathological features of the spicules.

Results: In total, 162 invasive lesions were evaluated. The presence of spicule-associated additional tumor foci was a common finding; 67.6% of the spiculated tumors and 48.9% of the other tumors had additional foci. Most additional tumor foci were within 1 cm of the tumor edge. The mean pathologically measured distance from the main tumor margin to the spicule-associated additional tumor foci was 4.3 ± 2.8 mm. Compared to the maximum spicule length determined from intraoperative images (9.5 ± 5.1 mm), the distance of actual tumor infiltration was much shorter, and a very weak correlation was observed.

Conclusions: Breast tumor spicules harbor additional tumor foci, which may lead to margin positivity and potential reoperation. Additional research is necessary to determine the actual tumor burden and clinical significance of spicules.

Background: We retrospectively assessed volumetric response of myxoid liposarcoma (MLPS) with preoperative radiotherapy (RT) and sought to identify disease and treatment characteristics associated with response.

Patients and methods: We identified all patients with a histologic diagnosis of MLPS who received preoperative RT from 2013 to 2021 at our institution. We used cone beam computed tomography (CBCT) to assess changes in tumor volume and greatest dimension during treatment. Tumors were contoured on CBCT images prior to treatment and at the end of each week of RT. Percentage change in tumor volume and greatest dimension were calculated based on pre-treatment and final week contours. Patients with tumors incompletely visualized on CBCT were excluded from volume analysis but included on greatest dimension analysis. Magnetic resonance imaging (MRI) was used to evaluate pre- and post-RT radiographic features. Surgical pathology was reviewed to record pathologic characteristics.

Results: Twenty patients met inclusion criteria. Most tumors (18/20) were low grade. The most frequent dose/fractionation scheme was 50 Gy in 25 fractions (16/20), with 3 patients receiving 36 Gy in 18 fractions. Median pre-RT volume and greatest dimension were 120 cc (interquartile range [IQR]: 56-399) and 11.2 cm (IQR: 8.4-14.1), respectively. Median percentage change in volume and greatest dimension were -37% (IQR: -57 to -29) and -10% (IQR: -20 to -7). All evaluable tumors decreased in volume during RT. Between pre- and post-RT MRI, most patients had a decrease in intratumoral (16/20) and peritumoral edema (11/20). Sixteen patients exhibited extensive pathologic response. There were no significant associations between radiographic and pathologic features and volumetric change. Local failure at 3 years was 9% (95% confidence interval: 1-59).

Conclusions: We report significant decreases in MLPS tumor size during preoperative RT. There may be a role for adaptive RT planning to reduce target volumes and minimize RT-associated morbidity.

Background: The incidental detection of indeterminate small renal masses (SRMs) has been rising continuously over the last few decades. The aim of our study was to assess selected contrast enhanced computed tomography (CECT) parameters in the characterization of indeterminate SRMs and compare them with selected magnetic resonance imaging (MRI) data.

Patients and methods: Patients with indeterminate SRMs discovered on CECT were included in the study. Selected CECT features have been analyzed as differentiating between clear cell renal cell carcinoma (ccRCC) and other etiologies of SRMs. In 82% of patients, which had available MRI data, a comparison between selected MRI and CECT parameters were performed.

Results: Relative washout in CECT had the best accuracy (76.5%), sensitivity (88.9%), as well as satisfactory specificity (69.7%) in ccRCC prediction. The cut-off point determined in receiver operating analysis using the Youden index for this parameter was 11.54. Multivariable analysis showed that only T1 SI ratio < 0.73 from MRI parameters and relative washout > 11.5 from CECT parameters were independent predictors of ccRCC (OR: 30.86, 95% CI: 1.58-600.26, p = 0.024; OR: 15.36, 95% CI: 1.52-155.16, p = 0.021).

Conclusions: In clinical practice, the use of both CECT and MRI indicators, especially T1 SI ratio < 0.73 for MRI and relative washout > 11.5 for CECT, can support physicians in diagnosing and treating patients effectively.

Background: Sarcopenia is a progressive and generalised skeletal muscle disorder which presents as loss of muscle mass and function and is associated with increased likelihood of adverse outcomes, reduced quality of life and increased mortality. In developed countries, the prevalence of sarcopenia is rising due to increasing life expectancy. Still, in many clinical settings, sarcopenia may be overlooked and undertreated. While several tools are available for assessment of muscle mass and quality, there remains a need for safe, reliable and accurate diagnostic methods which can be implemented for both sarcopenia diagnosis and the evaluation of treatment efficacy.

Conclusions: Ultrasound is an accessible and non-ionizing imaging technique that can potentially be used for that purpose. Several ultrasound parameters have been identified for their utility to provide assessment of muscle mass, quality and/or muscle function. Ultrasound is gaining recognition as an accurate and reproducible method of muscle mass assessment. However, there are still several limitations that preclude the application of ultrasound in routine clinical practice. Implementing a harmonized measurement protocol and conducting large-scale longitudinal studies on both healthy individuals and various patient cohorts could enable the establishment of clearly defined reference values for individual ultrasound parameters and, in turn, potentially reliable differentiation between normal and sarcopenic states.

Background: Radiation-induced lymphopenia (RIL) is associated with an increased risk of death in solid tumors, including rectal cancer. The aim of this study was to determine whether the sequencing of chemotherapy in total neoadjuvant treatment (TNT) for rectal cancer predicts the development of RIL.

Patients and methods: We analyzed acute hematologic toxicity data from 53 patients who underwent TNT for locally or locoregionally advanced rectal cancer between July 2022 and April 2023. Twenty-eight patients received induction chemotherapy with capecitabine and oxaliplatin [CAPOX], and 25 received consolidation chemotherapy (6 cycles of CAPOX in both groups). The chemoradiation protocol consisted of Volumetric Modulated Arc Therapy with Simultaneous Integrated Boost Radiotherapy (VMAT-SIB RT) up to 48.4 Gy in 22 fractions, concomitantly with capecitabine twice a day (lat. bis in die, BID). The Mann-Whitney U test was performed to compare RIL between the two patient groups. Pelvic bone marrow was contoured as a non-limiting organ-at-risk to assess the received dose, and binary logistic regression was used to determine whether RIL depends on V_5Gy~V_42Gy or the planning target volume (PTV) size.

Results: Thirty-four patients (64.2%) developed RIL of any grade, which was not significantly associated with either the induction or consolidation chemotherapy TNT regimen (Wald = 3.159, p = 0.076). No significant differences were found in neutrophil counts or the neutrophil-to-lymphocyte ratio. In the logistic regression model predicting the likelihood of RIL, two variables were statistically significant: V_10Gy (Wald = 4.366, p = 0.037) and V_30Gy (Wald = 6.084, p = 0.014). These results indicate that V_10Gy< 71% and V_30Gy< 26.6% may reduce the likelihood of developing RIL.

Conclusions: In our study, the sequencing of chemotherapy in TNT for rectal cancer did not predict the development of RIL. However, the incidence of RIL may be reduced by applying RT dosimetric constraints to the pelvic bone marrow.

Background: Malignant pleural mesothelioma (MPM) is a global health concern linked to asbestos exposure. In Slovenia, regions with high asbestos exposure rates make MPM a significant public health issue. Although thoracoscopic biopsy is the gold standard for MPM diagnosis, its invasiveness highlights the need for reliable, non-invasive diagnostic biomarkers.

Patients and methods: This prospective study evaluated the diagnostic potential of fibulin-3 as a biomarker for MPM, focusing on its ability to distinguish MPM from other pleural conditions, its association with disease stage and histological subtype, and its prognostic value for survival. Ninety patients, who underwent diagnostic thoracoscopic biopsy from January 2013 to October 2014, were included. Fibulin-3 levels in plasma and pleural effusion were measured using enzyme-linked immunosorbent assay (ELISA), and clinical data were analysed with statistical tests, including receiver operating characteristic (ROC) analysis.

Results: The study cohort comprised 32 patients with MPM, 24 with metastatic pleural carcinoma, and 34 with benign pleural diseases. Plasma fibulin-3 levels were significantly elevated (p = 0.0132) in MPM patients compared to those with benign pleural effusions due to asbestos exposure, with a cut-off of 12.31 ng/mL showing 100% specificity but low sensitivity (39.39%). Elevated fibulin-3 levels in pleural effusion correlated with advanced disease (p = 0.0463) and aggressive histological subtypes (p = 0.0324). No significant survival correlation was observed.

Conclusions: While plasma fibulin-3 is a highly specific biomarker for MPM, its low sensitivity limits its standalone diagnostic utility. Its potential role in risk stratification and early detection of MPM at-risk populations using combination of different and new biomarkers warrants further study.

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.