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The aim of the present study was to evaluate clinical and structural outcomes of patients with a massive irreparable rotator cuff tear treated with arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft. We hypothesized that this procedure would lead to improvement in clinical and functional results and that structural failure would not influence the final clinical results.A retrospective analysis on arthroscopic superior capsule reconstruction performed from October 2016 to January 2019 was conducted. The procedure was performed in patients with a massive irreparable posterosuperior rotator cuff tear without a severe glenohumeral arthropathy (Hamada I and II) and complaining a painful pseudoparalysis. Clinical evaluation and MRI study were performed before surgery and after at least 14 months.A comprehensive group of 21 patients with 11 females and 10 males and a mean age of 57 ± 8.5 years underwent arthroscopic superior capsule reconstruction. The graft had a thickness of 1.5 mm in the first 9 cases (43%) since it was used in a single layer. The graft was thereafter doubled for technique evolution in the following 12 cases (57%) achieving a graft thickness of 3 mm. Active ROM significantly improved with a mean increase of active forward flexion from 72.8° ± 7.5° to 120.6° ± 4.5°, active abduction from 68.3° ± 10.2° to 140.2° ± 8.8° and external rotation from 38.2° ± 11.2° to 56.7° ± 6.8° at the last follow-up. The mean Constant score significantly improved from 40.4 ± 6.7 to 73.3 ± 8.2. A graft tear revealed in 52% (11/21) of overall patients was significantly more frequent in single layer graft when compared to double layer (77% vs 33%, p 0.05). Location and type of graft tear significantly influenced final outcomes. Patients with a healed (graft continuity with bone at medial and lateral insertion) or medial graft tear showed statistically significant better outcomes when compared with patients in which the graft was completely reabsorbed or torn on humeral side (p 0.05).Arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft may be a viable alternative to treat massive posterosuperior rotator cuff tear in patients with a painful pseudoparalysis without anterosuperior escape. Structural failure may strongly influence final outcomes with significant role played by tear location.

The purpose of this study was to evaluate clinical outcomes and tendon integrity on magnetic resonance imaging (MRI) of chronic posterosuperior rotator cuff tears treated with single-row tensionless repair and subacromial balloon spacer as protection with a minimum follow-up of 2 years. The hypothesis of this study was that this procedure would have acceptable clinical outcomes and tendon-healing rate without increased complications.This is a retrospective study of patients with chronic posterosuperior rotator cuff tears repaired with a single-row technique protected with a subacromial balloon device. Patients were followed up for a minimum of 2 years. Clinical outcomes were evaluated with American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Numerical Rating Scale (NRS) for pain. MRI study was obtained likewise after at least 2 years to assess tendon-healing rate. Statistical comparison was performed between pre-operative and at least 2-year clinical and imaging follow-up.Thirty-two patients were included in the study with a mean follow-up of 27 ± 7 (range 24-48). The mean age of this cohort was 58 ± 6 (range 41-66) including 15 males and 17 females. The tear size was on average 2.3 cm (range 2-4) and a mean of 2.1 triple-loaded anchors were used (range 2-3). The ASES score significantly increased from a mean of 39 ± 12 points to a mean of 89 ± 12 at the final follow-up (P 0.001). Similarly, pain significantly reduced from a mean pre-operative NRS of 6.8 ± 1.4 to 0.8 ± 1.5 at the final follow-up (P 0.001). MRI scans showed that repair occurred in 26 patients (81.3%). Significant higher ASES score was reached at final follow-up in patients with a "healed" (Sugaya I-III) tendon when compared to patients with an evidence of tendon discontinuity on MRI study (Sugaya IV-V), 93 ± 9 and 74 ± 13, respectively (P 0.001).Arthroscopic repair of chronic posterosuperior rotator cuff tears using a single-row tensionless repair and subacromial spacer as protection resulted in an 81.3% of tendon integrity at a mean follow-up of 27 months. Clinical outcomes and pain scores significantly improved without severe complications reported after a minimum follow-up of 2 years.III.

Pancreatic cancer is the 7th leading cause of death due to cancer in industrialized countries and the 11th most common cancer globally, with 458918 new cases (2.5% of all cancers) and 432242 deaths (4.5% of all cancer deaths) in 2018. Unfortunately, 80% to 90% of the patients present with unresectable disease, and the reported 5-year survival rate range between 10% and 25%, even after successful resection with tumor-free margins. Systemic chemotherapy, radiotherapy, and minimally invasive image-guided procedures that have emerged over the past years, are used for the management of non-operable PC. This review focuses on currently available non-surgical options of locally advanced pancreatic cancer.

Purpose: Approaching treatment for elderly patients with atrial fibrillation is difficult. A prospective phase II trial evaluating LINAC-based stereotactic arrhythmia radioablation (STAR) safety in this population started in 2021. Dosimetric and planning data were reported. Materials and Methods: A vac-lock bag was used for immobilization in the supine position and a computed tomography (CT, 1 mm) was performed. The clinical target volume (CTV) was defined as the area around the pulmonary veins. An internal target volume (ITV) was added to the CTV to compensate heart and respiratory movement. The planning target volume (PTV) was defined by adding 0–3 mm to the ITV. STAR was performed during free-breathing with a PTV prescription total dose (Dp) of 25 Gy/1 fraction. Flattening filter-free volumetric-modulated arc therapy plans were generated, optimized, and delivered by TrueBeamTM. Image-guided radiotherapy with cone-beam CT and surface-guided radiotherapy with Align-RT (Vision RT) were employed. Results: From May 2021 to March 2022, 10 elderly patients were treated. Mean CTVs, ITVs, and PTVs were 23.6 cc, 44.32 cc, and 62.9 cc, respectively; the mean prescription isodose level and D2% were 76.5% and 31.2 Gy, respectively. The average heart and left anterior descending artery (LAD) Dmean were 3.9 and 6.3 Gy, respectively; the mean Dmax for LAD, spinal cord, left and right bronchus, and esophagus were 11.2, 7.5, 14.3, 12.4, and 13.6 Gy, respectively. The overall treatment time (OTT) was 3 min. Conclusions: The data showed an optimal target coverage, sparing surrounding tissue, in 3 min of OTT. LINAC-based STAR for AF could represent a valid non-invasive alternative for elderly patients who were excluded from catheter ablation.

Background: Glioblastoma (GBM) is a very poor-prognosis brain tumor. To date, maximal excision followed by radiochemotherapy, in 30 fractions, is the standard approach. Limited data are present in the literature about hypofractionated radiotherapy (hypo-RT) in GBM poor prognosis patients. Thus, this retrospective study was conducted to evaluate efficacy and toxicity of hypo-RT with simultaneous integrated boost (SIB) in association with temozolomide (TMZ) in this patient setting. Methods: Poor-prognosis GBM patients underwent surgery (complete, subtotal or biopsy) followed by SIB-hypo-RT and concomitant/adjuvant TMZ. The prescription dose was 40.05 Gy (15 fractions) with a SIB of 52.5 Gy (3.5 Gy/fraction) on surgical cavity/residual/macroscopic disease. Volumetric modulated arc therapy was performed. Results: From July 2019 to July 2021, 30 poor-prognosis patients affected by GBM were treated by SIB-hypo-RT, 25 were evaluated in the present analysis due to a minimum follow up of 6 months. The median age and KPS were 65 years and 60%, respectively. At the median follow-up time of 15 months (range 7–24), median and 1-year overall survival and progression-free survival were 13 months and 54%, and 8.4 months and 23%, respectively. No acute or late neurological side effects of grade ≥ 2 were reported. Grade 3–4 hematologic toxicity occurred in three cases. Conclusion: SIB-hypo-RT associated with TMZ in poor-prognosis patients affected by GBM is an effective and safe treatment. Prospective studies could be warranted.

Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University Hospital of Bari with abdominal pain. Blood tests revealed the presence of an untreated hepatitis B virus infection (HBV), with normal liver function and without jaundice. Abdominal ultrasonography revealed a cirrhotic liver with a segmental dilatation of the third bile duct segment, confirmed by a CT scan and liver MRI, which also identified a heterologous mass. No other focal hepatic lesions were identified. A percutaneous ultrasound-guided needle biopsy was then performed, detecting a moderately differentiated HCC. Finally, the patient underwent a third hepatic segmentectomy, and the histopathological analysis confirmed the endobiliary localization of HCC. Subsequently, the patient experienced a nodular recurrence in the fourth hepatic segment, which was treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). This case shows that HCC with BDTT can mimic different types of tumors. It also indicates the value of an early multidisciplinary patient assessment to obtain an accurate diagnosis of HCC with BDTT, which may have prognostic value that has not been recognized until now.

Aims: To report feasibility and efficacy of high-tech Radiotherapy (RT) for the treatment of synchronous Multiple Primary Malignancies (sMPM) for elderly patients with primary Prostate Cancer (PC). Methods: Two elderly patients with PC and synchronous Anal Cancer (AC) and sacrum chordoma, respectively, were described. The first one was treated with radical radio-chemotherapy. A total dose of 70 Gy / 65.5 Gy (28 fractions) was prescribed to prostate/ seminal vesicles, and concomitantly, 56 Gy / 50.4 Gy / 45 Gy were prescribed to tumor, anal canal/mesorectum/pelvic nodes, and inguinal nodes, respectively. For the second case, after resection of chordoma, adjuvant and prostate radical RT (65.5 Gy / 70 Gy) in 28 fractions were used. In both cases, Volumetric-Arc RT was performed. Results: Patients completed the planned treatment without severe toxicities. After a median follow-up of 12 months, no sign of PC and a controlled/reduction of chordoma/AC were observed. Conclusion: High-tech RT is safe and effective for sMPM elderly patients. Keywords: Synchronous cancers; Elderly; Treatment; Radiotherapy; Multidisciplinary evaluation.

Gastrointestinal (GI) cancers often require a multidisciplinary approach involving surgeons, endoscopists, oncologists, and interventional radiologists to diagnose and treat primitive cancers, metastases, and related complications. In this context, interventional radiology (IR) represents a useful minimally-invasive tool allowing to reach lesions that are not easily approachable with other techniques. In the last years, through the development of new devices, IR has become increasingly relevant in the context of a more comprehensive management of the oncologic patient. Arterial embolization, ablative techniques, and gene therapy represent useful and innovative IR tools in GI cancer treatment. Moreover, IR can be useful for the management of GI cancer-related complications, such as bleeding, abscesses, GI obstructions, and neurological pain. The aim of this study is to show the principal IR techniques for the diagnosis and treatment of GI cancers and related complications, as well as to describe the future perspectives of IR in this oncologic field.

Introduction: Evaluation of pancreatic ductal adenocarcinoma (PDAC) after chemoradiotherapy downstaging is challenging due to computed tomography (CT) overestimation of tumor extension and residual vascular involvement, limiting access to surgery to some patients with potentially resectable tumors. With this study, we wanted to assess which radiological findings are most reliable at pre-operative imaging in the evaluation of PDAC after chemoradiotherapy in order to achieve complete resection. Methods: We retrospectively enrolled 71 patients with locally advanced and borderline resectable PDAC who underwent neoadjuvant chemoradiotherapy. Pre-operative CT or magnetic resonance (MR) have been evaluated by three radiologists to assess major qualitative and quantitative parameters of lesions. Accuracy, sensitivity, and specificity compared to anatomopathological results were evaluated for each parameter. Cohen&rsquo, s K-coefficient has been calculated to evaluate the inter-observer agreement (IOA). Both single and consensus lecture have been tested. Different dimensional cut-offs were tested to categorize tumors according to their major axis and to compare with anatomopathological diameter, tumor persistence, and margin infiltration. Results: A 25 mm cut-off was 67% sensitive, 90% specific, and 77% accurate in assessing real tumor dimension. 25 mm cut-off reported a 64% sensitivity, 78% specificity, and 69% accuracy in assessing R0 resection. Each 5 mm increment of major axis dimension there is an odds ratio (OR) 1.79 (95% CI 1.13&ndash, 2.80, p = 0.012) for R+ resection. Imaging presence of the perivascular cuff is not associated with tumor persistence and resection margin infiltration (p = 0.362). Lesion enhancement and pattern homogeneity were not accurate in determining tumor persistence. IOA was generally poor to fair, except for &gt, 25 mm cut-off classification where IOA was moderate. Diagnostic accuracy is superior in consensus lecture rather than single lecture. Conclusion: Imaging methods tend to underestimate PDAC resectability after neoadjuvant-CRT. IOA is poor to fair in evaluating most of the qualitative parameters of downstaged pancreatic adenocarcinoma. Surgery should be considered for downstaged borderline resectable PDACs, independently from perivascular cuff presence, especially for tumors smaller than 25 mm.

Background Few studies have investigated clinical and structural outcomes after transosseous (TO) repair. The purpose of this study was to compare structural and clinical outcomes of rotator cuff tear, repaired arthroscopically, with a single row (SR) or transossoeus (TO) anchorless technique. Methods 96 patients who underwent an arthroscopic repair for superior or posterosuperior rotator cuff tear using TO (n:54) or a SR (n:42) were retrospectively enrolled in this study after evaluation of clinical and surgical notes. Functional evaluation was performed with the adjusted Constant score, and American Shoulder and Elbow Surgeons (ASES) score. Postoperative cuff integrity was determined through MRI study. Results Patients were recalled after a minimum follow-up of two years. All the patients were available for the study. In the SR group the Constant rating system showed a significant improvement from a preoperative average rating of 44.8 to an average of 85.7. In the group of TO repair the Constant rating system showed a significant improvement from a preoperative average of 46.1 to an average of 87.6 postoperatively. According to ASES index scores, the average total score improved from 42.8 to 92.0 in the anchor group and from 40.4 to 94.6 in the TO group. There was no statistical difference between the two groups about clinical outcomes. Postoperative MRI revealed no differences in term of complete re-tears between the two techniques. In the SR group at MRI we observe significant more cases of rotator cuff with a Sugaya type III healing. Conclusions Arthroscopic rotator cuff repair yielded successful clinical outcomes using SR and TO technique. However using the TO technique we saw less type 3 Sugaya readings on MRI suggesting a possible benefit with TO repair. Level of evidence II Retrospective study.

To assess the usefulness of multidetector CT (MDCT) with multiplanar reconstructions (MPR) and 3D reconstruction software, in the follow-up of patients who underwent gastrectomy for gastric carcinoma.From April 2001 to March 2003, 25 patients (16 males and 9 females) aged between 40 and 70 years (55 years on average) were assessed after gastric resection for gastric carcinoma. All patients underwent chest-abdominal MDCT and esophago-gastro-duodenoscopy (EGD). A biopsy was performed on 11 patients. All patients were examined after achieving gastric wall distension by administering 2 sachets of negative contrast agents, before and after intravenous injection of water-soluble contrast medium (2 ml for kg) at a flow-rate of 3-4 of ml/sec.CT demonstrated the absence of disease in 15 cases, tumour recurrence in 9 cases, associated with liver metastases in one case and lymphadenopathy in one case. All lesions were recognizable in the axial scans. MPR improved the visualization of the longitudinal extension of lesions and the 3D reconstructions were of assistance in the study of the inner surface of the anastomotic loops. EGD showed absence of disease in 15 cases, tumour recurrence in 9 cases and congested mucosa with small areas of superficial ulceration in one case, found at biopsy to be secondary to gastritis, in one case.MDCT with MPR and 3D reconstructions should be regarded as a promising method for the postoperative follow-up of patients after gastrectomy. This method is useful to demonstrate recurrences at the site of anastomosis, lymph node metastases or distant metastases, even if it cannot as yet replace traditional endoscopy.

To assess the feasibility of Multislice spiral CT (MSCT) with volume rendering (VR) and maximum intensity projection (MIP) reconstructions in recognizing ureteropelvic junction obstruction (UPJO).Twenty-seven patients with UPJO underwent MSCT. To visualise the excretory system, 50 ml of uroangiografic contrast medium was administered by drip infusion via the cubital vein 180 minutes before the CT scan. MSCT was performed after the injection of 120 ml of contrast medium at a flow rate of 3.5 ml/sec. Dual-phase scanning was performed 25s and 55s after contrast medium administration. MIP and VR reconstructions were obtained on a dedicated workstation.In 11/27 (41%) patients, UPJO was due to an anomalous ureteropelvic junction (UPJ). In 9/27 (33%), the stenosis was caused by anomalous vessels. In 3/27 (11%), stenosis was due to an anomalous UPJ position even though anomalous accessory vessels could be seen. In 4/27 (15%), anomalous vessels were also identified but the presence of a pyeloureteral stent did not allow us to establish whether these vessels were the cause of UPJO.MSCT and MIP and VR reconstructions allow identification of the causes of congenital UPJO and provide useful information for appropriate treatment planning.