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Purpose: To compare image quality and visibility of anatomical structures on contrast-enhanced thin-slice abdominal CT images reconstructed using super-resolution deep learning reconstruction (SR-DLR), deep learning-based reconstruction (DLR), and hybrid iterative reconstruction (HIR) algorithms., Materials and Methods: This retrospective study included 54 consecutive patients who underwent contrast-enhanced abdominal CT. Thin-slice images (0.5 mm thickness) were reconstructed using SR-DLR, DLR, and HIR. Objective image noise and contrast-to-noise ratio (CNR) for liver parenchyma relative to muscle were assessed. Two radiologists independently graded image quality using a 5-point rating scale for image noise, sharpness, artifact/blur, and overall image quality. They also graded the visibility of small vessels, main pancreatic duct, ureters, adrenal glands, and right adrenal vein on a 5-point scale., Results: SR-DLR yielded significantly lower objective image noise and higher CNR than DLR and HIR (P < .001). The visual scores of SR-DLR for image noise, sharpness, and overall image quality were significantly higher than those of DLR and HIR for both readers (P < .001). Both readers scored significantly higher on SR-DLR than on HIR for visibility for all structures (P < .01), and at least one reader scored significantly higher on SR-DLR than on DLR for visibility for all structures (P < .05)., Conclusion: SR-DLR reduced image noise and improved image quality of thin-slice abdominal CT images compared to HIR and DLR. This technique is expected to enable further detailed evaluation of small structures., Competing Interests: Declarations Conflict of interests Atsushi Nakamoto and Takahiro Tsuboyama received research support from Canon Medical Systems Corporation. Atsushi Nakamoto, Shinya Nakasone, and Noriyuki Tomiyama have received speaker honoraria from Canon Medical Systems Corporation. Ethical approval Approval was obtained from the ethics committee of Osaka University Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Informed consent Written informed consent was waived by our institutional review board. Consent to participate This study was approved by our institutional review board, and informed consent was waived for this retrospective study. Consent to publish This study was approved by our institutional review board, and informed consent was waived for this retrospective study., (© 2024. The Author(s).)

Competing Interests: Disclosure There are no conflict of interest.

Background: Particle therapy (PT) as an initial hepatocellular carcinoma (HCC) treatment has been reported to be effective; however, its efficacy for the treatment of recurrent HCC remains unclear., Objective: This study aimed to evaluate the efficacy of PT compared with repeat liver resection for treating recurrent HCC after initial LR, with a focus on prognostic outcomes., Methods: Between 2005 and 2019, 89 and 49 patients underwent repeat LR and PT for recurrent HCC after initial LR, respectively. The 5-year overall survival (OS) and recurrence-free survival (RFS) were evaluated using propensity score matching. Treatment-related complications were scored using the National Institute Common Terminology Criteria for Adverse Events (CTCAE) and were compared between the repeat LR and PT groups., Results: In the entire cohort, the 5-year OS was significantly better in the repeat LR group than in the PT group (75% vs. 48%; p = 0.0003), and the 5-year RFS was comparable in both groups (22% vs. 13%; p = 0.088). Propensity score matching created 34 pairs of patients; no significant differences in the 5-year OS (65% vs. 48%; p = 0.310) and RFS (21% vs. 8%; p = 0.271) were observed between the repeat LR and PT groups. The proportion of CTCAE grade ≥3 complications was 8.8% and 5.9% in the repeat LR and PT groups, respectively (p = 0.641)., Conclusions: After initial LR, the prognosis and treatment-related complications in patients with recurrent HCC were comparable between the repeat LR and PT groups in the matched cohort; therefore, PT may remain one of the multidisciplinary treatment options for recurrent HCC., (© 2024. Society of Surgical Oncology.)

Purpose: To determine the prevalence of adverse events after image-guided biopsy of histologically proven hepatocellular carcinomas (HCC) using a standardized, indirect access, coaxial biopsy technique., Methods: In this IRB-approved, HIPAA compliant, and retrospective study, we evaluated all consecutive adult patients from 2011 to 2016 who underwent image-guided biopsy of HCC with and without concurrent ablation. Tumor seeding was defined as any new lesion along the needle tract on subsequent imaging. Adverse events were graded using both the Clavien-Dindo Complication Classification system and the most recently proposed Society of Interventional Radiology (SIR) Adverse Event Classification System., Results: A total of 383 patients underwent 398 biopsies (64 ± 11 years; 112 women, 271 men). Most patients (282; 71%) underwent concurrent ablation. Adverse events occurred after 18 biopsies (4.5%): 13 were Grade I (Clavien-Dindo) or minor (SIR) and included hematoma (7), hepatic vein thrombus (2), portal vein thrombus (2), moderate pleural effusion (1), and small pneumothorax (1). The remaining 5 (1.3%) adverse events were classified as Grade II-IIIa (Clavien-Dindo) or moderate (SIR) and included hematoma requiring blood products (n = 1), arrhythmia (n = 1), and symptomatic pleural effusions requiring treatment (n = 3). Baseline age, sex, cause of liver disease, HCC diameter, and HCC grade were not associated with adverse events. There were no tumor seeding events after a median follow-up of 611 days (interquartile range of 211-1104)., Conclusion: Percutaneous image-guided tissue sampling using a standardized, indirect access, coaxial technique can be performed safely with and without concurrent ablation by trained cross-sectional interventional radiologists at a tertiary liver transplant center., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The optimal treatment for isolated local recurrence (ILR) of pancreatic adenocarcinoma (PDAC) after surgical resection remains unclear. This study aimed to evaluate the safety and efficacy of proton radiotherapy (PRT) for ILR of PDAC after surgery., Methods: The medical records of patients with ILR of PDAC after surgery who underwent proton beam therapy between 2011 and 2015 at Hyogo Ion Beam Medical Center were retrospectively studied., Results: The study analyzed 30 patients (14 women and 16 men) with a median age of 65 years (range 38-81 years) who had initially undergone pancreatoduodenectomy (n = 23) or distal pancreatectomy (n = 7) for their primary tumors. Upon ILR, PRT was administered with a median total cumulative dose of 67.5 gray equivalent (GyE) (range 50-67.5 GyE) using 19 to 25 fractions. For 25 patients, concurrent chemotherapy was administered using gemcitabine (n = 18) or S-1 (n = 7). Four patients (13.3%) experienced acute grade ≥ 3 gastrointestinal toxicities. After a median follow-up period of 17.6 months (range 2.1-50.4 months), 23 patients had experienced tumor progression and 10 had died. Nine patients (30%) experienced local tumor progression. The median overall, progression-free, and local progression-free survival rates were 26.1, 12.3, and 41.2 months, respectively. Pre-PRT serum levels of cancer antigen 19-9 higher than 100 U/mL and duke pancreatic monoclonal antigen type 2 higher than 150 U/mL were significantly associated with shorter progression-free survival rates., Conclusions: Proton radiotherapy for ILR of PDAC after surgery is well tolerated and produces good locoregional control and should be considered for eligible patients.

Metastatic intracranial germinoma is difficult to treat. Although the proto-oncogene KIT is recognized as one of the most frequent genetic abnormalities in CNS germinoma, the development of new target therapeutic agents for CNS germinoma is hampered by the lack of clinically-relevant animal models that replicate the mutated or over-expressed KIT. CNS germinoma tumor cells from five pediatric patients were directly implanted into the brains of Rag2/severe combined immune deficiency mice. Once established, the xenograft tumors were sub-transplanted in vivo in mouse brains. Characterization of xenograft tumors were performed through histologic and immunohistochemical staining, and KIT mutation analysed with quantitative pyro-sequencing. Expression of putative cancer stem cell markers (CD133, CD15, CD24, CD44, CD49f) was analyzed through flow cytometry. Two patient-derived orthotopic xenograft (PDOX) models (IC-6999GCT and IC-9302GCT) were established from metastatic germinoma and serially sub-transplanted five times in mouse brains. Similar to the original patient tumors, they both exhibited faint expression (+) of PLAP, no expression (-) of β-HCG and strong (+++) expression of KIT. KIT mutation (D816H), however, was only found in IC-9320GCT. This mutation was maintained during the five in vivo tumor passages with an increased mutant allele frequency compared to the patient tumor. Expression of putative cancer stem cell markers CD49f and CD15 was also detected in a small population of tumor cells in both models. This new pair of PDOX models replicated the key biological features of pediatric intracranial germinoma and should facilitate the biological and pre-clinical studies for metastatic intracranial germinomas.

The role of diffusion weighted imaging and apparent diffusion coefficient in intracranial germ cell tumors has not been fully elucidated. The aim of this study was to evaluate whether the ADC correlates with the histologic subtypes of germ cell tumors. We also aimed to investigate whether the ADC values can predict treatment response. The authors retrospectively analyzed the ADC values of the enhancing and solid regions of germ cell tumors. The absolute ADC values and the normalized ADC values were compared among different histologic diagnoses. The ADC values before and after the first course of chemotherapy were also compared between the different prognostic groups. Ten patients were included in the study. The median age at diagnosis was 9.3 years (range 5.3-13.8 years). There were four patients with germinoma and six patients with nongerminomatous germ cell tumor (NGGCT) including five mixed germ cell tumors and one immature teratoma. The mean absolute and normalized ADC values (×10(-3) mm(2)/s) were significantly lower in germinomas [0.835 ± 0.065 (standard deviation) and 1.11 ± 0.096, respectively] than in NGGCTs (1.271 ± 0.145 and 1.703 ± 0.223, respectively) (p = 0.01). The ADC values before and after the first course of chemotherapy were available in four patients. The ADC value after the first chemotherapy had a tendency to increase more in patients who eventually demonstrated complete response with chemotherapy than in patients who required second-look surgery. Assessment of the ADC values of germ cell tumors is considered to facilitate differentiation of histological subtypes of germ cell tumors. Evaluation of the ADC may also be useful for predicting treatment response.

Laryngeal radionecrosis is one of the most troublesome late complications of radiotherapy, because it is frequently resistant to treatment and laryngectomy is required in the worst case. Here, we report a case of laryngeal radionecrosis, successfully treated by use of hyperbaric oxygen (HBO) therapy, in which laryngectomy was avoided. A 67-year-old male received radical chemoradiotherapy (CRT) for mesopharyngeal cancer, which included radiotherapy with a total dose of 71.4 Gy/38 Fr and chemotherapy with CDDP + S-1. He developed dyspnea and throat pain 9 months after completion of CRT. Laryngoscopy revealed vocal cord impairment because of severe laryngeal edema. He was diagnosed as having laryngeal radionecrosis and initially received conservative therapy combined with antibiotics, steroids, and prostaglandins. Because his dyspnea was persistent despite this treatment, HBO therapy was administered 20 times, and resulted in complete remission of the dyspnea. HBO therapy, therefore, is regarded as an effective conservative therapeutic option for laryngeal radionecrosis.

To establish a high throughput and cost-efficiency procedure for distinguishing among cultivars in Lentinula edodes, the polymorphism in the genes reported previously in this fungus was examined using PCR or PCR-RFLP techniques with a high-efficiency genome scanning (HEGS) system. As a result, PCR-based markers derived from eight genes (tyr, cap, ppa, IGS-RFLP, pri B-RFLP, mfbC-RFLP, gla-RFLP, xy-RFLP) showed polymorphisms among cultivars in this fungus and consequently, enabled to distinguish seventy-nine cultivars used in this study.

Purpose: Small-cell esophageal carcinoma (SCEC) is a rare disease for which standard therapy has not yet been established. We report the results of three cases of limited-stage SCEC treated with combination therapy using carboplatin (CBDCA) and etoposide (VP-16) and radiotherapy., Materials and Methods: The clinical stage according to the Japanese Classification of Esophageal Cancer 7th ed. was stage III in 2 cases and stage IVa in 1. These patients with limited-stage SCEC were treated at our institution with four cycles of CBDCA and VP-16, either concurrent with radiotherapy for the second two cycles (n = 2) or followed by radiotherapy after the last cycle (n = 1)., Results: A complete response (CR) was obtained for all three patients, resulting in a response rate of 100%. Two patients are alive at 16.4 and 22.5 months after initial treatment. One patient died with myeloid leukemia at 43.5 months after initial treatment. None of the patients had loco-regional recurrence. Brain metastasis was detected in one patient at 7 months after initial therapy and was treated with stereotactic radiotherapy combined with whole brain irradiation., Conclusion: CBDCA and VP-16 in combination with radiotherapy should be considered an important treatment option for SCEC.