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

DOI： 10.1002/acm2.13322

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

DOI： 10.1007/s12194-020-00602-2

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

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

DOI： 10.1002/mp.14699

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

DOI： 10.1002/acm2.13081

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Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

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Other Link： http://id.ndl.go.jp/bib/030405007

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

DOI： 10.1016/j.ctro.2019.10.006

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Language：Japanese   Publisher：金原出版(株)  

当院における前立腺癌の放射線治療成績を三次元原体照射(3D-CRT)併用高線量率組織内照射(HDR-BT)と強度変調放射線治療(IMRT)について遡及的にまとめ、各リスク分類やリスク因子別に検討し、どのような症例が3D-CRT併用HDR-BTの良い適応となるのかを探索した。HDR-BTまたはIMRTを施行した前立腺癌の初発根治治療目的の連続症例を対象とした。症例の内訳はHDR-BT 230例、IMRT 140例である。HDR-BT群とIMRT群における5年時点での全生存率、生化学的非再発生存率、局所制御率は各94.7%/95.2%、95.2%/93.7%、98.4%/95.2%であり、両群間に有意差はなかった。CAPRA分類が高リスクの症例ではHDR-BTの局所制御率がIMRTよりも有意に高く、CAPRA中リスクの症例では全生存率、生化学的非再発生存率、局所制御率に有意差はなかった。D'Amico分類での高リスク症例、NCCN分類での高リスク以上の症例でも、両者には有意差がなかった。このほか、年齢、Tステージ、グリソンスコア、PSA、生検陽性本数で解析を行った結果、両群の差が統計学的有意となる因子は5年時点では見いだせなかった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01565&link_issn=&doc_id=20190531180011&doc_link_id=10.18888%2Frp.0000000891&url=https%3A%2F%2Fdoi.org%2F10.18888%2Frp.0000000891&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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

DOI： 10.1093/jrr/rry106

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Language：Japanese   Publisher：Japanese Society of Radiological Technology  

In monitor unit (MU) independent verification by calculation for irregular field (MLC field) using multileaf collimator in X-ray therapy, it has become common to use collimator scatter factor (<i>S</i>_c) and phantom scatter factor (<i>S</i>_p) instead of total scatter factor (<i>S</i>_{c, p}). It is usually expressed as <i>S</i>_{c, p} (<i>A</i>)=<i>S</i>_c (<i>A</i>)×<i>S</i>_p (<i>A</i>), and the field size <i>A</i> is considered but the depth <i>d</i> is not. <i>S</i>_c is data of in-air output, and measure with a mini-phantom at constant depth to remove electron contamination. On the other hand, <i>S</i>_p is obtained from measurement data of <i>S</i>_{c, p} and <i>S</i>_c, and can be expressed as <i>S</i>_{c, p} (<i>d</i>, <i>A</i>)=<i>S</i>_c (constant depth, <i>A</i>)×<i>S</i>_p (<i>d</i>, <i>A</i>) at an arbitrary depth <i>d</i>, thus <i>S</i>_p depends on the depth of <i>S</i>_{c, p}. Therefore, <i>S</i>_p needs to consider depth. In addition, a linear accelerator equipped with the tertiary MLC has two field sizes, that are collimator field by upper and lower collimators and MLC field by tertiary MLC below them. In MU independent verification by calculation, it is often used that the estimated value of <i>S</i>_p obtained by converting MLC field to equivalent square field and referring to data of <i>S</i>_p in square field. To convert the MLC field to equivalent square field, a conversion formula from sector radius <i>r</i> to equivalent square field <i>L</i> by Clarkson’s sector integration (Clarkson method) is used. In this study, using 24 types of MLC fields to evaluate estimation accuracy due to the difference of conversion formula in Clarkson method, we estimated value of <i>S</i>_p using <i>r</i>=0.5611<i>L</i> of B-Clarkson method and using <i>r</i>=0.5580<i>L</i> of A-Clarkson method. And the difference with the measured value of <i>S</i>_p obtained by measuring <i>S</i>_{c, p} and <i>S</i>_c in the same MLC fields was compared. While, to evaluate estimation accuracy due to the different depths using these Clarkson methods, the difference between estimated value and measured value of <i>S</i>_p similarly obtained at depth of 5, 10 and 15 cm was compared. As results, estimated value of <i>S</i>_p using A-Clarkson method than using B-Clarkson method was close to measured value, and it was the same trend at depth of 5, 10 and 15 cm. Therefore, it was suggested that estimation accuracy of <i>S</i>_p by A-Clarkson method is higher than B-Clarkson method when verifying beams with different depths in MU independent verification by calculation for MLC field.

DOI： 10.6009/jjrt.2019_jsrt_75.12.1426

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Other Link： http://id.ndl.go.jp/bib/030183658

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Radiological Technology  

Countermeasures against respiratory movement are important for tumors of thorax and abdomen in stereotactic body radiation therapy. In the present paper, a web-camera-based-respiratory monitoring method without contact with patient’s body was proposed for respiratory study. Thoracic and abdominal motion images were taken by a web camera, and were analyzed using simple image-processing techniques for obtaining respiratory waveforms. Four motion images with different respiration rate were obtained from resusci anne simulator. Respiration waveforms were estimated from the moving images by the proposed method, and were compared with respiration waveforms obtained by the conventional respiratory monitoring device. That was found to have a strong correlation. In addition, the two waveforms were similar in Bland–Altman method comparison. The proposed method can provide non-contact, non-invasive, simple, and realistic respiratory monitoring system for radiotherapy.

DOI： 10.6009/jjrt.2018_JSRT_74.11.1286

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Other Link： http://id.ndl.go.jp/bib/029359646

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

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

DOI： 10.1016/j.ctro.2017.12.003

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Language：Japanese   Publisher：日本定位放射線治療学会  

悪性神経膠腫において強度変調回転放射線療法(VMAT)がより有効である症例の選別基準の方法を構築することを目的として、VMATと三次元原体照射法(3DCRT)の治療計画を放射線誘発性脳壊死のリスク指標とした正常組織障害発生確率(NTCP)を用いて比較した。3DCRTで放射線治療が施行された20例を対象とした。PTVinitialについては、Conformity index(CI)に関してVMATが3DCRTよりも有意に向上しており、PTVboostについてもCIはVMATが有意に向上した。正常脳の平均線量については両治療計画間に有意差は認められなかった。3DCRTにおける正常脳のNTCP 5%未満の群においては、3DCRTとVMATのNTCPの中央値は各々1.2%、0.8%であり有意差は認められなかった。しかし、3DCRTにおける正常脳NTCP 5%以上の群においてはそれぞれ9.6%、4.0%であり、VMATで有意に減少した。また、肉眼的標的体積はNTCP 5%以上の群で大きく、カットオフ値は130.5ccであった。

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

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Other Link： http://hdl.handle.net/10191/47192

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

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：新潟大学医学部保健学科  

著者等は数値計算言語(MATLAB)を使ってPC上で動作するDICOM画像から体積を算出するプログラムを開発し、その有用性と正確度を検討した。CTの水平断像上に関心領域(ROI)を設置し、設定した閾値で必要な領域を抽出して三次元表示し、体積測定を行うこととした。本プログラムを用いて、64列CTで実施した死後CT検査5例について、肝、脾、腎を抽出した。ImageJにて目的とする臓器にROIを設定して面積を算出し、厚さを乗じて体積を測定した。臓器ごとに、ImageJにて求めた体積に最も近い値が得られるように閾値を決定した。著者等が開発したプログラムとImageJで測定した平均体積は、肝がそれぞれ1690.3±505.1cm3と107.9±60.7cm3、脾が107.9±60.7cm3と105.5±62.4cm3、腎が141.1±26.4cm3と143.9±32.1cm3であり、有意差は認められなかった。体積測定に要した平均時間は開発したプログラムの方が有意に短かった。著者等が開発したPC上で動作するDICOM画像の体積測定プログラムを用いると、簡便かつ正確に臓器の体積を測定することが可能であった。

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Other Link： http://dspace.lib.niigata-u.ac.jp/dspace/bitstream/10191/47194/1/14%281%29_27-33.pdf

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

We investigated the outcomes of treatment for patients with localized prostate cancer (PCA) treated with 3D conformal radiation therapy (3D-CRT) followed by two-fraction high-dose-rate brachytherapy within a single day (2-fr.-HDR-BT/day) at a single institution. A total of 156 consecutive Asian males (median age, 67 years) were enrolled. To compare our findings with those of other studies, we analyzed our results using the D'Amico classification, assigning the patients to low- (n =5
3.2%), intermediate- (n =36
23.1%) and high-risk (n =115
73.7%) groups (Stage T3 PCA patients were classified as high-risk). One patient in the D'Amico low-risk group (20%), 13 intermediate-risk patients (36.1%) and 99 high-risk patients (86.1%) underwent androgen deprivation therapy. We administered a prescription dose of 39 Gy in 13 fractions of 3D-CRT combined with 18 Gy of HDR-BT in two 9-Gy fractions delivered within a single day. We did not distinguish between risk groups in determining the prescription dose. The median follow-up period was 38 months. Of the 156 patients, one died from primary disease and five died from other diseases. The 3-year overall survival (OS) rates were 100%, 100% and 93.7%, and the 3-year 'biochemical no evidence of disease (bNED)' rates were 100%, 100% and 96.9% for the D'Amico low-, intermediate- and high-risk groups, respectively. No patient developed ≥ Grade 3 early toxicity. The Grade 3 late genitourinary toxicity rate was 2.6%, and no ≥ Grade 3 late gastrointestinal toxicity occurred. The efficacy and safety of this study were satisfactory, and longer-term follow-up is necessary.

DOI： 10.1093/jrr/rrw003

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Language：Japanese   Publisher：(公社)日本放射線技術学会-東北支部  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER ASSOC PHYSICISTS MEDICINE AMER INST PHYSICS  

Purpose: To achieve accurate tissue inhomogeneity corrections in radiotherapy treatment planning, the authors had previously proposed a novel conversion of the energy-subtracted computed tomography (CT) number to an electron density (Delta HU-rho(e) conversion), which provides a single linear relationship between Delta HU and rho(e) over a wide range of rho(e). The purpose of this study is to present an initial implementation of the Delta HU-rho(e) conversion method for a treatment planning system (TPS). In this paper, two example radiotherapy plans are used to evaluate the reliability of dose calculations in the Delta HU-rho(e) conversion method.
Methods: CT images were acquired using a clinical dual-source CT (DSCT) scanner operated in the dual-energy mode with two tube potential pairs and an additional tin (Sn) filter for the high-kV tube (80-140 kV/Sn and 100-140 kV/Sn). Single-energy CT using the same DSCT scanner was also performed at 120 kV to compare the Delta HU-rho(e) conversion method with a conventional conversion from a CT number to rho(e) (Hounsfield units, HU-rho(e) conversion). Lookup tables for.e calibration were obtained from the CT image acquisitions for tissue substitutes in an electron density phantom (EDP). To investigate the beam-hardening effect on dosimetric uncertainties, two EDPs with different sizes (a body EDP and a head EDP) were used for the rho(e) calibration. Each acquired lookup table was applied to two radiotherapy plans designed using the XiO TPS with the superposition algorithm for an anthropomorphic phantom. The first radiotherapy plan was for an oral cavity tumor and the second was for a lung tumor.
Results: In both treatment plans, the performance of the Delta HU-rho(e) conversion was superior to that of the conventional HU-rho(e) conversion in terms of the reliability of dose calculations. Especially, for the oral tumor plan, which dealt with dentition and bony structures, treatment planning with the HU-rho(e) conversion exhibited apparent discrepancies between the dose distributions and dose-volume histograms (DVHs) of the body-EDP and head-EDP calibrations. In contrast, the dose distributions and DVHs of the body-EDP and head-EDP calibrations coincided with each other almost perfectly in the Delta HU-rho(e) conversion for 100-140 kV/Sn. The difference between the V100' s (the mean planning target volume receiving 100% of the prescribed dose; a DVH parameter) of the body-EDP and head-EDP calibrations could be reduced to less than 1% using the H Delta U-rho(e) conversion, but exceeded 11% for the HU-rho(e) conversion.
Conclusions: The Delta HU-rho(e) conversion can be implemented for currently available TPS's without any modifications or extensions. The Delta HU-rho(e) conversion appears to be a promising method for providing an accurate and reliable inhomogeneity correction in treatment planning for any ill-conditioned scans that include (i) the use of a calibration EDP that is nonequivalent to the patient's body tissues, (ii) a mismatch between the size of the patient and the calibration EDP, or (iii) a large quantity of high-density and high-atomic-number tissue structures. (C) 2015 American Association of Physicists in Medicine.

DOI： 10.1118/1.4908207

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

BACKGROUND: To evaluate the risks and benefits of endoscopic submucosal dissection (ESD) in addition to chemoradiotherapy (CRT) for the treatment of superficial esophageal squamous cell carcinoma (SESCC). METHODS AND MATERIALS: We retrospectively reviewed the treatment outcomes of 47 patients with SESCC treated between October 2000 and December 2011. Sixteen patients with invasion into the submucosal layer (T1b) or the muscularis mucosa (m3) with positive vascular invasion were treated with CRT after ESD (ESD-CRT group). The lymph node area was irradiated to a total dose of 40-44 Gy and a boost radiation was administered if PET-positive lymph nodes or positive margins were observed. The remaining 31 patients received definitive CRT only (dCRT group). RESULTS: The radiation field was significantly larger in the ESD-CRT group; the "long T" was used in 11 patients (35.4%) in the dCRT group and 15 (93.7%) in the ESD-CRT group (p = 0.0001). The total radiation dose was smaller in the ESD-CRT group; 40 Gy was used in 10 patients (62.5%) in the ESD-CRT group and all but one patient in the dCRT group received ≥60 Gy (p = 0.00001). The 3-year overall survival rates in the dCRT and ESD-CRT groups were 63.2% and 90.0% respectively (p = 0.118). Recurrence developed in nine patients (29.0%) in the dCRT group and one (6.3%) in the ESD-CRT group. Local recurrence was observed in six patients (19%) in the dCRT group and none in the ESD-CRT-group (p = 0.029). Pericardial effusion (≥Grade 3) occurred in three patients (9.7%) in the dCRT group and none in the ESD-CRT group. CONCLUSIONS: ESD followed by CRT is an effective and safe approach for SESCC at m3 or T1b. This combination of ESD and CRT improves the local control rate, and it could decrease the number of cardiac toxicities due to a radiation-dose reduction relative to CRT alone.

DOI： 10.1186/s13014-015-0337-4

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

OBJECTIVE: For locoregional failure after chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC), salvage esophagectomy and endoscopic mucosal resection have disadvantages, such as a high morbidity rate and a high local recurrence rate, respectively. The aim of this study was to clarify the efficacy of salvage endoscopic submucosal dissection (ESD) for locoregional failure of CRT. METHODS: A total of 19 lesions in 19 patients were treated with salvage ESD; 15 lesions were local recurrences at the primary site and 4 lesions were residual. All lesions were intramucosal or submucosal tumors without metastases. A case-control study was retrospectively evaluated to clarify whether the clinical outcomes of salvage ESD were equivalent to those of control primary ESD. RESULTS: No significant differences were observed between salvage ESD and primary ESD in short-term outcomes, including procedure time. For salvage ESD, the complete en bloc resection rate was 94.7% (18 of 19), and no severe complications were observed. At a median follow up of 54.6 (range: 5-98) months after salvage ESD, the local recurrence rate was 0%. However, three patients (15.8%) died due to lymph node and distant metastases and six patients (31.5%) died from other diseases, including radiation pneumonitis, pyothorax or respiratory failure with no recurrence of ESCC. The 3-year overall survival rate for all 19 patients was 74%. CONCLUSIONS: ESD represents an acceptable treatment option for recurrent or residual ESCC because of its improvement in local control, when local failure after CRT is limited to the submucosal layer without metastases.

DOI： 10.3109/00365521.2013.822092

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Language：Japanese   Publisher：金原出版(株)  

2009年6月〜2011年4月に前立腺癌に対し、外照射と高線量率組織内照射の組み合わせで根治的な放射線治療を施行した64例を対象に、急性期の有害事象、主に尿路障害および消化管障害の発生頻度について調査した。対象はリンパ節および遠隔転移のない前立腺癌でUICC分類T1〜T3までの症例とした。Common Terminology Criteria Version4.0(CTCAE Ver4.0)でグレード(G)1以上の尿路障害は55例みられた。そのうちG2以上は8例で、内訳はG2頻尿3例、G2尿路痛2例、G2尿閉2例、G3前立腺痛1例であった。G1以上の消化管障害は34例で、G2以上は2例存在し、いずれも下痢症状であった。消化管以外の有害事象としてG2腰痛2例、G3意識消失発作2例、G1足背浮腫1例がみられた。意識消失発作はいずれも迷走神経反射によるもので、補液、硫酸アトロピン投与で軽快した。なお、アプリケータ抜去直後数日間は血尿が全例必発となり、出血量に応じ一時的な血圧低下が起こる症例もみられた。これらの項目は侵襲的な操作に伴い起こる有害事象のため集計から除いた。

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Language：Japanese   Publisher：医学図書出版(株)  

当院では、2009年より前立腺癌に対する放射線外照射併用による高線量率組織内照射療法(HDRBT)を開始した。初期経験(58例)における治療成績およびQOLの変化について検討した。周術期合併症(grade 2)が8例で認められた。追跡期間中央値20ヵ月にて、再発は1例のみであった。QOLに関しては、包括的尺度の一部および排尿機能においてHDRBT施行後早期より有意に低下したが、いずれも時間経過とともに改善する傾向が認められた。(著者抄録)

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

To determine the clinical results of radiotherapy (RT) for esophageal cancer in Japan.
A questionnaire-based survey was conducted for esophageal cancer treated by definitive RT between 1999 and 2003. Clinical results of definitive RT for patients were collected from 9 major institutions. Only patients with good performance status (PS 0-2) who received a total dose of 50 Gy or more were included. Patients were classified into three groups: (A) stage I, (B) resectable stages II-III, (C) unresectable stages III-IVA. For group A, all patients treated by RT alone or chemo-radiotherapy (CRT) were included. For groups B and C, only those treated by CRT were included.
In total, 167 patients were included in group A, 239 in group B, and 244 in group C. Approximately half of the patients in group A were treated by CRT. The median total RT dose ranged from 60 to 66 Gy. The median and range of the 5-year overall survival rates were 56% (48-83%) for group A, 29% (12-52%) for group B, and 19% (0-31%) for group C, respectively. A wide disparity in overall survival rates was noted among the institutions. A significant correlation between the number of patients treated per year and the 5-year overall survival rate was noted for groups B and C (both p &lt; 0.05).
Although the overall survival rates for stage I esophageal cancer were excellent, a significant disparity in survival rates was noted among the institutions for stage II-IVA tumors treated by CRT.

DOI： 10.1007/s10147-011-0254-y

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

A male in his seventies was referred to our hospital for treatment of superficial esophageal cancer. Esophagoscopy showed a circumferential reddish depressed and elevated lesion, about 7 cm in diameter located in the area from the middle to lower thoracic esophagus, and the depth of invasion was diagnosed as submucosal massive invasion. Chemoradiotherapy (CRT) that consisted of 66 Gy irradiation and low dose FP was performed and complete response was recognized. After 10 months of CRT, esophagoscopy revealed local recurrence at the primary site. Because the depth of invasion was sm2 by using EUS, we performed endoscopic submucosal dissection (ESD) for local recurrence lesion as salvage treatment. The lesion was successfully resected en-bloc fashion, with no complications. Histopathologically, the tumor was squamous cell carcinoma, with tumor size being 9x6 mm, pT1 b-SM (950 μm) , ly0, v0, HM0, VM0. For 41 months after ESD, the patient has been alive with no recurrence. Salvage esophagectomy for persistent or recurrent locoregional disease after CRT for esophageal cancer has a curative potential but is associated with high morbidity. Salvage ESD that enables the complete en bloc resection without complications provides an effective therapeutic option for locoregional failure after CRT.

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

We report the case of a 51-year-old woman who showed elevation of serum carcinoembryonic antigen (CEA) level 14 months after chemoradiation therapy for her cervical esophageal cancer. Close examination demonstrated that the patient was suffering from hypothyroidism probably due to the chemoradiation therapy. The serum CEA level decreased after starting supplementary treatment with oral levothyroxine. The exact mechanism underlying the elevated level of CEA observed in a patient with hypothyroidism is unclear. However, we should be aware of the possibility of transient elevation of CEA affected by thyroid function in patients after radiation therapy for head and neck cancer.

DOI： 10.1007/s10147-009-0005-5

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We present herein a case of a patient who was clinically diagnosed as having a granulocyte-colony stimulating factor (G-CSF)-producing tumor on the basis of the close correlation of the hematological parameters with the tumor status and his high serum G-CSF level. A 76-year-old male patient underwent transthoracic radical esophagectomy for advanced carcinoma of the lower esophagus. His leukocyte count and serum G-CSF level were markedly high at 24 260/μl and 134 pg/ml, respectively, before the operation. By immunohistochemical staining of the resected tumor, focal but obvious expression of G-CSF was demonstrated in the cytoplasm of cancer cells, and neutrophilic infiltration was histologically observed in adjacent struma of the tumor invasion front. After surgery, the leukocyte count decreased to a nearly normal level but increased again when the disease recurred in the pleura and lymph nodes 5 months later. Although palliative chemoradiotherapy decreased the leukocyte count to a normal level transiently, leukocyte count again markedly increased when metastatic disease occurred. The leukocyte count reached 78 060/μl the day before the patient died. © 2009 Japan Esophageal Soceity and Springer Japan.

DOI： 10.1007/s10388-009-0206-z

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OBJECTIVE: The aim of this study was to review the treatment outcomes of surgery and definitive chemoradiotherapy (CRT) in elderly patients with squamous cell carcinoma of the thoracic esophagus. METHODS: A total of 64 patients aged 75 or older were retrospectively reviewed; 40 were treated with surgery and 24 with CRT. The CRT group included eight patients with unresectable disease and four patients medically unfit for surgery. Surgery included esophagectomy with lymphadenectomy and CRT consisted of 60-70 Gy of radiation concurrent with 5-fluorouracil alone or combined with cisplatin. Short- and long-term outcomes and survival of each modality were assessed. RESULTS: In the surgery group, 33 patients (82.5%) had co-morbid conditions. Complete resection rate was 90.0%. An overall post-operative complication rate was 65.0% and in-hospital mortality was seen in three patients (7.5%). In the CRT group, complete response rate was 41.7%. Leukopenia was most common Grade 3 hematological toxicity. Treatment-related deaths caused by acute toxicities occurred in three patients (12.5%), whereas those caused by late toxicities in four (16.7%). For cStage I disease in the surgery group, the overall 1-, 3- and 5-year survival rate were 90.9%, 63.6% and 54.5%, respectively, with a median survival time of 78.7 months. For cStages II-IV, the median survival time of the surgery and the CRT group was 18.7 and 12.8 months, respectively. CONCLUSIONS: The short- and long-term outcomes of surgery for the elderly seemed acceptable; however, definitive CRT may be a promising treatment modality. Further investigation may alter the sphere of influence in the field of esophageal cancer treatment in the elderly.

DOI： 10.1093/jjco/hyp030

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

Background We evaluated the efficacy and toxicity of radiation combined with daily, low-dose protracted chemotherapy for locally advanced esophageal cancer.
Methods. We analyzed data for 68 patients with locally advanced esophageal cancer, including 1.8 surgical candidates. Standard fractionation (total dose range, 60 to 70Gy) was used for radiotherapy. The chemotherapy consisted of a daily 5-fluorouracil dose of 250mg/m(2), with a cis-diamminedichloro-platinum dose of 3 mg/m(2) administered on radiotherapy days.
Results. Sixty-four patients (94%) received at least 60Gy. Grade 3 acute hematological toxicity was observed in 13 (19%) patients; there was no grade 4 hematological toxicity. Complete response, partial response, no change, and progressive disease were obtained in 22, 35, 7, and 4 patients, respectively. Minimum follow-up for surviving patients was 45 months. Locoregional progression-free rates at 3 and 5 years were 47% and 47%. Four patients died of late cardiac toxicity; the primary site for all 4 patients was the middle thoracic esophagus. Overall survival rates at 2, 3, and 5 years were 40%, 32%, and 20%. The 3- and 5-year survival rates in patients with T2-3M0 disease were 43% and 27%, and the rates were 24% and 15% in patients with T4/M1.
Conclusion. Given the large proportion of patients in this study with inoperable disease (roughly three quarters), our treatment seemed to provide equivalent efficacy and less hematological toxicity than standard-dose chemoradiotherapy.

DOI： 10.1007/s10147-006-0617-y

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Purpose. To evaluate the incidence and risk factors of enlargement of cardiac silhouette on chest radiographs after radiotherapy for esophageal cancer. Materials and methods. We analyzed 67 patients with esophageal cancer who received external beam radiation therapy with a total dose of ≥50 Gy and were followed for ≥6 months. Sixteen patients received radiation alone, and the remaining 51 received chemoradiotherapy. The difference between the cardiothoracic ratio (CTR) on the pretreatment chest radiograph and that on the posttreatment radiograph with maximum cardiac silhouette for each patient was used for the analysis. Results. The average maximum increase in CTR for the entire group was 4.5%, which was statistically significant. Only the area of the cardiac silhouette in the initial radiation field was a significant risk factor for enlargement of the cardiac silhouette. Pericardial effusions were observed in all patients who underwent computed tomography with severe enlargement of the cardiac silhouette. Conclusion. The CTR value significantly increased after radiotherapy for esophageal cancer. Radiation-induced pericardial effusion may be the main cause of enlargement of the cardiac silhouette. The irradiated cardiac area was the only significant risk factor for enlargement of the cardiac silhouette
the use of chemotherapy was not. © Japan Radiological Society 2006.

DOI： 10.1007/s11604-006-0050-1

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Background: Superficial esophageal cancer (SEC) is defined as esophageal cancer limited to the submucosal layers, including mucosal cancer and submucosal cancer, and is squamous cell carcinoma in most patients. In 2000, the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group for SEC published a consensus guideline of standard radiotherapy methods. In this study, the interim treatment outcomes of SEC patients, who had received radiation therapy following the standard radiotherapy methods, were investigated. Patients and Methods: From 2000 to 2003, a total of 141 SEC patients were treated in 24 institutions in Japan. Results: The 1-, 2- and 3-year survival rates were 95%, 90% and 90%, respectively, for patients with mucosal cancer and 90%, 81% and 70%, respectively, for patients with submucosal cancer. The overall survival was better in patients who had undergone chemotherapy than in patients who had received radiation therapy alone, though the difference was not statistically significant. The clinical target volume (CTV) did not influence overall survival and intracavitary irradiation did not influence the local control rate in either patients with mucosal or submucosal cancer. Radiation-induced esophageal ulcer was not observed in this series. Conclusion: The standard radiotherapy methods are safe and effective for treating SEC. However, the usefulness of chemotherapy and intracavitary irradiation and the optimal setting of the CTV should be clarified by future randomized trials.

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Background. Radiotherapy plays an important role in salvaging patients who suffer locoregional recurrence
however, it displays poor prognosis. Because concurrent chemoradiotherapy offers superior treatment results compared to radiotherapy alone in patients with localized esophageal cancer, to improve survival rates, we treated patients displaying postoperative regional lymph node recurrence of esophageal squamous cell carcinoma using radiotherapy combined with protracted low-dose continuous infusion of 5-fluorouracil (5-FU). Methods. Between January 1992 and December 2001, 14 patients with postoperative regional lymph node recurrence of esophageal squamous cell carcinoma were treated with concurrent chemoradiotherapy. Radiotherapy was delivered at 1.8-2.0 Gy/day, for a total dose of 56-70Gy (median, 60Gy). Chemotherapy was administered 5 days/week as continuous infusion of 5-FU (250-300mg/m2) for at least 5 weeks. Median follow-up time was 27 months. Results. Twelve patients demonstrated partial response, and 2 patients displayed stable disease. Response rate was therefore 86% (12/14). In-field recurrence occurred in 3 patients. Involved lymph nodes that recurred in the irradiation field were ≥40 mm in maximum diameter and invaded into the surrounding normal tissues. Local progression-free rate at 2 years was 72%. As an initial failure, 6 patients displayed out-field recurrence. Disease progression-free rate at 2 years was 42%. Overall survival rates at 1 and 2 years were 85% and 57%, respectively. Conclusions. Concurrent chemoradiotherapy using low-dose continuous infusion of 5-FU was effective for patients with postoperative regional lymph node recurrence of esophageal squamous cell carcinoma. Close follow-up is crucial, and further investigation is required to prevent outfield recurrence. © Japan Esophageal Society and Springer-Verlag 2005.

DOI： 10.1007/s10388-005-0035-7

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

DOI： 10.11182/jastro.17.187

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

Giant cell reparative granuloma (GCRG) was first reported by Jaffe as a benign non-neoplastic process linked to intraosseous hemorrhage. These lesions in the jaw and the short tubular bones of the hands and feet frequently recur after surgery. We report a rare case: a 51-year-old male with a recurrent GCRG of the left temporal bone showing a good clinical response after 20-Gy irradiation. Although surgery is considered to be the first-line therapy for GCRG, if it has a high morbididy rate or brings a poor outcome, low dose radiotherapy with 15-20 Gy may be an alternative method.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society for Therapeutic Radiology and Oncology  

Background & Purpose: Recent literature on chemoradiotherapy for esophageal cancer report the comparable survival results as surgery, and suggest the importance of management for the late adverse effect of chemoradiotherapy. The aim of this study is to investigate the incidence and risk factors of cardiomegaly after chemoradiotherapy using low dose continuous infusion of 5FU/CDDP+5FU for esophageal cancer. Materials & Methods: Fifty-one patients with stage I-IVA esophageal cancer who were treated by radiotherapy with more than 50 Gy with or without chemotherapy and followed up for more than 6 months were analyzed. Sixteen patients were treated by radiation alone and 35 patients were treated by chemoradiotherapy. A change of CTR (cardio-thoracic ratio) was defined as the difference between CTR in the pre-treatment X-ray film and CTR in the post-treatment X-ray film with maximum cardiac silhouette. A change of CTR by more than 10% was defined as "significant cardiomegaly". In this study, "cardiac areadose", which is the sum of the products of cardiac area within every radiation field and its target dose, was calculated in each patient as a radiation parameter.<BR>Results: Significant cardiomegaly was noted in 1 patient (6%) in the radiation alone group, in 8 patients (23%) in the chemoradiotherapy group and in 9 patients (18%) in the total population. In cases with more than 0.4m<SUP>2</SUP>·Gy in cardiac area-dose, CTR elevation was significantly higher than in cases with less than 0.4 m<SUP>2</SUP>·Gy. More than moderate pleural effusion was noted in 5 patients (10%). Chronic pericardial effusion and subsequent cardiac tamponade was considered to be one of the contributing factors for pleural effusion, because increases of pleural effusion coincided with CTR elevations in 3 cases. In addition, the fact that no case had right-sided unilateral pleural effusion suggested the direct effect of radiation to the pleura.<BR>Conclusion: Significant cardiomegaly was seen in 18% of 51 patients with esophageal cancer treated by irradiation with or without chemotherapy. It was suggested that concurrent chemotherapy including 5FU and high "cardiac area-dose" were risk factors of pericardial effusion. More than moderate pleural effusion was noted in 10%. Cardiac tamponade following chronic pericarditis and radiation pleuritis were considered to be etiologic factors for pleural effusion after radiotherapy with or without chemotherapy for esophageal cancer.

DOI： 10.11182/jastro1989.14.153

CiNii Article

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Purpose: To evaluate the results of radiotherapy for low-grade gliomas focusing on the factors influencing progression-free rate, survival, and late complications. Materials and Methods: Forty-two patients consisting of 24 grade II astrocytomas and 18 oligoastrocytomas were treated with radiotherapy at Niigata University Hospital between 1982 and 1997. The patients ranged in age from 3 to 75 years (median: 39 years), of whom 8 were ≦ 15 years old. Twenty-six patients underwent tumor removal and 22 received chemotherapy mainly combined with radiotherapy. Radiotherapy was delivered in 2-Gy fractions to the tumor bed defined by CT or MRI usually with a 2-cm margin for a total dose ranging between 44 and 66 Gy (median: 50 Gy). Median follow-up time was 74.5 months (range: 4–193 months), and the progression-free rate and survival were calculated using the Kaplan-Meier method. Variables examined for prognostic significance included patient's age. gender. Karnofsky performance status (KPS), tumor location, pathology, maximum tumor diameter, calcification, enhancement with contrast material on CT or MRI, extent of tumor resection, radiation parameters (total dose and safety margin), interruption of radiotherapy, and chemotherapy. A log-rank test was used to analyze the statistical significance of differences in factors. Results: Tumor recurrence occurred in 10 adult patients. The 5- and the 10-year progression-free rates were 73% and 67% respectively. Seven were in-field recurrence, two were marginal, and one was a new lesion in the opposite cerebral hemisphere isolated from the original tumor. Nineteen patients had died at the time of the last follow-up and seven died of tumor progression. The overall survival at 5 and 10 years were 80% and 48% respectively. The cause-specific survival at 5 and 10 years were 92% and 73% respectively. Our analysis revealed that patient's age, extent of tumor resection, safety margin, and maximum tumor diameter were the significant factors influencing the progression-free rate. The factors influencing overall survival were age. maximum tumor diameter, and KPS. Age and extent of tumor resection were significant factors in cause-specific survival. Deterioration of quality of life occurred in 9 adult patients mainly due to dementia after radiotherapy. Most of them had the large frontal tumor and received chemotherapy. Conclusions: Radiotherapy was effective in the treatment of low-grade gliomas. An effort to reduce complications is required, because 9 of 34 adult patients suffered from dementia after radiotherapy in this study. The management of low-grade gliomas in adult patients is still controversial. Standardization of treatment strategy considering prognostic factors is awaited. © 2001, Japanese Society for Therapeutic Radiology and Oncology. All rights reserved.

DOI： 10.11182/jastro1989.13.163

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Purpose: To evaluate the effect of oral hygiene care of patients with oral cancer on alleviating acute radiation mucositis. Materials and methods: Eighteen patients receiving postoperative radiotherapy for tongue and oral floor cancer were evaluated. Radiotherapy was given in 2 Gy per fraction, 5 times a week for a total dose of 50 Gy in most patients. Radiation fields included the tongue and oral floor. During radiotherapy, 8 patients were treated by dento-maxillofacial radiologists with special concern on oral hygiene (oral hygiene group) and the remaining 10 patients were treated with routine dental care (standard medication group). Mucositis were evaluated using JCOG grade and EORTC/RTOG score by radiotherapists or dento-maxillofacial radiologists at 10 Gy intervals. Oral hygiene plans comprised motivation to maintain oral hygiene and establishing the habits of oral self care 4 times per day. Once a week, oral hygiene and oral cleaning of patients were checked by dento-maxillofacial radiologists. Oral self care included mechanical tooth brushing and a chemical mouthwash. Results: No patients with grade 3 and score 4 mucositis were noted in the oral hygiene group. Severe mucositis occurred less frequently in the oral hygiene group than in the standard medication group. Interruption of radiotherapy due to severe mucositis did not occur in the oral hygiene group. On the other hand, interruption of radiotherapy occurred in four patients in the standard medication group, and in three it was due to severe oral pain. Conclusions: Our results suggested that our method of oral hygiene was more effective for alleviating acute radiation mucositis than other methods so far reported. In addition, our method is considered to be useful in preventing rampant dental caries and severe periodontitis due to the xerostomia induced by radiotherapy. © 2000, Japanese Society for Therapeutic Radiology and Oncology. All rights reserved.

DOI： 10.11182/jastro1989.12.229

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japan Lung Cancer Society  

We retrospectively compared the specimens of CT guided percutaneous lung biopsy with the specimens surgically resected later in 17 cases with small adenocarcinoma of the lung to investigate the possibility of preoperative prediction of the Noguchi type pathological classification. The coincidence rate was 41.2%(7/17). It was considered difficult to guess the Noguchi type of small adenocarcinoma of the lung preoperatively by CT guided percutaneous lung biopsy. In this study, one resected specimen contained linearly-arranged fibrosis and fibroblasts suggesting the sequelae of lung biopsy. It seemed to be important to pay attention to the possibility of fibrosis resulting from biopsy in classifying the Noguchi type.

DOI： 10.2482/haigan.38.99

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Language：Japanese   Publisher：Japanese Society for Therapeutic Radiology and Oncology  

A total of 133 cases with 149 lesions consisting mainly of lung cancers with endobronchial lesions that were treated with low dose rate intraluminal brachytherapy from three institute were analyzed. All but one case had lung cancer. The roles of this radiotherapy were various. Of the cases, 91 with 101 lesions were roentgenographically occult endobronchial carcinoma (ROEC), 19 with 25 lesions were postoperative endobronchial recurrence of lung cancer (PER), thirteen cases were lung cancer without ROEC (advanced cancer).<BR>Brachytherapy alone was performed on a few lesions, in the other cases, a combination external beam radiotherapy using 4 to 10 MV linac x-ray and intraluminal low dose rate brachytherapy via 192 Iridium thin wire was performed. Most lesions were given 1.8 to 2.2 Gy per fraction with external beam radiotherapy and 4 to 6 Gy per fraction with brachytherapy, but their total doses differed widely. The 5 year overall survival, cause apecific survival, disease free rate of ROEC were respectively 52.1 %, 85.8 %, 82.2 %, the 5 year overall survival and cause specific survival of PER were 29.3 %, 39.4 %, and the 3 year overall survival and cause specific survival of advanced lung cancer were 20.1 %, 38.4 %. Radiation dose did not have a significant influence on either survival or recurrence. Of ROEC cases, the recurrence rate of patients who had over 20 mm lesions was significantly high. As for radiation injury, radiation pneumonitis, bronchial stenosis, ulcer formation and bleeding were observed, and 2 patients died due to radiation pneumonitis and bleeding. We observed a significantly high rate of radiation injury in ROEC patients who were treated with under 25 Gy for brachythrapy, over 40 Gy for external beam radiotherapy and over 65 Gy for total dose.<BR>We thought this treatment was good for small lesions such as ROEC or PER. But, because these cases were treated widely different doses and the number of cases was small, we could not find the relationship between dose and recurrence of all groups, or the relationship between dose and radiation injury of PER and advanced cancer groups. We hope to be able to conduct a multiinstitute prospective study.

DOI： 10.11182/jastro1989.10.135

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