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Spinal Instability as a Prognostic Factor in Patients With Spinal Metastasis of Castration-resistant Prostate Cancer. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:449-456. [PMID: 37405221 PMCID: PMC10316048 DOI: 10.21873/cdp.10238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND/AIM To evaluate the Spinal Instability Neoplastic Score (SINS) for prediction of survival in patients with spinal column metastasis of castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS A retrospective study of spinal instability was performed in patients with CRPC using SINS. Overall survival was evaluated starting from the time of SINS evaluation. The subjects were 42 patients with CRPC among 261 cases diagnosed with metastatic spinal tumors by radiologists, among 42,152 cases that underwent a body computed tomography scan at Kawasaki Medical School Hospital within 32 months from December 2013 to July 2016. RESULTS The median age was 78 (range=55-91 years), the median prostate-specific antigen (PSA) level at SINS evaluation was 42.1 (0.1-3,121.6) ng/ml, and 11 patients had visceral metastasis. The median periods from diagnosis of bone metastasis and development of CRPC to SINS evaluation were 17 (0-158) and 20 (0-149) months, respectively. The spine was stable in 32 cases (group S) and potentially unstable or unstable in 10 (24%) (group U). The median observation period was 17.5 (0-83) months and 36 patients died. The median survival period after SINS evaluation was longer in group S than that in group U (20 vs. 10 months, p=0.0221). In multivariate analysis, PSA level, visceral metastasis, and spinal instability were significant prognostic factors. The hazard ratio for patients in group U was 2.60 (95%CI=1.07-5.93, p=0.0345). CONCLUSION Spinal stability evaluated using SINS is a new prognostic factor for survival of patients with spinal metastasis of CRPC.
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Feasibility of magnetic resonance imaging-ultrasound guided high-dose-rate brachytherapy for localized prostate cancer: Preliminary results from a prospective study. Int J Urol 2022; 29:725-732. [PMID: 35355325 DOI: 10.1111/iju.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate preliminary outcomes of a prospective trial of magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer. METHODS In our prospective study, data from patients who underwent this treatment between April 1, 2020 and March 31, 2021 were analyzed. In the procedure, the applicator needle was inserted through the perineum to target the lesion on the multiparametric magnetic resonance imaging, which was fused onto the transrectal ultrasound image. The prescription dose was set at a single fraction of 19 Gy. Data from patients who received whole-gland high-dose-rate brachytherapy were extracted and compared with data from patients who received ultrafocal high-dose-rate brachytherapy, to evaluate the frequency of acute adverse events. RESULTS Eight patients underwent ultrafocal high-dose-rate brachytherapy with a median observation period of 7.75 months (range 5.96-15.36 months). No acute genitourinary or gastrointestinal adverse events were observed in this cohort. The planned procedure was completed in all patients, and no unexpected adverse events were observed; however, prostate-specific antigen failure was detected in one patient. In the 25 patients who underwent whole-gland high-dose-rate brachytherapy, acute genitourinary and gastrointestinal adverse events were observed in 88% and 20% of the patients, respectively. Ultrafocal high-dose-rate brachytherapy was a significant factor in avoiding acute adverse genitourinary events in univariate and multivariate analyses (P < 0.001 and P = 0.032, respectively). CONCLUSIONS Magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer is a safe and feasible treatment without acute genitourinary and gastrointestinal adverse events. Long-term observation and further investigation are warranted.
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A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using multicatheter interstitial brachytherapy: clinical results with a median follow-up of 60 months. Breast Cancer 2022; 29:636-644. [PMID: 35303282 DOI: 10.1007/s12282-022-01339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND We carried out the first multi-institutional prospective study on accelerated partial breast irradiation (APBI) via multicatheter interstitial brachytherapy in a shorter period for early breast cancer in Japan. METHODS Patient eligibility criteria included positive hormone receptors, tumors ≤ 3 cm and TNM stage pN0M0. After breast-conserving surgery (Japanese cylindrical resection) and histological confirmation of negative surgical margins and the absence of lymph node metastasis, applicator implantation was performed either postoperatively or intraoperatively. High-dose-rate brachytherapy of 36 Gy in 6 fractions was delivered. RESULTS Forty-six patients from six institutions received this treatment regimen, and the median follow-up time was 60 months (range 57-67 months). The median resected breast tissue volume was 81 cm3 (range 28-260 cm3). No Grade 4 late sequela, local recurrence nor death due to breast cancer were observed. Grade 2-3 sequelae such as rib fracture (2%), soft tissue necrosis (9%), fibrosis (20%), and breast pain (9%) were observed. The resected breast tissue volumes of the patients who had Grade ≥ 2 fibrosis and Grade < 2 fibrosis were 105.9 ± 32.3 cm3 and 76.3 ± 45.6 cm3, respectively, p = 0.02. The overall cosmetic outcome score of Excellent/Good was 74% at 60 months after APBI. Grade ≥ 1 fibrosis was observed in 44% and 92% of patients who scored Excellent/Good and Fair/Poor, respectively, p = 0.004. CONCLUSIONS This study showed excellent local control and survival results with minimal late sequelae.
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JASTRO/JCS Guidelines for radiotherapy in patients with cardiac implantable electronic devices. JOURNAL OF RADIATION RESEARCH 2020; 62:172-184. [PMCID: PMC7779359 DOI: 10.1093/jrr/rraa102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/19/2020] [Indexed: 06/12/2023]
Abstract
This publication is an English version of the Japanese Society for Radiation Oncology (JASTRO) and The Japanese Circulation Society official guidelines for patients with cardiac implantable electronic devices (CIEDs). Several radiotherapy-associated malfunctions have been reported for CIEDs such as pacemakers and implantable cardioverter-defibrillators. Accordingly, guidelines for radiotherapy in patients with CIEDs have been issued by other countries and societies. In August 2010, JASTRO published the ‘Radiotherapy Guidelines for Patients with Pacemakers and Implantable Defibrillators’ (hereafter referred to as the former guidelines). Given new findings in this decade, a multidisciplinary working group of radiation oncologists, medical physicists, radiation therapists and cardiologists jointly reviewed and revised the former guidelines.
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Long-term outcome of cutaneous melanoma patients treated with boron neutron capture therapy (BNCT). JOURNAL OF RADIATION RESEARCH 2020; 61:945-951. [PMID: 32990318 PMCID: PMC7674695 DOI: 10.1093/jrr/rraa068] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/15/2020] [Indexed: 05/11/2023]
Abstract
Our aim was to assess the long-term clinical outcome of boron neutron capture therapy (BNCT) using 10B-para-boronophenylalanine (BPA) as the boron delivery agent for cutaneous melanoma. Eight patients (eight lesions) were treated between October 2003 and April 2014. Their ages ranged from 48 to 86 years at the time of treatment. All of the targets were primary lesions and they were located on the sole or face. No patient had evidence of regional lymph node involvement, distant metastases or an active secondary cancer. The clinical stage was cT1-2N0M0 and performance scores were <2. BNCT was carried out at the Kyoto University Research Reactor (KUR). The patients were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin dose. Eight patients were evaluated and six showed a complete response (CR), while two patients had a partial response (PR). Of the two patients with a PR, one has remained a PR with brown spots persisting for 7.5 years following BNCT. The tumor in the other patient recurred after 6 years at the site of persisting brown macula. The overall control rate (CR + PR without recurrence) for the cohort was 88% (7/8). There have never been any adverse events >Grade 2 for the long follow-up period. Our results suggest that BNCT may be a promising treatment modality in the management of early stage cutaneous melanoma when wide local excision is not feasible.
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[The Liaison Service Models of Care for Metastatic Spinal Tumor]. Gan To Kagaku Ryoho 2020; 47:1135-1140. [PMID: 32829343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advances in cancer treatment helped in increasing the life expectancy of patients with cancer. However, a concomitant increase in the number of patients with bone metastases can be expected. A new multidisciplinary treatment strategy for patients with metastatic spinal tumors was designed, and has been practiced from 2013 in our hospital. The benefits of liaison treatment for metastatic spinal tumors is useful for early detection and early treatment before the collapse of the stabilization mechanism and the appearance of neurological symptoms, and enables team medical care by various experts. This system is a useful treatment for metastatic spinal tumors, because it enables radiotherapy and/or surgery before the onset of skeletal related events(SRE)and will also help maintain the activities of daily living(ADL)and quality of life(QOL)for patients with metastatic spinal tumors.
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Boron neutron capture therapy for vulvar melanoma and genital extramammary Paget's disease with curative responses. Cancer Commun (Lond) 2018; 38:38. [PMID: 29914570 PMCID: PMC6006671 DOI: 10.1186/s40880-018-0297-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/04/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although the most commonly recommended treatment for melanoma and extramammary Paget's disease (EMPD) of the genital region is wide surgical excision of the lesion, the procedure is highly invasive and can lead to functional and sexual problems. Alternative treatments have been used for local control when wide local excision was not feasible. Here, we describe four patients with genital malignancies who were treated with boron neutron capture therapy (BNCT). METHODS The four patients included one patient with vulvar melanoma (VM) and three with genital EMPD. They underwent BNCT at the Kyoto University Research Reactor between 2005 and 2014 using para-boronophenylalanine as the boron delivery agent. They were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin/mucosal doses. RESULTS All patients showed similar tumor and normal tissue responses following BNCT and achieved complete responses within 6 months. The most severe normal tissue response was moderate skin erosion during the first 2 months, which diminished gradually thereafter. Dysuria or contact pain persisted for 2 months and resolved completely by 4 months. CONCLUSIONS Treating VM and EMPD with BNCT resulted in complete local tumor control. Based on our clinical experience, we conclude that BNCT is a promising treatment for primary VM and EMPD of the genital region. Trial registration numbers UMIN000005124.
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Efficacy of prophylactic irradiation to the contralateral testis for patients with advanced-stage primary testicular lymphoma: an analysis of outcomes at a single institution. Int J Hematol 2017; 106:533-540. [DOI: 10.1007/s12185-017-2274-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/17/2022]
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Uncertainty of cosmetic evaluation after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study. Jpn J Radiol 2017; 35:381-388. [PMID: 28474300 DOI: 10.1007/s11604-017-0640-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We conducted a multi-institutional prospective study on accelerated partial breast irradiation (APBI) using interstitial brachytherapy. The clinical results over a minimum follow-up period of 30 months are presented here. MATERIALS AND METHODS Forty-six patients with breast cancer were treated with breast-conserving surgery and postoperative APBI. After confirmation of negative surgical margins and negative lymph nodes, a high-dose-rate brachytherapy protocol of 36 Gy/6 fractions was carried out. All clinical data were prospectively collected using the Common Terminology Criteria for Adverse Events ver. 3.0. RESULTS No recurrence was observed. Cumulative rates of grade 2 or higher late sequelae were 25% for fibrosis, 2% for fractures, 9% for pain, and 9% for soft tissue necrosis. Rates of excellent or good cosmetic results as assessed by the physician and patient were 93 and 89% at the 12-month follow-up and 76 and 74% at the 30-month follow-up, respectively. Large volumes of resected tissue in small breasts were associated with fibrosis of grade 2 or higher. CONCLUSION APBI in Japanese women provides satisfactory clinical results except for cosmetic outcomes. There is some difficulty with the assessment of fibrosis and cosmetic outcomes, especially in patients with small breasts. CLINICAL TRIAL REGISTRATION NUMBER UMIN000001677.
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A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: clinical results with a median follow-up of 26 months. Breast Cancer 2015; 23:861-868. [PMID: 26467037 DOI: 10.1007/s12282-015-0652-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy was performed. The first clinical results were reported with a median follow-up of 26 months. PATIENTS AND METHODS Forty-six female breast cancer patients with positive hormone receptors and tumors ≤3 cm, pN0M0, completed the protocol treatment. After breast-conserving surgery and histological confirmation of negative surgical margins and pN0, brachytherapy applicators were implanted either postoperatively (n = 45) or intraoperatively (n = 1). High-dose-rate brachytherapy of 36 Gy/6 fractions was delivered. All clinical data were prospectively collected using case report forms and the Common Terminology Criteria for Adverse Events ver.3.0. RESULTS At the median follow-up of 26 months, no breast cancer recurrence of any type was observed. Sequelae ≥G2 were dermatitis (G2, 7 %), fibrosis (G2, 11 %; G3, 4 %), fracture (G2, 2 %), pain (G2, 7 %; G3, 2 %), and soft tissue necrosis (G2, 6 %). Cosmetic outcomes evaluated by excellent/good scores were 100 % at pre-therapy (n = 46), 94 % at 12 months (n = 46), and 81 % at 24 months (n = 36), respectively. CONCLUSIONS Disease control and sequelae were satisfactory due to the strict eligibility and protocol-defined treatment parameters. The cosmetic outcomes were comparable to those of previous Japanese breast-conserving therapy series.
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A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: treatment planning and quality assurance. Radiat Oncol 2015; 10:126. [PMID: 26040632 PMCID: PMC4461989 DOI: 10.1186/s13014-015-0430-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Japan, breast-conserving surgery with closed cavity has generally been performed for breast cancer patients, and accelerated partial breast irradiation (APBI) is considered difficult because Asian females generally have smaller breast sizes than Western females. Therefore, common identification of target and treatment plan method in APBI is required. A prospective multicenter study was conducted in Japan to determine institutional compliance with APBI using high-dose-rate interstitial brachytherapy (ISBT) designed for Japanese female patients. METHODS For this study, 46 patients were recruited at eight institutions from January 2009 to December 2011. The reproducibility of the ISBT-APBI plan was evaluated using three criteria: (1) minimum clinical target volume dose with a clip dose ≥ 6 Gy/fraction, (2) irradiated volume constraint of 40-150 cm(3), and (3) uniformity of dose distribution, expressed as the dose non-uniformity ratio (DNR, V150/V100) < 0.35. The ISBT-APBI plan for each patient was considered reproducible when all three criteria were met. When the number of non-reproducible patients was ≤ 4 at study completion, APBI at this institution was considered statistically reproducible. RESULTS Half of the patients (52 %) had a small bra size (A/B cup). The mean values of the dose-constrained parameters were as follows: Vref, 117 cm(3) (range, 40-282), DNR, 0.30 (range, 0.22-0.51), and clip dose, 784 cGy (range, 469-3146). A total of 43/46 treatment plans were judged to be compliant and ISBT-APBI was concluded to be reproducible. CONCLUSIONS This study showed that multi-institutional ISBT-APBI treatment plan was reproducible for small breast patient with closed cavity.
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Docetaxel/ TS-1 with radiation for unresectable squamous cell carcinoma of the esophagus--a phase II trial. Anticancer Res 2014; 34:3759-3763. [PMID: 24982399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND We tried a new regimen of docetaxel / TS-1 (tegafur-gimestat-otastat potassium) combined with radiation for squamous cell carcinoma of the esophagus in a phase II trial. PATIENTS AND METHODS The patients, whose tumor invaded other organs without other organ metastasis, were given TS-1 (60 mg/m2/day) from days 1 to 14, and docetaxel (20-30 mg/m2) on days 1 and 8. They received radiation in 2.0 Gy from days 1 to 21. Patients were given a seven-day rest after the first course, and then were treated with the same regimen from days 28 to 49. RESULTS Seventeen cases were enrolled in the study. The response rate was 76.4% (13/17). The overall 5-year survival rate was 29.6% (5/17) and median survival time was 15.2 months. Adverse events more than grade 3 occurred in 10 cases. CONCLUSION This combination therapy may be one of the most effective treatments because of its lower rate of non-hematological adverse events and higher response rate. Three cases also underwent salvage surgery when the tumor recurred, and in one case, chemoradiation to a metastatic nodule on the thoracic wall was added.
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A survey of patients with inflammatory skin recurrence corresponding to the area of previous irradiation after postoperative radiotherapy for breast cancer. JOURNAL OF RADIATION RESEARCH 2011; 52:797-803. [PMID: 21997194 DOI: 10.1269/jrr.11010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One of the unusual patterns of local recurrence in breast cancer patient is an inflammatory skin recurrence (ISR) sharply demarcating the area of previous radiation fields. To clarify the characteristics of this recurrence, we conducted a nationwide survey. We sent a survey to radiation oncologists at 200 institutions in Japan and received answers from 92. Of these, 24 institutions had some experience with patients who developed ISR affecting the previously irradiated area. The case details of 16 patients from 11 institutions were available and analyzed in this study. Eight patients experienced ISR after breast conservative therapy (groupA) and 8 patients experienced ISR after post-mastectomy radiotherapy (groupB). The postoperative pathological examination of groups A and B showed positive axillary lymph-nodes in 7/8 and 8/8 patients, positive lymphatic invasion in 4/7 and 7/8 patients, and ER status negative in 7/8 and 6/7 patients respectively. Median survival period was 266 days in groupA and 1105 days in groupB (p = 0.0001). Patients who developed the ISR tended to have several characteristics, including positive lymph-node metastases, intensive lymphatic invasion, and ER status negative. Physicians should contemplate the diagnosis of ISR next to radiation recall or radiation dermatitis, especially when the aforementioned risk factors are present.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Data Collection
- Female
- Humans
- Inflammatory Breast Neoplasms/etiology
- Inflammatory Breast Neoplasms/pathology
- Japan
- Lymphatic Metastasis
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/etiology
- Neoplasm Recurrence, Local/pathology
- Skin Neoplasms/etiology
- Skin Neoplasms/pathology
- Skin Neoplasms/secondary
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Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radiotherapy - preliminary results. BJU Int 2011; 109:835-9. [DOI: 10.1111/j.1464-410x.2011.10519.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Japanese Multi-Institutional Feasibility Study of APBI Using Interstitial Brachytherapy. Brachytherapy 2011. [DOI: 10.1016/j.brachy.2011.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Radiation therapy in patients with implanted cardiac pacemakers and implantable cardioverter defibrillators: a prospective survey in Japan. JOURNAL OF RADIATION RESEARCH 2011; 52:516-521. [PMID: 21905310 DOI: 10.1269/jrr.10143] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Radiation Therapy in Patients with Implanted Cardiac Pacemakers and Implantable Cardio-defibrillators: A Prospective Survey in Japan. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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[A case of chemo-radiation therapy with high degree of efficacy for esophageal cancer with liver metastasis]. Gan To Kagaku Ryoho 2009; 36:2045-2048. [PMID: 20037318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 78-year-old man underwent a radical resection for esophageal cancer (Stage III) and cardiac gastric cancer (Stage IA) at another hospital 2 years ago. After the operation, he was followed at that hospital. In 2008, abdominal CT scan and FDG-PET/CT revealed a liver tumor. He was referred to our hospital and was diagnosed as esophageal cancer with liver metastasis. He received chemo-radiation therapy (CRT). The regimen was docetaxel hydrate (30 mg/m2, day 1, 8, 29 and 36) and S-1 (60 mg/m2, day 1-14 and day 29-45) with radiation (45 Gy) for liver metastasis. He finished the CRT without any hematotoxicity, liver disorder and non-hematotoxic adverse event (grade 3). Abdominal CT was done 2 months after the end of CRT and revealed that the tumor lesion disappeared completely. The patient is alive for 11 months after the CRT without any evidence of recurrence. The tumor disappeared completely for the last 11 months. We conclude that CRT is safe and very effective for esophageal cancer with liver metastasis.
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Whole-breast radiotherapy with shorter fractionation schedules following breast-conserving surgery: short-term morbidity and preliminary outcomes. Breast Cancer 2007; 15:86-92. [DOI: 10.1007/s12282-007-0010-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 08/13/2007] [Indexed: 11/28/2022]
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Does the Lung Dose/Volume Constraint on V20 Reduce the Incidence of Radiation Pneumonitis Without Compromising Treatment Outcome in Patients With Locally Advanced Non-Small Cell Lung Cancer? Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Efficacy and Feasibility of Cisplatin-Based Concurrent Chemoradiotherapy for Nasopharyngeal Carcinoma*. Jpn J Clin Oncol 2006; 36:620-5. [PMID: 16905756 DOI: 10.1093/jjco/hyl083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and feasibility of a cisplatin-based concurrent chemoradiotherapy (CRT) protocol based on Intergroup Study 0099 for nasopharyngeal carcinoma (NPC). METHODS Sixteen patients with stage II-IVB NPC were treated with a protocol of cisplatin-based concurrent CRT and adjuvant chemotherapy from 1998 to 2002. Three courses of cisplatin (80 mg/m2) were scheduled during 70 Gy of radiotherapy (RT), and two agents of adjuvant chemotherapy (FP regimen: cisplatin 80 mg/m2 and 5-fluorouracil 800 mg/m2/day by 4-day continuous infusion) were challenged. Overall survival (OS) and relapse-free survival (RFS) rates were calculated by the Kaplan-Meier method. RESULTS Median follow-up duration was 45 months. Both 3-year OS and RFS rates were 81%. Proportions of patients who tolerated each scheduled treatment were 94% for RT, 63% for concurrent chemotherapy and 38% for adjuvant chemotherapy. CONCLUSIONS Our protocol of the cisplatin-based concurrent CRT followed by adjuvant chemotherapy consisting of FP regimen was effective for Japanese patients with NPC. However, the doses and numbers of cycle of chemotherapy need to be modified because of the low compliance rate. Larger numbers of data accumulation and/or multi-institutional trials may be warranted to confirm the efficacy of this protocol.
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White matter changes on magnetic resonance imaging following whole-brain radiotherapy for brain metastases. ACTA ACUST UNITED AC 2006; 24:345-50. [PMID: 16958412 DOI: 10.1007/s11604-006-0039-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate white matter (WM) abnormalities induced by WBRT. MATERIALS AND METHODS Twenty-four patients (11 men and 13 women; age range 38-74 years, median 60 years) who survived for more than 1 year after completion of WBRT (radiation dose range 30-40 Gy, median 35 Gy) at our institution between January 2000 and June 2003 were followed up with magnetic resonance (MR) scans for 11-51 months (median 19 months). We evaluated WM changes attributable to WBRT as grade 0-6 and assessed possible contributing factors by statistical analysis. RESULTS WM changes were found in 20 patients: Eight were assessed as grade 2, three as grade 3, and nine as grade 5. In total, 12 patients developed grade 3 or higher WM changes. Age (<60 vs > or =60 years), sex, radiation dose (< or =35 vs >35 Gy), chemotherapy (with CDDP vs without CDDP), biologically effective dose (< or =120 vs >120 Gy1), and head width (<16.3 vs > or =16.3 cm) were found not to be relevant to the incidence or severity of the WM changes. CONCLUSION Long-term survivors who have under-gone WBRT may have a higher incidence of WM abnormalities.
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Radiation pneumonitis following concurrent accelerated hyperfractionated radiotherapy and chemotherapy for limited-stage small-cell lung cancer: Dose-volume histogram analysis and comparison with conventional chemoradiation. Int J Radiat Oncol Biol Phys 2005; 64:1100-5. [PMID: 16373082 DOI: 10.1016/j.ijrobp.2005.09.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 09/14/2005] [Accepted: 09/16/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was twofold: to determine whether the dose-volume metrics are valuable in predicting radiation pneumonitis (RP) in small-cell lung cancer (SCLC) patients treated with accelerated hyperfractionated radiotherapy and chemotherapy (AHFRT + CT); and to clarify how AHFRT influences the risk of RP in comparison to conventional once-daily radiotherapy and chemotherapy (QDRT + CT). METHODS AND MATERIALS Study subjects were 43 patients with SCLC treated with AHFRT + CT. Radiotherapy was delivered at 1.5 Gy/fraction (fr) twice daily to 45 Gy/30 fr/3 weeks. We analyzed the relation between RP incidence and several dosimetric factors. We also compared this series data with our previously published data from lung cancer patients treated with QDRT + CT. RESULTS Radiation pneumonitis Grades 1, 2, and 3 were observed in 28 patients, 7 patients, and 1 patient, respectively. Univariate analysis revealed that the percentage of lung volume receiving more than 15 Gy, 20 Gy, and 30 Gy (V15, V20, V30) and normal tissue complication probability were of predictive value for the development of RP. The 12-month cumulative incidences of RP greater than Grade 2 were 0%, 7.1%, 25%, and 42.9% in patients with a V20 of < or =20%, 21-25%, 26-30%, and > or =31%, respectively. These incidences were lower than that of our patients treated with QDRT + CT. CONCLUSIONS Dosimetric factors are valuable in predicting RP in SCLC patients treated with AHFRT + CT. Regarding the incidence of RP, AHFRT appears to have some advantage over QDRT.
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Radiation pneumonitis following accelerated hyperfractionated concurrent chemoradiation for small cell lung cancer-DVH analysis in comparison with conventionally fractionated chemoradiation. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Predictive value of dose-volume histogram parameters for pericardial effusion after concurrent chemoradiotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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[Hypothyroidism after radiotherapy to the neck]. NIHON IGAKU HOSHASEN GAKKAI ZASSHI. NIPPON ACTA RADIOLOGICA 2004; 64:146-50. [PMID: 15148791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE The purpose of this study was to investigate the incidence and possible predictors of hypothyroidism after radiotherapy to the neck, focusing on radiation dose-volume factors. METHODS AND MATERIALS Thyroid function was measured in 169 patients treated with radiation ports including the thyroid, between 1989 and 2000. Hypothyroidism was determined with an endpoint of elevated serum thyroid stimulating hormone(TSH) levels > 10.0 microU/ml. In 60 patients, radiation dose-volume factors were calculated; e.g., total volume of the thyroid, mean radiation dose to the thyroid, and %-volume of the thyroid which received radiation doses of no less than 10-70 Gy(V10-V70). The evaluated risk factors for hypothyroidism included these dose-volume factors, sex, age, primary disease, combined chemotherapy, and follow-up period. RESULTS Hypothyroidism was detected in 33 (19.5%) of the 169 patients. None of them had clinical symptoms of hypothyroidism. V10, V20, and V30 seemed to be possible predictors of hypothyroidism and had a significant impact on the peak level of serum TSH. CONCLUSION Radiation dose-volume factors of the thyroid seemed to correlate with the incidence of hypothyroidism, and V10, V20, and V30 had a significant impact on the peak level of serum TSH.
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Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2003; 57:113-9. [PMID: 12909223 DOI: 10.1016/s0360-3016(03)00434-6] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE We conducted a prospective trial of combined transarterial chemoembolization (TACE) and three-dimensional conformal radiotherapy (3D-CRT) for portal vein tumor thrombus (PVTT) in unresectable hepatocellular carcinoma (HCC). The aim of the present study was to investigate the efficacy and toxicity of this trial regime. METHODS AND MATERIALS Patients with unresectable HCC complicated with tumor thrombus in the first branch of portal vein were selected as eligible for this study. TACE was performed using Lipiodol, epirubicin hydrochloride, and mitomycin, followed by gelatin sponge cubes. The 3D-CRT was performed targeting the clinical target volume (CTV) defined as PVTT only to a total dose of 60 Gy using 10-MV accelerator. RESULTS A total of 19 patients were enrolled in this study. Survival rates at 1 and 2 years were 40.6% and 10.2%, respectively. The median survival time was 7.0 months. An objective response was observed in 11 of 19 cases (57.9%). Recanalization of the first portal branches was not observed; however, the protrusion of PVTT into the main portal trunk decreased in all cases. Growth of intrahepatic metastasis outside the 3D-CRT field was observed in 12 cases (63%). Deterioration of the Child-Pugh Score was observed in 5 of 6 cases with the percent volume of the total liver receiving a dose exceeding 30 Gy (V(30)) > or =40%, vs. 2 of 13 cases with a V(30) <40% (p < 0.01). CONCLUSION This combined therapy was feasible. Our results indicate that V(30) was a predictive test for deterioration of liver function. Further investigation of treatment modalities is needed to prevent the growth of intrahepatic metastasis.
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Three-dimensional treatment planning using electrocardiographically gated multi-detector row CT. Int J Radiat Oncol Biol Phys 2003; 56:235-9. [PMID: 12694844 DOI: 10.1016/s0360-3016(03)00096-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Information concerning the amount and nature of target motion is essential for the determination of internal margin size. However, there are few published reports outlining the motion with heart and aortic pulsation. We introduce a method for three-dimensional radiation treatment planning (3D-RTP) by using electrocardiographically (ECG) gated spiral scanning with a four-section CT system. We describe a new approach to visualize internal organ motion resulting from cardiac motion with ECG gated multidetector row CT. MATERIALS AND METHODS Five patients with lung or liver tumors were studied with a multidetector row CT system under shallow inspiration breath-holding. With retrospective ECG gating, only data acquired within a predefined interval of the cardiac cycle are used for image reconstruction. All reconstructed image data at diastolic and systolic phases of the cardiac cycle were transferred to the 3D-RTP system. The shift of the internal organs between the cardiac cycles was evaluated. RESULTS Cardiac contraction influences anterior thorax, pulmonary peripheral vessels, and liver position, in addition to locations near the heart. Apparent movements more than 5 mm between diastolic and systolic phases were observed in the left ventricle, right atrium, and superior vena cava. Two-phase imaging was useful for showing the movement of internal organs during cardiac contraction under breath-holding. CONCLUSIONS Spatial information using ECG-gated CT has the potential to determine the planning target volume of moving lung and liver tumors more precisely than conventional CT planning.
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Abstract
Esophageal ulcer is one of the most important late complications of the esophagus treated with radiation therapy, especially with intraluminal brachytherapy. We encountered a patient with esophageal cancer treated with external radiation therapy and intraluminal brachytherapy, who developed radiation ulcer and who had severe dysphagia soon after endoscopic biopsy of the ulcer edge. A 55-year-old man was diagnosed as esophageal cancer without symptoms. He received 60 Gy/30 Fr of external radiation therapy and 12 Gy/3 Fr of intraluminal brachytherapy at a point of 5 mm in depth from the mucosa surface. He developed an asymptomatic esophageal ulcer 13 months after treatment, and endoscopic biopsy was obtained from the edge of the ulcer. Thereafter, swallowing difficulties appeared, and endoscopy revealed severe esophageal stenosis and a deep ulcer. A possibility that the biopsy contributed to worsening the ulcer can be considered. Except for cases where relapse is apparent, endoscopic biopsy is considered to be avoided.
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Abstract
We reviewed the records of 36 patients with medically inoperable stage l-ll non-small cell lung carcinoma who were treated with radiotherapy. The median dose to the target was 60 Gy with conventional fractionation. Fifteen patients were treated without elective irradiation fields, while the remaining 21 were treated with extended fields including elective mediastinal regional lymph nodes. The overall survival rates at three and five years were 32.3% and 18.8%, the cause-specific survival rates were 40.9% and 27.3%, and the local control rates were 31.7% and 23.8%, respectively. In multivariate analysis the radiation dose had a marginally significant influence on the cause-specific survival, while tumor size had a significant influence on the local control rate. Only one patient had relapse in the regional mediastinal lymph nodes as the only site of metastasis. We conclude that the dose used in the present study is inadequate and recommend that further efforts be made to improve local control by dose escalation within a small target volume.
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Improvement of three-dimensional treatment planning models of small lung targets using high-speed multi-slice computed tomographic imaging. Int J Radiat Oncol Biol Phys 2002; 54:1210-6. [PMID: 12419450 DOI: 10.1016/s0360-3016(02)03813-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To improve the reliability of the patient model and reduce treatment volume by acquiring multi-slice computed tomographic (CT) data with the patients' single holding of breath at normal inhalation and exhalation. METHODS AND MATERIALS Seven patients with nine small peripheral lung cancer tumors underwent CT scanning under three respiration conditions using multi-slice CT: free breathing (FB), shallow inspiration (SI), and shallow expiration (SE). To compare the treatment plan created using the two-respiratory-phase images (SI + SE) with the plans created using only SE images or using only FB images, we attempted to calculate the true dosimetric characteristics for three-dimensional treatment planning taking respiratory movement into consideration. Minimum dose to the gross tumor volume (GTV) and ipsilateral lung dose-volume histogram (DVH) were calculated for the inhalation and exhalation positions of shallow breathing. RESULTS There was no significant difference between minimum doses of the GTV in the three treatment plans when using anteroposterior/posteroanterior parallel-opposed fields. However, there was a significant difference between the minimum doses of the GTV in the two-phase treatment plan and the minimum dose in the other treatment plans when using the four-field technique, consisting of shaped anterior, posterior, right and left lateral fields (p = 0.03, 0.04). Comparison of the percent volume of ipsilateral lung receiving a dose exceeding 20 Gy (V(20)) based on inhalation and exhalation CT data revealed that the V(20) of the two-phase plan was the smallest of the three treatment planning fields (p < 0.001). CONCLUSION Two-phase planning using multi-slice CT provides an immediate reduction in the amount of normal tissue treated and improved reliability of patient data for DVH modeling.
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Local radiation therapy for localized relapsed or refractory ovarian cancer patients with or without symptoms after chemotherapy. Int J Gynecol Cancer 2002; 12:250-6. [PMID: 12060445 DOI: 10.1046/j.1525-1438.2002.01096.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of this paper is to prospectively evaluate the effects of local radiation therapy upon localized ovarian cancer following chemotherapy. Patients with objective relapses or refractory disease but with localized epithelial ovarian cancers and who had undergone at least one regimen of chemotherapy were enrolled in this study. External irradiation was performed on all patients. Twenty patients, with a mean age of 53.8 +/- 10.3 y, were enrolled in this study. The median number of previous chemotherapies was 2. The interval between previous chemotherapy and radiation therapy was 4.5 months. The maximum diameter of the lesions was 3.6 +/- 1.8 cm. The irradiation dose was 52.3 +/- 8.3 Gy. Neither hematologic nor intestinal toxicity >grade 3 was observed. Forty-four disease sites, including the lymph nodes, vaginal cuff, pelvis, abdomen, subcutaneous regions, and the brain were irradiated. Thirty of these sites were symptom-free before irradiation. In patients with symptoms, the symptomatic relief was obtained in approximately 50% of patients. Smaller lesions (P = 0.024) and lymph nodes (P = 0.042) demonstrated better responses than larger lesions or other sites, respectively. Regression rates correlated with longer survivals (P = 0.0195) after radiation therapy. Survival was significantly better when radiation therapy was given before patients had symptoms (P = 0.001). Survival was also better in patients with lymph node disease only (P = 0.0069). We conclude that local radiation therapy may be one of the treatment options for relapsed or refractory but localized ovarian cancer, particularly when the tumor is small and/or located in the lymph nodes, even when patients had no symptoms.
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MESH Headings
- Adenocarcinoma, Clear Cell/drug therapy
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/radiotherapy
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/radiotherapy
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Carcinoma/drug therapy
- Carcinoma/pathology
- Carcinoma/radiotherapy
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/radiotherapy
- Combined Modality Therapy
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/radiotherapy
- Female
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Staging
- Neoplasms, Glandular and Epithelial/drug therapy
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/radiotherapy
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/radiotherapy
- Pilot Projects
- Prognosis
- Prospective Studies
- Survival Rate
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Local radiation therapy for localized relapsed or refractory ovarian cancer patients with or without symptoms after chemotherapy. Int J Gynecol Cancer 2002. [DOI: 10.1136/ijgc-00009577-200205000-00003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract.Fujiwara K, Suzuki S, Yoden E, Ishikawa H, Imajo Y, Kohno I. Local radiation therapy for localized relapsed or refractory ovarian cancer patients with or without symptoms after chemotherapy.The purpose of this paper is to prospectively evaluate the effects of local radiation therapy upon localized ovarian cancer following chemotherapy. Patients with objective relapses or refractory disease but with localized epithelial ovarian cancers and who had undergone at least one regimen of chemotherapy were enrolled in this study. External irradiation was performed on all patients. Twenty patients, with a mean age of 53.8 ± 10.3 y, were enrolled in this study. The median number of previous chemotherapies was 2. The interval between previous chemotherapy and radiation therapy was 4.5 months. The maximum diameter of the lesions was 3.6 ± 1.8 cm. The irradiation dose was 52.3 ± 8.3 Gy. Neither hematologic nor intestinal toxicity >grade 3 was observed. Forty-four disease sites, including the lymph nodes, vaginal cuff, pelvis, abdomen, subcutaneous regions, and the brain were irradiated. Thirty of these sites were symptom-free before irradiation. In patients with symptoms, the symptomatic relief was obtained in approximately 50% of patients. Smaller lesions (P = 0.024) and lymph nodes (P = 0.042) demonstrated better responses than larger lesions or other sites, respectively. Regression rates correlated with longer survivals (P = 0.0195) after radiation therapy. Survival was significantly better when radiation therapy was given before patients had symptoms (P = 0.001). Survival was also better in patients with lymph node disease only (P = 0.0069). We conclude that local radiation therapy may be one of the treatment options for relapsed or refractory but localized ovarian cancer, particularly when the tumor is small and/or located in the lymph nodes, even when patients had no symptoms.
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Reirradiation for locally recurrent lung cancer previously treated with radiation therapy. Int J Radiat Oncol Biol Phys 2002; 52:390-6. [PMID: 11872284 DOI: 10.1016/s0360-3016(01)02644-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Local recurrence of lung cancer after previous external beam irradiation poses some problems for subsequent management. We retrospectively reviewed our series of patients with local recurrence of lung cancer to evaluate the efficacy and safety of reirradiation. PATIENTS AND METHODS Between 1979 and 2000, 34 patients with local recurrence of lung cancer were retreated with external radiation. There were 29 males and 5 females ranging in age from 38 to 85 years (median: 69 years). At the time of reirradiation, the clinical stage was I or II in 2 patients, IIIa in 5 patients, IIIb in 14 patients, and IV in 13 patients. Reirradiation was performed in 18 patients with the aim of achieving a cure or prolongation of survival (radical treatment), while 16 patients were treated for improvement of their symptoms (symptomatic treatment). RESULTS The median interval between the initial radiation therapy and reirradiation was 23 months, with a range of 5 to 87 months. The dose of initial irradiation delivered to the tumor ranged from 30 to 80 Gy (median: 60 Gy) in 1.5--2.0-Gy fractions per day. During reirradiation, it ranged from 10 to 70 Gy (median: 50 Gy) in 1.8--3.0-Gy fractions per day. The cumulative dose delivered to the tumor by treatments of both initial and second irradiation ranged from 56.5 to 150 Gy (median: 110 Gy). A response was observed in 14 out of 18 patients given radical treatment (complete response, 6; partial response, 8). Twelve of the 16 patients (75%) given symptomatic treatment also showed a symptomatic benefit. The overall survival rate after reirradiation was 43% at 1 year and 27% at 2 years, with a median survival time of 8 months. The median survival time after radical treatment was 15 months, with a range of 3 to 58 months, whereas that after symptomatic treatment was 3 months, with a range of 1 to 14 months. Six long-term survivors lived for more than 20 months. Reirradiation-induced toxicity included symptomatic radiation pneumonitis in 19 patients and symptomatic radiation esophagitis in 6 patients. These toxicities were not fatal, and radiation myelopathy was not caused by reirradiation. CONCLUSION Based on this study, external beam reirradiation can achieve satisfactory results for local recurrence of lung cancer provided that attention is paid to the possible hazards.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Small Cell/mortality
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/radiotherapy
- Female
- Humans
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Staging
- Radiation Pneumonitis/etiology
- Radiotherapy Dosage
- Retrospective Studies
- Survival Rate
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A long-term survivor of leiomyosarcoma around the right side of the base of the skull: effective radiotherapy combined with intra-arterial chemotherapy. Int J Clin Oncol 2002; 7:57-61. [PMID: 11942051 DOI: 10.1007/s101470200007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a rare case of a leiomyosarcoma that developed around the right side of the base of the skull in a 51-year-old woman. The patient consulted our hospital complaining of pain in the right side of her neck and upper right arm in August 1994. A leiomyosarcoma, originating around the right side of the neck and base of the skull was diagnosed. Initially, surgery was planned, but invasion into the spinal canal was discovered. Curative resection of the leiomyosarcoma around the right side of the base of the skull was not possible. Therefore, external beam radiotherapy (EBRT) combined with intra-arterial chemotherapy and hyperthermia was employed. After the treatment, the tumor decreased in size to 45% of its initial volume, and, simultaneously, her symptoms completely disappeared. The patient initially remained clinically free of the disease, but showed reaggravations at the primary tumor site 3 years and 3 months, and 4 years and 11 months, after the first treatment. The reaggravations were treated with EBRT combined with intra-arterial chemotherapy. As a result, she survived for 5 years and 7 months after the first treatment.
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The transcriptional inhibition of DNA repair protein Rad51 enhances radiosensitivity in prostate cancer cells. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(01)01926-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Interstitial brachytherapy for recurrent breast cancer using a high dose rate Ir-192 remote afterloading system: a report of two cases. Breast Cancer 2001; 7:252-5. [PMID: 11029807 DOI: 10.1007/bf02967469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We employed interstitial brachytherapy using a high dose rate Ir-192 remote afterloading unit in two breast cancer patients with locoregional recurrence. In the first case, skin metastasis was treated, with favorable control of the infield tumor but subsequent persistent sequelae and multiple outfield metastases. This experience caused us to be cautious when choosing brachytherapy for the second case, in whom a solitary metastasis to an axillary lymph node was successfully treated. Although this method is still investigational, it may play a critical role in the treatment of locoregional recurrence resistant to other treatment modalities.
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Breast conservation for huge-sized locally advanced breast cancer: a case report. RADIATION MEDICINE 2001; 19:155-9. [PMID: 11467383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A 35-year-old woman with locally advanced stage IIIB breast cancer (medullary carcinoma) 12 cm in diameter underwent neoadjuvant chemotherapy consisting of three courses of intraarterial infusion [adriamycin (ADR), mitomycin (MMC), cisplatin (CDDP), 5-fluorouracil (5FU)] and four cycles of systemic chemotherapy (ADR, epirubicin, cyclophosphamide, MMC, CDDP) for three months. The tumor markedly diminished after the first course of intraarterial infusion chemotherapy, with a 3-cm tumor remaining after the completion of preoperative administration. Pathologically complete response was noted in specimens resected following breast conservation surgery. Postoperative radiotherapy was added and adjuvant chemohormonal therapy was continued for two years. The patient is alive without recurrence and has been able to conserve the breast for the past eight years, neoadjuvant chemotherapy including intraarterial infusion enabled breast conservation treatment even for huge-sized locally advanced breast cancer.
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Ectopic pregnancy showing interesting findings on MR imaging. AJR Am J Roentgenol 2001; 176:818-9. [PMID: 11222240 DOI: 10.2214/ajr.176.3.1760818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
A case of florid endocervical glandular hyperplasia with pyloric gland metaplasia is described. MR images showed multiple and conjugated cysts in the uterine cervix, which suggested adenoma malignum. A postoperative examination revealed florid but definitely benign endocervical glandular hyperplasia. Hitherto described radiologic features considered suggestive of adenoma malignum are not necessarily specific and can be a diagnostic pitfall.
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[A case of clear cell carcinoma of the ovary responding to a paclitaxel-carboplatin combination chemotherapy]. Gan To Kagaku Ryoho 2000; 27:2259-62. [PMID: 11142173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Clear cell carcinoma of the ovary is believed to be chemoresistant; therefore, choosing anticancer agents is often difficult. In this report we present a case of ovarian clear cell carcinoma that showed a significant response to a combination chemotherapy with paclitaxel and carboplatin. The patient is a 51-year-old Japanese female with a history of Gn-RH treatment for endometriosis that was terminated three years before the presentation of this disease. She was referred to our hospital because of a huge abdominal mass. The initial surgery revealed the tumor was a clear cell carcinoma of the left ovary, showing a predominantly solid growth pattern as well as papillary and tubular patterns. Both architectural and nuclear grades were interpreted as 3, and mitotic count was up to 5/10 high-power fields. Therefore, the tumor was considered to be grade 2. A huge para-aortic lymph node metastasis was not resectable. Combination chemotherapy using paclitaxel at 175 mg/m2 in 3 hr intravenous infusion followed by intraperitoneal infusion of carboplatin at AUC of 7.5 as a bolus was administered. The regression rate of the para-aortic lymph node metastasis was 85%, lasting more than 5 months. We believe that the combination of paclitaxel and carboplatin is one treatment choice for clear cell carcinoma of the ovary.
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Abstract
OBJECTIVE We attempted to prospectively determine the role of magnetic resonance imaging (MRI) in very early cervical cancer. STUDY DESIGN T2-weighted and T1-dynamic enhanced images from patients with invasive or noninvasive lesions of the cervix were reviewed by two radiologists who had no clinical information on these patients. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist. The correlation between MRI and histological findings was analyzed in terms of depth of invasion. RESULTS Seventy-nine cases were entered into the study and 75 were evaluable. Accuracy of T2 MR images for invasive and noninvasive disease by Radiologist 1 and Radiologist 2 was 0.8533 and 0.7733, respectively. Accuracy was greater (0.9867 and 0.9467, respectively) for the detection of noninvasive plus microinvasive lesions </=5 mm vs invasive lesions >5 mm. Dynamic technique provided only limited additional value in the detection of microinvasive cervical carcinoma. CONCLUSION Simple T2 MRI is useful in differentiating noninvasive or microinvasive cervical lesions from invasive cervical carcinoma of the cervix >5 mm.
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Expression of cell cycle regulator genes in KB, a human squamous cell carcinoma cell line, after irradiation. Int J Oncol 2000; 17:947-54. [PMID: 11029497 DOI: 10.3892/ijo.17.5.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
DNA damage induced by irradiation causes overexpression of the p53 gene, and subsequently the upregulation of p53 downstream genes involved in cell cycle modification. Irradiated malignant cells which possess wild-type p53 have been known to undergo G1 arrest due to p21/Cip1/Waf1 upregulation. Other p53 downstream genes related to the modification of the cell cycle such as gadd45 may cause G2 arrest. Many of the genes which regulate the cell cycle progression have been identified, including the G1 phase specific ink4 family of cyclin-dependent kinase inhibitors (CDK-I), another group of CDK-Is, which affect the cyclin-CDK complexes ubiquitously, and S/G2 accelerator genes. The sequential changes in these cell cycle regulator genes after irradiation has not been clarified. We analyzed the appearance of the apoptotic fraction and cell cycle perturbation after irradiation using KB, a human squamous cell carcinoma line derived from oral floor, and examined the alteration of gene expression for cell cycle regulator genes. The KB cells proceeded to undergo apoptosis in a time and dose dependent manner after irradiation and showed G2 arrest accompanied by upregulation of p53, ubiquitous CDK-Is, and S and G2 accelerator genes.
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The efficacy of conventional radiation therapy in the management of pituitary adenoma. Int J Radiat Oncol Biol Phys 2000; 47:1337-45. [PMID: 10889388 DOI: 10.1016/s0360-3016(00)00503-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of conventional radiotherapy for reducing tumor size and endocrine hypersecretion of pituitary adenomas. METHODS AND MATERIALS We reviewed the records of 91 patients with pituitary adenoma, who were first treated between 1969 and 1994 and had been followed for more than 2 years (median, 8.2 years.) Of these patients, 86 had received postoperative radiotherapy, and 5 had received radiotherapy alone. The median total dose was 51 Gy. Clinical symptoms related to mass effects or endocrine hypersecretion were assessed. The efficacy of radiotherapy was evaluated before treatment and during the follow-up period (1-14 years; median, 3 years) by estimating tumor size on computed tomography or magnetic resonance imaging in 56 patients, as well as by endocrine testing in the 22 patients who had secreting adenomas. Local control rate, prognostic factors, and side effects were analyzed. RESULTS Mass-effect symptoms improved in 72% and 79% of patients who had such symptoms due to nonsecreting adenomas and secreting adenomas, respectively. Symptoms of endocrine hypersecretion abated in 67% of patients who had such symptoms. Excessive hormone levels normalized in 74% of patients who showed endocrine hypersecretions. The greatest size reduction was seen 3 years after the completion of radiotherapy (24% CR, 62% PR, 12% NC, and 3% PD in nonsecreting adenomas, and 32% CR, 36% PR, 27% NC, and 5% PD in secreting adenomas). Three patients with secreting adenomas (2 with prolactinoma and 1 with Cushing's disease) showed a mismatch between reduction in tumor size and normalization of endocrine hypersecretion. The 10-year local control rates were 98%, 85%, 83%, and 67% for nonsecreting adenoma, growth-hormone-secreting adenoma, prolactinoma, and Cushing's disease, respectively. Univariate analyses showed that disease type and radiation field size were significant prognostic factors. Brain necrosis occurred in 1 patient who received a 60-Gy dose of irradiation. CONCLUSION We conclude that conventional external radiotherapy with 50 Gy is safe and sufficient to control pituitary adenoma. Careful observation is required in the management of secreting adenomas because the effects on tumor size and endocrine hypersecretion may be mismatched in some secreting adenomas.
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Role of magnetic resonance imaging (MRI) in early cervical cancer. Gan To Kagaku Ryoho 2000; 27 Suppl 2:576-81. [PMID: 10895214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The aim of this study was to prospectively determine if invasive carcinoma of the cervix can be ruled out by negative magnetic resonance image (MRI) findings. Eligible patients were those who were scheduled to undergo either hysterectomy or conization because of invasive or non-invasive lesions of the cervix. T2-weighted and T1-dynamic enhancement images were reviewed by two radiologists who had no information on these patients except for the preoperative diagnosis. Clinical information regarding location of the disease was not given. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist who was not provided with MRI information. The correlation between MRI and histological findings was analyzed in terms of depth of invasion. Seventy cases were entered and 66 were evaluable. Sensitivities of T2 and dynamic MRI for invasive and non-invasive disease by radiologist 1 were 0.8824 and 0.8235, respectively, and those by radiologist 2 were 0.6296 and 0.7647, respectively. Specificities were 0.8776 and 0.8571, respectively, for radiologist 1 and 0.8974 and 0.8367, respectively, for radiologist 2. When sensitivities and specificities were calculated for prediction of non-invasive plus microinvasive lesions < or = 5 mm vs. invasive lesions > 5 mm, specificities of T2 and dynamic MRI became 1.0000 for both radiologists. Negative findings on T2 and/or dynamic MRI indicated non-invasive or early invasive cervical diseases < or = 5 mm. The dynamic technique provided only limited additional value in the detection of early invasive cervical carcinoma.
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High dose rate Microselectron mould radiotherapy of a widespread superficial oral cancer. Int J Oral Maxillofac Surg 1999. [DOI: 10.1016/s0901-5027(99)80059-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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High dose rate microselectron mould ratiotherapy of a widespread superficial oral cancer. Int J Oral Maxillofac Surg 1999; 28:451-3. [PMID: 10609747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Treatment of a case of widespread superficial oral squamous cell carcinoma with external beam irradiation, followed by high dose rate Microselectron mould radiotherapy, is reported. The tumor disappeared macroscopically after treatment, but there was infield recurrence in the buccogingival sulcus where the radiation dose might have been inadequate. Apart from some radiation mucositis within the treated area, edema and a superficial ulcer were observed in the tongue. These were considered to be due to radiation overdose. Although there is room for improvement, this mode of treatment has something to offer patients with hard-to-cure cancer.
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High dose rate Microselectron mould radiotherapy of a widespread superficial oral cancer. Int J Oral Maxillofac Surg 1999. [DOI: 10.1034/j.1399-0020.1999.280609.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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[Optimal thoracic irradiation for stage IV lung cancer]. NIHON IGAKU HOSHASEN GAKKAI ZASSHI. NIPPON ACTA RADIOLOGICA 1999; 59:689-97. [PMID: 10565173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
To investigate optimal thoracic irradiation (TI) for stage IV lung cancer, we retrospectively reviewed 150 patients. In all, 101 patients underwent radiotherapy for the primary lesion, and 130 had radiotherapy for metastasized sites. TI fields were basically divided into two groups; whole thoracic lesion irradiation (WTLI) and partial thoracic lesion irradiation (PTLI). Overall survival rates at 6 months, 1 year and 2 years were 58%, 27% and 11%, respectively, and MST was 7.1 months. There was no difference in survival according to histological type. On univariate analysis, the factors of good prognosis included good PS, free of bone metastasis, metastasis limited to a single organ, TI, chemotherapy, age (less than or equal to 75 years), and TN factors (T0-2 and N0-1). Multivariate analysis showed PS was the predominant factor. Among the patients treated with TI, survival rates of patients with PS 0-1 were superior to those of patients with PS 2-4. Radiation pneumonitis was more frequent in WTLI than in PTLI. The rates of thoracic failure death were 31.7% in patients treated with TI and 63.3% without TI. However, the size of the thoracic radiation field did not affect the rates of thoracic failure death. We concluded that TI for stage IV patients could reduce thoracic symptoms and increase the survival rate in the subgroup with good PS. Furthermore, we considered PTLI was worth while in the subgroup with poor PS.
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