To investigate the feasibility of image-based intracavitary brachytherapy (IBICBT) for uterine cervical cancer, we evaluated the dose–volume histograms (DVHs) for the tumor and organs at risk (OARs) and compared results from the IBICBT plan and the standard Manchester system (Manchester plan) in eight patients as a simulation experiment. We performed magnetic resonance imaging (MRI) and computed tomography (CT) following MRI-adapted applicator insertion, then superimposed MR images on the planning CT images to describe the contours of high-risk clinical target volume (HR CTV) and OARs. The median volume of HR CTV was 29 cm3 (range, 21–61 cm3). Median D90 (HR CTV) and V100 (HR CTV) were 116.1% prescribed doses (PD) (90.0–150.8%) and 96.7% (84.2–100%), respectively, for the Manchester plan. In comparison, we confirmed that the median D90 (HR CTV) was 100% PD in the IBICBT plan for all patients. Mean D2cc (bladder) was 101.8% PD for the Manchester plan and 83.2% PD for the IBICBT plan. Mean D2cc (rectum) was 80.1% PD for the Manchester plan and 64.2% PD for the IBICBT plan. Mean D2cc (sigmoid) was 75% PD for the Manchester plan and 57.5% PD for the IBICBT plan. One patient with a large tumor (HR CTV, 61 cm3) showed lower D90 (HR CTV) with the Manchester plan than with the IBICBT plan. The Manchester plan may represent overtreatment for small tumors but insufficient dose distribution for larger tumors. The IBICBT plan could reduce OAR dosage while maintaining adequate tumor coverage.
Abstract Background The prognosis of metastatic hepatoblastoma remains poor; to improve it, pulmonary metastasis must be controlled. Indocyanine green (ICG) fluorescent imaging has been used recently for lung metastasectomy. The objective of our study was to clarify the usefulness of ICG imaging for lung metastasectomy of hepatoblastoma using detailed clinicopathological analysis. Procedure Patients with hepatoblastoma who underwent resection of pulmonary metastases with ICG fluorescent imaging were studied using a retrospective analysis of clinical information, a review of their surgical records, and a histological analysis of their metastatic nodules. Results Sixteen patients were enrolled. In total, 61 ICG imaging‐guided pulmonary metastasectomies were performed, and 350 ICG‐positive and 23 ICG‐negative specimens were identified. Tumors were confirmed in 250 of the ICG‐positive specimens, including eight nonpalpable nodules, on microscopic examination. ICG‐positive and tumor‐negative specimens showed histological changes suggesting the regression of a tumor or bloodstream disturbance. Conclusions Surgical resection is one of the few treatment strategies available to patients with hepatoblastoma with multiple relapses of pulmonary metastasis resistant to chemotherapy. This study demonstrates the high sensitivity of ICG imaging and that thorough metastasectomy can be achieved with ICG imaging. Because a number of false‐positive specimens were detected, further optimization of the dose of ICG and the timing of its administration, and establishment of detection of ICG‐positive, tumor‐negative nodules during surgery are important issues. Several false‐negative specimens were also detected, suggesting the presence of ICG‐negative metastatic tumors. Palpation during surgery and imaging studies remain essential for detecting metastatic lesions, even in the era of ICG imaging.
Bowel endometriosis sometimes causes repeated intestinal obstruction during menstruation. Recently, there are an increasing number of cases of bowel endometriosis treated with laparoscopic bowel resection. We had a case of ileal endometriosis with recurrence of intestinal obstruction during menstruation. A 34 year-old woman was referred with a left ovarian endometrioma 4 cm in diameter. She had just recovered from conservative treatment of intestinal obstruction, which had developed during menstruation. We planned a laparoscopic cystectomy of her left ovarian endometrioma. She relapsed with intestinal obstruction during menstruation, which was again treated conservatively. Computed tomography at the onset of intestinal obstruction showed stenosis of the distal ileum. Ileal endometriosis was suspected as the cause of this stenosis. Her next menstrual period was estimated to overlap with the planned laparoscopic operation. Another recurrence of intestinal obstruction during her next menstruation could necessitate a delay in the operation, or a conversion to laparotomy. She was treated with dienogest for prevention of intestinal obstruction recurrence for one month before the operation. Concurrent laparoscopic resection of the left ovarian endometrioma and ileal endometriosis was performed as scheduled without recurrence of intestinal obstruction. Pathological examination confirmed ileal endometriosis and left ovarian endometrioma. No recurrence of either ovarian endometrioma or intestinal obstruction has been detected for one year after the operation. Our experience suggests that it would be better to avoid planning laparoscopic surgery during menstruation in suspected bowel endometriosis, or to start drug treatment to prevent endometriosis-associated bowel obstruction.
Neuroblastoma (NB) is the most common solid tumor found in children, and deletions within the 11q region are observed in 11% to 48% of these tumors. Notably, such tumors are associated with poor prognosis; however, little is known regarding the molecular targets located in 11q.Genomic alterations of ATM , DNA damage response (DDR)-associated genes located in 11q ( MRE11A, H2AFX , and CHEK1 ), and BRCA1, BARD1, CHEK2, MDM2 , and TP53 were investigated in 45 NB-derived cell lines and 237 fresh tumor samples. PARP (poly [ADP-ribose] polymerase) inhibitor sensitivity of NB was investigated in in vitro and invivo xenograft models. All statistical tests were two-sided.Among 237 fresh tumor samples, ATM, MRE11A, H2AFX , and/or CHEK1 loss or imbalance in 11q was detected in 20.7% of NBs, 89.8% of which were stage III or IV. An additional 7.2% contained ATM rare single nucleotide variants (SNVs). Rare SNVs in DDR-associated genes other than ATM were detected in 26.4% and were mutually exclusive. Overall, samples with SNVs and/or copy number alterations in these genes accounted for 48.4%. ATM-defective cells are known to exhibit dysfunctions in homologous recombination repair, suggesting a potential for synthetic lethality by PARP inhibition. Indeed, 83.3% NB-derived cell lines exhibited sensitivity to PARP inhibition. In addition, NB growth was markedly attenuated in the xenograft group receiving PARP inhibitors (sham-treated vs olaprib-treated group; mean [SD] tumor volume of sham-treated vs olaprib-treated groups = 7377 [1451] m 3 vs 298 [312] m 3 , P = .001, n = 4).Genomic alterations of DDR-associated genes including ATM, which regulates homologous recombination repair, were observed in almost half of NBs, suggesting that synthetic lethality could be induced by treatment with a PARP inhibitor. Indeed, DDR-defective NB cell lines were sensitive to PARP inhibitors. Thus, PARP inhibitors represent candidate NB therapeutics.
Objective: Traditionally, laparotomy has been the main surgical treatment in gynecologic oncology. However, the recent development of various devices and the results of randomized controlled studies have enabled the introduction of total laparoscopic hysterectomy for early-stage endometrial cancer. The aim of this single-center study was to compare laparotomy and laparoscopy for endometrial cancer.
