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  • ISSN: 2333-7095
    Early Online
    Volume 8, Issue 1
    Research Article
    Robson Ferrigno*, Maria Thereza Mansur Starling, Erlon Gil, Paulo Lazaro de Moraes, Pedro Henrique da Rocha Zanuncio, and Livia Alvarenga Fagundes Ferrigno
    Purpose: This retrospective series aims to report the Brazilian single institutional experience and predictive factors for outcomes in patients with early stage and medically inoperable NSCLC treated with SBRT.
    Materials/methods: Retrospective analysis of 82 consecutive patients with NSCLC stages IA – IIA (T1aN0M0 – T2bN0M0), by AJCC 8th edition criteria treated from May 2013 to March 2019 with SBRT. All patients were staged with PET/CT and considered medically inoperable. The median age was 77 years old and median tumor size was 2.2cm. Histological subtype was adenocarcinoma in 54 (65.8%), patients, squamous cell carcinoma (SCC), in 25 (30.5%), and 3 (3.7%), had no biopsy. Fifty and six (68.3%), patients were treated with 48Gy in 4 fractions (BED=105.6Gy10), and 26 (31.7%), with 40Gy in 4 fractions (BED=80Gy10) delivered twice a week. Local recurrence free survival (LRFS), disease free survival (DFS) and overall survival (OS), were estimated by Kaplan-Meier method. BED, histological subtype, age and tumor size were factors analyzed for outcomes. Statistical differences in survival curves were calculated by Long Rank test and the hazard ratios were determined by Cox regression model.
    Results: With a median follow up of 25 months, the 3-year LRFS, DFS and OS were 82.8%, 68.4%, and 57.9%, respectively. Patients treated with BED=10.6Gy10 had superior 3-year LRFS (89.9% vs 70.0%; p=0.049) and SCC histological subtype was a negative predictive factor for 3-year LRFS compared with adenocarcinoma (90.8% Vs 55.7%; p=0.023). Tumor size and age were not predictive factors for LRFS, DFS and OS. Patients with adenocarcinoma had better 3-year DFS than those with SCC (75.7% % Vs 40.9%; p=0.014). Any grade of pneumonitis occurred with a median of 11 months after the last fraction of SBRT. RTOG grades 1 and 2 pneumonitis occurred in 36 (43.9%), and 4 (4.9%), patients, respectively. Four (4.9%) patients developed thoracic pain with no rib fracture and one patient developed rib fracture.
    Conclusions: Results of this series are similar to the literature and confirm that BED larger than 100Gy10 is more effective for local control than lower level in the treatment of NSCLC with SBRT. Patients with SCC had lower LRFS and DFS compared with those with adenocarcinoma. The radiation dose of 48Gy in 4 fractions was effective and safe for patients with peripheral early stages tumors.
    Special Issue on Head and Neck Imaging
    Review Article
    Toru Chikui1*, Masahiro Ohga2, Erina Kitamoto1, Tomoko Shiraishi3, Shintaro Kawano4, Takashi Yoshiura5 and Kazunori Yoshiura1
    Abstract: Diffusion Weighted Image (DWI) has various roles such as tissue characterization, the prediction and monitoring of the response to treatment and differentiation of recurrent tumors from post-therapeutic changes. The malignant tumors have a lower ADC compared to benign lesions. Follow-up of early response to cancer treatment is reflected in an ADC increase in the primary tumor and nodal metastases; whereas nonresponding lesions tend to reveal only a slight increase or even a decrease in ADC during follow-up. However, there are many limitations regarding the performance of DWI in the head and neck region, therefore, many attempts has been performed to overcome the flaws of the diffusion-weighted single-shot-echo planar imaging.
    The pharmacokinetic analyses of dynamic contrast enhanced MRI (DCE-MRI) can provide physiological condition of the tissue, and Tofts and Kermode Model has been applied to the head and neck region. Some researchers have used it for the prediction and monitoring of the tumor response to cancer therapy. The general consensus is that the early changes of these parameters during the early phase after the treatment are useful for the interpretation of the response to the treatment. However, the parameters reported in the literature vary considerably; therefore, it is difficult to compare the values of the parameters among research groups.
    Both DWI and the pharmacokinetic analysis of the DCE-MRI have shown a wide range of potential benefits in this region, but more comparative studies with established scan techniques and the quantification of the data are required.
    Tanaka R* and Hayashi T
    Abstract: Dual Energy or dual source Computed Tomography (DECT) is advantageous for clinical CT interpretation. Compared to conventional imaging, this technique enables tissue differentiation of tissues, such as kidney stones, with higher precision and has additional features such as automatic bone-, bone marrow-, and plaque removal and virtual non-contrast image generation. Moreover, DECT can potentially remove beam hardening artifacts and generate images as good as those acquired using monoenergetic high energy. This review includes studies on DECT dentomaxillofacial imaging and discusses potential applications of DECT in dentomaxillofacial imaging, focusing on monoenergetic imaging.
    Ariji Y*, Nakayama M, Nishiyama W and Ariji E
    Abstract: Sonographic elastography is a new technique for measurement of the tissue stiffness, and is currently under investigation for tissue characterization in several anatomic sites. This article introduces methodologies of sonographic elastography, and mentions the possibility of its application to oral and maxillofacial regions.
    Sonographic elastography seems to be suboptimal for salivary gland malignancies, because there are many pathological types, and overlap between pleomorphic adenoma and malignant tumors. As to cervical lymph nodes, most studies have documented promising results of high accuracy for malignancy, although further larger studies are required to validate these findings. Therefore, sonographic elastography may become a useful ancillary technique in the routine diagnostic work-up for lymph nodes in the near future. For the masseter muscle, sonographic elastography has a possibility for exploring the causes of muscle pain, understanding the state of the muscle, selecting therapeutic methods, and evaluating therapeutic effect.s
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