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Abstract. The decision to repeat transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is based on correct evaluation of response to therapy. The purpose of this study was to investigate whether apparent diffusion coefficient (ADC), a quantitative parameter of diffusionweighted imaging (DWI), can predict early HCC recurrence after TACE. Results obtained using this method were compared with those using iodized-oil computed tomography (CT). DWI was performed on 25 patients with 36 HCCs before and 5-7 days after TACE to calculate the ADC of HCC. Patients were also evaluated with iodized-oil CT immediately after TACE. Contrast-enhanced CT was performed 3 months after TACE to confirm early relapse of HCC lesion. After TACE, the percent change in ADC (%ADC) from before to after therapy was significantly increased in non-relapsed lesions (85.2±12.4%) compared to relapsed lesions (8.0±56.7%, p=0.0004). However, no difference in area under the curve was seen for receiver operating characteristic analysis to predict early relapse after TACE between %ADC from DWI (95% confidence interval, 0.743-1.026) and iodized-oil CT (95% confidence interval, 0.703-1.016). ADC from DWI can evaluate the efficacy of TACE for HCC as effectively as iodized-oil CT, and may help in deciding whether to repeat TACE.

Linear accelerator-based radiotherapy has little effect on the majority of locally advanced neoplasms. Thus, the novel radiosensitizer Kochi Oxydol Radiation Therapy for Unresectable Carcinomas, Type II (KORTUC II), which contains hydrogen peroxide and sodium hyaluronate, was developed. The effectiveness of KORTUC II for the treatment of chemotherapy-resistant supraclavicular lymph node metastases has been previously demonstrated. The present study evaluated the safety and effectiveness of KORTUC II in patients with recurrent breast cancer. A total of 20 patients (age range, 39–84 years) were enrolled in the study. The majority of patients underwent positron emission tomography (PET)-computed tomography (CT) examinations prior to and 1–7 months following KORTUC II treatment, and every 6 months thereafter when possible. The radiotherapy regimen was 2.75 Gy/fraction, 5 fractions/week, for 16–18 fractions, with a total radiation dose of 44.00–49.50 Gy (X-ray irradiation), or 4.00 Gy/fraction, 3 fractions/week, for 10–12 fractions, with a total radiation dose of 40.00–48.00 Gy (electron beam irradiation). The injection of 3–6 ml of the KORTUC II agent was initiated at the fifth radiotherapy fraction, and was performed twice/week under ultrasonographic guidance. The therapeutic effects were evaluated by PET-CT examinations prior and subsequent to KORTUC II treatment, which was observed to be well tolerated with minimal adverse effects. Of the 24 lesions presented by the 20 patients, 18 exhibited complete response, 5 partial response, 0 stable disease and 1 progressive disease. The overall survival rate was 100% at 1 year and 95% at 2 years. The mean duration of follow-up at the end of June 2014 was 51 months. Based on the results of the PET-CT studies conducted, KORTUC II treatment demonstrated marked therapeutic effects, with satisfactory treatment outcomes and acceptable adverse events.

Abstract.We have previously developed a new enzymetargeting radiosensitization treatment named Kochi OxydolRadiation Therapy for Unresectable Carcinomas, Type II (KORTUC II), which markedly enhances radiotherapeutic effects on various types of locally advanced malignant neoplasms. KORTUC II was approved by our local ethics committee for use against various types of malignant neoplasms. A maximum of 6 ml of radiosensitizer was injected into tumor tissue under ultrasonographic guidance just before each administration of radiotherapy. Seventeen patients with locally advanced breast cancer were enrolled to receive KORTUC II with systemic chemotherapy without surgical care. Patients were eligible if they had declined surgical treatment. Median observation period was 13.4 months (range, 1-26 months). This therapy was well tolerated. Contrastenhanced magnetic resonance imaging revealed complete response in all primary breast tumors, and no patients displayed local recurrence during the follow-up period. Ultrasonography depicted tumor-like findings in 9 of 17 cases after therapy. The existence rate of posterior shadow artifacts behind the tumor was 2/17 before therapy, increasing to 8/17 after therapy. Intratumoral flow signals on color Doppler sonography were seen in 16/17 cases before therapy, but had disappeared from all cases after therapy. The increased rate of posterior shadow artifacts and absence of flow signals after therapy suggest that the tumor-like finding on ultrasonography represents scar tissue. Computed tomography revealed positive axillary nodes metastases in 16/17 and 2/17 cases before and after therapy, respectively. Nodal metastatic failure affected only 1 patient, who refused adjuvant systemic chemotherapy at the end of the observation period. Abnormal lymph node findings on computed tomography remained stable in the other patient. Excellent locoregional control based on accurate radiological evaluation implies that KORTUC II with chemotherapy has the potential to replace surgery in therapy for locally advanced breast cancer. IntroductionLarge tumors (>5 cm) and/or extensive regional lymph node involvement, which correspond to stage IIIA, IIIB and IIIC in the TNM stage classification, are widely called locally advanced breast cancer (LABC) (1). Induction chemotherapy is considered essential in the care of LABC (2-6). Surgery alone and radiotherapy alone following induction chemotherapy for LABC both result in similar survival rates (5,6). Progress in radiotherapeutic methods may thus obviate surgical care as a therapeutic option for LABC. We have introduced a new enzyme-targeting radiosensitizer and have reported the efficacy of radiotherapy with this new radiosensitizer in vivo and in clinical trials (7-11). This radiosensitizer inactivates peroxidase/catalase in tumor tissue through the application of hydrogen peroxide, thus reoxygenizing the tumor tissue with the oxygen produced by the degradation of hydrogen peroxide (10,11). We have named this new enzyme-targeting radiosensitizer treatment, wh...

Abstract. The study aimed to evaluate the utility of diffusionweighted imaging (DWI) and to assess the response of breast cancer patients to neoadjuvant chemotherapy (NAC), based on morphological concepts. This retrospective study included 35 breast cancer patients (36 lesions) who had conventional magnetic resonance imaging (MRI), with DWI acquired before and after NAC. The morphological pattern of delayed enhancement on MRI before NAC was classified into two types: focal mass (FM), and multiple masses and/or non-mass like (MM/NM), based on Breast Imaging Reporting and Data System (BI-RADS). Of the 36 tumors, 26 were classified as FM and 10 as MM/NM. Tumors were clearly visualized on the initial DWI although one case of suspected MM/NM was not observed on DWI following NAC. A correlation was found between changes in the apparent diffusion coefficient and response rates to NAC in FM tumors (r=0.608, p<0.001), but not in MM/NM tumors (r=0.141, p=0.717). There was agreement between MRI findings after NAC and pathological findings in 30 of the 36 tumors (83.3%). Thus, we concluded that DWI is potentially useful in assessing the response to NAC for breast cancer for tumors diagnosed as FM on the initial conventional MRI.