Search

During radiotherapy, some patients owing to the variability in skin sensitivities, may experience adverse skin reactions for doses at which other patients are asymptomatic. Hence, when abnormal symptoms appear on a patient’s skin, the etiology should be verified. Accordingly, a surface dosimeter on the skin can help ascertain whether accurate doses are irradiated. Furthermore, surface doses are measured in the field junction gaps during craniospinal irradiation or during large-area radiotherapy to avoid adverse reactions due to cumulative skin doses from multiple beams. However, the point dose measurement errors of surface dosimeters exceed approximately 10% and have low-positional accuracies because the attachment sites are approximated with the help of the naked eye. Moreover, accurate information on field junction gaps cannot be obtained. Therefore, in clinical practice, a flexible array dosimeter is required as it can measure the dose distribution on the body surface by adapting its shape to the body curvatures. In this study, we implemented a flexible array dosimeter and, based on its constituent materials, evaluated the attenuation rate associated with its use. A polyester (PET) film was used as the underlying substrate. HgI2 and PbI2 photoconductors were used for their good performances in films. Furthermore, the measurement accuracy was verified through comparisons with Monte Carlo simulation outcomes. The resulting PET film had an attenuation rate of 2.22% at a 50-µm thickness. At the minimum material thickness of 25 µm, the attenuation rates for HgI2 and PbI2 were 4.69% and 5.72%, respectively. Further research is needed to fabricate HgI2-based digital skin dosimeters with a thickness under 25 µm. Radiation detection and pixel resolution should be evaluated to accurately confirm the field junction gap.

Tacrolimus is a key drug in kidney transplantation (KT) with a narrow therapeutic index. The association between the tacrolimus metabolism rate and KT outcomes have not been investigated in large-scale multi-center studies. The Korean Organ Transplantation Registry (KOTRY) datasets were used. A total of 3456 KT recipients were analyzed. The tacrolimus metabolism rate was defined as blood trough concentration of tacrolimus (C0 ) divided by the daily dose (D). The patients were grouped into fast, intermediate, or slow metabolizers by the C0 /D measured 6 months after transplantation. The slow metabolism group was associated with a 2.7 ml/min/1.73 m2 higher adjusted estimated glomerular filtration rate (eGFR) at 6 months [95% confidence interval (C.I.) 1.2-4.3, P = 0.001], less acute rejection (AR) within 6 months [Odds ratio (OR) 0.744, 95% C.I. 0.585-0.947, P = 0.016], and less interstitial fibrosis and tubular atrophy [OR 0.606, 95% C.I. 0.390-0.940, P = 0.025]. Fast tacrolimus metabolism affected the 6-month post-KT eGFR through mediation of AR [natural indirect effect (NIE) -0.434, 95% C.I. -0.856 to -0.012, P = 0.044) and delayed graft function (DGF; NIE -0.119, 95% C.I. -0.231 to -0.007, P = 0.038). Slow tacrolimus metabolism was associated with better post-KT eGFR. AR and DGF were found to be significant mediators.

The postoperative hypofractionated intensity-modulated radiation therapy (POHIM-RT) trial is a phase II study to evaluate toxicity following hypofractionated intensity modulated radiation therapy (IMRT) for cervical cancer. This study describes the results of a benchmark procedure for RT quality assurance of the POHIM-RT trial. Six participating institutions were provided computed tomography for RT planning and an IMRT plan for a sample and were instructed to delineate volumes, create a treatment plan and quality assurance (QA) plan, and submit the results of all procedures. The inter-institutional agreements on RT volume and plan results were evaluated using the kappa value and dice similarity coefficients. The simultaneous truth and performance level estimation (STAPLE) method was employed to generate a consensus target volume. The treatment volumes, organs-at-risk volumes, and results of the RT plan and QA reported by the institutions were acceptable and adhered well to the protocol. In terms of clinical target volume (CTV) delineation, there were differences between the institutions, particularly in vaginal cuff and paracolpium subsites. Consensus CTV was generated from the collected CTVs with the STAPLE method. The participating institutions showed considerable agreement regarding volume, dose and QA results. To improve CTV agreement in CTV, we provided feedback with images of the consensus target volume and detailed written guidelines for specific subsites that were the most heterogeneous.

In intracavitary radiotherapy, it is essential to verify the correct location of radiation source among quality control items because an incorrect location will irradiate an unnecessary dose to normal tissues. As a basic study of digital line dosimeters, this study fabricated a unit cell dosimeter based on polycrystalline mercury (II) iodide (HgI2) and compared its performance with a diode. The study result showed that for reproducibility, the relative standard deviation (RSD) was 1.21%, satisfying the RSD evaluation criterion of within 1.5%. Considering linearity, the coefficient of determination R2 showed an excellent result of 0.9997. Regarding the evaluation of distance dependence, it showed a similar trend in general with a difference of 0.035 cm for intensity 50% when compared with the inverse square value. The angular dependence gradually decreased in intensity as the angle increased, showing a difference of up to 25%. This study suggests the applicability of a digital dosimeter for brachytherapy quality control by evaluating the performance of the HgI2 dosimeter. However, to develop it into a quality assurance (QA) dosimeter, correction factor for sensitivity according to angle should be applied. This study on dosimeter for candidate photoconductor materials can be used as basic data in all areas using radiation.

In patients with early-stage breast cancer, the treatment results of hypofractionated radiation therapy (RT) and conventional RT are evaluated in efficacy and cost.We retrospectively evaluated 280 patients with early-stage (Tis-2N0M0) breast cancer (including 100 hypofractionated RT patients) with regards to treatment outcomes according to the RT schedule. The median whole-breast RT dose was 42.56 Gy/16 fractions for hypofractionated RT and 50.4 Gy/28 fractions for conventional RT. Most patients (n = 260, 92.9%) additionally received a tumor bed boost RT. We used propensity score matching (PSM) analysis to balance the baseline risk factors for recurrence. The co-primary endpoints of this study were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR). DFS or IBTR was analyzed using the Kaplan-Meier survival curve and log-rank test.Total 89 pairs of matched patients (1:1 matching, n = 178) were finally evaluated. The median follow-up was 23.6 months. After matching, the 3-year DFS was 100% in the hypofractionated RT group and 98.4% in the conventional RT group; there was no significant difference in DFS between the groups (Hypofractionated RT showed good IBTR and DFS, which were compatible to those in conventional RT in breast cancer. Hypofractionated RT is expected to be used more widely because of its low cost and convenience.

Human immunodeficiency virus (HIV) infection was traditionally considered an absolute contraindication for transplantation because of concerns about HIV disease progression due to immunosuppression. Since potent antiretroviral therapies (ARTs) have become widely available, the prognosis of HIV-infected kidney transplant recipients has dramatically improved. Recent results of prospective multicenter trials on kidney transplantation (KT) in HIV-positive candidates have demonstrated the success and challenges of transplantation in this population. Several studies have reported comparable patient and graft outcomes between HIV-infected and HIV-uninfected recipients after KT in the era of potent combined ARTs. We report two cases of HIV-infected patients who underwent KT at our hospital. In this paper, we present a detailed report of two cases and provide a short review of the existing literature.

Generally, electron therapy is applied to tumors on or close to the skin surface. However, this causes a variety of skin-related side effects. To alleviate the risk of these side effects, clinical treatment uses skin dosimeters to verify the therapeutic dose. However, dosimeters suffer from poor accuracy, because their attachment sites are approximated with the help of naked eyes. Therefore, a dosimeter based on a flexible material that can adjust to the contours of the human body is required. In this study, the reproducibility, linearity, dose-rate dependence, and percentage depth ionization (PDI) of PbO and HgO film-based dosimeters are evaluated to explore their potential as large-scale flexible dosimeters. The results demonstrate that both dosimeters deliver impressive reproducibility (within 1.5%) and linearity (≥ 0.9990). The relative standard deviations of the dose-rate dependence of the PbO and HgO dosimeters were 0.94% and 1.16% at 6 MeV, respectively, and 1.08% and 1.25% at 9 MeV, respectively, with the PbO dosimeter outperforming the 1.1% of existing diodes. The PDI analysis of the PbO and HgO dosimeters returned values of 0.014 cm (–0.074 cm) and 0.051 cm (–0.016 cm), respectively at 6 MeV (9 MeV) compared to the thimble chamber and R50. Therefore, the maximum error of each dosimeter is within the allowable range of 0.1 cm. In short, the analysis reveals that the PbO dosimeter delivers a superior performance relative to its HgO counterpart and has strong potential for use as a surface dosimeter. Thus, flexible monoxide materials have the necessary qualities to be used for dosimeters that meet the requisite quality assurance standards and can satisfy a variety of radiation-related applications as flexible functional materials.

Radiation therapy uses high-energy radiation that can cause various side effects depending on the patient's exposure. In particular, side effects occur in the skin due to its radiation exposure to reach the target volume. Therefore, side effects are reduced by clinical trials using various skin dosimeters such as films and glass detectors to determine the dose exposed to the skin. However, accurately measuring the doses using these dosimeters is challenging due to human curvature. In this study, a flexible skin dosimeter was produced using the photoconductor materials mercury oxide (HgO) and lead oxide (PbO). The performance of the proposed dosimeter was evaluated by measuring reproducibility, linearity, dose rate independency according to dose, and percent depth dose (PDD) at photon energy beam. The results showed that the flexible skin dosimeter using HgO material has high applicability as a skin dosimeter due to its stability compared to PbO. The results provide useful insights for the radiation therapy field, particularly in areas where radiation measurement is difficult, depending on the human curvature. The proposed flexible skin dosimeter could serve in various radiation detection areas as a flexible, functional material

Background and Aims Biomarkers associated with chronic kidney disease (CKD) may play a crucial role in patients with diabetic kidney diseases. Vascular endothelial growth factor (VEGF)-C and VEGF-D are lymphangiogenic growth factors. It has been well demonstrated that there is lympnagiogenesis in fibrotic kidney disease in human. Previously, we showed that renal VEGF-C and VEGF-D are involved in lymphangiogensis in renal fibrosis model. Recent studies have shown a relationship between sodium load and serum VEGF-C levels in hypertensive patients. Lymphatic endothelial proliferation has been detected in diabetic nephropathy. Thus, serum VEGF-C level has been introduced as a candidate marker of chronic kidney disease. However, until now, there have been few report about serum VEGF-D in patients with diabetic CKD. Thus, we evaluated the relationships between serum VEGF-D and renal function and albuminuria of diabetic CKD. Method We divided diabetic CKD patients into four groups: CKD stage 3, CKD stage 4, and CKD stage 5 (without dialysis). Total forty two Asian patients with diabetic CKD (14 patients with CKD stage 3, 14 patients with CKD stage 4 and 14 patients with CKD stage 5) and seven healthy controls without diabetes mellitus have been enrolled in this study. In this cross-sectional study, we performed comparative analysis with serum level of VEGF-D in patients with each group. We measured the levels of VEGF-D through the multiplexing using Luminex® technology. Results The serum levels of VEGF-D were higher in the CKD 3, CKD 4 and CKD 5 group compared with the control group (25.9±5.6 pg/ml in control group, 60.3±9.7in stage 3, 62.9±8.5 in stage 4, and 66.5±8.0 in stage 5). However, there was not a significant difference between CKD stage III or IV and CKD stage V in serum levels of VEGF-D. Serum VEGF-D level were negatively correlated with estimated glomerular filtration rate and positively correlated with serum creatinine. At GFR level ≥60 ml/min per 1.73 m2, serum VEGF-D were biomarkers in ROC analysis. There was a positive correlation between serum VEGF-D level and albuminuria in patient with diabetic CKD. We also found that serum VEGF-D level also correlated with urine protein-to-creatinine ratio in patient with diabetic CKD. Conclusion Serum VEGF-D is correlated with renal function in patients with diabetic CKD. VEGF levels in the serum correlate to the severity of proteinuria and albuminuria in diabetic CKD patients. Further large-scale studies are required to confirm these findings.

Cisplatin-based chemotherapy is commonly used in the treatment of solid tumors; however, this agent is limited by its adverse effects on normal tissues, including the kidneys, ears and peripheral nerves. Mechanisms of cisplatin nephrotoxicity are proposed to involve oxidative stress, inflammation, cellular apoptosis and cell cycle regulation. Sirtuin 3 (Sirt3) is a member of the sirtuin family of NAD+-dependent enzymes with homology to Saccharomyces cerevisiae gene silent information regulator 2. Sirt3 is located in mitochondria and is involved in mitochondrial energy metabolism and function; however, the role of Sirt3 in cisplatin nephrotoxicity remains unclear. In the present study, whether Sirt3 has anti-inflammatory and anti-apoptotic effects on cisplatin-induced nephrotoxicity was investigated in mice. Sirt3 knockout mice (Sirt3(−/−)) and corresponding wild type mice were employed in the present study. Cisplatin nephrotoxicity was induced by intraperitoneal injection of cisplatin (20 mg/kg). After 3 days following cisplatin treatment, blood and kidney tissues were harvested. Renal function and histology were evaluated. Tubular apoptosis, cell adhesion molecule expression, and inflammatory cells were evaluated by immunohistochemistry and western blot analysis. Following the induction of cisplatin nephrotoxicity, renal function was significantly aggravated in Sirt3 knockout (KO) mice. Tubular injury and inflammatory cell infiltration were significantly increased in Sirt3KO mice compared with wild type mice. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end label-positive tubular cells and renal monocyte chemoattractant protein-1 expression levels were increased in Sirt3KO mice compared with in wild type mice. In summary, the absence of Sirt3 aggravated in renal injury by increasing renal inflammation and tubular apoptosis. The results of the present study suggested that Sirt3 may have an important role in cisplatin-induced nephrotoxicity.

Brachytherapy is a cancer treatment that involves intensively irradiating a tumor by placing a sealed radioactive isotope inside the body. Determining the position of the source through accurate quality assurance (QA) is important, because brachytherapy uses radioactive isotope sources with high dose rates. However, in clinical practice, the source position is determined with the naked eye through the use of a ruler, autoradiograph, video monitor, etc., which yields inaccurate results. Therefore, in this study, a lead (II) iodide (PbI2) based polycrystalline digital dosimeter that can measure the relative dose was developed for the QA of the brachytherapy device, and its applicability was evaluated in terms of reproducibility, linearity, percentage interval distance (PID), and angular dependence. Reproducibility evaluation yielded a relative standard deviation value of 1.41%, which satisfied the evaluation criterion of 1.5%. The linearity evaluation yielded an R2 value of 0.9993, which satisfied the evaluation criterion of 0.9990. The PID evaluation revealed that, as the distance from the source increased, the signal decreased according to the inverse-square law. When the PbI2-based digital dosimeter was rotated up to 45°, a difference of up to 13.20% in the angular dependence was observed. Thus, the dosimeter fabricated in this experiment met all the criteria of the aforementioned evaluations. Therefore, it is considered to be highly applicable as a dosimeter for the QA of brachytherapy devices.

Currently, in the radiation diagnosis field, mammography is used for the early detection of breast cancer. In addition, studies are being conducted on a grid to produce high-quality images. Although the grid ratio of the grid, which affects the scattering removal rate, must be increased to improve image quality, it increases the total exposure dose. While the use of automatic exposure control is recommended to minimize this problem, existing mammography equipment, unlike general radiography equipment, is mounted on the back of a detector. Therefore, the device is greatly affected by the detector and supporting device, and it is difficult to control the exposure dose. Accordingly, in this research, an integrated AEC-grid device that simultaneously performs AEC and grid functions was used to minimize the unnecessary exposure dose while removing scattering, thereby realizing superior image quality.

Cyclosporine A (CsA) is a widely used immunosuppressive agent that may provoke unexpected neurologic complications. The mechanism is unclear and variable intervals have been reported between CsA administration and onset of the related side effects. Here, we describe a case of delayed-onset CsA neurotoxicity presenting as opsoclonus-myoclonus syndrome (OMS).A 37-year-old woman with a two-week period of opsoclonus and upper extremity myoclonus was admitted to our hospital. The patient had been taking CsA for 17 years after receiving a kidney transplant. Further evaluation did not reveal any other abnormalities. Seven days after switching from CsA to tacrolimus, in the absence of additional immune-modulating therapy, her neurologic symptoms improved considerably.This is the case of delayed, long-term complications of CsA presenting as OMS. Symptoms resolved by substituting CsA with another immunomodulating drug. The etiology of the neurologic complications may involve paradoxically-enhanced delayed-type hypersensitivity.

Purpose This study aimed to assess the effects of body mass index (BMI) on survival in cervical cancer patients who had undergone surgery and radiotherapy (RT). Materials and methods We retrospectively reviewed the medical records of 70 cervical cancer patients who underwent surgery and RT from 2007 to 2012. Among them, 40 patients (57.1%) had pelvic lymph node metastases at the time of diagnosis. Sixty-seven patients (95.7%) had received chemotherapy. All patients had undergone surgery and postoperative RT. Median BMI of patients was 22.8 kg/m2 (range, 17.7 to 35.9 kg/m2). Results The median duration of follow-up was 52.3 months (range, 16 to 107 months). Twenty-four patients (34.3%) showed recurrence. Local failure, regional lymph nodal failure, and distant failure occurred in 4 (5.7%), 6 (8.6%), and 17 (24.3%) patients, respectively. The 5-year actuarial pelvic control rate was 83.4%. The 5-year cancer-specific survival (CSS) and disease-free survival (DFS) rates were 85.1% and 65.0%, respectively. The presence of pelvic lymph node metastases (n = 30) and being overweight or obese (n = 34, BMI ≥ 23 kg/m2) were poor prognostic factors for CSS (p = 0.003 and p = 0.045, respectively). Of these, pelvic lymph node metastasis was an independent prognostic factor (p = 0.030) for CSS. Conclusion Overweight or obese cervical cancer patients showed poorer survival outcomes than normal weight or underweight patients. Weight control seems to be important in cervical cancer patients to improve clinical outcomes.

Darbepoetin-alfa is an erythropoiesis-stimulating agent (ESA) with a long elimination half-life that achieves better hemoglobin (Hb) stability than short-acting ESAs. We aimed to evaluate the efficacy and safety of intravenous CKD-11101 (a biosimilar of darbepoetin-alfa) compared with those of darbepoetin-alfa in hemodialysis patients. The study was performed in 24 centers in Korea between June 2015 and June 2017. The study subjects were randomized in a double-blind manner. The follow-up duration was 24 weeks, which consisted of 20 weeks of maintenance and 4 weeks of evaluation period. All patients underwent a stabilization period to achieve a target baseline Hb of 10–12 g/dL before randomization. Following randomization, patients received darbepoetin-alfa or CKD-11101 weekly or biweekly. A total of 403 patients were randomized into two groups, and a total of 325 patients (80.6%) completed the investigation. The differences between the two groups in terms of change in the average Hb level from baseline to evaluation were not significant. The average administered dose of ESA was similar between the groups. There was no difference in the proportion of patients who maintained the target Hb during the evaluation period [60.4% vs. 66.2% in the CKD-11101 and darbepoetin-alfa groups, respectively (p = 0.3038)]. In addition, the safety analysis, consisting of adverse events and adverse drug reactions, showed comparable results between the two groups. The changes in the level of Hb, dose of erythropoietin, and achievement rate of the target Hb during the study period were comparable between the groups. CKD-11101 has an equivalent efficacy and safety compared with darbepoetin-alfa in patients undergoing hemodialysis.

Recent studies revealed that metabolic stress influences the outcomes of breast cancer treatment. We sought to evaluate the prognostic effect of type 2 diabetes and find the molecular mechanism of relapses in postoperative HER-2+ breast cancer patients treated with HER-2 targeted therapy. We evaluated 190 HER-2+ breast cancer patients (pT1-4N0-2M0) who were treated with surgical resection and trastuzumab (HER-2 targeted therapy) between 2006 and 2015. Survival outcomes and failure patterns were compared between such patients with (n = 12) and without (n = 178) type 2 diabetes. The median follow-up period was 42.4 months (range 12.0–124.7 months). Twenty-one patients (11.1%) showed relapse (including nine patients with locoregional failure), and three patients (1.6%) died as a result of cancer relapse. One-third of the patients with diabetes experienced relapse (4/12, 33.3%). The 3-year disease-free survival (DFS) and overall survival (OS) rates were 90.7% and 98.6%, respectively. Diabetic patients showed shorter DFS compared with non-diabetic patients (p = 0.006, 74.1% vs. 91.9%). OS was also shorter in diabetic patients compared with non-diabetic patients (p = 0.017, 91.7% vs. 99.1%). Of our interest, the levels of HER-3 and its ligand neuregulin-1 were significantly increased in the tumor specimen in HER-2+ breast cancer patients suffering with type 2 diabetes than that in the euglycemic control group. Type 2 diabetes was associated with detrimental effects on survival in postoperative HER-2+ breast cancer patients who were treated with trastuzumab. The poor prognostic effect of diabetes in HER-2+ breast cancer patients could be associated with the high levels of HER-3 and neuregulin 1, thus it should be considered and evaluated more.

Purpose This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). Materials and methods Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. Results The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progressionfree survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). Conclusion SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.

Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 109 /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine. After stopping heparin rinsing, the platelet count recovered completely, without further thrombotic or other sequelae. Our experience indicates that for patients with acute HIT, besides the well-known practice of using non-heparin anticoagulation during dialysis and avoiding heparin "locking" of dialysis catheters, it is also important to avoid inadvertent rinsing of the circuit with heparin during preparation for hemodialysis.

Because systems that reduce radiation exposure during diagnostic procedures must be developed, significant time and financial resources have been invested in constructing radiation dose management systems. In the present study, the characteristics of an existing ionization-based system were compared to those of a system based on the kinetic energy released per unit mass (KERMA). Furthermore, the feasibility of using the KERMA-based system for patient radiation dose management was verified. The ionization-based system corrected the effects resulting from radiation parameter perturbations in general radiography whereas the KERMA-based system did not. Because of this difference, the KERMA-based radiation dose management system might overestimate the patient’s radiation dose due to changes in the radiation conditions. Therefore, if a correction factor describing the correlation between the systems is applied to resolve this issue, then a radiation dose management system can be developed that will enable real-time measurement of the patient’s radiation exposure and acquisition of diagnostic images.

Purpose The association between metabolism and cancer has been recently emphasized. This study aimed to find the prognostic significance of obesity in advanced stage rectal cancer patients treated with surgery and radiotherapy (RT). Materials and methods We retrospectively reviewed the medical records of 111 patients who were treated with combined surgery and RT for clinical stage 2-3 (T3 or N+) rectal cancer between 2008 and 2014. The prognostic significance of obesity (body mass index [BMI] ≥25 kg/m(2)) in local control was evaluated. Results The median follow-up was 31.2 months (range, 4.1 to 85.7 months). Twenty-five patients (22.5%) were classified as obese. Treatment failure occurred in 33 patients (29.7%), including local failures in 13 patients (11.7%), regional lymph node failures in 5, and distant metastases in 24. The 3-year local control, recurrence-free survival, and overall survival rates were 88.7%, 73.6%, and 87.7%, respectively. Obesity (n = 25) significantly reduced the local control rate (p = 0.045; 3-year local control, 76.2%), especially in women (n = 37, p = 0.021). Segregation of local control was best achieved by BMI of 25.6 kg/m(2) as a cutoff value. Conclusion Obese rectal cancer patients showed poor local control after combined surgery and RT. More effective local treatment strategies for obese patients are warranted.

// Eun-Tae Park 1 , Sung Kwang Park 1 1 Department of Radiation Oncology, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea Correspondence to: Sung Kwang Park, email: physicist@paik.ac.kr Keywords: head and neck cancer, setup error, cervical spine, organ motion Received: March 07, 2016 Accepted: April 27, 2016 Published: May 31, 2016 ABSTRACT Purpose: The aim of this study is to determine the inter-fractional motion of cervical spine in radiotherapy (RT). Materials and Methods: Eleven localized head and neck cancer patients who were treated from April 2014 to September 2015 were evaluated. Every patient underwent 3 times of computed tomography (CT) simulation with equivalent setting. Left-right (LR, x) and antero-posterior (AP, z) directional shift of cervical spine were evaluated using 33 number of CT image. In regard to random error, geometric changes were evaluated by 22 data set (compared the first obtained CT to second or third CT) by one-sample T test. Systemic error was evaluated by each patients’ data set (11 pairs) by paired T test. Results: The mean random error of LR and AP translational shift of cervical spine were −0.39 ± 3.24 mm and −0.57 ± 0.99 mm respectively. The mean random error of translational change of AP direction showed statistical significance ( p = 0.014). The mean random error of x and z rotational shift were −0.07 ± 0.29° and −0.05 ± 0.35°, respectively. The mean systemic error of translational shift of LR and AP direction were −0.64 ± 2.57 mm and −0.33 ± 1.22 mm, respectively. The mean systemic error of rotational shift of x and z were 0.01 ± 0.18° and −0.27 ± 0.33°, respectively. The mean systemic error of rotational changes of z direction showed statistical difference ( p = 0.022). Conclusions: We have to be aware of the inter-fractional motion of cervical spine in head and neck RT and give enough margins in RT planning.

Purpose This study aimed to evaluate the effects of radiotherapy (RT) on progression-free survival (PFS) for patients with recurrent colorectal cancer. Methods We reviewed the records of 22 patients with recurrent colorectal cancer treated with RT between 2008 and 2014. The median radiation dose for recurrent disease was 57.6 Gy (range, 45–75.6 Gy). Patients were divided into 2 groups according to the type of RT: patients underwent RT without previous history of irradiation (n = 14) and those treated with secondary RT (reirradiation: n = 8) at the time of recurrence. Results The median follow-up period was 24.9 months (range, 4.5–66.6 months). Progression was observed in 14 patients (including 8 with loco-regional failure and 9 with distant metastases). Distant metastases were related to the RT dose (

Radiation treatment requires high accuracy to protect healthy organs and destroy the tumor. However, tumors located near the diaphragm constantly move during treatment. Respiration-gated radiotherapy has significant potential for the improvement of the irradiation of tumor sites affected by respiratory motion, such as lung and liver tumors. To measure and minimize the effects of respiratory motion, a realistic deformable phantom is required for use as a gold standard. The purpose of this study was to develop and study the characteristics of a deformable moving lung (DML) phantom, such as simulation, tissue equivalence, and rate of deformation. The rate of change of the lung volume, target deformation, and respiratory signals were measured in this study; they were accurately measured using a realistic deformable phantom. The measured volume difference was 31%, which closely corresponds to the average difference in human respiration, and the target movement was - 30 to + 32mm. The measured signals accurately described human respiratory signals. This DML phantom would be useful for the estimation of deformable image registration and in respiration-gated radiotherapy. This study shows that the developed DML phantom can exactly simulate the patient׳s respiratory signal and it acts as a deformable 4-dimensional simulation of a patient׳s lung with sufficient volume change.

Yes-associated protein (YAP) activation after acute ischemic kidney injury might be related to interstitial fibrosis and impaired renal tubular regeneration. Verteporfin (VP) is a photosensitizer used in photodynamic therapy to treat age-related macular degeneration. In cancer cells, VP inhibits TEA domain family member (TEAD)-YAP interactions without light stimulation. The protective role of VP in unilateral ureteral obstruction (UUO)-induced renal fibrosis and related mechanisms remains unclear. In this study, we investigate the protective effects of VP on UUO-induced renal tubulointerstitial inflammation and fibrosis and its regulation of the transforming growth factor-&beta, 1 (TGF-&beta, 1)/Smad signaling pathway. We find that VP decreased the UUO-induced increase in tubular injury, inflammation, and extracellular matrix deposition in mice. VP also decreased myofibroblast activation and proliferation in UUO kidneys and NRK-49F cells by modulating Smad2 and Smad3 phosphorylation. Therefore, YAP inhibition might have beneficial effects on UUO-induced tubulointerstitial inflammation and fibrosis by regulating the TGF-&beta, 1/Smad signaling pathway.

Renal fibrosis is a common feature of all progressive chronic kidney diseases. Sirtuin 3(SIRT3) is one of the mitochondrial sirtuins, and plays a role in the regulation of mitochondrialbiogenesis, oxidative stress, fatty acid metabolism, and aging. Recently, honokiol (HKL), as apharmaceutical SIRT3 activator, has been observed to have a protective effect against pressureoverload‐induced cardiac hypertrophy by increasing SIRT3 activity. In this study, we investigatedwhether HKL, as a SIRT3 activator, also has protective effects against unilateral ureteral obstruction(UUO)‐induced renal tubulointerstitial fibrosis through SIRT3‐dependent regulation ofmitochondrial dynamics and the nuclear factor‐&kappa, B (NF‐&kappa, B)/transforming growth factor‐&beta, 1 (TGF‐&beta, 1)/Smad signaling pathway. We found that HKL decreased the UUO‐induced increase in tubularinjury and extracellular matrix (ECM) deposition in mice. HKL also decreased myofibroblastactivation and proliferation in UUO kidneys and NRK‐49F cells. Finally, we showed that HKLtreatment decreased UUO‐induced mitochondrial fission and promoted mitochondrial fusionthrough SIRT3‐dependent effects. In conclusion, activation of SIRT3 via HKL treatment might havebeneficial effects on UUO‐induced renal fibrosis through SIRT3‐dependent regulation ofmitochondrial dynamics and the NF‐&kappa, B/TGF‐&beta, 1/Smad signaling pathway.

Digital tomosynthesis (DTS) is a geometric tomography technique using a limited-angle scan. It has been popularly used in both medical and industrial x-ray imaging applications. DTS provides the tomographic benefits of computed tomography with reduced dose and time. However, conventional DTS reconstruction based on the computationally cheap filtered back-projection (FBP) method typically produces poor image quality due to limited angular samplings. To overcome these difficulties, iterative reconstruction methods are often used in DTS reconstruction as they have the potential to provide multiplanar images of higher quality than conventional FBP-based methods. However, they require enormous computational cost in the iterative process, which remains an obstacle to practical applications. In this study, we propose a method for effectively reducing limited-angle artifacts in conventional FBP reconstruction, using a state-of-the-art deep learning scheme with a convolutional neural network. Our results indicate that the proposed DTS reconstruction method effectively minimized limited-angle artifacts, thus improving image performance in DTS, and that further it provided good image quality in both sagittal and coronal views (as in computed tomography) as well as in axial view.

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation, which can occur in approximately 10% to 15% of renal transplant patients and usually affects males with relatively good renal function. It is also associated with an increased incidence of thromboembolic events. Clinical manifestations of PTE include malaise, headache, plethora, lethargy, and dizziness. It is correlated with use of cyclosporin, gender, posttransplant renal function, and type of antihypertensive medication. The angio- tensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor is preferred as an initial treatment for PTE because these agents are effective and reasonably safe in the majority of patients with PTE, and can also provide a necessary antihypertensive effect for kidney transplant patients. We report here on a 35-year-old male who had erythrocytosis after renal transplantation. After renal transplantation, his level of hemoglobin was 21 g/dL. We treated this patient with ARB and his symptoms and signs have been completely relieved.