BackgroundThe purpose of this study was to compare carbon ion radiotherapy (C-ion RT) and stereotactic radiotherapy (SBRT) with photon beams for the treatment of hepatocellular carcinoma (HCC), specifically with regard to the dose volume parameters for target coverage and normal tissue sparing.MethodsData of 10 patients who were treated using C-ion RT with a total dose of 60 Gy(RBE) in four fractions were used. The virtual plan of SBRT was simulated on the treatment planning computed tomography images of C-ion RT. Dose volume parameters such as minimum dose covering 90 % of the planning target volume (PTV D90), homogeneity index (HI), conformity index (CI), mean liver dose (MLD), volume of the liver receiving 5 to 60 Gy (V5-60), and max point dose (Dmax) of gastrointestinal (GI) tract were calculated from both treatment plans.ResultsThe PTV D90 was 59.6 ± 0.2 Gy(RBE) in C-ion RT, as compared to 56.6 ± 0.3 Gy in SBRT (p < 0.05). HI and CI were 1.19 ± 0.03 and 0.79 ± 0.06, respectively in C-ion RT, as compared to 1.21 ± 0.01 and 0.37 ± 0.02, respectively in SBRT. Only CI showed a significant difference between two modalities. Mean liver dose was 8.1 ± 1.4 Gy(RBE) in C-ion RT, as compared to 16.1 ± 2.5 Gy in SBRT (p < 0.05). V5 to V50 of liver were higher in SBRT than C-ion RT and significant differences were observed for V5, V10 and V20. Dmax of the GI tract was higher in SBRT than C-ion RT, but did not show a significantly difference.ConclusionsC-ion RT provides an advantage in both target conformity and normal liver sparing compared with SBRT.

BackgroundTo evaluate the safety and efficacy of carbon ion radiotherapy (C-ion RT) for 80 years or older patients with hepatocellular carcinoma (HCC).MethodsEligibility criteria of this retrospective study were: 1) HCC confirmed by histology or typical hallmarks of HCC by imaging techniques of four-phase multidetector-row computed tomography or dynamic contrast-enhanced magnetic resonance imaging; 2) no intrahepatic metastasis or distant metastasis; 3) no findings suggesting direct infiltration of the gastrointestinal tract; 4) performance status ≤2 by Eastern Cooperative Oncology Group classification; and 5) Child-Pugh classification A or B. Patients received C-ion RT with 52.8 Gy (RBE) or 60.0 Gy (RBE) in four fractions for usual cases and 60.0 Gy (RBE) in 12 fractions for close-to-gastrointestinal tract cases. Toxicities were classified using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (Version 4.0).ResultsBetween March 2011 and November 2015, 31 patients were treated. The median follow-up period of all patients was 23.2 months (range: 8.4–55.3 months). Median age at the time of registration of C-ion RT was 83 years (range: 80–95 years). Child-Pugh grade A and B were 27 patients and 4 patients, respectively.The 2-year estimated overall survival, local control, and progression-free survival rates were 82.3%, 89.2%, and 51.3%, respectively. No patients had Grade 2 or higher acute toxicities (within 3 months after C-ion RT). One patient experienced progression in Child-Pugh classification from A to B within 3 months after C-ion RT. In late toxicities, Grade 3 encephalopathy was observed in 3 patients, and 2 improved with medication.ConclusionsC-ion RT was effective with minimal toxicities for 80 years or older patients with hepatocellular carcinoma.Trial registration UMIN000020571: date of registration, 14 January 2016, retrospectively registered.

Aim In Japanese‐Oriental (Kampo) medicine, the abdominal examination is an important diagnostic method. We examined the influence of anatomical factors in Kampo medicine on the Kampo diagnosis of abdominal aortic pulsation using abdominal computed tomography (CT). Methods Our subjects were 67 patients (34 men, 33 women; average age: 61.4 ± 16.3 years) who underwent abdominal CT in the Department of Japanese‐Oriental ‘Kampo’ Medicine at Chiba University Hospital. We measured the depth of the abdominal artery from the midline of the body surface and the blood vessel diameter at that point, and calculated the averages of these parameters among all patients at three locations of abdominal aortic pulsation (epigastrium, supra‐umbilical region, and infra‐umbilical region) on the CT section. Results The detection rate of abdominal aortic pulsation was highest in the supra‐umbilical region (30%), followed by the epigastrium (21%) and the infra‐umbilical region (15%). The average depth of the aorta from the body surface was shallowest in the supra‐umbilical region (74.9 mm) and deepest at the epigastrium (103.5 mm). As the depth of the artery decreased at the epigastrium and supra‐umbilical region, significant abdominal aortic pulsation was observed (P = 0.006 and P = 0.001, respectively). Conclusion Our study demonstrates that abdominal aortic pulsation is anatomically associated with the depth of the artery. The supra‐umbilical region appeared to be the most suitable location for evaluating abdominal aortic pulsation, as the aortic artery is shallowest at that point and is least influenced by the depth of the abdominal artery.

The number of drugs used in Western medicine among improved patients significantly decreased from 5.6 ± 3.6 at hospitalization to 5.3 ± 3.5 at discharge, but the number of Kampo medicine drugs was not changed. The total number of drugs including both Western medicine and Kampo medicine significantly decreased from 7.0 ± 3.8 to 6.7 ± 3.6. The number of drugs used in Western medicine among nochanged patients decreased from 5.1 ± 3.4 at hospitalization to 5.0 ± 3.7 at discharge, but the number of Kampo medicine drugs significantly increased from 1.0 ± 0.0 at hospitalization to 1.3 ± 0.5. The total number of drugs including both Western medicine and Kampo medicine increased from 6.1 ± 3.4 to 6.3 ± 3.9. We thus conclude that a combination of Kampo medicine with Western medicine can be useful for reducing the number of drugs related to polypharmacy. To achieve these results, it is essential to use the concept of sho (a way of pattern recognition of a patient's symptoms in Kampo medicine). polypharmacy, Kampo medicine, hospitalized patient, sho

We report a case of prolonged lumbago with severe cold intolerance successfully treated with keppuchikuoto and uzushakusekishigan. The patient was a 71-year-old female with lumbar spinal canal stenosis which was refractory to several nerve and intervertebral disc block therapies and oral medications. She had been also suffering from constipation, leg cramps, intermittent chest pains, and severe cold intolerance. We prescribed keppuchikuoto for chronic blood stagnation and deficiency and uzushakusekishigan for intermittent chest pains in order to improve those symptoms all together. The severity of her lumbago and severe cold intolerance were remarkably reduced after the administration of the two formulas. This case suggests that the two formulas exerted their effectiveness by ameliorating chronic severe cold intolerance, blood stagnation, and blood deficiency and resulted in remarkable improvement in lumbago.lumbago, Kampo medicine, cold intolerance, keppuchikuoto, uzushakusekishigan