Treatment Of Malignant Lesions Research Articles

Primary treatment of malignant retinal detachment caused by choroidal breast cancer metastasis using only systemic chemotherapy and anti-HER-2 therapy

Introduction: Choroidal metastasis is a disabling complication of several types of common cancer, including breast cancer. Metastases to the choroid may present insidiously but ultimately cause significant visual disturbance and more rarely may result in retinal detachment, causing sudden and profound visual impairment. The usual treatment of choice for choroidal metastases is palliative radiotherapy. External beam radiotherapy to the posterior orbit is often effective in stabilizing and improving the symptoms but it can usually be given only once and carries the risk of cataract induction as a side effect. Case Report: Here we report using only systemic therapy [chemotherapy and initial dual anti-human epidermal growth factor receptor-2 (HER-2) therapy] to treat a 69-year-old female presenting with newly diagnosed widespread secondary breast cancer, a major symptom of which was visual disturbance related to exudative retinal detachment caused by choroidal metastases. The systemic therapy treated the choroidal metastases effectively and allowed the retinal detachment to improve quickly, and the positive effect of the systemic anti-cancer therapy could be observed directly by serial ophthalmological examination over the first two months of the cancer treatment, allowing earlier detection of treatment response than would normally be seen on routine radiological scanning. Conclusion: We propose that in selected cases systemic therapy alone may be sufficient initial treatment for choroidal metastases from cancers that are expected to show a marked and relatively rapid response to systemic therapy, such as HER-2-positive breast cancer, allowing radiotherapy to be kept in reserve for further treatment of malignant lesions in the choroid in the future.

Ovary: MRI characterisation and O-RADS MRI.

Ultrasound has a high specificity for the diagnosis of a benign lesion in cases of classic appearing simple cyst, hemorrhagic cyst, endometrioma and dermoid. However, ultrasound can sometimes be limited for definitive characterisation and risk stratification of other types of lesions, including those with echogenic content that may appear solid, with or without blood flow. Frequently, MRI can be used to further characterise these types of lesions, due to its ability to distinguish solid tissue from non-tissue solid components such as fat, blood, or debris. Incorporating the MR imaging into the evaluation of adnexal lesions can improve diagnostic certainty and guide clinical management potentially avoiding inappropriate surgery for benign lesions and expediting appropriate treatment for malignant lesions, particularly in the females with sonographically indeterminate adnexal lesions.

Direct N-butyl-2-cyanoacrylate injections to the head and neck for percutaneous embolized devascularization.

Background: N-butyl-2-cyanoacrylate (NBCA) has been used for vascular malformations since the 1980s; however, few studies have looked at applications, procedural techniques, and outcome throughout many institutions. Herein, we review applications, procedural techniques, previous literature, and outcomes for the use of NBCA specifically through percutaneous technique in treating head and neck vascular pathology.Methods: An extensive literature review using PubMed database with published literature containing “N-butyl-2-cyanoacrylate embolization,” was performed. No date restrictions were used. Cross-checking of articles was conducted to exclude duplicate articles. The articles were screened for their full text and English language availability. We finalized those articles pertaining to the topic.Results: The search yielded 1124 related articles. When comparing surgical resection to embolization with NBCA for cerebral AVMs, complications were similar in both groups and included hemorrhage (15%), residual AVM (6%), and cerebrospinal fluid leak (3%). Their mortality rate was 3% in both groups. Preoperative percutaneous embolization does show improved surgical outcomes.Conclusion: NBCA is a fast-acting liquid embolic material used in the treatment of a variety of vascular malformations and lesions of the head and neck. Investigations surrounding the use of NBCA injections as a new alternative embolic agent began in the 1980’s. Administration of NBCA has been shown to be useful in minimizing intraoperative blood loss and controlling acute hemorrhage. Performing percutaneous embolization with NBCA provides a successful alternative for surgeons when transcatheter embolization techniques may prove to be too difficult to perform. Embolization using NBCA will continue to play in integral role in the treatment of malignant lesions and vascular malformations. Continued research is warranted to improve safety, outcomes, and further develop clinical applications of NBCA.

Population pharmacokinetic modeling and simulation of HPPH in Chinese patients with esophageal carcinoma

1. 2-[1-Hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH), a second-generation photosensitizer, has been widely employed in photodynamic therapy (PDT) for the treatment of malignant lesions. The objective of this study was to characterize the pharmacokinetics of HPPH in Chinese patients using a population pharmacokinetic (PopPK) approach.2. For the first time, a PopPK model of HPPH for Chinese (n = 20) was developed (registration number: CTR20160425). The pharmacokinetics of HPPH was described by a three-compartment model with linear elimination. Through the stepwise addition (p < 0.05) and backward elimination (p < 0.001) approach, fat-free mass (FFM) was identified to be the most significant covariate and V1 increased with FFM. Visual predictive check (VPC) was employed for the evaluation of the final model. Subsequent full covariate analysis indicated that FFM has considerable impact (∼30%) on HPPH exposure and fat mass also has a modest (∼25%) impact.3. The simulations suggested that a dose adjustment of HPPH may be necessary for Chinese and the dose of 3 mg/m2 should be appropriate. HPPH exposure increases with fat mass while being inversely related to FFM. HPPH-PDT for overweight patients should be monitored with more caution and PDT conditions should be optimized if necessary.

Relationship between solitary pulmonary nodule lung cancer and CT image features based on gradual clustering

Abstract Background The relationship between the medical characteristics of lung cancers and computer tomography (CT) images are explored so as to improve the early diagnosis rate of lung cancers. Methods This research collected CT images of patients with solitary pulmonary nodule lung cancer, and used gradual clustering methodology to classify them. Preliminary classifications were made, followed by continuous modification and iteration to determine the optimal condensation point, until iteration stability was achieved. Reasonable classification results were obtained. Results the clustering results fell into 3 categories. The first type of patients was mostly female, with ages between 50 and 65 years. CT images of solitary pulmonary nodule lung cancer for this group contain complete lobulation and burr, with pleural indentation; The second type of patients was mostly male with ages between 50 and 80 years. CT images of solitary pulmonary nodule lung cancer for this group contain complete lobulation and burr, but with no pleural indentation; The third type of patients was also mostly male with ages between 50 and 80 years. CT images for this group showed no abnormalities. Conclusions the application of gradual clustering methodology can scientifically classify CT image features of patients with lung cancer in the initial lesion stage. These findings provide the basis for early detection and treatment of malignant lesions in patients with lung cancer.

In Vitro Assessment of the Composition and Microhardness of the Hard Tissues of Oral Cavity Submitted To Gamma Irradiation

Introduction: Clinical radiotherapy is one of the most important techniques for the treatment of malignant lesions in head and neck; however, exposure to ionizing radiation may lead to both systemic and local complications, immediately and after this treatment, where the main issue is the xerostomia and its consequent oral mucositis. Regarding late complications produced by radiation, decay of radiation and osteoradionecrosis, both dosedependent lesions, showed a high level of incidence in recent decades and it would be difficult to manage, although patients referred after treatment’s completion and under the influence of local factors. Methodology: Then, This study evaluated the effect of ionizing radiation from gamma source onto samples of enamel, root dentin and jawbone samples undergone to the same absorbed dose / dose rate that those in patients with head and neck cancer. The non-irradiated and irradiated samples were analyzed by microhardness surface analysis; scanning electron microscopy (SEM) and Fourier transform infrared spectrometry (FTIR). Results and discussion: Microhardness data were analyzed statistically with a confidence level of 95% (p value &lt;0.05%), using parametric Student’s t-test for related averages and ANOVA statistical test, finding a statistically significant result (p = 0.00) to all four groups samples. Conclusion: It was observed a high deleterious and statistical significant effect of gamma radiation on hard tissues from oral cavity, regarding to physical, compositional and morphological properties.

ATR-FTIR Assessment of the Biochemical Composition and Micro Hardness of the Hard Tissues of Oral Cavity Submitted to Gamma Irradiation

Back ground: Clinical radiotherapy is one of the most important techniques for the treatment of malignant lesions in head and neck; however, exposure to ionizing radiation may lead to both systemic and local complications, immediately and after this treatment, where the main issue is the xerostomia and its consequent oral mucositis. Regarding late complications produced by radiation, decay of radiation and osteoradionecrosis, both dosedependent lesions, showed a high level of incidence in recent decades and it would be difficult to manage, although patients referred after treatment’s completion and under the influence of local factors. Methodology: Then, this study evaluated the effect of ionizing radiation from gamma source onto samples of enamel, root dentin and jawbone samples undergone to the same absorbed dose/dose rate that those in patients with head and neck cancer. The non-irradiated and irradiated samples were analyzed by microhardness surface analysis; scanning electron microscopy (SEM) and Fourier transform infrared spectrometry (ATR-FTIR). Results and Discussion: Microhardness data were analyzed statistically with a confidence level of 95% (p value <0.05%), using parametric Student’s t-test for related averages and ANOVA statistical test, finding a statistically significant result (p=0.00) to all four groups samples. Conclusion: It was observed a high deleterious and statistical significant effect of gamma radiation on hard tissues from oral cavity, regarding to physical, compositional and morphological properties.

99mTc-phytate as a diagnostic probe for assessing inflammatory reaction in malignant tumors.

Once administered intravenously, technetium-99m (99mTc)-labeled phytate binds to calcium in the serum and behaves as a nanoparticle. On the basis of the high permeability of the tumor vasculature, 99mTc-phytate is expected to leak and accumulate specifically in inflammatory cells. The aim of this study was to evaluate the potential of 99mTc-phytate in assessing the degree of inflammation in Ehrlich solid tumors in mice. 99mTc-phytate was prepared by adding pertechnetate to a solution containing phytic acid and stannous chloride. The blood half-life of this particle following intravenous injection was determined using blood samples from healthy animals, whereas its size was measured by photon correlation spectroscopy. Scintigraphic imaging and biodistribution studies were carried out in tumor-bearing mice at 30 min and 2 h after injection. The average size of the particles was in the range of 200 nm, suggesting that they are capable of passively passing through fenestrations in tumor vessels, which are 200-2000 nm in size. The blood half-life for 99mTc-phytate was found to be 2.1 min, a result that is in agreement with previous studies. Data from tumor-bearing mice showed high tumor uptake at 2 h after 99mTc-phytate administration. As a result, a high tumor-to-muscle ratio was achieved (T/M = 25.9 ± 7.54). These findings indicate that 99mTc-sodium phytate has promising properties for identifying the type of tumor. This approach will have significant implications for characterizing tumor biology and treatment of malignant lesions.

Robotic Pancreatectomy: What is the Current Evidence?

Laparoscopic pancreatectomy has evolved from resection of benign lesions to the treatment of malignant lesions without compromising patient safety and oncologic principles. Driven by the technical shortcomings of laparoscopic surgery, robotic pancreatectomy is the latest development in this evolution. Presently, there are limited but increasing amount of data comparing the outcomes of the various approaches for pancreatectomy: robotic versus laparoscopic and open pancreatectomy. Most studies to date are single large institutional retrospective case series or case-control studies reporting on the safety and feasibility of robotic pancreatectomies but most fail to address key issues like cost-benefit ratio and selection biases. Hence, presently, there is only low level evidence from retrospective studies supporting the use of robotic pancreatectomy. These studies have demonstrated that robotic pancreatectomy is safe and feasible with outcomes at least comparable to conventional laparoscopy and open surgery. There is some evidence suggesting that robotic surgery may decrease the learning curve and conversion rate in minimally invasive pancreatic surgery. Further research is needed to evaluate and compare the effectiveness of robotic pancreatectomy with conventional laparoscopy and open surgery.

Endoscopic resection: when is EMR/ESD sufficient?

Endoscopic treatment of malignant lesions in the gastrointestinal tract can be treated curatively if the risk for lymph node metastasis is lower than 1%. In the lower gi-tract (colon and rectum) the low risk criteria for this situation are well-defined (G1/G2, LO, invasion depth ≤1000μm). However, en-bloc R0-resection is also mandatory. Benign lesions such as lateral spreading tumors (granular-type) can be also treated with piecemeal EMR, however, recurrence rate is up to 30%. All other cases, regardless of size, such as non-granular type lesions or mixed type lesions should be treated with endoscopic submucosal dissection. The definitive histopathology of the resected specimen allows further decision (e.g., surgery if invasion depth of tumor is >1000μm).

First Multimodal Embolization Particles Visible on X-ray/Computed Tomography and Magnetic Resonance Imaging

Embolization therapy is gaining importance in the treatment of malignant lesions, and even more in benign lesions. Current embolization materials are not visible in imaging modalities. However, it is assumed that directly visible embolization material may provide several advantages over current embolization agents, ranging from particle shunt and reflux prevention to improved therapy control and follow-up assessment. X-ray- as well as magnetic resonance imaging (MRI)-visible embolization materials have been demonstrated in experiments. In this study, we present an embolization material with the property of being visible in more than one imaging modality, namely MRI and x-ray/computed tomography (CT). Characterization and testing of the substance in animal models was performed. To reduce the chance of adverse reactions and to facilitate clinical approval, materials have been applied that are similar to those that are approved and being used on a routine basis in diagnostic imaging. Therefore, x-ray-visible Iodine was combined with MRI-visible Iron (Fe3O4) in a macroparticle (diameter, 40-200 μm). Its core, consisting of a copolymerized monomer MAOETIB (2-methacryloyloxyethyl [2,3,5-triiodobenzoate]), was coated with ultra-small paramagnetic iron oxide nanoparticles (150 nm). After in vitro testing, including signal to noise measurements in CT and MRI (n = 5), its ability to embolize tissue was tested in an established tumor embolization model in rabbits (n = 6). Digital subtraction angiography (DSA) (Integris, Philips), CT (Definition, Siemens Healthcare Section, Forchheim, Germany), and MRI (3 Tesla Magnetom Tim Trio MRI, Siemens Healthcare Section, Forchheim, Germany) were performed before, during, and after embolization. Imaging signal changes that could be attributed to embolization particles were assessed by visual inspection and rated on an ordinal scale by 3 radiologists, from 1 to 3. Histologic analysis of organs was performed. Particles provided a sufficient image contrast on DSA, CT (signal to noise [SNR], 13 ± 2.5), and MRI (SNR, 35 ± 1) in in vitro scans. Successful embolization of renal tissue was confirmed by catheter angiography, revealing at least partial perfusion stop in all kidneys. Signal changes that were attributed to particles residing within the kidney were found in all cases in all the 3 imaging modalities. Localization distribution of particles corresponded well in all imaging modalities. Dynamic imaging during embolization provided real-time monitoring of the inflow of embolization particles within DSA, CT, and MRI. Histologic visualization of the residing particles as well as associated thrombosis in renal arteries could be performed. Visual assessment of the likelihood of embolization particle presence received full rating scores (153/153) after embolization. Multimodal-visible embolization particles have been developed, characterized, and tested in vivo in an animal model. Their implementation in clinical radiology may provide optimization of embolization procedures with regard to prevention of particle misplacement and direct intraprocedural visualization, at the same time improving follow-up examinations by utilizing the complementary characteristics of CT and MRI. Radiation dose savings can also be considered. All these advantages could contribute to future refinements and improvements in embolization therapy. Additionally, new approaches in embolization research may open up.

The Effects of Photodynamic Therapy in Upper-Gastrointestinal Malignant Diseases

Photodynamic therapy (PDT) is a promising new modality that utilizes the combination of a photosensitizing chemical and visible light for the management of various solid malignancies, including gastrointestinal (GI) cancer. PDT has some advantages over chemotherapy in terms of its greater safety and lower toxicity in the treatment of malignant lesions. However, PDT has not been used widely for treating upper GI cancer due to its relatively low cost-effectiveness and anatomical characteristics of the GI system. Nevertheless, PDT may be an effective alternative therapy for early upper-GI cancer patients who are at a high risk of curative surgical resection or systemic chemotherapy. In some clinical studies, PDT for various upper GI cancer showed positiveresults. To improve the efficacy of PDT for upper GI cancer, development of photosensitezer and light delivery system is needed.

Percutaneous Cement Augmentations of Malignant Lesions of the Sacrum and Pelvis: Fig 1.

Although cement augmentation has been described in the literature for the treatment of benign sacral insufficiency fractures, only a few case reports have described the procedure's usage in the treatment of malignant lesions. The purpose of this study was to evaluate the feasibility, effectiveness, safety, and clinical outcome for percutaneous cement augmentation of patients with malignant lesions in the sacrum and pelvis. A prospective study of 12 patients (7 men and 5 women) with a median age of 64.5 years was conducted under appropriate institutional review board protocol. Patients had different types of malignant metastatic lesions of the sacrum and pelvic bones. All but 1 patient underwent preprocedure CT and MR imaging. All patients had a postprocedure CT, and all but 1 had sacral lesions. Six patients had a second lesion in the iliac bones. Under CT guidance, percutaneous cement augmentation was performed in 8 cases and under fluoroscopy guidance in 2 cases. In 2 cases, needles were placed under CT guidance, and the injection was performed under fluoroscopy. In 5 patients, a single needle was used; in another 5 patients, 2 needles were used. One patient had 3 needles, and another patient required 4 needles. Adequate cement deposition was seen in all cases. Three patients had minimal clinically insignificant cement leakage. All treated patients (except 1 patient) reported decreased pain level with use of the visual analog scale (VAS) within 2 to 4 weeks of follow-up. No other subsequent surgical interventions were required. Percutaneous cement augmentation of metastatic lesions of the sacrum and pelvic bones is a feasible and safe technique that can be performed under CT or fluoroscopic guidance. The technique results in decreased pain relief on short-term follow-up that can allow patients to tolerate future treatment.

Progress in photodynamic therapy on tumors

Photodynamic therapy (PDT) is a promising treatment on neoplastic pathologic tissues, which involves the administration of a photosensitizing agent followed by the exposure of the tissue to visible nonthermal light. Light energy is captured and transferred to other molecules resulting in the formation of short-lived energetic species, which interact with biological systems and then produce tissue damage. Photosensitizer can be taken up selectively by tumor cells because of the upregulation of low-density lipoprotein receptor-mediated endocytosis and the acidic tumor environments. In recent years, the application of PDT in the treatment of malignant lesions has increased dramatically. The first health agency approval for PDT was granted for Photofrin in Canada in 1993, and, now, it is licensed in many countries for the treatment of cancers. Although Photofrin is the most commonly used photosensitizer, it has significant side effects. Therefore, major effort has been invested in the development of new sensitizers and, to this end, many photosensitizers have been described and some are now in clinical trials.

Gallengangsprobleme – durch technische Entwicklungen zu verändertem Patientenmanagement

Modern cross sectional imaging methods like CT and MRCP have replaced more invasive methods for the diagnosis of cholangiolithiasis as well as benign and malignant biliary strictures. Only if a histologic or cytologic confirmation of the diagnosis is necessary, is a direct access to the biliary tract either with ERC or PTC justified as a diagnostic procedure. Due to technical advancements in laparoscopic surgery intraoperative bile duct revision has become a standard procedure for patients with choledocholithiasis discovered during cholecystectomy. It has been shown to be equally effective to ERC. In this setting ERC therefore has lost its unique claim for the treatment of bile duct stones, while it remains the treatment of choice in patients with prior cholecystectomy. In contrast ERC, sometimes in combination with PTC, has become the mainstay in the treatment of biliary lesions like leakage and benign strictures. The same is true for the palliation of malignant biliary strictures. Surgery should be reserved for patients in whom minimal invasive methods fail and for the curative treatment of malignant lesions.

A Facile High-Yield Synthesis of [10 B]-8-Dihydroxyboryl Harmine, a Potential Agent for Boron Neutron Capture Therapy

Jose A. Sintas, Norberto J. Macareno and Arturo A. VitalePROPLAME-CONICET, Departamento de Quimica Organica, Facultad de Ciencias Exactas y Natu-rales, Universidad de Buenos Aires, Pabellon 2, Ciudad Universitaria, 1428 Buenos Aires, ArgentinaThe resurgence of interest in Boron Neutron Capture Therapy (BNCT) as a treatment for malignantlesions has resulted in the synthesis of numerous boron compounds as candidates for clinical use.BNCT is a selective radiotherapy using boron-10 which absorbs thermal neutrons and releases highLinear Energy Transfer (LET) alpha particles by

Does δ-aminolaevulinic acid induce genotoxic effects?

5-Aminolaevulinic acid (ALA) is a precursor of protoporphyrin IX (PpIX) in the biosynthetic pathway for haem. The presence of exogenous ALA bypasses the feedback control and may induce the accumulation of PpIX. Since haem-containing enzymes are essential for energy metabolism, every nucleated cell in the body must have at least a minimal capacity to synthesize PpIX. Photodynamic therapy (PDT), which is the treatment of malignant lesions with light following the administration of a tumour-localizing photosensitizers leads to oxidative damage, including the formation of genotoxic membrane degradation products via lipid peroxidation. In addition, it has been demonstrated that ALA itself can form the reactive oxygen species O 2, H 2O 2 and OH − by auto-oxidation, suggesting that it could potentially induce DNA damage. Therefore cultures of rat hepatocytes, which have been demonstrated to be very sensitive indicators for genotoxic effects induced by the lipid peroxidation product 4-hydroxynonenal and analogous aldehydes, were examined for possible mutagenic effects after treatment with ALA in the absence of light. The cytogenetic endpoints determined were chromosomal aberrations and the induction of micronuclei. Compared with the controls, significantly elevated levels of chromosomal aberrations and micronuclei were observed at concentrations of 1 μg ml 1 or greater. Chromosomal aberrations and micronuclei were found to increase up to a concentration of 100 μg ml 1 ALA. While micronuclei decrease at higher concentrations, chromosomal aberrations remain at the same level. The kinetics of PpIX formation after induction with 100 and 1000 μg ml −1 ALA appear to be the same for both concentrations, suggesting that the induction of chromosomal aberrations may be due to PpIX.

The Use Of Porphyrins And Non-Ionizing Radiation For Treatment Of Cancer

Photodynamic therapy (PDT) is the treatment of malignant lesions with visible light following systemic or local administration of a photosensitizer or its precursor. Initially, hematoporphyrin derivative and a purified component called Photofrin II was used for clinical PDT. Later on interest has focused on new sensitizers with more favourable absorption as regards light transmission in tissues. Twenty years of clinical experience has revealed that PDT is best applied to early stage cancers. The present review discusses the basic components of PDT and its clinical use in treatment of cancer.

Cisplatin-loaded poly (methyl methacrylate) implants: a sustained drug delivery system

We investigated the possible use of a local chemotherapy in the treatment of malignant lesions in bone. Therefore, the diffusion of cisplatin from polymethyl methacrylate implants was studied in vitro and in vivo in rabbits. Cisplatin-loaded implants were prepared by extemporaneous polymerization of methyl methacrylate added to a poly (methyl methacrylate)/drug blending. The in vitro release rate of cisplatin was very slow and incomplete, but increased when the drug loading was higher, suggesting a percolation release model. In vivo, drug-loaded implants showed sustained release characteristics and no plasma peak, compared to control intravenous cisplatin administration. After implantation, local concentrations of platinum were higher in bone marrow than in bone tissue. Comparative safety studies with cisplatin infusion showed a slight, but not clinically significant, renal and haematologic toxicity for drug-loaded implants.

A radiosurgical approach to fractionated treatment of malignant lesions of the central nervous system

A radiosurgical approach to fractionated treatment of malignant lesions of the central nervous system