Radioactive ⁹⁰Y-selective internal radiation (SIR) sphere therapy is increasingly used for the treatment of nonresectable hepatocellular carcinoma (HCC). However, the maximum delivered dose is limited by severe injury to the nontarget tissue, including liver parenchyma. Our study aimed to implement radiobiologic models for both tumor control probability (TCP) and normal-tissue complication probability (NTCP) to describe more effectively local response and the liver toxicity rate, respectively. Methods: Patients with documented HCC, adequate bone marrow parameters, and regular hepatic and pulmonary function were eligible for the study. Patients who had pulmonary shunt greater than 20% of ^99mTc-labeled macroaggregated albumin or any uncorrectable delivery to the gastrointestinal tract, reverse blood flow out of the liver, or complete portal vein thrombosis were excluded. Patients received a planned activity of the ⁹⁰Y-SIR spheres, determined using the empiric body surface area method. The dose distribution was determined using posttreatment (3-dimensional) activity distribution and Monte Carlo dose voxel kernel calculations, and the mean doses to healthy liver and tumor were calculated for each patient. Response was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) and recommendations of the European Association for the Study of the Liver (EASL). Criteria were used to assess possible liver toxicities. The parameters of TCP and NTCP models were established by direct maximization of the likelihood. Results: Seventy-three patients were treated. With an average dose of 110 Gy to the tumor, complete or partial response was observed in 74% and 55% of patients according to the EASL guideline and RECIST, respectively, and the predicted TCPs were 73% and 55%, respectively. With a median liver dose of 36 Gy (range, 6–78 Gy), the ≥grade 2 (G2), ≥grade 3 (G3), and ≥grade 4 (G4) liver toxicities were observed in 32% (23/73), 21% (15/73), and 11% (8/73) of patients, respectively. The parameters describing the ≥G2 liver toxicity data using the NTCP model were a tolerance dose of the whole organ leading to a 50% complication probability of 52 Gy (95% confidence interval, 44–61 Gy) and a slope of NTCP versus dose of 0.28 (95% confidence interval, 0.18–0.60), assuming n = 1. Conclusion: The radiobiologic approach, based on patient-specific dosimetry, could improve the ⁹⁰Y-microsphere therapeutic approach of HCC, maintaining an acceptable liver toxicity.

Background: Methods: Results: Conclusion:

Background: The aims of this study were to define the clinicopathological features and prognosis of gastric cancer in young European adults.Methods: Between 1990 and 2004, 603 patients with gastric cancer were enrolled in a prospective database. The findings for 51 (8·5 per cent) patients aged 45 years or less were compared with those of 457 aged between 46 and 75 years.Results: In the younger group there were significantly more women (57 versus 36·3 per cent; P = 0·004), Laurén diffuse-type carcinomas (73 versus 42·7 per cent; P < 0·001), N2–3 lymph node metastases (59 versus 38·9 per cent; P = 0·005), stage IV disease (49 versus 35·7 per cent; P = 0·085) and resections that were non-curative (36 versus 18·5 per cent; P = 0·007) than in the older patients. Actuarial survival rates in younger patients at 5 and 10 years after resection were 40 and 32 per cent respectively, similar to those in older patients (P = 0·540). Unfavourable prognostic factors associated with poor 5-year survival were the degree of gastric wall invasion (T3–4 versus T1–2; P < 0·001), lymph node invasion (positive versus negative; P < 0·001), disease stage (III–IV versus I–II; P < 0·001) and curability of resection (non-curative versus curative; P < 0·001).Conclusion: Gastric cancer in young adults tends to be more advanced; however, when matched for stage, the prognosis does not differ from that of older patients.

The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts’ recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.