Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.ctro.2022.09.005

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Intensive chemotherapeutic regimens with craniospinal irradiation have greatly improved survival in medulloblastoma patients. However, survival markedly differs among molecular subgroups and their biomarkers are unknown. Through unbiased screening, we found Schlafen family member 11 (SLFN11), which is known to improve response to DNA damaging agents in various cancers, to be one of the top prognostic markers in medulloblastomas. Hence, we explored the expression and functions of SLFN11 in medulloblastoma. METHODS: SLFN11 expression for each subgroup was assessed by immunohistochemistry in 98 medulloblastoma patient samples and by analyzing transcriptomic databases. We genetically or epigenetically modulated SLFN11 expression in medulloblastoma cell lines and determined cytotoxic response to the DNA damaging agents cisplatin and topoisomerase I inhibitor SN-38 in vitro and in vivo. RESULTS: High SLFN11 expressing cases exhibited significantly longer survival than low expressing cases. SLFN11 was highly expressed in the WNT-activated subgroup and in a proportion of the SHH-activated subgroup. While WNT activation was not a direct cause of the high expression of SLFN11, a specific hypomethylation locus on the SLFN11 promoter was significantly correlated with high SLFN11 expression. Overexpression or deletion of SLFN11 made medulloblastoma cells sensitive and resistant to cisplatin and SN-38, respectively. Pharmacological upregulation of SLFN11 by the brain-penetrant histone deacetylase-inhibitor RG2833 markedly increased sensitivity to cisplatin and SN-38 in SLFN11-negative medulloblastoma cells. Intracranial xenograft studies also showed marked sensitivity to cisplatin by SLFN11-overexpression in medulloblastoma cells. CONCLUSIONS: High SLFN11 expression is one factor which renders favorable outcomes in WNT-activated and a subset of SHH-activated medulloblastoma possibly through enhancing response to cisplatin.

DOI： 10.1093/neuonc/noac243

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

Purpose: Patients with lung cancer and brain metastases represent a markedly heterogeneous population. Accurate prognosis is essential to optimally individualize care. In prior publications, we described the graded prognostic assessment (GPA), but a GPA for patients with small cell lung cancer (SCLC) has never been reported, and in non-small cell lung cancer (NSCLC), the effect of programmed death ligand 1 (PD-L1) was unknown. The 3-fold purpose of this work is to provide the initial report of an SCLC GPA, to evaluate the effect of PD-L1 on survival in patients with NSCLC, and to update the Lung GPA accordingly.Methods and Materials: A multivariable analysis of prognostic factors and treatments associated with survival was performed on 4183 patients with lung cancer (3002 adenocarcinoma, 611 nonadenocarcinoma, 570 SCLC) with newly diagnosed brain metastases between January 1, 2015, and December 31, 2020, using a multi-institutional retrospective database. Significant variables were used to update the Lung GPA.Results: Overall median survival for lung adenocarcinoma, SCLC, and nonadenocarcinoma was 17, 10, and 8 months, respectively, but varied widely by GPA from 2 to 52 months. In SCLC, the significant prognostic factors were age, performance status, extracranial metastases, and number of brain metastases. In NSCLC, the distribution of molecular markers among patients with lung adenocarcinoma and known primary tumor molecular status revealed alterations/expression in PD-L1 50% to 100%, PD-L1 1% to 49%, epidermal growth factor receptor, and anaplastic lymphoma kinase in 32%, 31%, 30%, and 7%, respectively. Median survival of patients with lung adenocarcinoma and brain metastases with 0, 1% to 49%, and >= 50% PD-L1 expression was 17, 19, and 24 months, respectively (P < .01), confirming PD-L1 is a prognostic factor. Previously identified prognostic factors for NSCLC (epidermal growth factor receptor and anaplastic lymphoma kinase status, performance status, age, number of brain metastases, and extracranial metastases) were reaffirmed. These factors were incorporated into the updated Lung GPA with robust separation between subgroups for all histologies.Conclusions: Survival for patients with lung cancer and brain metastases has improved but varies widely. The initial report of a GPA for SCLC is presented. For patients with NSCLC-adenocarcinoma and brain metastases, PD-L1 is a newly identified significant prognostic factor, and the previously identified factors were reaffirmed. The updated indices establish unique criteria for SCLC, NSCLC-nonadenocarcinoma, and NSCLC-adenocarcinoma (incorporating PD-L1). The updated Lung GPA, available for free at brainmetgpa.com, provides an accurate tool to estimate survival, individualize treatment, and stratify clinical trials. (C) 2022 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.ijrobp.2022.03.020

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

This study aimed to evaluate the effect of target positioning error (TPE) on radiobiological parameters, such as tumor control probability (TCP) and normal tissue complication probability (NTCP), in stereotactic radiosurgery (SRS) for metastatic brain tumors of different sizes using CyberKnife. The reference SRS plans were created using the circular cone of the CyberKnife for each spherical gross tumor volume (GTV) with diameters (φ) of 5, 7.5, 10, 15, and 20 mm, contoured on computed tomography images of the head phantom. Subsequently, plans involving TPE were created by shifting the beam center by 0.1-2.0 mm in three dimensions relative to the reference plans using the same beam arrangements. Conformity index (CI), generalized equivalent uniform dose (gEUD)-based TCP, and NTCP of estimated brain necrosis were evaluated for each plan. When the gEUD parameter "a" was set to - 10, the CI and TCP for the reference plan at the φ5-mm GTV were 0.90 and 80.8%, respectively. The corresponding values for plans involving TPE of 0.5-mm, 1.0-mm, and 2.0-mm were 0.62 and 77.4%, 0.40 and 62.9%, and 0.12 and 7.2%, respectively. In contrast, the NTCP for all GTVs were the same. The TCP for the plans involving a TPE of 2-mm was 7.2% and 68.8% at the φ5-mm and φ20-mm GTV, respectively. The TPEs corresponding to a TCP reduction rate of 3% at the φ5-mm and φ20-mm GTV were 0.41 and 0.99 mm, respectively. TPE had a significant effect on TCP in SRS for metastatic brain tumors using CyberKnife, particularly for small GTVs.

DOI： 10.1007/s12194-022-00655-5

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Other Link： https://link.springer.com/article/10.1007/s12194-022-00655-5/fulltext.html

Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/acm2.13322

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/acm2.13322

Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

<title>Abstract</title>
We aimed to compare the outcomes of high-dose-rate brachytherapy (HDR-BT) boost and external beam radiation therapy (EBRT) alone for high-risk prostate cancer. This was a single-center, retrospective and observational study. Consecutive patients who underwent initial radical treatment by HDR-BT boost or EBRT alone from June 2009 to May 2016 at the Niigata University Medical and Dental Hospital, Japan were included. A total of 96 patients underwent HDR-BT boost, and 61 underwent EBRT alone. The prescription dose of HDR-BT boost was set to 18 Gy twice a day with EBRT 39 Gy/13 fractions. The dose for EBRT alone was mostly 70 Gy/28 fractions. The high-risk group received &amp;gt;6 months of prior androgen deprivation therapy. Overall survival, biochemical-free survival, local control and distant metastasis-free survival rates at 5 years were analyzed. The incidence of urological and gastrointestinal late adverse events of Grade 2 and above was also summarized. In the National Comprehensive Cancer Network (NCCN) high-risk calssification, HDR-BT boost had a significantly higher biochemical-free survival rate at 5 years (98.9% versus 90.7%, P = 0.04). Urethral strictures were more common in the HDR-BT boost group. We will continuously observe the progress of the study patients and determine the longer term results.

DOI： 10.1093/jrr/rrab006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Through geometrical simulation, we evaluated the effect of rotational error in patient setup on geometrical coverage and calculated the maximum distance between the isocenter and target, where the clinical PTV margin secures geometrical coverage with a single-isocenter technique. We used simulated spherical GTVs with diameters of 1.0 (GTV 1), 1.5 (GTV 2), 2.0 (GTV 3), and 3.0 cm (GTV 4). The location of the target center was set such that the distance between the target and isocenter ranged from 0 to 15 cm. We created geometrical coverage vectors so that each target was entirely covered by 100% of the prescribed dose. The vectors of the target positions were simultaneously rotated within a range of 0°-2.0° around the x-, y-, and z-axes. For each rotational error, the reduction in geometrical coverage of the targets was calculated and compared with that obtained for a rotational error of 0°. The tolerance value of the geometrical coverage reduction was defined as 5% of the GTV. The maximum distance that satisfied the 5% tolerance value for different values of rotational error at a clinical PTV margin of 0.1 cm was calculated. When the rotational errors were 0.5° for a 0.1 cm PTV margin, the maximum distances were as follows: GTV 1: 7.6 cm; GTV 2: 10.9 cm; GTV 3: 14.3 cm; and GTV 4: 21.4 cm. It might be advisable to exclude targets that are > 7.6 cm away from the isocenter with a single-isocenter technique to satisfy the tolerance value for all GTVs.

DOI： 10.1007/s12194-020-00602-2

PubMed

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Other Link： http://link.springer.com/article/10.1007/s12194-020-00602-2/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：British Institute of Radiology  

<sec><title>Objectives:</title> We evaluated the radiobiological effectiveness based on the yields of DNA double-strand breaks (DSBs) of field induction with flattening filter (FF) and FF-free (FFF) photon beams.

</sec><sec><title>Methods:</title> We used the particle and heavy ion transport system (PHITS) and a water equivalent phantom (30 × 30 × 30 cm³) to calculate the physical qualities of the dose-mean lineal energy (y_D) with 6 MV FF and FFF. The relative biological effectiveness based on the yields of DNA-DSBs (RBE_DSB) was calculated for standard radiation such as 220 kVp X-rays by using the estimating yields of SSBs and DSBs. The measurement points used to calculate the in-field y_D and RBE_DSB were located at a depth of 3, 5, and 10 cm in the water equivalent phantom on the central axis. Measurement points at 6, 8, and 10 cm in the lateral direction of each of the three depths from the central axis were set to calculate the out-of-field y_D and RBE_DSB.

</sec><sec><title>Results:</title> The RBE_DSB of FFF in-field was 1.7% higher than FF at each measurement depth. The RBE_DSB of FFF out-of-field was 1.9 to 6.4% higher than FF at each depth measurement point. As the distance to out-of-field increased, the RBE_DSB of FFF rose higher than those of FF. FFF has a larger RBE_DSB than FF based on the yields of DNA-DSBs as the distance to out-of-field increased.

</sec><sec><title>Conclusions:</title> The out-of-field radiobiological effect of FFF could thus be greater than that of FF since the spreading of the radiation dose out-of-field with FFF could be a concern compared to the FF.

</sec><sec><title>Advances in knowledge:</title> The RBE_DSB of FFF of out-of-field might be larger than FF.

</sec>

DOI： 10.1259/bjro.20200072

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/acm2.13081

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/acm2.13081

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

This study investigated the efficacy and safety of radiotherapy as part of multidisciplinary therapy for advanced hepatocellular carcinoma (HCC). Clinical data of 49 HCC patients treated with radiotherapy were assessed retrospectively. The efficacy of radiotherapy was assessed by progression-free survival, disease control rate, and overall survival. Safety was assessed by symptoms and hematological assay, and changes in hepatic reserve function were determined by Child–Pugh score and albumin–bilirubin (ALBI) score. Forty patients underwent curative radiotherapy, and nine patients with portal vein tumor thrombus (PVTT) underwent palliative radiotherapy as part of multidisciplinary therapy. Local disease control for curative therapy was 80.0% and stereotactic body radiotherapy was 86.7% which was greater than that of conventional radiotherapy (60.0%). Patients with PVTT had a median observation period of 651 days and 75% three-year survival when treated with multitherapy, including radiotherapy for palliative intent, transcatheter arterial chemoembolization, and administration of molecular targeted agents. No adverse events higher than grade 3 and no changes in the Child–Pugh score and ALBI score were seen. Radiotherapy is safe and effective for HCC treatment and can be a part of multidisciplinary therapy.

DOI： 10.3390/cancers12102955

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Society of Clinical Oncology (ASCO)  

<sec><title>PURPOSE</title> Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility.

</sec><sec><title>METHODS</title> A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively.

</sec><sec><title>RESULTS</title> Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation ( P &lt; .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non–small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively.

</sec><sec><title>CONCLUSION</title> Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient &gt; 0.50).

</sec>

DOI： 10.1200/jco.20.01255

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

PURPOSE: Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. METHODS AND MATERIALS: A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively. RESULTS: Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01). CONCLUSIONS: MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.

DOI： 10.1016/j.ijrobp.2020.01.051

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.ejmp.2020.04.007

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

<title>Abstract</title>
<sec>
<title>Background</title>
Breast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM).


</sec>
<sec>
<title>Methods</title>
A retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the BCBM.


</sec>
<sec>
<title>Results</title>
The overall receptor discordance rate was 132/316 (42%), and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors—nonetheless, median survival (MS) improved but did not reach statistical significance (HR, 17–28 mo, P = 0.12; HER2, 15–19 mo, P = 0.39). MS for patients who lost receptors was worse (HR, 27–18 mo, P = 0.02; HER2, 30–18 mo, P = 0.08).


</sec>
<sec>
<title>Conclusions</title>
Receptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost, and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly.


</sec>
<sec>
<title>Key Points</title>
1. Receptor discordance alters subtype in 32% of BCBM patients.


2. The frequency of receptor gain for HR and HER2 was 25% and 13%, respectively.


3. If receptors are lost, survival suffers. If receptors are gained, consider targeted treatment.


</sec>

DOI： 10.1093/neuonc/noaa025

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

Background and purpose: Concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). As Candida spp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients. Patients and methods: We retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC. Results: We identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22-6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029). Conclusion: Candida infection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.

DOI： 10.1016/j.ctro.2019.10.006

PubMed

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1186/s12885-020-6559-3

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Other Link： http://link.springer.com/article/10.1186/s12885-020-6559-3/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：AME Publishing Company  

DOI： 10.21037/apm.2018.12.02

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

There are no quantitative selection criteria for identifying high-grade glioma (HGG) patients who are suited for volumetric-modulated arc therapy (VMAT). This study aimed to develop selection criteria that can be used for the selection of the optimal treatment modality in HGG. We analyzed 20 patients with HGG treated by 3D conformal radiotherapy (3DCRT). First, VMAT plans were created for each patient retrospectively. For each plan, the normal tissue complication probability (NTCP) for normal brain was calculated. We then divided the patients based on the NTCPs of the 3DCRT plans for normal brain, using the threshold of 5%. We compared the NTCPs of the two plans and the gross tumor volumes (GTVs) of the two groups. For the GTVs, we used receiver operating characteristic curves to identify the cut-off value for predicting NTCP < 5%. We determined the respective correlations between the GTV and the GTV's largest cross-sectional diameter and largest cross-sectional area. In the NTCP ≥ 5% group, the NTCPs for the VMAT plans were significantly lower than those for the 3DCRT plans (P = 0.0011). The NTCP ≥ 5% group's GTV was significantly larger than that of the NTCP < 5% group (P = 0.0016), and the cut-off value of the GTV was 130.5 cm3. The GTV was strongly correlated with the GTV's largest cross-sectional diameter (R2 = 0.82) and largest cross-sectional area (R2 = 0.94), which produced the cut-off values of 7.5 cm and 41 cm2, respectively. It was concluded that VMAT is more appropriate than 3DCRT in cases in which the GTV is ≥130.5 cm3.

DOI： 10.1093/jrr/rry106

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

BACKGROUND: To determine the current practice of stereotactic irradiation (STI) for brain metastases in Japan by a questionnaire survey. METHODS: A questionnaire was distributed to 313 institutions performing STI with one of the following machines: Gamma Knife (GK), CyberKnife (CK), Novalis (Nov), or other linear accelerator (LINAC)-based systems (OLS). The participation was voluntary. RESULTS: There were 163 responding institutions. The total number of STI treatments between April 2013 and March 2014 was 10,684. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) were performed in 8624 (80.7%) and 2060 (19.3%) cases, respectively. Whole-brain radiation therapy (WBRT) was performed for a total of 3515 cases. For a case model of a 1.5-cm solitary brain metastasis in a non-eloquent area, the most common GTV-PTV margin was 2 mm (22 of 114 institutions), and an institutional standard fraction was 1 (75 of 114 institutions). The doses for the model case also varied from 13.0 to 26.0 Gy (Median 20 Gy) when converted to SRS (α/β = 10). A prescription point was at the PTV margin the most. The median dose constraints which were converted to SRS (α/β = 3) to organs at risk were 12.2, 12.7, and 13.7 Gy for optic nerves, cavernous sinus, and brainstem, respectively. CONCLUSIONS: STI for brain metastases in current practice varied significantly among institutions. These different strategies relied mostly on the type of treatment machine used. It is thus necessary to establish a common guideline to express dose prescriptions and plan qualities for different STI machines.

DOI： 10.1007/s10147-018-1313-4

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Other Link： http://link.springer.com/content/pdf/10.1007/s10147-018-1313-4.pdf

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

Background and purpose: To compare chemoradiotherapy (CRT) with low-dose continuous 5-fluorouracil (5FU) to CRT with 5FU+cisplatin (CDDP) for esophageal squamous cell carcinoma (ESCC) in a retrospective cohort study. Methods and materials: We reviewed the cases of Stage I-IV ESCC patients who underwent definitive CRT in 2000-2014. Concomitant chemotherapy was one of the three regimens: (1) high-dose intermittent 5FU and CDDP (standard-dose FP: SDFP), (2) low-dose continuous 5FU and CDDP (LDFP), or (3) low-dose continuous 5FU (LD5FU). The general selection criteria for chemotherapy were: SDFP for patients aged <70 yrs; LDFP for those aged 70-74 yrs; LD5FU for those aged ≥75 yrs or with performance status (PS) ≥3. Propensity scores were derived with chemotherapy (LD5FU vs. 5FU+CDDP) as the dependent variable. Results: In a multivariate analysis, chemotherapy (LD5FU vs. SDFP, p = .24; LDFP vs. SDFP, p = .52) did not affect the overall survival (OS). LD5FU caused significantly less grade 3-4 leukopenia (9%) compared to SDFP (47%) and LDFP (44%) (p < .001). In a propensity-matched analysis, LD5FU affected neither OS (HR 1.06; 95%CI 0.55-2.05; p = .87) nor progression-free survival (HR 0.95, 95%CI 0.50-1.81; p = .87). Conclusion: CRT with low-dose continuous 5FU may be a less toxic option for elderly ESCC patients.

DOI： 10.1016/j.ctro.2017.12.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

PURPOSE: To investigate the effects of a respiratory gating and multifield technique on the dose-volume histogram (DVH) in radiotherapy for esophageal cancer. METHODS AND MATERIALS: Twenty patients who underwent four-dimensional computed tomography for esophageal cancer were included. We retrospectively created the four treatment plans for each patient, with or without the respiratory gating and multifield technique: No gating-2-field, No gating-4-field, Gating-2-field, and Gating-4-field plans. We compared the DVH parameters of the lung and heart in the No gating-2-field plan with the other three plans. RESULT: In the comparison of the parameters in the No gating-2-field plan, there are significant differences in the Lung V5Gy, V20Gy, mean dose with all three plans and the Heart V25Gy-V40Gy with Gating-2-field plan, V35Gy, V40Gy, mean dose with No Gating-4-field plan and V30Gy-V40Gy, and mean dose with Gating-4-field plan. The lung parameters were smaller in the Gating-2-field plan and larger in the No gating-4-field and Gating-4-field plans. The heart parameters were all larger in the No gating-2-field plan. CONCLUSION: The lung parameters were reduced by the respiratory gating technique and increased by the multifield technique. The heart parameters were reduced by both techniques. It is important to select the optimal technique according to the risk of complications.

DOI： 10.1007/s11604-016-0606-7

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AME Publishing Company  

DOI： 10.21037/tcr.2016.12.71

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Our objectives were to (1) investigate the feasibility of the use of the Japanese version of the Hopkins Verbal Learning Test-Revised (HVLT-R); (2) identify the clinical factors influencing the HVLT-R scores of patients undergoing whole-brain radiation therapy (WBRT); and (3) compare the neurocognitive function (NCF) after WBRT in different dose fractionation schedules. We administered the HVLT-R (Japanese version) before (baseline) and at four and eight months after WBRT in 45 patients who received either therapeutic (35Gy-in-14, n = 16; 30Gy-in-10, n = 18) or prophylactic (25Gy-in-10, n = 11) WBRT. Sixteen patients dropped out before the eight-month examination, due mostly to death from cancer. The Karnofsky Performance Status (KPS) 80-100 group had significantly higher baseline total recall (TR) scores (p = 0.0053), delayed recall (DR) scores (p = 0.012), and delayed recognition (DRecog) scores (p = 0.0078). The patients aged ≤65 years also had significantly higher TR scores (p = 0.030) and DRecog scores (p = 0.031). The patients who underwent two examinations (worse-prognosis group) had significantly decreased DR scores four months after WBRT compared to the baseline (p = 0.0073), and they were significantly more likely to have declined individual TR scores (p = 0.0017) and DR scores (p = 0.035) at four months. The eight-month HVLT-R scores did not significantly decline regardless of the WBRT dose fractionation. The baseline NCF was determined by age and KPS, and the early decline in NCF is characteristic of the worse-prognosis group.

DOI： 10.3390/ijms17111834

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Event date： 2022.11

Presentation type：Oral presentation (general)  

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Event date： 2022.11

Language：Japanese   Presentation type：Symposium, workshop panel (nominated)  

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Event date： 2022.11

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2022.7

Language：Japanese  

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Event date： 2021.11

Language：English  

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Event date： 2021.7

Language：English  

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Event date： 2020.10

Language：English   Presentation type：Poster presentation  

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Event date： 2020.10

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2020.10

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Event date： 2020.7 - 2020.8

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2019.11

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2019.11

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Event date： 2019.10

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2019.10

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Event date： 2018.10

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Event date： 2018.10

Language：English   Presentation type：Poster presentation  

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Event date： 2018.10

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Event date： 2018.10

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2018.7

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Event date： 2018.4

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Event date： 2018.4

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Event date： 2018.4

Language：Japanese   Presentation type：Poster presentation  

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Event date： 2017.11

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Event date： 2017.11

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Event date： 2017.11

Language：Japanese   Presentation type：Oral presentation (general)  

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Event date： 2017.11

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Event date： 2017.9

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Event date： 2017.9

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Event date： 2017.9

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Event date： 2017.4

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Event date： 2017.4

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Event date： 2017.4

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Event date： 2016.11

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Event date： 2016.11

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Event date： 2016.11

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Event date： 2016.11

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Event date： 2016.11

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Event date： 2016.10

Presentation type：Oral presentation (general)  

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Event date： 2016.10

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Event date： 2016.9

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Event date： 2016.4

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Event date： 2015.11

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Event date： 2015.10

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Event date： 2015.4

Language：Japanese  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：English  

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Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Language：Japanese   Presentation type：Public lecture, seminar, tutorial, course, or other speech  

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Language：Japanese   Presentation type：Poster presentation  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese  

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