PURPOSE To compare the survival outcomes of neoadjuvant three-dimensional conformal radiotherapy (RT) followed by hepatectomy with hepatectomy alone in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). PATIENTS AND METHODS A randomized, multicenter controlled study was conducted from January 2016 to December 2017 in patients with resectable HCC and PVTT. Patients were randomly assigned to receive neoadjuvant RT followed by hepatectomy (n = 82) or hepatectomy alone (n = 82). The modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines were used to evaluate the therapeutic effects of RT. The primary end point was overall survival. The expression of interleukin-6 (IL-6) in patients’ serum before RT and in surgical specimens was correlated with response to RT. RESULTS In the neoadjuvant RT group, 17 patients (20.7%) had partial remission. The overall survival rates for the neoadjuvant RT group at 6, 12, 18, and 24 months were 89.0%, 75.2%, 43.9%, and 27.4%, respectively, compared with 81.7%, 43.1%, 16.7%, and 9.4% in the surgery-alone group ( P < .001). The corresponding disease-free survival rates were 56.9%, 33.0%, 20.3%, and 13.3% versus 42.1%, 14.9%, 5.0%, and 3.3% ( P < .001). On multivariable Cox regression analyses, neoadjuvant RT significantly reduced HCC-related mortality and HCC recurrence rates compared with surgery alone (hazard ratios, 0.35 [95% CI, 0.23 to 0.54; P < .001] and 0.45 [95% CI, 0.31 to 0.64; P < .001]). Increased expressions of IL-6 in pre-RT serum and tumor tissues were significantly associated with resistance to RT. CONCLUSION For patients with resectable HCC and PVTT, neoadjuvant RT provided significantly better postoperative survival outcomes than surgery alone. IL-6 may predict response to RT in these patients.

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Based on the low-energy band structure of carbon nanotubes (CNs), we develop a generalized Fowler-Nordheim theory of the CN field emission, in which the behavior of the current-voltage (I-V) characteristics depends on the electric field and the diameter of the CNs. This formalism reveals the key differences of field emission between conventional bulk metallic emitters and low-dimensional emitters and gives a clear physical understanding of the non-Fowler-Nordheim feature of the I-V characteristics of the CN field emission.

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[1] Long-term averaged three-dimensional (3-D) databased magnetotail models have been created for many plasma and field parameters. A simple modeling technique that was used in earlier work is compared with a new more comprehensive procedure. Good agreement between the two methods was found when both produced stable results. The simpler method generated reliable models from any of the available data sets, while the more complex method did not. It is shown how analyses of the models can determine plasma and field parameters that are too small to be measured directly. The magnetic field data was used to calculate average electric currents flowing in the x and y directions. Full 3-D distributions of j x and j y were determined from the models even though these currents were too small to measure directly with adequate accuracy. Changes of the electron and ion pressure anisotropies as a function of distance along an average magnetic field line then were analyzed. It was concluded that the electron anisotropy was created by an electric field with a parallel component near the neutral sheet. The parallel electric field is small but is required to maintain charge neutrality in the region containing guiding center electron and nonguiding center ion orbits. In addition to creating anisotropic electron distributions the presence of this parallel electric field violates the ideal MHD assumptions near the neutral sheet. The ion anisotropy suggests that the net effect of chaotic ion motion near the neutral sheet is to create a weak source cone distribution superimposed on a denser isotropic component.