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BACKGROUND: Angiographic computed tomography (CT) is useful in various medical contexts, but little research has been presented regarding the application of cone beam CT (CBCT) in airway stenting. This study set out to evaluate the clinical feasibility of using CBCT in airway stent placement in a single-center retrospective cohort. METHODS: A total of 228 patients with stenosis or fistula diseases were treated with metallic airway stents in the First Affiliated Hospital of Zhengzhou University from January 1, 2015, to December 31, 2018. Of them, 128 patients underwent fluoroscopy-guided airway stenting. CBCT scanning was performed on the other 100 patients during and after treatment, and their images were compared with those from postoperative multidetector CT (MDCT). The outcomes and complications in the CBCT-guided and fluoroscopy-guided groups were also assessed via Pearson’s χ(2) test or Fisher’s exact test. RESULTS: Tracheal stenting was performed successfully on the first attempt for 90 patients in the CBCT-guided group and 123 patients in the fluoroscopy-guided group. The mean measured diameters of the central airway in the CBCT images and MDCT images were 18.2±2.81 and 19.0±2.33 mm, respectively, and the mean lengths were 58.7±16.82 and 58.5±17.06 mm, respectively. In the CBCT-guided group and the fluoroscopy-guided group, the mean scores for visibility of the distal bronchus were 3.7±0.49 and 3.9±0.34, respectively; the mean scores for the pulmonary parenchyma were 3.3±0.71 and 3.9±0.31, respectively; and the mean scores for the airway above the upper stent graft were 1.8±0.41 and 4.0±0.20, respectively. Two of the three anatomical areas were reproduced in a diagnostically relevant way. The major complications rate was 7% and 19% in the CBCT-guided and fluoroscopy-guided groups, respectively. CONCLUSIONS: CBCT produces images with sufficient quality to replace MDCT as a reasonable control measure after stent implantation, and its use during surgery reduces complications relating to airway stent placement.

To evaluate the efficacy and safety of brachytherapy with double-strand42 patients with obstructive jaundice because of extrahepatic cholangiocarcinoma were enrolled. 22 patients (group A) received a biliary stent with common drainage tube implantation, and 20 patients (group B) received a biliary stent with double-strandThere was no significant difference in the length, location and pathological stage of biliary stenosis between the two groups. There was no significant difference in TBIL, DBIL, IgA, IgG, IgM, alanine aminotransferase and WBC count between the two groups before or after PTCD (P 0.05). Three months after PTCD, tumors growth in group A and tumors shrinkage in group B. The difference in tumor size between the two groups before and after PTCD was statistically significant (P 0.05). The average stent patency times in groups A and B were 3.55 ± 0.76 months and 8.76 ± 1.85 months, respectively (P 0.05). The average survival times in groups A and B were 133.5 ± 27.8 days and 252.5 ± 114.5 days, respectively (P 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P 0.05).Double-strand

BACKGROUND Hilar cholangiocarcinoma (CC) is a common malignant tumor with high malignancy and poor prognosis. Most patients have lost the opportunity to undergo radical surgery when diagnosed. Although palliative drainage or biliary stent placement is a preferable choice, the tumor cannot be controlled. This study aimed to develop a novel brachytherapy drainage tube for low-dose-rate brachytherapy with an effective drainage, thereby prolonging the survival time of patients. CASE SUMMARY A 54-year-old male patient had undergone choledochal stent implantation due to obstructive jaundice. He was admitted to the hospital because of the recurrence of jaundice. Preoperative imaging and pathological biopsy revealed hilar CC (Bismuth-Corlette type IIIa). First, the patient underwent percutaneous transhepatic cholangial drainage and the symptoms of jaundice gradually relieved. To further treat hilar CC and remove the biliary drainage tube as far as possible, the patient chose to use the novel brachytherapy drainage tube after a multi-disciplinary consultation. After 1 mo of brachytherapy, the re-examination revealed that the obstructive lesions disappeared, and the drainage tube was finally removed. During the following 10 mo of follow-up, the patient's hilar CC did not recur. CONCLUSION The novel brachytherapy drainage tube may be a new choice for patients with unresectable hilar CC.

To evaluate effects of microwave ablation with a 2,450-MHz internally cooled-shaft antenna in animal experiments and in a clinical study. Microwave ablation was performed using a cooled-shaft antenna in eight in vivo (36 ablations) porcine livers. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Sixty patients (44 men, 16 women; mean age 53 years) with 96, 1–8 cm (mean 3.20 ± 0.17 cm) liver cancers were treated with the same microwave ablation technique. Complete ablation (CA), local tumor progression (LTP) rates and complications were determined. In vivo livers, short axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60-W group R 2 = 0.76, 80-W group R 2 = 0.87), with a relative plateau achieved within 10 min for power settings of 60 or 80 W. Within 10 min in the 60 and 80-W groups, respectively, 89 and 85.76% of maximum short axis diameter were achieved. CA rates in small (3.0 cm), intermediate (3.1–5.0 cm) and large (5.1–8.0 cm) liver cancers were 96.43% (54/56), 92.31% (24/26) and 78.57% (11/14), respectively. During a mean follow-up period of 17.17 ± 6.52 months, LTP occurred in five (5.21%) treated cancers. There was no significant difference in the CA and LTP rate between the HCC and liver metastasis patient subgroups (P > 0.05). The short axis diameter enlargement has a relative plateau within 10 min by fixing power output to 60 or 80 W, using the 2,450-MHz internally cooled-shaft antenna in vivo porcine livers. Effective local tumor control was achieved during one microwave ablation session.

The appropriate selection of an anti-cancer treatment after biliary stenting for bile duct cancer and the effects of new anti-cancer treatments are unclear. To determine the clinical efficacy of metallic biliary stents combined with different anticancer treatments in the management of bile duct cancer.We compared 49 patients with bile duct cancer who underwent biliary stenting plus anticancer treatment with 60 patients who underwent stenting alone (controls) in our hospital, between December 1998 and December 2012.In the combined-treatment group, 23 patients underwent three-dimensional radiation therapy, 21 underwent chemotherapy, and 5 underwent both three-dimensional radiation therapy and chemotherapy. The survival rate (chi2 = 41.563, P = 0.000) and duration of stent patency (chi2 = 50.268, P = 0.000) were significantly greater in the combined-treatment group than the control group. Adverse reactions were observed .The patients in the combined-treatment group developed nausea, vomiting and leukopenia, which were cured with symptomatic treatment. No biliary stent-related complications occurred in either group.Metallic biliary stent insertion combined with different anti-cancer treatments can increase survival and stent patency rates in bile duct cancer patients. This combination treatment was safe and effective.

Imaging-guided thermal ablation using different energy sources continues to gain favor as a minimally invasive technique for the treatment of primary and metastatic hepatic malignant tumors. This study aimed to evaluate the performance of microwave ablation with 2450-MHz internally cooled-shaft antenna in ex vivo and in vivo porcine livers.All studies were animal care and ethics committee approved. Microwave ablation was performed using a noncooled or cooled-shaft antenna in 23 ex vivo (92 ablations) and eight in vivo (36 ablations) porcine livers. Diameters of the coagulation zone were observed on gross specimens. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Curve estimation analysis was performed to characterize the relationship between applied power and treatment duration and coagulation diameter (including short-axis and long-axis diameter).Coagulation zones were elliptical and an arrowed-shaped carbonization zone around the shaft was observed in all groups. But the antenna track was also coagulated in the noncooled-shaft antenna groups. In ex vivo livers, the short-axis diameter correlated with the power output in a quadratic curve fashion (R(2) = 0.95) by fixing ablation duration to 10 minutes, and correlated with the ablation duration in a logarithmic curve fashion (R(2) = 0.98) by fixing power output to 80 W. The short-axis reached a relative plateau within 25 minutes. In in vivo livers, short-axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60 W group R(2) = 0.76, 80 W group R(2) = 0.87), with a relative plateau achieved within 10 minutes for power settings of 60 W and 80 W.The internally cooled microwave antenna may be advantageous to minimize collateral damage. The short-axis diameter enlargement has a plateau by fixing power output.

To investigate the clinical effect of transcatheter arterial chemoembolization (TACE) combined with high intensity focused ultrasound (HIFU) ablation in treatment of large hepatocellular carcinoma (HCC).Sixty-eight patients with unresectable HCC were randomized into 2 age, tumor size, TNM stages, and liver function grade-matched groups: TACE group (n=30) undergoing TACE and TACE+HIFU group (n=38) undergoing 2-3 weeks after TACE. A total of 88 tumors (9.3+/-3.2) (5.0-14.5) cm in diameter were detected, and the largest tumor in a specific patients with multiple lesions was selected for observation. Follow-up was conducted for (13+/-7) (3-24) months to observe the necrosis of tumor, size of tumor, local recurrence, and survival of patient.The clinical symptom remission rate was 90.6% (29/32) in the TACE+HIFU group and 70.8% (28/38) in the TACE group. The tumor necrosis and minification rates of the TACE+HIFU and TACE groups were 73.7% and 68.4% respectively, both significantly higher than those of TACE group (26.7% and 33.3% respectively, both P0.01). The tumor local recurrence rate of the TACE+HIFU group was 21.1%, not significantly different from that of the TACE group (33.3%, P0.05). The median survival duration of the TACE+HIFU group was 18 months, significantly longer than that of the TACE group (10 months, P0.05).Compared with the TACE therapy alone, the combination therapy improves the tumor necrosis rate and prolongs the patients' survival duration.

to evaluate the short- and medium-term clinical effects of 125I seed implantation on recurrent or metastatic head and neck cancers.Thirty patients with recurrent or metastatic head and neck cancers after operation, radiotherapy, or chemotherapy, totaling 421 lesions 4.2 (2-9) cm in diameter, 23 males and 12 females, aged 56 (39-71), underwent implantation of 12-70 125I seeds (on average 33 per person) under the guidance of CT, ultrasonography, or endoscopy with an interval of 1 cm between any 2 seeds with the radioactive activity per seed of 29.6 MBq and matched peripheral dose of 90-160 Gy. Follow-up was conducted for 13 (4-40) months to observe the local control rate, overall survival rate, pain relief, and clinical complications.Follow-up 4 months later showed that 24 of the 42 lesions obtained complete remission, 11 obtained partial remission, 5 no change, and 2 progress of disease, with a clinical response rate of 83.3% (CR+PR). The overall 1-, 2-, and 3-year survival rates were 88.4%, 72.4%, and 45.2% respectively with a median survival time of 31 months. The pain relief rate was 73.4% (17/23). The long-term complications included hyperpigmentation at operative sites (n=4), insensible feeling on lateral cheek (n=3), dryness of oral cavity (n=2), and headache combined with infection (n=1).Relieving the pain, improving the life quality, CT guided radioactive 125I seed implantation is a simple, safe, and effective method in treating recurrent or metastatic head and neck cancer with minimal damage and few complications.

To evaluate the safety and short- to mid-term efficacy of CT-guided (125)I brachytherapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma (HCC).Among the ten patients, one died of liver failure 15 months and one of renal failure 29 months after brachytherapy. All other eight patients survived till the end of the follow-up. Four of them presented good control of local tumor and no systemic recurrence; the other four survived with tumor presence, including three with recurrent tumors undergoing a second (125)I brachytherapy and one switching to a biological target drug treatment. The local control rates after 4, 6, 12 and 24 months are 90.3, 84.0, 75.6 and 72.7% respectively. Procedure-related complications were minimal.From November 2004-May 2008, ten patients with intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for HCC underwent (125)I brachytherapy under the guidance of computed tomography. They were followed up for 4-44 months after brachytherapy and the treatment's efficacy was evaluated.CT-guided (125)I brachytherapy is a safe and effective therapy on intra-hepatic recurrent tumors and/or extra-hepatic metastases after liver transplantation for hepatocellular carcinoma. It has the advantages of minimal invasion, significant short- to mid-term local control and minimal complications.

To investigate the Short- and medium-term clinical effects of clinical value of CT guided radioactive seed (125)I implantation in treating recurrent/metastatic malignant pelvic tumors.30 patients (10 males and 20 females, the age ranges from 31 to 85, median 55 years) with recurrent/metastatic malignant pelvic tumors after combined therapy such as surgery, chemotherapy and radiotherapy et al, were enrolled in this study. The total lesions were 32 and the max diameter of each lesion ranges from 3.0 cm to 12.2 cm, median 4.8 cm. Under CT guidance, the operations were performed under local anesthesia and (125)I seeds of 2.96 x 10(7) Bq were implanted into tumors at a distance of 0.5 cm according to TPS (Treatment Plan System), and the MPG (matched peripheral doses) was 100 - 160 Gy Observed the the local control rate, overall survival rate, pain reliefs and clinical complications after 2 - 40 months follow-up (median 28 months).After 2 - 40 months follow-up (median 28 months), 10/32 obtained CR, 13/32 obtained PR, 5/32 NC and 4/32 PD. The clinical effective rate was 87.5% (CR + PR + SD2 months). 1- and 2-year Local control rate were 83.3% and 62.5%, and overall 1- and 2- and 3- year survival rate were 87.7%, 73.1% and 45.7%, respectively, the median survival time was 28 months. The rate of pain relief was 21/23 (91.3%). Complications in the long term were Grade I - II radioactive rectum proctitis observed in 3 cases, Grade I radioactive cystitis observed in 1 case, insensible feeling in lower limb observed in 1 case for a long time. No other severe complications such as menorrhoea, acute pulmonary embolism, abscess, intestinal fistula, intestinal perforation, sinus tract were encountered in all patients.CT guided radioactive seed (125)I implantation procedure can be a simple, safe and effective method in treating recurrent/metastatic malignant pelvic tumors, which can ease the pain of patients and improve the qualities of patients' lives and obtain good clinical effects with minimal damage and few complications.

Background This study evaluated the clinical application of CT guided (125)iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods The ten patients (9 males and 1 female, aged from 36 to 72 years) with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery, transcatheter arterial chemoembolization, radiotherapy ablation, microwave ablation or percutaneous ethanol injection. The average diameter of each tumor thrombus was 21.5 mm x 30.5 mm. Seeds of 30 MBq (125)I were implanted 5 mm apart within the portal vein tumor thrombus. The follow-up after 4 months included enhanced spiral CT. Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy, 5 partial response and 1 stable disease. Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase, which were controlled by medical management. Severe complications such as haemorrhage, biliary fistula, hepatic abscess, pancreatic fistula and hepatic function failure were not observed. Implanted seeds migrated to lung and left hepatic lobe in 1 case. Conclusion CT guided implantation of 125 iodine seeds, can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.

To investigate the clinical value of CT guided radioactive 125I seed implantation (CTRISI) in the treatment of localized advanced pulmonary carcinoma.Thirty-two biopsy -confirmed localized advanced pulmonary carcinoma patients (Group A) with 48 lesions, 5.5 (4.5 -7.5) cm in diameter, clearly demarcated from the adjacent normal tissue, who failed to be improved in the first line chemotherapy, underwent CI-guided implantation of 125I seeds of 23.3 - 30.0 megabecquerel (MBq) into these lesions with the matched peripheral dose of 100-150 Gy. Thirty patients (Group B) treated by first line chemotherapy were randomly selected as the control group.CT follow-up two months later proved that the local control rate of Group A was 78.1%, significantly higher than that of Group B; the one year survival rate of Group A was 65.0%, significantly higher than that of Group B (48.0%); the median survival time of Group A was 15 months, significantly longer than that of Group B (11 months); no myelosuppression was found in Group, and the myelosuppression rate of Group B was 46.3%. In Group A small amount of effusion was observed, pneumothorax occurred in 4 cases with one of the lungs compressed by less than 30% that was improved after conservative treatment; one week after the procedure bloody sputum occurred in 15 cases.Improving the living quality obviously and with good short-term effects and few complications, CTGRISI procedure is safe and well-tolerated in treating localized advanced pulmonary carcinoma in Chinese patients.

What damages 125Iodine (125I) seed implantation will do to normal tissue is an observation topic in clinic. This study was to investigate the impact of 125I seed implantation to the femoral arteries of rabbits.A total of 30 healthy rabbits were divided into 3 groups. The femoral sheath in the hind leg at one side selected by random was opened and 10 125I seeds at 0.79-0.85 mCi were implanted near the femoral artery according to the treatment planning system (TPS) before operation. In control group, 10 seeds without radioactivity were implanted. After 2 weeks, 2 months and 4 months, the rabbits were killed, the vessel wall nearest to the seeds was taken out and its morphologic changes were observed by gross examination, light microscopy and electron microscopy.In gross observation, the vessel segments of the legs with 125I seed implantation had no apparent abnormality. Under light microscope, a few exfoliative endothelial cells were observed. Under electron microscope, exfoliation of endothelial cells, degeneration of endothelial cells and smooth muscle cells were observed. The ratios of degenerative vessel endothelial cells to all vessel endothelial cells were 60%-70% in 2-week group, 50% in 2-month group and 30% in 4-month group; the ratios of degenerative vessel smooth muscle cells to all vessel smooth muscle cells in the 3 groups were 50%, 30% and 10%.125I permanent implantation at 0.79-0.85 mCi mainly damages endothelial cells and smooth muscle cells of the normal vessels and this damnification is reversible.