In recent years, technological innovations in radiotherapy have been remarkable, thanks to progress in computer technology and therapeutic equipment, and various high precision radiotherapy have been established.

Intensity-modulated radiation therapy (IMRT) can conduct complicated dose calculations by computer control and inverse planning and allows sufficient target dose applications while keeping the risk organs within the tolerance dose. Volumetric-modulated arc therapy (VMAT) is an irradiation technique that adds intensity-modulation to conformal radiotherapy, which shortens the treatment time. Image-guided radiotherapy (IGRT) is an irradiation technique that reproduces the irradiation position, which is determined by the treatment plan, by three-dimensional measurements.

Particle therapy is a form of high-precision radiotherapy that uses protons and heavy-particles (carbon-ion), which are obtained from large accelerators, such as cyclotrons and synchrotrons. Since the particle does not advance beyond a certain depth, called Bragg peak, it is possible to concentrate the dose onto the lesion. Particle therapy has the advantage of providing a low radiation dose to risk organs; thus, the risk of adverse events is low.

High-precision radiotherapy is expected to improve treatment outcomes and reduce side effects.

Our philosophy is to conduct chemotherapy for patients with advanced cancers as safely as possible and to carry out palliative care in parallel. To further promote home palliative care as a medical policy in Japan, we examined how extensively this policy was introduced among terminal patients discharged from our hospital department in the past year. We reviewed the records of deceased discharged patients for one year from Nov. 2015 to Oct. 2016. The total number of hospitalizations was 353, and the number of hospitalized patients was 173. Among all hospitalized cancer patients, 33 patients left hospital mortality, of which 25 were hospitalized urgently. Overall, only 27 % received home palliative care. We were not able to confirm the place of death desired by many of these discharged terminal patients. Therefore, we recommend that terminal cancer patients and their families decide in advance where and when home palliative care should start to maintain high quality of life until the end of life.

Objective: The relationship between cerebral infarction (CI) and cerebral microbleeds (CMB) is not fully understood. We sought to elucidate the clinical features of CMB by investigating its incidence and distribution in CI patients, and examined relationships among the risk factors for stroke.

Materials and Methods: We retrospectively reviewed 162 CI patients who were treated and underwent head MRI including T2*-weighted images at our hospital in 2016. Clinical information, such as type of CI, past history, MRA findings and laboratory data, were collected and analyzed for correlation with CMB.

Results: CMB was observed in 59 patients (36.4 %). The factors found to significantly correlate with CMB were male sex (p=0.0351), past history of hypertension (p=0.0152) and lacunar infarction as the current CI subtype (p=0.0489). Anti-thromboembolic drug use (p=0.5148) and hemorrhagic tendency based on laboratory data were not significant factors (p=0.4912). EGFR (estimated glomerular filtration rate) was significantly lower in patients with CMB (57.9±22.4 mL/min vs 66.3±24.6 mL/min, p=0.0276). We analyzed the location of major vessel stenosis and the distribution of CMB, but no relationships were observed (p=0.5672).

Conclusion: There was no correlation between the location of major vessel stenosis and the distribution of CMB, confirming that CMB is not an ischemic change but rather lipohyalinosis induced by hypertension. Deep CMB may be a useful biomarker for chronic kidney disease or underlying hypertension with careful differentiation of iron deposits in basal ganglia.