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We aimed to assess the efficacy and safety of stereotactic body radiation therapy (SBRT) in treating oligometastatic non-spine bone metastases (NSBM). This retrospective study analyzed patients treated with SBRT for oligometastatic NSBM at two centers between 2019 and 2023. The oligometastatic disease was defined as a limited number of 3 or fewer metastases in this study. The NSBM lesions were categorized into the pelvis (excluding the sacrum), ribs, shoulders, and others. The primary endpoint was the local failure (LF) and pathologic fracture (PF) rates. Secondary endpoints included overall survival (OS) and other adverse events based on the Common Terminology Criteria for Adverse Events, version 5.0. Cumulative incidence with death as a competing event was used to assess rates of LF and PF at 1 and 2 years. Among the 61 lesions from 55 patients screened, 43 oligometastatic NSBM lesions from 38 patients met the criteria. The median patient age was 65, and major primary cancers included the prostate (30%), gastrointestinal (16%), and lung (14%). When the oligometastatic lesion was diagnosed, 20% were painful lesions, 80% were asymptomatic, and 50% were on systemic therapy (i.e., oligoprogression). SBRT targeted lesions in the pelvis (53%), ribs (23%), and shoulders (5%), and the dose prescription was used with 30–35 Gy in 5 fractions (79%), 27 Gy in 3 fractions (5%), and 24 Gy in 2 fractions (7%). The number of target lesions was one (87%), two (10%), and three (3%). In a median follow-up time of 16.8 months (range = 2.7–54.7 months), 5 LFs (3 in the pelvis, 1 in the rib, and 1 in the others) and 6 PFs (3 in the pelvis and 3 in the rib) were recorded. All the PF lesions were grade 1 and did not require any treatment. The cumulative incidence of LF at 1 and 2 years was 10.4% (95% CI: 3.1–22.7%) and 15.1% (95% CI: 4.9–30.4%), respectively. The cumulative incidence of PF at 1 and 2 years was 7.8% (95% CI: 1.9–19.3) and 15.2% (95% CI: 5.2–30.1), respectively. The 1-year and 2-year OS were 89.5% (95% CI: 74.3–95.9%) and 73.5% (95% CI: 53.0–86.1), respectively. The recorded adverse events included 1 case of nausea (Grade 1) and 2 cases of dermatitis (Grade 2). No events of grade 3 or higher were observed. The results of this study may confirm the high efficacy and tolerable toxicity of SBRT for oligometastatic NSBM, highlighting the need for future clinical trial enrollment. [ABSTRACT FROM AUTHOR]

This study compared the pain response to palliative radiotherapy for bone metastases and non-bone lesions based on the International Consensus on Palliative Radiotherapy Effectiveness (ICPRE) criteria. In our prospective observational study, 867 lesions from 500 patients undergoing palliative radiotherapy for a painful tumor between August 2021 and September 2023 were screened for this study, except for postoperative settings or brain metastases. The eligibility criteria were a numerical rating scale (NRS) of two or more before treatment. Information about pain sites, NRS, and opioid use was collected before treatment and 2, 4, 12, 24, 36, and 52 weeks later. The pain response was assessed based on the ICPRE criteria. The primary outcome was the pain response rate within 12 weeks, comparing two groups of patients with bone and non-bone lesions. A multivariate logistic regression analysis was conducted to adjust for confounding covariates based on opioid use, irradiation history, performance status, NRS, primary disease, and radiation dose. Statistical significance was defined as P <0.05. Among 678 lesions from 441 patients who met the criteria, the mean age was 63 years, and 45% were female. Treatment included conventional radiotherapy of a single 8 Gy dose, 20 Gy in 5 fractions, and 30 Gy in 10 fractions was used in 89% of lesions. With a median follow-up of 9.2 months, 270 patients had died. Painful bone metastases accounted for 541 lesions (80%), and the distribution of the 137 (20%) non-bone lesions of the primary lesions, lymph nodes, and other sites was 46/33/58. There were no differences in opioid use (67%) or re-irradiation rates (22%) between the two groups. Patients with non-bone lesions had a shorter median survival period than those with bone lesions (4.9 months vs. 6.3 months, P = 0.017) and were more frequently treated with fractionated irradiation (85% vs. 67%, P < 0.001). There were no differences in pain response rates between the two groups (57% vs. 62%, P = 0.33), and this remained consistent after adjusting covariates by a multivariate analysis (P = 0.19). The results of this study suggest that palliative radiotherapy for pain response is effective not only for bone metastases but also for painful non-bone lesions. Future prospective clinical trials are awaited to determine the appropriate radiotherapy doses and fractions for painful non-bone lesions. [ABSTRACT FROM AUTHOR]

We aimed to investigate the impact of concurrent antibody-drug conjugates (ADC) and radiotherapy on symptomatic brain necrosis (SBN) in patients with brain metastases (BM) from breast cancer. This study is a multicenter retrospective design using data from four institutions. Eligibility patients were selected based on the following criteria: (1) histologically proven breast cancer and subtypes; (2) BM was diagnosed with gadolinium-enhanced MRI; (3) a Karnofsky performance status (KPS) score of 60 or higher at the time of the BM diagnosis; and (4) underwent radiotherapy for all BM lesions between 2017 and 2022. Patients with leptomeningeal dissemination were excluded. For this study, concurrent ADC is defined as using ADC within four weeks of the first day of radiotherapy, and trastuzumab deruxtecan (T-DXd) and trastuzumab emtansine (T-DM1) are the ADCs under investigation. The rate of SBN until the last follow-up date or until December 2023 and the cumulative incidence of SBN with death as a competing event were compared between the two groups with and without concurrent ADC. Univariable and multivariable models were developed using Fine and Gray competing risks regression, and subdistribution hazard ratios (SHRs) are shown with 95% confidence interval (CI). Among the 168 patients who met the criteria, 48 (29%) received ADC, and 19 (11%) received concurrent ADC: T-DXd (n = 4) or T-DM1 (n = 15). Key characteristics were the median age of 57 and the HER2-positive status of 36%. Radiotherapy underwent SRS in 60%, and 33% had a prior radiation history. Maximum tumor volume larger than 14 mL were in 24% of patients, and neurologic symptoms were present in 62%. In a median follow-up time of 31 months and median survival time of 15 months, eighteen SBN events (11%) were registered overall. The distribution of these SBNs was 11 patients in grade 2 requiring steroids, 7 patients in grade 3, 6 of whom underwent surgery, and 1 was treated with bevacizumab. Between the groups, 5 cases (26%) out of 19 concurrent ADC patients, in contrast to 13 cases (9%) of the other 149 patients. The two-year cumulative incidence of SBN was 27% in the concurrent ADC group and 7% in the others (P = 0.014). Concurrent ADC was independently associated with a higher risk of SRN on multivariable analysis (SHR, 3.2 [95% CI: 1.1–9.8], P = 0.039). The results of this multicenter study suggest that concurrent ADC and radiotherapy are associated with a higher risk of SBN. [ABSTRACT FROM AUTHOR]

Treadmill exercise electrocardiography (ECG) is one of the most common noninvasive methods for detecting ischemic heart disease. However, this method has problems due to false-positive and false-negative results in a significant number of patients. The aim of this study was to determine whether the diagnostic accuracy of treadmill exercise ECG for detecting significant coronary stenosis can be improved by employing a step-up diagnostic method using multiple diagnostic indicators. We studied 273 consecutive patients (mean age, 56 +/- 9 years; 190 men and 83 women) without a history of myocardial infarction who underwent treadmill exercise ECG and coronary angiography for ischemic chest pain. Of these, 146 patients had no significant coronary stenosis, 61 had single-vessel disease, 56 had multivessel disease, and 10 patients had left main truncus disease. A multivariate logistic regression analysis was used to select 3 treadmill exercise electrocardiographic parameters that were independent predictors of the presence or absence of significant coronary stenosis: exercise-induced maximum ST-segment depression, QT dispersion immediately after exercise, and Athens QRS score. Significant coronary stenosis was diagnosed with a sensitivity of 84% and a specificity of 90% when a step-up diagnostic method using these 3 indicators was employed. These results were better than those obtained for each indicator alone (exercise-induced maximum ST-segment depression: sensitivity, 66%, and specificity, 73%; QT dispersion immediately after exercise [> or =60 ms positive]: sensitivity, 76%, and specificity, 86%; and Athens QRS score [< or =5 mm positive]: sensitivity, 72%, and specificity, 72%). We conclude that this step-up diagnostic method, using multiple diagnostic indicators, is a clinically useful predictor of the presence or absence of significant coronary stenosis. [ABSTRACT FROM AUTHOR]

It has recently been reported that increased QT dispersion seen on standard 12-lead electrocardiograms (ECGs) reflects transient myocardial ischemia. The present study investigates whether increased QT dispersion induced by exercise is a useful indicator for detecting significant coronary stenosis in patients who do not have chest pain or significant ST-segment depression in response to exercise. We studied 135 consecutive patients (mean age +/- SD, 55 +/- 9 years; 97 men and 38 women) who complained of anginal chest pain and who did not have exercise-induced chest pain or significant ST-segment depression during treadmill exercise electrocardiography. Coronary angiography was performed in all of patients. Of the 135 patients, 97 had no significant coronary stenosis, 25 had 1-vessel coronary artery disease (CAD), and 13 had multivessel CAD. QT dispersion immediately after exercise was significantly greater in the group with significant coronary stenosis than without significant coronary stenosis (62 +/- 13 vs 40 +/- 14 ms, p <0.0001). When QT dispersion >/=60 ms immediately after exercise was considered a positive result, this indicator had a sensitivity of 74%, a specificity of 85%, and an accuracy of 81% for the diagnosis of significant coronary stenosis. In conclusion, we have shown that QT dispersion immediately after exercise is useful for detecting significant CAD in patients who do not have exercise-induced chest pain or significant ST-segment depression. [ABSTRACT FROM AUTHOR]

Deep inspiration breath-hold (DIBH) is widely used to reduce the cardiac dose in left-sided breast cancer radiotherapy. This study aimed to develop a deep learning chest X-ray model for cardiac dose prediction to select patients with a potentially high risk of cardiac irradiation and need for DIBH radiotherapy. We used 103 pairs of anteroposterior and lateral chest X-ray data of left-sided breast cancer patients (training cohort: n = 59, validation cohort: n =19, test cohort: n = 25). All patients underwent breast-conserving surgery followed by DIBH radiotherapy: the treatment plan consisted of two opposing tangential radiation fields. The prescription dose of the planning target volume was 42.56 Gy in 16 fractions. A convolutional neural network-based regression model was developed to predict the mean heart dose (∆MHD) reduction between free-breathing (MHD FB) and DIBH. The model performance is evaluated as a binary classifier by setting the cutoff value of ∆MHD >1 Gy. The patient characteristics were as follows: the median (IQR) age was 52 (47–61) years, MHD FB was 1.75 (1.14–2.47) Gy, and ∆MHD was 1.00 (0.52–1.64) Gy. The classification performance of the developed model showed a sensitivity of 85.7%, specificity of 90.9%, a positive predictive value of 92.3%, a negative predictive value of 83.3%, and a diagnostic accuracy of 88.0%. The AUC value of the ROC curve was 0.864. The proposed model could predict ∆MHD in breast radiotherapy, suggesting the potential of a classifier in which patients are more desirable for DIBH. [ABSTRACT FROM AUTHOR]

This study aimed to investigate preoperative spirometry and BMI as early predictors of the mean heart and lung dose (MHD, MLD) in deep inspiration breath-hold (DIBH) radiotherapy. Left-sided breast cancer patients underwent breast-conserving surgery followed by DIBH radiotherapy enrolled. Patients who were not available for preoperative spirometry were excluded. One hundred eligible patients were performed free-breathing (FB-) CT and DIBH-CT for plan comparison. We completed the correlative and multivariate analysis to develop the linear regression models for dose prediction. The residuals were calculated to explore the unpreferable subgroups and compare the prediction accuracy. Among the parameters, vital capacity (VC) and BMI showed the strongest negative correlation with MHD (r = –0.33) and MLD (r = –0.34), respectively. They were also significant in multivariate analysis (P <0.001). Elderly and less VC were independent predictors of increasing absolute residuals (AR). The VC model showed no significant difference in AR compared to the model using the CT parameter of lung volume in FB (LV-FB): median AR of the LV-FB model vs. the VC model was 0.12 vs. 0.11 Gy (P = 0.79). On the other hand, the median AR of the MLD model was 0.38 Gy, showing no specific subgroups of larger AR. Preoperative spirometry and BMI are significant predictors of MHD and MLD, respectively. Although elderly and low-VC patients may have larger predictive variations, spirometry might be a substitute for LV-FB as a predictor of MHD. [ABSTRACT FROM AUTHOR]

Abstract: We investigate electrical and optical properties of a vertical-type Schottky-barrier photodiode (SPD) using a boron (B)-doped p-diamond epilayer grown on a heavily B-doped p+-diamond (100) substrate with B concentration ([B]) of 1×1020 cm−3 by microwave plasma chemical-vapor deposition. Surface morphology and [B] in the epilayer are strongly affected by the growth temperature (T g). Smooth surface and low [B] of (3±2)×1015 cm−3 with an abrupt [B] profile at epilayer interface are reproducibly obtained for T g lower than 900 °C. The vertical-type SPD with a semitransparent WC Schottky contact is fabricated on an oxidized surface of the p-diamond epilayer. The SPDs with an ideality factor lower than 1.1 and a reverse leakage current less than 10−14 A are reproducibly obtained. The SPD is operable at zero or reverse bias mode with a fast response speed less than 1 s. The external quantum efficiency for 220-nm light illumination is measured to be almost constant value of 3.5±0.5% with increasing the reverse bias voltage from 0 to 5 V before and after annealing at 400 °C for 10 min. It is found that the vertical-type SPD using p+-diamond substrate does not provide the photoconductivity gain property. [Copyright &y& Elsevier]

The use of transoesophageal ultrasound (TOE) is often cited as a limitation in TAVI under local anaesthesia and sedation. The reason is that moderate or deeper sedation is required when using TOE because of its invasiveness, and if deep sedation is used, its respiratory depression becomes stronger and airway and respiratory management become unstable. High flow nasal cannula oxygen therapy (HFNC) is a device that has recently been attracting attention as one that is expected to have oxygenation and ventilation assistance effects by using a high flow of humidified gas. We inserted TOE and managed by using HFNC in TAVI under local anaesthesia and sedation. After entering the room and securing various monitors and arterial pressure lines, HFNC was started with FiO2 40%, flow 40L. For induction of anaesthesia, fentanyl 0.5-1 mcg / kg and Propofol 20-30 mg were administered. After the disappearance of the eyelash reflex was confirmed, TOE was inserted after local anaesthesia to the pharynx with 8% Lidocaine spray. The state of anaesthesia was maintained at Propofol 2 mg / kg / hr and Remifentanil 0.01-0.03 mcg / kg / min. A retrospective chart review was conducted from April 2017 to March 2018, and arterial blood gas analysis data at induction of anaesthesia (PaO2, PaCO2, BE), intubation event incidence rate and its breakdown were examined. Defects in the description were excluded. There were 88 cases in the period. Six cases were intubation cases, but 2 cases were intubated condition from before operation, 3 cases were extracorporeal circulation introduction due to hemodynamic instability, 1 case was due to coronary artery occlusion and There was no intubation and general anaesthesia due to anaesthesia related and patient movement control difficulty. Arterial blood gas analysis data were PaO 2 138.3 mmHg 95%CI[125.9, 150.7], PaCO 2 37.5 mmHg, 95%CI[35.7, 39.3], BE 0.09mEq/l, 95%CI[-0.60, 0.79]. Hypoxemia or hypercapnia did not occur even under moderate to deep sedation where TOE insertion did not cause movement. HFNC can suppress the occurrence of hypoxemia and hypercapnia even in moderate to deep sedation where TOE insertion is possible. [ABSTRACT FROM AUTHOR]