Shohei Komatsu

Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma

The objective of this study was to evaluate the clinical outcome of proton and carbon ion therapy for hepatocellular carcinoma (HCC).

Particle beam radiotherapy with a surgical spacer placement for advanced abdominal leiomyosarcoma results in a significant clinical benefit

Leiomysarcoma is a rare malignant tumor originating from smoothmuscle cells. Because of the limited number of cases, the naturalhistory and optimal treatment have not been clarified. In particular,prognosis of leiomyosarcoma originating from large vessels includingthe inferior vena cava (IVC) and aorta is extremely poor. Recent datasupport an aggressive surgical resection combined with adjuvantchemotherapy as the best treatment option for a leiomyosarcoma fromthe IVC [1,2]. However, the long-term outcome of curative resectionsfor leiomyosarcoma from large vessels has been disappointing. The5-year survival rates obtained with absolute curative resections wereobserved to range from 34.8% to 53.3% [1,2]. Hines et al. [2]suggested that radiation therapy after a surgical resection may prolongsurvival. It should be noted, however, that an absolute curativeresection was performed in all of their cases and the effectiveness ofchemotherapy and radiotherapy were assessed in the framework ofadjuvant therapy. There is no report about the treatment of anunresectable leiomyosarcoma and the overall survival rate.Particle beam radiotherapy is a new mode of radiotherapy that hasan inherent advantage over photon radiotherapy. Particle beams, suchas proton and carbon ion beams, show an increase in energy depositionwith penetration depth up to a sharp maximum at the end of their rangeto form the so-called Bragg peak. It thus permits delivery of higherdoses of radiation to the tumor, which may lead to profoundlyimproved tumor eradication. Recent results from major centers haveshown the therapeutic superiority of particle radiotherapy for variouskinds of malignant tumors [3,4]. However, the application of particlebeam radiotherapy for abdominal malignant tumors is restrictedbecause most of them come in contact with the intestine that cannottolerate the radical dose of particle beams. Several studies haveinvestigated the risk factors related to late gastrointestinal tractdisturbance after radiotherapy. Ishikawa et al. [5] assessed that thedosimetric parameter was a very important factor in the occurrence ofgastrointestinal bleeding after particle radiotherapy. Gastrointestinaldisturbances, such as ulcer formation and colitis, generally occurwithin several months after the completion of particle radiotherapy.However, the irradiated volume of a marginal tumor is normallylimited to make it lower than the maximum dose in order to prevent anytoxicity to the nearby gastrointestinal tract. To overcome thislimitation, we developed a novel two-step treatment with a surgicalspacer placement and subsequent proton beam radiotherapy andachieved a significant clinical benefit for three patients.

Recurrent hepatocellular carcinoma: a Western strategy that emphasizes the impact of pathologic profile of the first resection.

BACKGROUND Hepatocellular carcinoma (HCC) often recurs after curative resection, and thus the optimal treatment strategy to treat recurrences remains uncertain. We analyzed the results of different options to treat recurrent HCC and emphasized the impact of pathologic patterns of the tumor at initial resection. METHODS Between 2000 and 2014, 293 patients underwent potentially curative hepatic resection for HCC. Among them, 150 experienced a recurrence and have been treated by repeat resection (RR), radiofrequency ablation (RFA), salvage liver transplantation (SLT), transarterial chemoembolization (TACE), or conservative treatment, including systemic or targeted chemotherapy. Clinical outcomes were analyzed and compared between the treatment groups, focusing on clinical and pathologic characteristics of the tumor at initial resection. RESULTS After a median follow-up of 26 months, the overall survival (OS) at 1, 3, and 5 years after recurrence was 62%, 48%, and 40%, respectively. Survival rates were greater in patients treated by a curative approach (RR, RFA, SLT) than those treated by TACE, with 5-year OS of >70% and 37%, respectively. Univariate analysis showed satellitosis and microvascular invasion (MVI) at initial resection as negative prognostic factors of survival after recurrence (P < .05). On multivariate analysis, type of treatment was the only independent factor associated with survival. A subgroup analysis showed that RR/RFA led to better survival outcomes than TACE for early stage intrahepatic recurrences in the absence of satellitosis or MVI on the primary resected tumor. CONCLUSION Curative treatments of recurrent HCC improve patient survival. Satellitosis and MVI on the primary resected specimen may be used as selection criteria for the best treatment strategy for intrahepatic recurrences.

Role of percutaneous transhepatic gallbladder aspiration in the early management of acute cholecystitis

Early cholecystectomy is currently the gold standard treatment for acute cholecystitis (AC). However, the acceptability and safety of this strategy remain in dispute. The aim of this study was to clarify the role of percutaneous transhepatic gallbladder aspiration (PTGBA) in the early management of AC in a single center.

Risk factors for survival and local recurrence after particle radiotherapy for single small hepatocellular carcinoma

Particle radiotherapy is a novel treatment for malignant tumours. The present study aimed to evaluate risk factors for overall survival and local control after particle radiotherapy of single small hepatocellular carcinoma (HCC), and to identify suitable candidates for this treatment.

Two-stage treatment with hepatectomy and carbon-ion radiotherapy for multiple hepatic epithelioid hemangioendotheliomas.

Hepatic epithelioid hemangioendothelioma (HEH) is a rare neoplasm of vascular origin with variable malignant potential. Because most patients with this condition have multiple bilobar lesions, liver transplantation is the standard treatment, and hepatectomy is much less frequently indicated. We describe a case of a 35-year-old woman with unresectable multiple bilobar HEH successfully treated by combination treatment with hepatectomy and carbon-ion radiotherapy. This case is very meaningful since it demonstrated the effectiveness of carbon-ion radiotherapy for HEH and the possibility of expanding the curative treatment options for multiple bilobar hepatic tumors.

Morphometric analysis of conformational changes in hepatic venous system after right lobe living donor liver transplantation

Aim:  After living donor liver transplantation (LDLT), the graft liver regenerates to the standard liver volume. However, little is known about the influence of this phenomenon on the hepatic venous system.

Current role of percutaneous transhepatic gallbladder aspiration: from palliative to curative management for acute cholecystitis.

The present study assessed conservative management of acute cholecystitis (AC) with a focus on percutaneous transhepatic gallbladder aspiration (PTGBA).

Growth velocity of the portal vein tumor thrombus accelerated by its progression, alpha-fetoprotein level, and liver fibrosis stage in patients with hepatocellular carcinoma

Background Progression of portal vein tumor thrombus directly affects the prognosis and treatment for patients with hepatocellular carcinoma; there are no data on the growth velocity of portal vein tumor thrombus. We analyzed the growth velocity of portal vein tumor thrombus and its risk factors to propose the best timing of surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus. Methods We retrospectively collected data on 57 hepatocellular carcinoma patients with portal vein tumor thrombus who underwent computed tomography twice preoperatively and hepatectomy between 2005 and 2015. To calculate the growth velocity of portal vein tumor thrombus, migration lengths of portal vein tumor thrombus were divided by the number of days. To identify risk factors for rapid growth of portal vein tumor thrombus, patients were classified according to the velocity: rapid (≥ 1.0 mm/day, n = 23) and slow (< 1.0 mm/day, n = 34). Results Median survival times of patients with portal vein tumor thrombus that invaded the ipsilateral second portal branch, ipsilateral first portal branch, and portal trunk were 42.9, 11.7, and 12.3 months, respectively. The average growth velocity of portal vein tumor thrombus was 0.9 ± 1.0 mm/day. Median estimated times required from ipsilateral second portal branch to ipsilateral first portal branch and ipsilateral first portal branch to portal trunk were 8.2 and 11.5 days, respectively. Liver fibrosis, alpha‐fetoprotein, and extent of portal vein tumor thrombus were independent risk factors for rapid progression of portal vein tumor thrombus. Proteins induced by vitamin K absence or antagonist II, extent of portal vein tumor thrombus, and liver fibrosis, not rapid growth of portal vein tumor thrombus, were independent prognostic factors. Conclusion An understanding of the rapid progression of portal vein tumor thrombus and its risk factors can be helpful in deciding an appropriate timing of surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus.

Outcomes of Consistent Conservative Management for Acute Cholecystitis Followed by Delayed Cholecystectomy

Objective: This study’s objective was to assess outcomes of a totally conservative strategy for acute cholecystitis (AC) followed by delayed elective cholecystectomy. Patients and Methods: Consecutive patients who underwent cholecystectomy for AC were divided into the Emergent and Elective cholecystectomy groups. Patients in the elective cholecystectomy group were divided into early, medium, and late groups according to time from symptoms onset. Results: The success rate for conservative management reached 97.2%. Increased blood loss and a higher conversion rate were significantly associated with the emergent group. Patients in the late group had significantly lower operative time and tended to have lower blood loss and less frequent conversion to open surgery than those in the early and medium groups. Conclusions: Most AC cases could be managed conservatively, and elective cholecystectomy was performed safely regardless of the time. Elective cholecystectomy carried out in late phase was likely to be associated with decreased surgical difficulty.