A case of massive hemoptysis due to pulmonary sequestration is presented. Initially, the diagnosis of sequestration was unsuspected and bronchial artery embolization was done for management of hemoptysis from the left lower lobe, but 4 days later massive hemoptysis recurred. Repeat arteriography, including a thoracoabdominal aortogram, revealed two large abdominal arteries penetrating the left diaphragm and feeding the lower lung. Embolization of the aberrant artery from the celiac trunk and the left inferior phrenic artery resulted in complete hemostasis until elective surgical ligation of the two arteries was performed 2 months later. The massive hemoptysis from a pulmonary sequestration could only be controlled after embolization of the transdiaphragmatic aberrant pulmonary arteries.
Aim: The aim of this study was to evaluate the dosevolume histogram parameters for late hematuria and rectal hemorrhage in patients receiving radiotherapy after radical prostatectomy. Patients and Methods: Data of 86 patients treated between January 2006 and June 2019 were retrospectively evaluated. The median radiation dose was 64 Gy in 32 fractions. Receiver operating characteristic (ROC) curves were used to identify optimal cut-off values for late adverse events. Results: Eleven patients experienced hematuria, and the 5-year cumulative rate was 18%. Four patients experienced rectal hemorrhage, and the 5-year cumulative rate was 7%. ROC curve analysis demonstrated the following significant cutoff values: bladder V50 Gy: 43% (p=0.02) and V40 Gy: 50% (p=0.03) for hematuria, and rectum V60 Gy: 13% (p=0.04) and V50 Gy: 33% (p=0.03) for rectal hemorrhage. Conclusion: This is the first study to identify dose constraints that may reduce hematuria and rectal hemorrhage in patients receiving radiotherapy in the postoperative setting.Prostate cancer is the most common malignancy in men worldwide (1). Surgery is the mainstay of curative treatment for prostate cancer (2). In recent years, robotic-assisted radical prostatectomy (RARP), which offers minimally invasive treatment, has rapidly gained global popularity (3-5). However, positive surgical margins have been reported in 14-33%, with 5-year prostate-specific antigen (PSA) failure rates of 13-37% after surgery (4-8). Postoperative radiotherapy has been reported to improve overall and biochemical progression-free survival in patients with positive surgical margins and seminal vesicle invasion (9, 10). In addition, salvage radiotherapy has been found to improve prostate cancer-specific survival compared with observation in patients with PSA recurrence after radical prostatectomy (11). Therefore, radiotherapy plays a major role as adjuvant therapy in prostate cancer.Radiotherapy is generally considered to be less invasive than surgery. The recent development of high precision radiotherapy for prostate cancer has improved dose conformity to the target (12-14). However, preventing adverse events remains a challenge, as the base of the prostate is located in close proximity to the organs at risk, which include the bladder and rectum. Late hematuria and rectal hemorrhage are particularly considered to be refractory and chronic conditions that decrease patient quality of life. Establishing appropriate dose constraints for minimizing these adverse events is therefore of particular necessity. The dose constrains for several organs, including the rectum, bladder, penile bulb, and femoral head have been reported from cases of prostate cancer treated with radical radiotherapy (15-18). However, reports regarding the association between dose-volume histogram (DVH) parameters and late hematuria and rectal bleeding in the postoperative setting are scarce (19).Therefore, we evaluated the DVH parameters and clinical factors associated with late hematuria and rectal hemorrhage in patients...
An 83-year-old man with a history of carbon ion radiotherapy for hepatocellular carcinoma nine years ago presented to a primary care hospital with a fever and abdominal pain. He underwent computed tomography, which revealed the rupture of a hepatic pseudoaneurysm close to the fiducial marker for carbon ion radiotherapy and bleeding into the bile duct. He was successfully treated with transcatheter arterial embolization. Thereafter, re-rupture occurred from a site proximal to the first rupture, and this was treated similarly. It is necessary to be alert for not only tumor recurrence but also pseudoaneurysm occurrence after carbon ion radiotherapy.
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