Imidazofurin

We aimed to evaluate the effect of tumor absorbed doses (TAD) on treatment response in patients with hepatocellular cancer (HCC) treated with 90Y glass microspheres. We aimed to define a cutoff value for complete response (CR).

The voxel-based dosimetry for the treatment of 66 HCC lesions in 56 patients was analyzed retrospectively. Nineteen patients had BCLC A, 23 patients had BCLC B, and 14 patients had BCLC C disease. Treatments were grouped as selective (radiation segmentectomy and super-selective segmentectomy, n:49) and nonselective (palliative treatments for tumors occupying >2 segments, n:17). Treatment response was evaluated by mRECIST criteria, defined as CR, partial response (PR), stable lesion (SL), and progressive lesion (PL). TAD associated with CR was analyzed.

TAD was 525 ± 222 Gy in our cohort. Fifteen lesions had CR, 28 had PR, eight remained stable, and 15 lesions progressed. CR, PR, SL, and PL rates for selective vs. nonselective treatments were 31, 42, 12, and 14% vs. 0, 41, 11, and 47% for nonselective treatments, respectively (P:0.01). TAD was significantly associated with treatment response. Receiver operating characteristic analysis showed TAD > 475 Gy predicted CR with 100% sensitivity and 68% specificity (area under the curve = 0.83, P < 0.001). Overall survival declined as treatment response deteriorated. None of the patients had radiation-induced liver dysfunction on follow-up (6–21 months).

Higher TAD is crucial for CR. Segmentectomy with TAD > 475 Gy is associated with favorable response and better survival in HCC patients. Even for palliative treatments, as high as reasonably tolerated doses must be applied to achieve a favorable response.

For patients with node-positive breast cancer whose axilla is clinically downstaged after neoadjuvant chemotherapy (NAC), targeted axillary dissection (TAD) has been adopted at several institutions. This study compared axillary nodal recurrence between TAD and sentinel lymph node biopsy (SLNB) alone.

Consecutive patients with stage II or III biopsy-proven node-positive breast cancer treated with NAC from August 2018 to June 2022 were identified. Patients who became clinically node-negative after NAC and had tumor-free SLNB were evaluated. The patients were divided into two groups: the TAD and SLNB-alone groups.

Of the 377 patients treated with NAC, 143 (38 %) had stage II or III node-positive breast cancer, 105 (73 %) were converted to ycN0, and 44 (42 %) had tumor-free SLNB and avoided an axillary lymph node dissection (ALND). Of the 44 patients, 25 (57 %) had TAD, and 19 (43 %) had SLNB alone. The TAD and SLNB-alone groups were clinically similar. The median tumor size was 2.7 cm (range, 1.9–3.4 cm). The SLNB-alone approach was less likely to retrieve the biopsy-proven clipped node (clipped node retained: overall [n = 5/37], TAD [n = 1], SLNB alone [n = 4]; p = 0.03). Adjuvant radiotherapy (RT) was administered to 40 patients (91 %) and regional nodal RT to 32 patients (73 %). During a median follow-up period of 28 months, no axillary nodal recurrences were found in either group.

For the patients with stage II or III node-positive breast cancer who became cN0 after NAC, with tumor-free sentinel nodes, axillary nodal recurrence rates were low after both TAD and SLNB alone despite rates of higher non-retrieval of the clipped node in the SLNB-alone group. These findings suggest that either method affords excellent staging and regional control.