Toshihiko Inoue

Phase III trial of high- vs. low-dose-rate interstitial radiotherapy for early mobile tongue cancer.

PURPOSEnOral tongue carcinomas are highly curable with radiotherapy. In the past, patients with tongue carcinoma have usually been treated with low dose rate (LDR) interstitial radiation. This Phase III study was designed to compare the treatment results obtained with LDR with those obtained with high dose rate (HDR) interstitial radiotherapy for tongue carcinoma.nnnMETHODS AND MATERIALSnThe criteria for patient selection for the Phase III study were: (a) presence of a T1T2N0 tumor that could be treated with single-plane implantation, (b) localization of tumor at the lateral tongue border, (c) tumor thickness of 10 mm or less, (d) performance status between O and 3, and (e) absence of any severe concurrent disease. From April 1992 through December 1993, 15 patients in the LDR group (70 Gy/4 to 9 days) and 14 patients in the HDR group (60 Gy/10 fractions/6 days) were accrued. The time interval between two fractions of the HDR brachytherapy was more than 6 h.nnnRESULTSnLocal recurrence occurred in two patients treated with LDR brachytherapy but in none of the patients treated with HDR. One- and 2-year local control rates for patients in the LDR group were both 86%, compared with 100% in the HDR group (p = 0.157). There were four patients with nodal metastasis in the LDR group and three in the HDR group. Local recurrence occurred in two of the four patients with nodal metastases in the LDR group. One- and 2-year nodal control rates for patients in the LDR group are were 85%, compared with 79% in the HDR group.nnnCONCLUSIONnHDR fractionated interstitial brachytherapy can be an alternative to traditional LDR brachytherapy for early tongue cancer and eliminate the radiation exposure for medical staffs.

Regional distribution of the cells expressing glycine receptor β subunit mRNA in the rat brain

The expression of mRNA of the beta subunit of the glycine receptor was investigated in the rat by in situ hybridization histochemistry using an oligonucleotide probe specific to the sequence of the beta subunit. Neurons expressing beta subunit mRNA were widely and abundantly distributed in the rat brain from the olfactory bulb to the spinal cord. The pattern of distribution of cells containing beta subunit mRNA in the lower brainstem was very similar to that of cells containing alpha 1 subunit mRNA. In addition, beta subunit mRNA was strongly expressed by the neurons of the cerebral cortex, hippocampal formation and diencephalon as well as by the Purkinje cells where alpha 1 subunit mRNA expression is rare. These findings indicated that the glycine receptor is heterogeneous. The sites where strong labeling was noted were as follows. In the forebrain and diencephalon, strongly labeled neurons were abundant in the olfactory region, hippocampal formation, cerebral cortex, and thalamus. In the hippocampal formation, neurons in the subiculum, pyramidal cells in Ammons horn, and neurons in the polymorphic layer of the dentate gyrus were strongly labeled. In the thalamus, the anterodorsal, reticular, parafascicular, and the subthalamic nuclei were strongly labeled. In the brainstem, the red nucleus, almost all of the motor neurons in the cranial motor nuclei innervating striated muscles, the trigeminal mesencephalic nucleus, the ventral tegmental nucleus of Gudden, and the pontine nucleus were strongly labeled. In the cerebellum, Purkinje cells in the Purkinje cell layer and all of the cerebellar nuclei were strongly labeled.

Primary Thyroid Lymphoma: Evaluation with Us, Ct, and Mri

Objective Our goal was to determine the most effective radiologic workup in diagnosing and staging primary thyroid lymphomas and the value of knowing the extent of tumors for prognostic purposes. Materials and Methods Magnetic resonance imaging, CT, US, and fine-needle aspiration (FNA) biopsy (palpation- or US-guided) findings were retrospectively reviewed in 14 patients with primary thyroid lymphomas (5 palpable, 9 nonpalpable). Survival was correlated with the presence or absence of extrathyroidal spread of lymphoma. Results Thyroid lymphomas were detected in all patients with US and 12 (86%) each with CT and MRI. Histopathologic diagnosis was obtained with FNA in 11 patients (79%) and with surgical procedures in 3. Magnetic resonance imaging correctly diagnosed tumor involvement of the lymph nodes (four of four patients), muscle (five of five), esophagus (one of one), internal jugular vein (one of one), and carotid artery (one of one). Muscle invasion was missed with CT in one patient. Ultrasound was not accurate for diagnosing tumor invasion of the esophagus, carotid artery, and lymph nodes. The survival of patients without extrathyroidal spread was significantly (p < 0.05) better than that of patients (n = 5) with extrathyroidal spread. Conclusion Palpable thyroid masses should undergo palpation-guided FNA for diagnosis and nonpalpable masses US-guided FNA. Tumor extent and staging should be determined with MRI, which will contribute to initiating appropriate therapy and prediction of prognosis. Index Terms Thyroid, neoplasms—Lymphoma—Magnetic resonance imaging—Ultrasound—Computed tomography.

Sonographic Staging of Cancer of the Mobile Tongue

In order to determine the value of sonography (US), in staging cancer of the mobile tongue, 57 patients were studied prospectively. Real-time sector scanners (5 and 7.5 MHz) were used with a submental approach. The findings by US were compared with those obtained by inspection and palpation and in 13 operated patients with the surgical results. US failed to visualize the tumor in 3 of the 57 patients (5%); in 30 patients (53%), the tumor was considered to be of nearly the same size by US and by palpation, but in 17 cases (30%), to be larger by US than by palpation, and in the remaining 7 cases (12%), to be smaller by US. Extension across the midline (8/8), and depth of tumor penetration, or extension to adjacent structures (5/5) were more correctly evaluated by US. We conclude that US is useful for staging work-up of tumors of the mobile tongue.

Head and neck carcinoma: Detection of extraorgan spread with MR imaging and CT

A retrospective analysis of the Magnetic resonance (MR) and CT findings in 18 untreated carcinomas of the oral cavity (7), oropharynx (2), hypopharynx (7), and larynx (2) was performed to assess the accuracy in evaluating extraorgan tumor spread and nodal involvement. Surgical and pathologic correlation was available for 13 primary tumors and nodal status was analyzed in 18. Nine primary tumors had extraorgan extension. MR had a tendency to be superior to CT in predicting tumor invasion of the cartilage and muscle. Sensitivity, specificity and accuracy for extraorgan spread of primary tumors were 89%, 100% and 92%, respectively, for MR and 78%, 75% and 77% for CT. Accuracy for nodal classification (83%) and carotid invasion (94%) of MR was equal to that of CT. CT was more sensitive than MR for demonstrating necrosis within the nodes and vice versa for detecting retropharyngeal nodes. MR imaging is a useful radiologic modality in evaluating extraorgan tumor spread and nodal levels of the head and neck carcinomas.

Focal Residual Contrast Media in the Kidney 24 Hours after Angiography

Purpose: To examine the relationship between focal renal cortical retention (FRCR) and contrast-associated nephropathy (CAN). Material and Methods: We investigated the incidence of both phenomena in 105 patients. CAN was defined as an increase in the creatinine level >0.3 mg/dl and >20% on days 1, 3, or 7. We compared predisposing factors for FRCR and CAN. Serum creatinine and blood urea nitrogen (BUN) for renal function were determined on the morning of the day of the angiography. The BUN/creatinine ratio was used as an indicator of the degree of hydration. Results: FRCR was demonstrated in 17 patients (16%) by delayed CT 24 h after angiography, and CAN was found in 16 patients (15%). No significant relationship between CAN and FRCR was found. We found a correlation between high total volumes of contrast and FRCR. Advanced age, high blood urea nitrogen, high creatinine, and dehydration were risk factors for CAN. Conclusion: Delayed CT showed a higher incidence of injury to the renal parenchyma than previously detected by conventional radiography.