scholarly journals Yttrium-90 radioembolization as a possible new treatment for brain cancer: proof of concept and safety analysis in a canine model

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Alexander S. Pasciak ◽  
Sasicha Manupipatpong ◽  
Ferdinand K. Hui ◽  
Larry Gainsburg ◽  
Rebecca Krimins ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Brain Cancer ◽  
Canine Model ◽  
Post Treatment ◽  
Cortical Atrophy ◽  
Proof Of Concept ◽  
Invasive Treatment ◽  
Treatment Research ◽  
Post Therapy ◽  
Yttrium 90

Abstract Purpose To evaluate the safety, feasibility, and preliminary efficacy of yttrium-90 (90Y) radioembolization (RE) as a minimally invasive treatment in a canine model with presumed spontaneous brain cancers. Materials Three healthy research dogs (R1–R3) and five patient dogs with spontaneous intra-axial brain masses (P1–P5) underwent cerebral artery RE with 90Y glass microspheres (TheraSphere). 90Y-RE was performed on research dogs from the unilateral internal carotid artery (ICA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) while animals with brain masses were treated from the ICA. Post-treatment 90Y PET/CT was performed along with serial neurological exams by a veterinary neurologist. One month after treatment, research dogs were euthanized and the brains were extracted and sent for microdosimetric and histopathologic analyses. Patient dogs received post-treatment MRI at 1-, 3-, and 6-month intervals with long-term veterinary follow-up. Results The average absorbed dose to treated tissue in R1–R3 was 14.0, 30.9, and 73.2 Gy, respectively, with maximum doses exceeding 1000 Gy. One month after treatment, research dog pathologic analysis revealed no evidence of cortical atrophy and rare foci consistent with chronic infarcts, e.g., < 2-mm diameter. Absorbed doses to masses in P1–P5 were 45.5, 57.6, 58.1, 45.4, and 64.1 Gy while the dose to uninvolved brain tissue was 15.4, 27.6, 19.2, 16.7, and 33.3 G, respectively. Among both research and patient animals, 6 developed acute neurologic deficits following treatment. However, in all surviving dogs, the deficits were transient resolving between 7 and 33 days post-therapy. At 1 month post-therapy, patient animals showed a 24–94% reduction in mass volume with partial response in P1, P3, and P4 at 6 months post-treatment. While P2 initially showed a response, by 5 months, the mass had advanced beyond pre-treatment size, and the dog was euthanized. Conclusion This proof of concept demonstrates the technical feasibility and safety of 90Y-RE in dogs, while preliminary, initial data on the efficacy of 90Y-RE as a potential treatment for brain cancer is encouraging.

scholarly journals Correction to: Yttrium-90 radioembolization as a possible new treatment for brain cancer: proof of concept and safety analysis in a canine model

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Alexander S. Pasciak ◽  
Sasicha Manupipatpong ◽  
Ferdinand K. Hui ◽  
Larry Gainsburg ◽  
Rebecca Krimins ◽  
...  
Keyword(s):  
Brain Cancer ◽  
Safety Analysis ◽  
Canine Model ◽  
Proof Of Concept ◽  
New Treatment ◽  
Yttrium 90

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Added value of diffusion weighted mri to conventional mri in the assessment of uterine cervix cancer post therapy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Nasr ◽  
O A Kamal ◽  
O F Kamel ◽  
S A N Hashim
Keyword(s):  
Cervical Cancer ◽  
Diffusion Weighted Imaging ◽  
Tumor Resection ◽  
Post Treatment ◽  
Added Value ◽  
Diffusion Weighted Mri ◽  
Conventional Mri ◽  
Diffusion Weighted ◽  
Adc Mapping ◽  
Post Therapy

Abstract Purpose of this study is: Assessing the role of Diffusion weighted imaging with ADC mapping in the evaluation of uterine cervical cancer post therapy regarding tumor residual, recurrence or post treatment benign changes/ complications after tumor resection and/or chemotherapy/radiotherapy. Methods The study included 48 female underwent cervical cancer treatment, referred to Radio diagnosis Department of National Cancer Institute for post therapy assessment. Each patient included in the study was subjected to full history taking, reviewing medical sheet and MR examination including: Conventional MR examination and Diffusion Weighted imaging. Results The study showed that the use of quantitative DW imaging with ADC mapping provide added value in the detection of post-treatment malignant masses and differentiating it from post-treatment benign changes. Conclusion The current application of diffusion Weighted MRI as a routine with conventional MRI sequences increased the accuracy of detection of post therapy benign and malignant masses , Our results suggested also that the use of ADC can be helpful in differentiating post-treatment malignant masses from benign post-treatment changes.

Multimodal MRI for MRgFUS in essential tremor: post-treatment radiological markers of clinical outcome

2020 ◽  
Vol 91 (9) ◽  
pp. 921-927
Author(s):  
Anish N Kapadia ◽  
Gavin J B Elias ◽  
Alexandre Boutet ◽  
Jürgen Germann ◽  
Aditiya Pancholi ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Focused Ultrasound ◽  
Lesion Size ◽  
Post Treatment ◽  
Medial Lemniscus ◽  
Invasive Treatment ◽  
Tremor Suppression ◽  
Registration Number

BackgroundMRI-guided focused ultrasound (MRgFUS) thalamotomy is a promising non-invasive treatment option for medication-resistant essential tremor. However, it has been associated with variable efficacy and a relatively high incidence of adverse effects.ObjectivesTo assess the evolution of radiological findings after MRgFUS thalamotomy and to evaluate their significance for clinical outcomes.MethodsNinety-four patients who underwent MRgFUS between 2012 and 2017 were retrospectively evaluated. Lesion characteristics were assessed on routine MRI sequences, as well as with tractography. Relationships between imaging appearance, extent of white matter tract lesioning (59/94, on a 4-point scale) and clinical outcome were investigated. Recurrence was defined as >33% loss of tremor suppression at 3 months relative to day 7.ResultsAcute lesions demonstrated blood products, surrounding oedema and peripheral diffusion restriction. The extent of dentatorubrothalamic tract (DRTT) lesioning was significantly associated with clinical improvement at 1 year (t=4.32, p=0.001). Lesion size decreased over time (180.8±91.5 mm3 at day 1 vs 19.5±19.3 mm3 at 1-year post-treatment). Higher post-treatment oedema (t=3.59, p<0.001) was associated with larger lesions at 3 months. Patients with larger lesions at day 1 demonstrated reduced rates of tremor recurrence (t=2.67, p=0.019); however, lesions over 170 mm3 trended towards greater incidence of adverse effects (sensitivity=0.60, specificity=0.63). Lesion encroachment on the medial lemniscus (Sn=1.00, Sp=0.32) and pyramidal tract (Sn=1.00, Sp=0.12) were also associated with increased adverse effects incidence.ConclusionLesion size at day 1 predicts symptom recurrence, with fewer recurrences seen with larger lesions. Greater DRTT lesioning is associated with treatment efficacy. These findings may have implications for lesion targeting and extent.Trial registration numberNCT02252380.

scholarly journals Heptanoate is neuroprotective in vitro but triheptanoin post-treatment did not protect against middle cerebral artery occlusion in rats

2018 ◽  
Vol 683 ◽  
pp. 207-214 ◽  
Author(s):  
Kah Ni Tan ◽  
Rebecca Hood ◽  
Kirby Warren ◽  
Debbie Pepperall ◽  
Catalina Carrasco-Pozo ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Post Treatment ◽  
Cerebral Artery Occlusion

Assessment of Suitability of Thrombolysis in Middle Cerebral Artery Infarction: A Proof of Concept Study of a Stereologically-Based Technique

2007 ◽  
Vol 24 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Thanh G. Phan ◽  
Geoffrey A. Donnan ◽  
Masatoshi Koga ◽  
L. Anne Mitchell ◽  
Maurice Molan ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Proof Of Concept ◽  
Middle Cerebral Artery Infarction ◽  
Concept Study

scholarly journals Reduction of Vertebral Bone Density in Patients with Hodgkin Lymphoma Above 30 Years of Age Correlates with the Cumulative Dose of Steroids They Receive As Part of Treatment Protocol

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4042-4042
Author(s):  
Nadav Ofshenko ◽  
Eyal Bercovich ◽  
Tania Mashiach ◽  
Michal Weiler-Sagie ◽  
Daniela Militianu ◽  
...  
Keyword(s):  
Bone Density ◽  
Hodgkin Lymphoma ◽  
Treatment Protocol ◽  
Significant Risk ◽  
Post Treatment ◽  
The Body ◽  
Newly Diagnosed ◽  
Mineral Density ◽  
The Mean ◽  
Post Therapy

Introduction: In the last decades, Hodgkin lymphoma (HL) has become a curable disease with a long-term disease-free survival achieved in about 80% of patients. The two main chemotherapy protocols presently used in HL treatment are: ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (EB) (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone). Patients treated with ABVD also receive glucocorticoids to minimize regimen toxicity and as antiemetic prophylaxis. Similarly, prednisolone given for 14 days is an integral part of the EB regimen. However, glucocorticoids are known to interfere with bone formation and remodeling, which results in increased fracture risk. To reduce the rate of complications, such as aseptic necrosis of the femur head, according to the H2 Israeli protocol, patients treated with EB receive prednisone for seven days only. The current study was designed to evaluate the vertebral density (VD) changes associated with HL therapy. Methods: In this retrospective study, data on all newly-diagnosed HL patients treated at the Rambam Health Care Campus between 2008-2016 were retrieved from the institutional computerized database. Patients were grouped based on their treatment protocol and further sub-grouped according to the number of treatment cycles: I ‒ ABVDx2-4, II ‒ ABVDx6, III ‒ EBx2+ABVDx4, IV ‒ EBx4-6+ABVDx2. VD findings of PET/CT scans performed at baseline and post-treatment were compared at L3 vertebral level. The Hounsfield unit (HU) scale was used to evaluate bone mineral density (BMD). The dose of hydrocortisone equivalents (HE) per meter square of the body surface area was calculated for each patient. Results: All the identified newly-diagnosed HL patients (n=213) were included in the analysis. Their median age was 29 (18-59) years. Both baseline and post-treatment scan results were available for all patients. Mean VD at baseline was 198 HU (30.5-320) and post-treatment ‒ 165.5 HU (27.5-277.3). At baseline, 7 patients had osteopenia (<120 HU) and 1 patient had osteoporosis (<90 HU). The corresponding post-treatment numbers were 21 and 9 patients, respectively. Data on mean VD at baseline and post-therapy categorized according to the treatment received are presented in Table 1. The mean VD change from the baseline level was 14.7% in the ABVD group as a whole, 9.3% HU in the ABVDx2-4 subgroup and 17.3% in the ABVDx6 subgroup. The mean VD change from the pre- to post-therapy level was 20.5% for the whole EB group, 24.3% for the EBx2 + ABVDx4 subgroup and 15.4% for the EBx4-6 + ABVDx2 subgroup. The relative VD decreased post-treatment in all the subgroups. Using the ABVDx2-4 group as reference (HR=1), the HR for ABVDx6 group was 6.51 (95% CI 2.8-15.3; P=0.000), with HR=16.11 (95% CI 5.6-46.8; P=0.000) for EBx2 + ABVDx4 group and HR=2.78 (95% CI 0.9-8.2; P=0.065) for EBx4-6 + ABVDx2 group. There was a significant decrease in VD of 116 patients with HE >3.4gm/m2 compared to 24 patients with HE ≤2.1 gm/m2 (HR=6; 95% CI 2.1-17.2; P=0.001). The present study demonstrated a bone density loss of ≥16% in 48% of patients and of ≥26% in 20% of patients. Osteopenia and osteoporosis developed in 7% and 4% of treated patients. Individuals receiving EBx6 had a less significant bone loss compared to those receiving EBx2 +ABVDx4. This could be explained in part by the older age (19% were above 46 years) of the latter patients. A similar VD loss of ≥16% was observed in patients treated with ABVDx6 and those receiving EB containing regimen (one week of steroids only) (56.6 and 59%, respectively). A multivariate analysis for prediction of VD loss showed that age ≥30 (HR=2.19; 95% CI 1.13-4.24; P=0.02) and chemotherapy protocols other than ABVDx2-4 (ABVDx6: HR=6.65; 95% CI 2.80-15.78; P=0.000; BEACOPPx2-6: HR=7.87; 95% CI 3.14-19.71; P=0.000) were significant risk factors (Fig. 1). Conclusions: The current study demonstrates that VD reduction is a significant problem in HL patients above the age of 30 years, treated with 6 cycles of chemotherapy containing HE >3.4gm/m2. As it may lead to osteopenia, a restrictive approach to the use of glucocorticoids should be applied in this patient population. These findings suggest that bone density should be followed in this group of HL survivors. Disclosures No relevant conflicts of interest to declare.

scholarly journals Transcranial ultrasound pulse stimulation reduces cortical atrophy in Alzheimer's patients: a follow-up study

2020 ◽  
Author(s):  
Tudor Popescu ◽  
Cyril R Pernet ◽  
Roland Beisteiner
Keyword(s):  
Cortical Thickness ◽  
Brain Morphology ◽  
Cortical Atrophy ◽  
Transcranial Ultrasound ◽  
Therapeutic Concept ◽  
The Brain ◽  
Post Therapy ◽  
Ultrasound Pulse ◽  
Pulse Stimulation

INTRODUCTION: Ultrasound for the brain is a revolutionary therapeutic concept. The first clinical data indicate that 2-4 weeks of therapy with Transcranial Pulse Stimulation improve functional networks and cognitive performance of Alzheimer’s disease (AD) patients for up to 3 months. No data currently exist on possible benefits concerning brain morphology, concerning namely the cortical atrophy characteristic of AD. METHODS: We performed a pre-/post-therapy analysis of cortical thickness in a group of N=17 Alzheimer’s patients. RESULTS: We found a significant correlation between neuropsychological improvement and cortical thickness increase in AD-critical brain areas. DISCUSSION: AD patients who benefit from TPS appear to reduce cortical atrophy within the default mode network in particular.

scholarly journals Radiofrequency ablation for hepatocellular carcinoma - analysis of the clinical outcome

2017 ◽  
Vol 145 (9-10) ◽  
pp. 475-480
Author(s):  
Dragan Masulovic ◽  
Danijel Galun ◽  
Ruza Stevic ◽  
Aleksandar Filipovic ◽  
Aleksandar Bogdanovic ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Clinical Outcome ◽  
Liver Tumors ◽  
Early Stage ◽  
Post Treatment ◽  
Liver Imaging ◽  
Invasive Treatment ◽  
Liver Transaminase ◽  
Liver Specific Contrast Agent

Introduction/Objective. Radiofrequency ablation (RFA) is a minimally invasive treatment modality for primary and metastatic liver tumors. It can be performed percutaneously or as a laparoscopic or open surgical procedure under ultrasound or computerized tomography guidance. The objective of the study was to evaluate the clinical outcome of the initial 16 patients with hepatocellular carcinoma (HCC) managed by percutaneous RFA at a tertiary institution and to assess the efficacy of this procedure in the management of selected patients with HCC. Method. From June 2011 until December 2013, 16 patients with early-stage HCC were managed by percutaneous radiofrequency ablation at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. All the patients were treated by the same team composed of an interventional radiologist and a liver surgeon. We analyzed the clinical outcome and the biologic effect of this treatment by comparing the pre- and post-treatment levels of alpha-fetoprotein (AFP). Results. Post-treatment values of liver transaminase levels returned to the pre-treatment values from Day 3. Post-treatment hospital stay was two days. Post-procedural complications included mild pain in all patients, skin necrosis at the site of the electrode puncture in five patients, and transient hepatic decompensation in one patient. In all the patients the AFP level correlated with the findings of liver imaging (ultrasound and/or magnetic resonance imaging with liver-specific contrast agent) indicating viability of the treated tumor. Conclusion. RFA is a feasible and effective procedure providing favorable clinical outcome in patients with early-stage HCC.

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