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At least 127 records · Page 7

Rationale for and Preliminary Results of Proton Beam Therapy for Mediastinal Lymphoma

Purpose: To evaluate the potential of three-dimensional proton beam therapy (3D-PBT) for reducing doses to normal structures in patients with mediastinal lymphomas compared with conventional photon radiation therapy (RT). Methods and Materials: We treated 10 consecutive patients with mediastinal masses from lymphomas with 3D-PBT between July 2007 and February 2009 to 30.6-50.4 cobalt-Gray equivalents (CGE). Of those patients, 7 had primary refractory or recurrent disease, and 8 had Hodgkin lymphoma. Dosimetric endpoints were compared with those from conventional RT plans. Results: PBT delivered lower mean doses to the lung (6.2 vs. 9.5 Gy), esophagus (9.5 vs. 22.3 Gy), and heart (8.8 vs. 17.7 Gy) but not the breasts (5.9 vs. 6.1 Gy) than did conventional RT. Percentages of lung, esophagus, heart, and coronary artery (particularly the left anterior descending artery) volumes receiving radiation were consistently lower in the 3D-PBT plans over a wide range of radiation doses. Of the 7 patients who had residual disease on positron emission tomography before PBT, 6 (86%) showed a complete metabolic response. Conclusions: In patients with mediastinal lymphomas, 3D-PBT produced significantly lower doses to the lung, esophagus, heart, and coronary arteries than did the current conventional RT. These lower doses would be expected to reduce the risk of late toxicities in these major organs.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Percutaneous Transumbilical Portal Vein Embolization in a Patient with a Ruptured Hepatocellular Carcinoma Supplied by the Portal Vein

We describe a case of a ruptured hepatocellular carcinoma supplied by the portal vein that was successfully treated with portal vein embolization via a percutaneous transumbilical approach. A contrast material-enhanced computed tomographic (CT) scan showed the presence of a large hypervascular tumor on portal venous phase as well as right hepatic vein thrombosis and hemoperitoneum that prevented portal vein embolization by the use of the percutaneous and transjugular transhepatic approach. The use of percutaneous transumbilical portal vein embolization can be an alternative option in this situation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Dose-Volume Histogram Parameters and Clinical Factors Associated With Pleural Effusion After Chemoradiotherapy in Esophageal Cancer Patients

Purpose: To investigate the dose-volume histogram parameters and clinical factors as predictors of pleural effusion in esophageal cancer patients treated with concurrent chemoradiotherapy (CRT). Methods and Materials: Forty-three esophageal cancer patients treated with definitive CRT from January 2001 to March 2007 were reviewed retrospectively on the basis of the following criteria: pathologically confirmed esophageal cancer, available computed tomography scan for treatment planning, 6-month follow-up after CRT, and radiation dose {>=}50 Gy. Exclusion criteria were lung metastasis, malignant pleural effusion, and surgery. Mean heart dose, mean total lung dose, and percentages of heart or total lung volume receiving {>=}10-60 Gy (Heart-V{sub 10} to V{sub 60} and Lung-V{sub 10} to V{sub 60}, respectively) were analyzed in relation to pleural effusion. Results: The median follow-up time was 26.9 months (range, 6.7-70.2) after CRT. Of the 43 patients, 15 (35%) developed pleural effusion. By univariate analysis, mean heart dose, Heart-V{sub 10} to V{sub 60}, and Lung-V{sub 50} to V{sub 60} were significantly associated with pleural effusion. Poor performance status, primary tumor of the distal esophagus, and age {>=}65 years were significantly related with pleural effusion. Multivariate analysis identified Heart-V{sub 50} as the strongest predictive factor for pleural effusion (p = 0.01). Patients with Heart-V{sub 50} <20%, 20%{<=} Heart-V{sub 50} <40%, and Heart-V{sub 50} {>=}40% had 6%, 44%, and 64% of pleural effusion, respectively (p < 0.01). Conclusion: Heart-V{sub 50} is a useful parameter for assessing the risk of pleural effusion and should be reduced to avoid pleural effusion.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Salvage Reirradiaton With Stereotactic Body Radiotherapy for Locally Recurrent Head-and-Neck Tumors

Purpose: In this study, we present our results of reirradiation of locally recurrent head-and-neck cancer with image-guided, fractionated, frameless stereotactic body radiotherapy technique. Methods and Materials: From July 2007 to February 2009, 46 patients were treated using the CyberKnife (Accuray, Sunnyvale, CA) at the Department of Radiation Oncology, Hacettepe University, Ankara, Turkey. All patients had recurrent, unresectable, and previously irradiated head-and-neck cancer. The most prominent site was the nasopharynx (32.6%), and the most common histopathology was epidermoid carcinoma. The planning target volume was defined as the gross tumor volume identified on magnetic resonance imaging and computed tomography. There were 22 female and 24 male patients. Median age was 53 years (range, 19-87 years). The median tumor dose with stereotactic body radiotherapy was 30 Gy (range, 18-35 Gy) in a median of five (range, one to five) fractions. Results: Of 37 patients whose response to therapy was evaluated, 10 patients (27%) had complete tumor regression, 11 (29.8%) had partial response, and 10 (27%) had stable disease. Ultimate local disease control was achieved in 31 patients (83.8%). The overall survival was 11.93 months in median (ranged, 11.4 - 17.4 months), and the median progression free survival was 10.5 months. One-year progression-free survival and overall survival were 41% and 46%, respectively. Grade II or greater long-term complications were observed in 6 (13.3%) patients. On follow-up, 8 (17.3%) patients had carotid blow-out syndrome, and 7 (15.2%) patients died of bleeding from carotid arteries. We discovered that this fatal syndrome occurred only in patients with tumor surrounding carotid arteries and carotid arteries receiving all prescribed dose. Conclusions: Stereotactic body radiotherapy is an appealing treatment option for patients with recurrent head-and-neck cancer previously treated with radiation to high doses. Good local control with considerable 1-year survival is achieved with a relatively high rate of morbidity and related mortality.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Foam Sclerotherapy Using Polidocanol (Aethoxysklerol) for Preoperative Portal Vein Embolization in 16 Patients

Purpose: To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for preoperative portal vein embolization (PVE) before hemihepatectomy of the liver. Materials and Methods: From March 2006 to October 2008, foam sclerotherapy using polidocanol was performed in 16 patients (male-to-female ratio of 12:4, age range 48-75 years [mean 62]) for PVE. Patients were diagnosed with Klatskin tumor (n = 13), gallbladder (GB) cancer (n = 2), or hepatocellular carcinoma (HCC) (n = 1). The foam was composed of a 1:2:1 ratio of 3% polidocanol (Aethoxysklerol; Kreussler Pharma, Wiesbaden, Germany), room air, and contrast media (Xenetix 350; Guerbet, Aulnay-Sous-Bois, France). The total amount of polidocanol used (2 to 8 mL [mean 4.6]) varied according to the volume of the target portal vein. We calculated the volume of future liver remnant (FLR) before and after PVE and evaluated complications associated with the use of polidocanol foam sclerotherapy for PVE. Results: Technical success was achieved in all patients. All patients were comfortable throughout the procedure and did not experience pain during sclerotherapy. No periprocedural morbidity or mortality occurred. Patients underwent a liver dynamic computed tomography (CT) scan 2-4 weeks after PVE. FLR increased significantly after PVE using polidocanol foam from 19.3% (range 16-35%) before PVE to 27.8% (range 23-42%) after PVE (p = 0.001). All patients were operable for hemihepatectomy of the liver and achieved effective resection. Conclusion: Foam sclerotherapy using polidocanol is clinically safe and effective for preoperative PVE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

C-Arm Computed Tomography Compared With Positron Emission Tomography/Computed Tomography for Treatment Planning Before Radioembolization

The purpose of this study was to determine whether rotational C-arm computed tomography (CT) allows visualization of liver metastases and adds relevant information for radioembolization (RE) treatment planning. Technetium angiography, together with C-arm CT, was performed in 47 patients to determine the feasibility for RE. C-arm CT images were compared with positron emission tomography (PET)/CT images for the detection of liver tumors. The images were also rated according one of the following three categories: (1) images that provide no additional information compared with DSA alone; (2) images that do provide additional information compared with DSA; and (2) images that had an impact on eligibility determination for and planning of the RE procedure. In all patients, 283 FDG-positive liver lesions were detected by PET. In venous contrast-phase CT, 221 (78.1%) and 15 (5.3%) of these lesions were either hypodense or hyperdense, respectively. In C-arm CT, 103 (36.4%) liver lesions were not detectable because they were outside of either the field of view or the contrast-enhanced liver segment. Another 25 (8.8%) and 98 (34.6%) of the liver lesions were either hyperdense or presented primarily as hypodense lesions with a rim enhancement, respectively. With PET/CT as the standard of reference, venous CT and C-arm CT failed to detect 47 (16.6%) and 57 (20.1%) of all liver lesions, respectively. For RE planning, C-arm CT provided no further information, provide some additional information, or had an impact on the procedure in 20 (42.5%), 15 (31.9%) and 12 (25.6%) of patients, respectively. We conclude that C-arm CT may add decisive information in patients scheduled for RE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Combination Therapy of Transcatheter Arterial Chemoembolization and Arterial Administration of Antiangiogenesis on VX2 Liver Tumor

Purpose: This study was designed to evaluate the antitumorigenic efficiency of Endostar (an antiangiogenic agent) arterially administrated combined with transcatheter arterial chemoembolization (TACE) on liver tumor, and validation of perfusion CT for quantitative measurements of the results.Experimental DesignThirty rabbits bearing VX2 liver tumors were randomly and equally distributed into three groups. One of the following treatment protocols was performed in each group: 1) group 1 was treated with TACE and simultaneously arterially administrated Endostar; 2) group 2 with TACE alone, and 3) a control group that had saline injected through hepatic artery. Routine CT scan was performed before treatment, and perfusion CT imaging was performed 2 weeks after treatment. Immunohistochemical biomarkers of microvascular density (MVD) and the expression of vascular endothelial growth factor (VEGF) were measured for assessments of angiogenesis. Results: We observed a statistically significant reduction from the control in the volume, growth rate, and size of the tumor 2 weeks after treatment with both TACE plus Endostar and with TACE alone (P < 0.01). Although there was no statistically significant difference in tumor size between the group with TACE plus Endostar and the group with TACE alone (P > 0.05), MVD and VEGF were significantly less expressed in the TACE plus Endostar group than both groups with TACE alone and the control group (P < 0.01). Blood flow (BF), blood volume (BV), and permeability-surface area products (PS) in the group with TACE plus Endostar on perfusion CT were significantly higher than other two groups (P < 0.05), which were positively correlated with the MVD and VEGF values (P < 0.05). Conclusions: TACE with arterial administration of Endostar simultaneously significantly inhibited the angiogenesis biomarkers associated with TACE in a rabbit model bearing VX2 liver tumor, which indicates that the combined treatment protocol may have potential synergistic effects on liver cancer. It also is suggested that perfusion CT may be useful for monitoring antiangiogenic/antivascular treatment in the liver tumors.

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Development of a Multicomponent Prediction Model for Acute Esophagitis in Lung Cancer Patients Receiving Chemoradiotherapy

Purpose: To construct a model for the prediction of acute esophagitis in lung cancer patients receiving chemoradiotherapy by combining clinical data, treatment parameters, and genotyping profile. Patients and Methods: Data were available for 273 lung cancer patients treated with curative chemoradiotherapy. Clinical data included gender, age, World Health Organization performance score, nicotine use, diabetes, chronic disease, tumor type, tumor stage, lymph node stage, tumor location, and medical center. Treatment parameters included chemotherapy, surgery, radiotherapy technique, tumor dose, mean fractionation size, mean and maximal esophageal dose, and overall treatment time. A total of 332 genetic polymorphisms were considered in 112 candidate genes. The predicting model was achieved by lasso logistic regression for predictor selection, followed by classic logistic regression for unbiased estimation of the coefficients. Performance of the model was expressed as the area under the curve of the receiver operating characteristic and as the false-negative rate in the optimal point on the receiver operating characteristic curve. Results: A total of 110 patients (40%) developed acute esophagitis Grade {>=}2 (Common Terminology Criteria for Adverse Events v3.0). The final model contained chemotherapy treatment, lymph node stage, mean esophageal dose, gender, overall treatment time, radiotherapy technique, rs2302535 (EGFR), rs16930129 (ENG), rs1131877 (TRAF3), and rs2230528 (ITGB2). The area under the curve was 0.87, and the false-negative rate was 16%. Conclusion: Prediction of acute esophagitis can be improved by combining clinical, treatment, and genetic factors. A multicomponent prediction model for acute esophagitis with a sensitivity of 84% was constructed with two clinical parameters, four treatment parameters, and four genetic polymorphisms.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Technical Solutions to Ensure Safe Yttrium-90 Radioembolization in Patients With Initial Extrahepatic Deposition of {sup 99m}Technetium-Albumin Macroaggregates

Purpose: To evaluate the incidence of extrahepatic deposition of technetium-99m-labeled albumin macroaggregates ({sup 99m}Tc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton ({sup 90}Y-RE), and to report on technical solutions that can be used to ensure safe delivery of {sup 90}Y-microspheres in patients with initial extrahepatic deposition. Materials and Methods: A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with {sup 90}Y-RE in our institution in 2009, was performed. The angiograms and single-photon emission computed tomography images of all patients were reviewed by an interventional radiologist and a nuclear medicine physician, respectively, to identify and localize extrahepatic deposition of {sup 99m}Tc-MAA when present. Subsequently, the technical solutions were used to successfully perform {sup 90}Y-RE in these patients were evaluated and described. Results: Extrahepatic deposition of {sup 99m}Tc-MAA was observed in 8 of 26 patients (31%). In 7 of 8 patients, a second pretreatment angiography was performed to detect the cause of extrahepatic deposition. The technical solutions to enable safe {sup 90}Y microspheres delivery included more distal placement of the microcatheter in the proper/right hepatic artery in 4 of 7 (57%) patients; (super)selective catheterization of multiple segmental branches in 2 of 7 (29%); and additional coiling of a newly detected branch in the remaining patient (14%). This was confirmed by a second MAA procedure. {sup 90}Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (<30 days) were observed. Conclusion: Extrahepatic deposition of {sup 99m}Tc-MAA after pretreatment angiography did occur in 8 of 26 (31%) patients. The technical solutions as presented allowed safe {sup 90}Y-RE delivery in 25 of 26 (96%) patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Total Marrow Irradiation With RapidArc Volumetric Arc Therapy

Purpose: To develop a volumetric arc therapy (VMAT)-total marrow irradiation (TMI) technique for patients with hematologic malignancies. Methods and Materials: VMAT planning was performed for 6 patients using RapidArc technology. The planning target volume consisted of all the bones in the body from the head to the mid-femur, excluding the extremities, except for the humerus, plus a 3.0-mm margin. The organs at risk included the lungs, heart, liver, kidneys, bowels, brain, eyes, and oral cavity. The VMAT-TMI technique consisted of three plans: the head and neck, the chest, and the pelvis, each with three 330{sup o} arcs. The plans were prescribed to ensure, at a minimum, 95% planning target volume dose coverage with the prescription dose (percentage of volume receiving dose of {>=}12 Gy was 95%). The treatments were delivered and verified using MapCheck and ion chamber measurements. Results: The VMAT-TMI technique reported in the present study provided comparable dose distributions with respect to the fixed gantry linear accelerator intensity-modulated TMI. RapidArc planning was less subjective and easier, and, most importantly, the delivery was more efficient. RapidArc reduced the treatment delivery time to approximately 18 min from 45 min with the fixed gantry linear accelerator intensity-modulated TMI. When the prescription dose coverage was reduced to 85% from 95% and the mandible and maxillary structures were not included in the planning target volume as reported in a tomotherapy study, a considerable organ at risk dose reduction of 4.2-51% was observed. The average median dose for the lungs and lenses was reduced to 5.6 Gy from 7.2 Gy and 2.4 Gy from 4.5 Gy, respectively. Conclusion: The RapidArc VMAT technique improved the treatment planning, dose conformality, and, most importantly, treatment delivery efficiency. The results from our study suggest that the RapidArc VMAT technology can be expected to facilitate the clinical transition of TMI.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A Case Report on the Effect of Fan Beam Thickness in Helical Tomotherapy of Nasopharyngeal Carcinoma

The fan beam thickness (FBT) in helical tomotherapy is defined by a pair of collimators parallel to the rotational orbit of the radiation beam and is fixed for a specific patient treatment. The aim of this case study is to evaluate the dosimetric influence of changing the FBT in the treatment of a nasopharyngeal carcinoma (NPC) patient. The subject was a T2N1M0 stage NPC patient. The planning target volumes (PTVs) of the primary nasopharyngeal tumor and the left and right cervical lymphatics were delineated along with the organs at risk (OARs) in the corresponding computed tomography slices. Three treatment plans with FBT of 1.0 cm, 2.5 cm, and 5.0 cm (FBT-10, FBT-25, and FBT-50) were generated separately based on similar dose constraints and planning parameters. The dosimetric results of the PTV and OARs were collected and compared among the 3 treatment plans. The differences in the dose parameters of the PTVs were small among the 3 plans. The FBT-10 plan demonstrated the most homogeneous PTV doses with the smallest homogeneity indices (HIs). The FBT-50 plan delivered the highest dose to the OARs and the FBT-10 plan delivered the lowest. The differences between the 2 plans were more significant in the spinal cord, optic chiasm, optic nerves, and lens. This case study demonstrated that the variation of FBT in tomotherapy affected the quality of the treatment plan mainly in the OAR doses, but not so much in the PTV. Increasing the FBT reduced the effectiveness in the sparing of OARs.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Energy Economics of Farm Biogas in Cold Climates

Anaerobic digestion of farm and dairy waste has been shown to be capital intensive. One way to improve digester economics is to co-digest high-energy substrates together with the dairy manure. Cheese whey for example represents a high-energy substrate that is generated during cheese manufacture. There are currently no quantitative tools available that predict performance of co-digestion farm systems. The goal of this project was to develop a mathematical tool that would (1) predict the impact of co-digestion and (2) determine the best use of the generated biogas for a cheese manufacturing plant. Two models were developed that separately could be used to meet both goals of the project. Given current pricing structures of the most economical use of the generated biogas at the cheese manufacturing plant was as a replacement of fuel oil to generate heat. The developed digester model accurately predicted the performance of 26 farm digesters operating in the North Eastern U.S.

09 BIOMASS FUELS↗

Zero-gap microbial electrolysis cells for efficient hydrogen production from real liquid waste streams

Zero-gap microbial electrolysis cells (MECs) have demonstrated large current and hydrogen production rates from defined substrates in synthetic media, but operation with real waste streams has yet to be proved. This study evaluated the performance and 30-days stability of zero-gap MECs operated with effluent from a single-stage anaerobic digester. The system achieved a maximum current density of 8.8 ± 0.3 A/m 2 with a hydrogen production rate of 32 ± 6 L/L-d, and during 30 days of continuous operation, sustained an average current density of 7 ± 2 A/m 2 and a hydrogen production rate of 20.8 ± 0.2 L/L-d. Carbonate precipitation was identified as a major challenge to long-term stability, and mild acid washing effectively mitigated its adverse effects. The low buffer capacity of the effluent was primarily limiting performance. Furthermore, these findings underscore the significant impact of wastewater chemistry on MEC operation and validate the feasibility of utilizing real waste streams as viable feedstocks for biohydrogen production in zero-gap configurations.

Acid wash↗

Integrated Solar Thermochemical Reaction System (Final Report)

This report describes progress accomplished in a three-phase project that has advanced the concept for a Solar Thermochemical Advanced Reactor System (STARS) – a system that is designed to convert solar energy into storable/useful chemical energy – from Technology Readiness Level 3 to Technology Readiness Level 6. STARS accomplishes its objective by directing the heat from a dish concentrator onto a chemical reaction system, increasing the energy content of the feedstock, methane, a chemical fuel that is available from multiple sources including natural gas, landfills and anaerobic digesters. The system uses a parabolic dish solar concentrator, previously developed for electrical power generation, and a compact, process-intensive chemical reaction system based on micro- and meso-channel process technology (MMPT). The combined Dish-STARSTM system provides a solar augment to the incoming methane stream, increasing its chemical energy content by 20-30% while decreasing its carbon intensity. When the immediate chemical product, known as syngas, is directly used for power generation the result is electricity with approximately 20% less CO 2 emissions. Alternately, if the syngas is further reacted to produce valuable chemical products, such as hydrogen, the reduction in carbon emissions is retained and reduced carbon intensities can be attained for the chemical products. In a co-production mode, lowcarbon hydrogen or electricity plus various hydrocarbons (for example, methanol, olefins or plastics) can be produced. Over the course of this project, the efficiency of Dish-STARSTM was improved from a previous value of 63% to slightly over 70%, with results and analyses indicating a potential for values greater than 80%; manufacturing investigations identified fabrication methods for the MMPT components, proofed-out additive manufacturing for microchannel heat exchangers, developed equipment cost models and, together with on-sun testing, supported technoeconomic evaluations. If developed into commercial products, project results indicate the potential for the efficient use of concentrated solar energy in nearterm applications for electrical power generation and the production of chemicals, including hydrogen.

14 SOLAR ENERGY↗

Policy impact on economic and environmental sustainability of anaerobic digestion: Industrial case study Insights

This paper thoroughly examines how policy incentives impact the economic and environmental sustainability of anaerobic digestion (AD) systems. It uses techno-economic and life cycle analyses, along with real industry data, to explore the entire AD process—from feedstock acceptance to digestate disposal. It evaluates the effects of various U.S. policy crediting programs on the economic viability of different AD pathways for treating sewage sludge and food waste. Furthermore, tipping fees are identified as the primary driver of profitability, while policy credits play a crucial role in enhancing economic feasibility, particularly for renewable natural gas production. However, future regulatory changes could reshape this economic landscape. All AD pathways are found to significantly reduce greenhouse gas emissions, though economic outcomes are highly sensitive to digestate disposal costs and feedstock tipping fees. Co-digestion with food waste is proposed as a strategy to reduce dependence on policy credits and improve long-term economic stability.

Anaerobic Digestion↗

Methane production using resin-wafer electrodeionization

The present invention provides an efficient method for creating natural gas including the anaerobic digestion of biomass to form biogas, and the electrodeionization of biogas to form natural gas and carbon dioxide using a resin-wafer deionization (RW-EDI) system. The method may be further modified to include a wastewater treatment system and can include a chemical conditioning/dewatering system after the anaerobic digestion system. The RW-EDI system, which includes a cathode and an anode, can either comprise at least one pair of wafers, each a basic and acidic wafer, or at least one wafer comprising of a basic portion and an acidic portion. A final embodiment of the RW-EDI system can include only one basic wafer for creating natural gas.

03 NATURAL GAS↗

Radioembolization of Symptomatic, Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres

Purpose: To evaluate safety, efficacy, and symptom-control of radioembolization in patients with unresectable liver metastases from neuroendocrine tumors (NETLMs). Materials and Methods: Forty-two patients (mean age of 62 years) with treatment-refractory NETLMs underwent radioembolization using yttrium-90 ({sup 90}Y) resin microspheres. Posttreatment tumor response was assessed by cross-sectional imaging using the Response Evaluation Criteria in Solid Tumors (RECIST) and tumor-marker levels. Laboratory and clinical toxicities and clinical symptoms were monitored. Results: The median activity delivered was 1.63 GBq (range 0.63-2.36). Imaging follow-up using RECIST at 3-month follow-up demonstrated partial response, stable disease, and progressive disease in 22.5, 75.0, and 2.5% of patients, respectively. In 97.5% of patients, the liver lesions appeared hypovascular or partially necrotic. The mean follow-up was 16.2 months with 40 patients (95.2%) remaining alive. The median decrease in tumor-marker levels at 3 months was 54.8% (chromogranin A) and 37.3% (serotonin), respectively. There were no acute or delayed toxicities greater than grade 2 according to Common Terminology Criteria for Adverse Events [CTCAE (v3.0)]. No radiation-induced liver disease was noted. Improvement of clinical symptoms 3 months after treatment was observed in 36 of 38 symptomatic patients. Conclusion: Radioembolization with {sup 90}Y-microspheres is a safe and effective treatment option in patients with otherwise treatment-refractory NETLMs. Antitumoral effect is supported by good local tumor control, decreased tumor-marker levels, and improved clinical symptoms. Further investigation is warranted to define the role of radioembolization in the treatment paradigm for NETLMs.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Experimental Study of Poly-l-Lactic Acid Biodegradable Stents in Normal Canine Bile Ducts

Purpose: This study was designed to clarify the advantages of biodegradable stents in terms of mucosal reaction and biodegradation after placement. We designed a biodegradable stent and assessed stent degradation and changes in the normal bile ducts of dogs. Methods: The biodegradable stent is a balloon-expandable Z stent consisting of poly-l-lactic acid (PLLA) with a diameter of 6 mm and a length of 15 mm. We assessed four groups of three beagle dogs each at 1, 3, 6, and 9 months of follow-up. After evaluating stent migration by radiography and stent and bile duct patency by cholangiography, the dogs were sacrificed to remove the bile duct together with the stent. The bile duct lumen was examined macroscopically and histologically, and the stent degradation was examined macroscopically and by scanning electron microscopy (SEM). Results: Bile duct obstruction was absent and none of the stents migrated. Macroscopic evaluation showed moderate endothelial proliferation in the bile ducts at the implant sites at 3 and 6 months and a slight change at 9 months. Slight mononuclear cell infiltration was histologically identified at all time points and epithelial hyperplasia that was moderate at 3 months was reduced to slight at 6 and 9 months. Stent degradation was macroscopically evident in all animals at 9 months and was proven by SEM in two dogs at 6 months and in all of them at 9 months. Conclusions: Our results suggest that PLLA bioabsorbable stents seems to be useful for implantation in the biliary system with further investigation.

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