Background and Objective: It is unclear if stereotactic body radiation therapy (SBRT) or transarterial chemoembolization (TACE) is better for the treatment of inoperable early-stage hepatocellular carcinoma (HCC). This study aimed to retrospectively compare the efficacy of SBRT to TACE in patients with inoperable Barcelona Clinic Liver Cancer (BCLC)-A stage HCC. Materials and Methods: In this multi-institutional retrospective study, a total of 326 patients with inoperable BCLC-A stage HCC were enrolled. Totally, 167 patients initially received SBRT and 159 initially received TACE. Overall survival (OS), local control (LC), intrahepatic control (IC), and progression-free survival (PFS) were evaluated in univariable and propensity-score matched analyses. Results: There was a smaller median tumor size in the SBRT group than in the TACE group (3.4 cm vs. 7.2 cm, P < 0.001). After propensity score matching in the selection of 95 patient pairs, SBRT had better LC, IC, and PFS than TACE but showed comparable OS. The accumulative 1-, 3-, and 5-year OS rates were 85.7, 65.1, and 62.8% in the SBRT group and 83.6, 61.0, and 50.4% in the TACE group, respectively (P = 0.29). The accumulative 1-, 3-, and 5-year PFS were 63.4, 35.9, and 27.5% in the SBRT group and 53.5, 27.4, and 14.2% in the TACE group, respectively (P = 0.049). The accumulative 1-, 3-, and 5-year LC were 86.8, 62.5, and 56.9% in the SBRT group and 69.3, 53.3, and 36.6% in the TACE group, respectively (P = 0.0047). The accumulative 1-, 3-, and 5-year IC were 77.3, 45.9, and 42.4% in the SBRT group and 57.3, 34.1, and 17.7% in the TACE group, respectively (P = 0.003). On multivariate analysis, treatment (SBRT vs. TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.59; 95% CI: 1.03-2.47; P = 0.04; HR = 1.61; 95% CI: 1.13-2.29; P = 0.009). Su et al. SBRT vs. TACE in HCC Conclusions: SBRT was an alternative to TACE for inoperable BCLC-A stage HCC with better local and intrahepatic control. Controlled clinical trials are recommended to evaluate the actual effects of this novel regimen adequately.

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A novel RIA was used to examine the release of agouti-related protein-like immunoreactivity (AGRP-LI) from perfused rat hypothalamic tissue slices and to characterize AGRP-LI in rat serum. A continuous low level basal AGRP-LI release was observed from hypothalami of rats fed ad libitum before the rats were killed. Basal AGRP-LI release was 3-fold greater in rats fasted 48 h. In fasted animals leptin dose-dependently suppressed basal AGRP-LI release. In fed animals no change in basal AGRP-LI release was detected in response to 10(-6) M alpha-MSH, orexin B, melanin-concentrating hormone, or serotonin. HPLC analysis of AGRP-LI in rat serum identified a single peak that eluted in close proximity to synthetic AGRP (87-132) and mouse [Leu127Pro]AGRP and that was identical to the peak seen in hypothalamic and adrenal tissue extracts. The serum concentration of AGRP-LI in rats fed ad libitum was 0.865+/-0.323 nmol/liter (mean +/- SE). Food deprivation resulted in a slow, but statistically significant rise in serum immunoreactivity at 48 h [1.174+/-0.118 nmol/liter (mean +/- SE)]. Bilateral adrenalectomy did not change serum levels of AGRP-LI. These studies demonstrate that in the rat there are different levels of basal hypothalamic AGRP-LI release in fed and fasted states and that in the fasted rat this release can be profoundly suppressed by leptin. These studies also suggest that AGRP is present in the systemic circulation of rats.

PurposeTo investigate dosimetry of submandibular glands on xerostomia after intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).MethodsFrom September 2015 to March 2016, 195 NPC patients were investigated. Xerostomia was evaluated at 12 months after treatment via the RTOG/EORTC system. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for grades 2–3 xerostomia. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis.ResultsThe V30 of the parotid glands was selected based on the least absolute shrinkage and selection operator regression. The nomogram displayed good discrimination with a C-index of 0.698 (95% confidence interval [CI]: 0.626–0.771) and good calibration (model 1). Addition of the dosimetric parameters including the mean dose to the submandibular glands, V50 of the submandibular glands, and volume of the submandibular glands to the model 1 failed to show incremental prognostic value (model 2). The model 2 showed a C-index of 0.704 (95% CI: 0.632–0.776). Decision curve analysis demonstrated that the model 1 was clinically useful when intervention was decided at the possibility threshold of &gt; 20%. Within this range, net benefit was comparable between the model 1 and model 2.ConclusionPGv30 was a major predictive factor of grades 2–3 xerostomia for NPC. In contrast, the mean dose to the submandibular glands, V50 of the submandibular glands, and volume of the submandibular glands were not independent predictive factors.

BackgroundThe 8th edition of AJCC/UICC TNM staging system (TNM system) and the previous nomograms have limitations, therefore we aimed to develop and validate nomograms incorporating routine hematological biomarkers with or without EBV DNA for overall survival (OS) and progression-free survival (PFS). We also evaluated the prognostic role of EBV DNA.Material and Methods1203 patients at our hospital from 2013 to 2016 were retrospectively reviewed and divided into two parts (922 patients for primary cohort and 281 for validation cohort). Nomograms (nomogram with or without EBV DNA) were developed and compared with other models (TNM system alone, TNM system with EBV DNA), via comparison the prognostic role of EBV DNA was evaluated. Internal and external validation were performed. Risk stratification were conducted with recursive partitioning analysis.ResultsThe nomograms with EBV DNA for OS and PFS included sex, age, T category, N category, EBV DNA, albumin, neutrophil to lymphocyte ratio and lactate dehydrogenase. The nomograms without EBV DNA for OS and PFS included the same variables but without EBV DNA. The C-index for nomogram with EBV DNA was 0.715 for OS and 0.705 for PFS. For nomogram without EBV DNA, it was 0.709 and 0.700, respectively. It was 0.639 and 0.636 for TNM system alone and 0.648, 0.646 respectively for TNM system with EBV DNA. The nomograms with or without EBV DNA had better performance than both the TNM system alone and TNM system with EBV DNA, while the TNM system with EBV DNA were better than TNM system alone. The validation cohort indicates great applicability of nomograms. The patients were stratified into 4 risk groups.ConclusionThe nomograms with or without EBV DNA provide better prognostication than the TNM system and also the TNM system with EBV DNA. EBV DNA is valuable in predicting survival, but it is not suggested to incorporate EBV DNA alone to TNM system.