The text consists of two sections, one for those studying or practicing diagnostic radiology, nuclear medicine and radiation oncology; the other for those engaged in the study or clinical practice of radiation oncology--a new chapter, on radiologic terrorism, is specifically for those in the radiation sciences who would manage exposed individuals in the event of a terrorist event. The 17 chapters in Section I represent a general introduction to radiation biology and a complete, self-contained course especially for residents in diagnostic radiology and nuclear medicine that follows the Syllabus in Radiation Biology of the RSNA. The 11 chapters in Section II address more in-depth topics in radiation oncology, such as cancer biology, retreatment after radiotherapy, chemotherapeutic agents and hyperthermia.

Radiobiology for the Radiologist

" Management of Hyperglycemia in Type 2Diabetes : A Patient-Centered Approach — Position Statement of the American Diabetes Association(ADA) and the European Association for the Study of Diabetes(EASD)" was published in Diabetes Care and Diabetology in April this year.It,first,emphasizes the control of hyperglycemia in the treatment of T2DM;second,sets up the target of control of hyperglycemia flexibly according to natural course of disease,pathological condition,accompanied diseases,age,and life expectancy of the patients;third,once again emphasizes metformin for first-line use;fourth,more specifically discusses the applications,therapeutic effects,and advantages and disadvantages of various insulin preparations,GLP-1,DPP-4inhibitors and GLP-1receptor agonists;fifth,states the individualization treatment;and sixth,underlines that all patients should accept diabetes education aimed at hyperglycemia control.

A better comprehension of “Management of Hyperglycemia in Type 2 Diabetes:A Patient-Centered Approach—Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)”

Osteosarcoma is the most common malignant bone tumor, currently treated with pre-and postoperative chemotherapy in association with the surgical removal of the tumor. About 15-20% of patients have evidence of metastases at diagnosis, mostly in the lungs. Patients with metastatic disease still have a very poor prognosis, with approximately 20-30% of long-term survivors, as compared with 65-70% of patients with localized disease. The optimum management of these patients has not been standardized yet due to several patterns of metastatic disease harboring different prognosis. Complete surgical resection of all sites of disease is mandatory and predictive of survival. Patients with multiple sites of disease not amenable to complete surgery removal should be considered for innovative therapeutic approaches because of poor prognosis.

Metastatic osteosarcoma: a challenging multidisciplinary treatment

Cholangiocarcinomas are rare biliary tract tumors that are often challenging to diagnose and treat. Cholangiocarcinomas are generally categorized as intrahepatic or extrahepatic depending on their anatomic location. The majority of patients with cholangiocarcinoma do not have any of the known or suspected risk factors and present with advanced disease. The optimal evaluation and management of patients with cholangiocarcinoma requires thoughtful integration of clinical information, imaging studies, cytology and/or histology, as well as prompt multidisciplinary evaluation. The current review focuses on recent advances in the diagnosis and treatment of patients with cholangiocarcinoma and, in particular, on the role of endoscopy, surgery, transplantation, radiotherapy, systemic therapy, and liver-directed therapies in the curative or palliative treatment of these individuals. Cancer 2016;122:1349-1369. © 2016 American Cancer Society.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.29692

Evaluation and management of intrahepatic and extrahepatic cholangiocarcinoma

Although a variety of imaging modalities are used or currently being investigated for patients with brain tumors including brain metastases, clinical image interpretation to date uses only a fraction of the underlying complex, high-dimensional digital information from routinely acquired imaging data. The growing availability of high-performance computing allows the extraction of quantitative imaging features from medical images that are usually beyond human perception. Using machine learning techniques and advanced statistical methods, subsets of such imaging features are used to generate mathematical models that represent characteristic signatures related to the underlying tumor biology and might be helpful for the assessment of prognosis or treatment response, or the identification of molecular markers. The identification of appropriate, characteristic image features as well as the generation of predictive or prognostic mathematical models is summarized under the term radiomics. This review summarizes the current status of radiomics in patients with brain metastases.

PET/MRI Radiomics in Patients With Brain Metastases

PURPOSE To report the results of stereotactic body radiotherapy (SBRT) for unresectable primary or recurrent cholangiocarcinoma. MATERIALS AND METHODS From January 2005 through August 2013, 58 patients with unresectable primary (n = 28) or recurrent (n = 30) cholangiocarcinoma treated by SBRT were retrospectively analyzed. The median prescribed dose was 45 Gy in 3 fractions (range, 15 to 60 Gy in 1-5 fractions). Patients were treated by SBRT only (n = 53) or EBRT + SBRT boost (n = 5). The median tumor volume was 40 mL (range, 5 to 1,287 mL). RESULTS The median follow-up duration was 10 months (range, 1 to 97 months). The 1-year, 2-year overall survival rates, and median survival were 45%, 20%, and 10 months, respectively. The median survival for primary group and recurrent group were 5 and 13 months, respectively. Local control rate at 1-year and 2-year were 85% and 72%, respectively. Disease progression-free survival rates at 1-year and 2-year were 26% and 23%, respectively. In univariate analysis, ECOG performance score (0-1 vs. 2-3), treatment volume ( 12 months interval from surgery to recurrence showed statistically significant higher overall survival rate than those with ≤12 months (p = 0.026). Six patients (10%) experienced ≥grade 3 complications. CONCLUSION SBRT can be considered as an effective local modality for unresectable primary or recurrent cholangiocarcinoma.

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Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma.

// Won Il Jang 1, * , Mi-Sook Kim 1, 2 , Shin Hee Kang 2, * , Ae Jung Jo 2 , Yun Jung Kim 2 , Ha Jin Tchoe 2 , Chan Mi Park 2 , Hyo Jeong Kim 2 , Jin A Choi 2 , Hyung Jin Choi 3 , Eun-Kyung Paik 1 , Young Seok Seo 1 , Hyung Jun Yoo 1 , Jin-Kyu Kang 1 , Chul Ju Han 4 , Yeon Ju Kim 4 , Sang Beom Kim 5 , Min Jung Ko 2 1 Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea 2 Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul 04554, Republic of Korea 3 Department of Anatomy, Seoul National University College of Medicine, Seoul 03080, Republic of Korea 4 Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea 5 Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea * These authors contributed equally to this work and share co-first author Correspondence to: Mi-Sook Kim, email: mskim@kirams.re.kr Min Jung Ko, email: minjungko@neca.re.kr Keywords: pancreatic cancer, resection, diabetes, metformin, nationwide database Received: October 04, 2016      Accepted: November 24, 2016      Published: January 05, 2017 ABSTRACT Background: Preclinical studies support an antitumor effect of metformin. However, clinical studies have conflicting results and metformin’s effect remains controversial. The aim of this study was to evaluate metformin’s effect on clinical outcomes in diabetic patients with pancreatic cancer treated with curative resection. Results: A total of 764 patients underwent curative resection, met none of the exclusion criteria, and were prescribed oral hypoglycemic agents. The cancer-specific survival (5-year, 31.9% vs. 22.2%, p < 0.001) was significantly higher in the 530 metformin users than in the 234 diabetic metformin non-users. After multivariable adjustments, metformin users had significantly lower cancer-specific mortality as compared with metformin non-users (hazard ratio, 0.727; 95% confidence interval, 0.611–0.868). Cubic spline regression analysis demonstrated significantly decreased cancer-specific mortality with increasing dose of metformin ( p = 0.0047). Materials and Methods: Data were provided from the Korea Central Cancer Registry and the National Health Insurance Service in the Republic of Korea. The study cohort consisted of 28,862 patients newly diagnosed with pancreatic cancer between 2005 and 2011. Metformin exposure was determined from prescription information from 6 months before the first diagnosis of pancreatic cancer to last follow-up. The main outcome was cancer-specific survival. Conclusions: This large study indicates that metformin might decrease cancer-specific mortality rates in localized resectable pancreatic cancer patients with pre-existing diabetes, independently of other factors, with a dose-response relationship.

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Association between metformin use and mortality in patients with type 2 diabetes mellitus and localized resectable pancreatic cancer: a nationwide population-based study in korea

Background It is unclear whether radiomic phenotypes of brain metastases (BM) are related to radiation therapy prognosis. This study assessed whether a convolutional neural network (CNN)-based radiomics model which learned computer tomography (CT) image features with minimal preprocessing, could predict early response of BM to radiosurgery. Materials and methods Tumor images of 110 BM post stereotactic-radiosurgery (SRS) (within 3 months) were assessed (Response Evaluation Criteria in Solid Tumor, version 1.1) as responders (complete or partial response) or non-responders (stable or progressive disease). Datasets were axial planning CT images containing the tumor center, and the tumor response. Datasets were randomly assigned to training, validation, or evaluation groups repeatedly, to create 50 dataset combinations that were classified into five groups of 10 different dataset combinations with the same evaluation datasets. The CNN learned using training-group images and labels. Validation datasets were used to choose the model that best classified evaluation images as responders or non-responders. Results Of 110 tumors, 57 were classified as responders, and 53 as non-responders. The area under the receiver operating characteristic curve (AUC) of each CNN model for 50 dataset combinations ranged from 0.602 [95% confidence interval (CI)=36.5-83.9%] to 0.826 [95% CI, 64.3-100%]. The AUC of ensemble models, which averaged prediction results of 10 individual models within the same group, ranged from 0.761 (95% CI=55.2-97.1%) to 0.856 (95% CI=68.2-100%). Conclusion A CNN-based ensemble radiomics model accurately predicted SRS responses of unlearned BM images. Thus, CNN models are able to predict SRS prognoses from small datasets.

Prediction of Response to Stereotactic Radiosurgery for Brain Metastases Using Convolutional Neural Networks.

PURPOSE The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2009 and 2013. MATERIALS AND METHODS We analyzed open claims data from the Health Insurance Review and Assessment Service. The subjects were patients who had diagnostic codes C00-C97 or D00-D48 according to the 10th revision of the International Classification of Diseases, with procedure codes indicating RT treatment. RESULTS The total number of patients who received RT in 2009, 2010, 2011, 2012, and 2013 were 45,571, 49,593, 54,671, 59,172, and 61,485, respectively. Among them, the total numbers of male and female patients were 20,780/24,791 in 2009, 22,711/26,882 in 2010, 24,872/29,799 in 2011, 27,101/32,071 in 2012, and 27,941/33,544 in 2013. The five cancers that were most frequently treated with RT between 2009 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. The three leading types of cancer among the male patients were lung, colorectal, and liver cancers, whereas in female patients, they were breast, uterine cervical, and lung cancers. The type of cancer most commonly treated by RT was cancer of the central nervous system in patients aged 20 years or less, breast cancer in patients aged 30-50 years, and lung cancer in patients aged 60 years or more. CONCLUSION Data from this study provided the clinical utilization of RT in Korea between 2009 and 2013.

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The clinical utilization of radiation therapy in Korea between 2009 and 2013

Purpose The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2011 and 2015. Materials and methods We analyzed the claims data from the Health Insurance Review and Assessment Service to estimate the clinical utilization of RT. The source population consisted of all patients who had any of the International Classification of Diseases 10th revision cancer diagnoses (C00-C97) and those with diagnostic codes D00-D48, who were also associated with at least one of the procedure codes related to RT. Results The total number of patients who received RT in 2011, 2012, 2013, 2014, and 2015 were 54,810, 59,435, 61,839, 64,062, and 66,183, respectively. Among them, the total numbers of male and female patients were 24,946/29,864 in 2011, 27,211/32,224 in 2012, 28,111/33,728 in 2013, 29,312/34,750 in 2014, and 30,266/35,917 in 2015. The utilization rate of RT in cancer patients has also increased steadily over the same period from 25% to 30%. The five cancers that were most frequently treated with RT between 2011 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. More than half of cancer patients (64%) were treated with RT in the capital area (Seoul, Gyeonggi, and Incheon). Conclusion The total number of patients who underwent RT increased steadily from 2011 to 2015 in Korea. The utilization rate of RT in cancer patients is also increasing.

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Eun Kyung Paik

Papers

Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma.

Association between metformin use and mortality in patients with type 2 diabetes mellitus and localized resectable pancreatic cancer: a nationwide population-based study in korea

Prediction of Response to Stereotactic Radiosurgery for Brain Metastases Using Convolutional Neural Networks.

The clinical utilization of radiation therapy in Korea between 2009 and 2013

The Clinical Utilization of Radiation Therapy in Korea between 2011 and 2015.