掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/acm2.13322

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/acm2.13322

掲載種別：研究論文（学術雑誌）   出版者・発行元：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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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s12194-020-00602-2

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その他リンク： http://link.springer.com/article/10.1007/s12194-020-00602-2/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/mp.14699

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/mp.14699

掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/acm2.13081

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/acm2.13081

記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）   出版者・発行元：新潟大学医学部保健学科  

X線治療の計算によるMU独立検証で等価正方形照射野（等価正方形辺）は，検証の精度に影響するため重要である．等価正方形辺は深さやエネルギーに依存しないと仮定されている．しかし，先行研究で線形加速器Clinac-iX（Varian社製）の矩形照射野で求めたファントム散乱係数S_pの測定値と，同じ矩形照射野を等価正方形辺に変換して求めたS_pの推定値の差は深さによって変わる深さ依存があり，その仮定は有効ではなかった．また，Day法やA/P法に比べARC法の等価正方形辺はその深さ依存が小さいことも報告された．本研究は，Clinac-iXとガントリヘッドの構造が異なる線形加速器Synergy（Elekta社製）で，同じ方法によりS_pの測定値と推定値の差を調べた．その結果，Synergyでも深さ依存が見られ，ARC法がDay法やA/P法に比べて小さく，S_pの推定精度が良いことが示された．
In X-ray therapy, equivalent square field (side of equivalent square field) is important because it influences the accuracy of monitor unit (MU) independent verification by calculation. It is assumed that equivalent square field does not depend on depth and X-ray energy. However, in Clinac-iX (manufactured by Varian Co.) linear accelerator of previous research, the difference between measured value of S_p obtained by measuring rectangular field and estimated value of S_p obtained from equivalent square field of same rectangular field indicated depth dependency that varied with depth, and it was suggested that the assumption was not valid. And it was reported that the depth dependency in side of equivalent square of ARC method was smaller than Day method and A/P method. In this study, using Synergy (manufactured by Elekta Co.) that was linear accelerator with different structure in the gantry head of Clinac-iX investigated the difference between measured value and estimated value of S_p by the same method of previous research. As result, the depth dependency was found also in Synergy, and it was shown that side of equivalent square of ARC method was smaller than Day method and A/P method, and the estimation accuracy of S_p was better.

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その他リンク： http://id.ndl.go.jp/bib/030405007

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier {BV}  

DOI： 10.1016/j.ctro.2019.10.006

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記述言語：日本語   出版者・発行元：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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その他リンク： 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

掲載種別：研究論文（学術雑誌）   出版者・発行元：Oxford University Press (OUP)  

DOI： 10.1093/jrr/rry106

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記述言語：日本語   出版者・発行元：公益社団法人 日本放射線技術学会  

DOI： 10.6009/jjrt.2019_jsrt_75.12.1426

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その他リンク： http://id.ndl.go.jp/bib/030183658

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：公益社団法人 日本放射線技術学会  

DOI： 10.6009/jjrt.2018_JSRT_74.11.1286

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その他リンク： http://id.ndl.go.jp/bib/029359646

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：新潟大学医学部保健学科  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.ctro.2017.12.003

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：新潟大学医学部保健学科  

放射線治療の呼吸同期照射において，同期信号の発生からビームオン・オフまでには遅延時間（timedelay）がある．今回，time delayの計測に適した動体ファントムの運動パターンと，新潟大学医歯学総合病院の呼吸同期照射システムにおけるtime delayを明らかにすることを目的として検討を行った．動体ファントムの運動波形はサイン波形と等速波形とし，運動幅は30 mmとした．ラジオクロミックフィルムを動体ファントムに乗せ，直径4 mm coneで連続照射を行ったところ，フィルム上の照射陰影はサイン波形で31.7±0.2mm，等速波形で30.4±0.1 mmであり，等速波形の方が実際の運動幅に近く，測定精度が高かった．次に等速波形を用いた10-40%位相の同期照射を行い，照射陰影の長さを理論値と比較したところ，time delayはビームオンで0.11±0.01秒，ビームオフで0.07±0.00秒であった．In respiratory gated radiotherapy, there are time delays between the target entering the gated region and treatment beam on, and between the target exiting the gated region and treatment beam off. The aim of this study was to clarify the appropriate motion profile of motion phantom for measuring the time delays, and to measure the beam on and beam off time delays in respiratory gated radiotherapy system at Niigata University Medical and Dental Hospital. We irradiated radiochromic films on the motion phantom using 4 mm diameter cone without gating. As a motion profile for the motion phantom (motion width: 30.0 mm), a sinusoidal profile and a constant velocity profile ware used. Measured length of the exposure streaks on the films were more accurate with the constant velocity profile than those with the sinusoidal profile (30.4±0.1 mm vs. 31.7±0.2 mm). Then we used the constant velocity profile for gating irradiation with a gating phase range of 10-40%, and compared the exposure streak length with a theoretical value. The calculated beam on time delay was 0.11±0.01 sec, and the beam off time delay was 0.07±0.00 sec.

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その他リンク： http://hdl.handle.net/10191/47192

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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その他リンク： http://dspace.lib.niigata-u.ac.jp/dspace/bitstream/10191/47194/1/14%281%29_27-33.pdf

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：日本語   出版者・発行元：(公社)日本放射線技術学会-東北支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

JASTRO研究グループによる標準的放射線治療法を用いた食道表在癌の治療成績の中間報告を行なった。

DOI： 10.11182/jastro.17.187

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society for Therapeutic Radiology and Oncology  

【背景・目的】近年, 食道癌に村する化学放射線療法は手術に匹敵するともいえる治療成績が報告されてきており, 今後それに伴う晩期障害が問題となってくることが予想される. 従来我々は5FU及び5FU+CDDPの少量持続静注併用放射線治療を行っているが, 長期生存例の中に心拡大を呈する症例を少なからず経験している, 今回その頻度と関遮因子を遡及的に明らかにすることを検討の目的とした.<BR>【対象・方法】1期～IVA期までの食道癌症例中, 50Gy以上照射され6ヶ帰以上画像的な追跡が可能であった5蓋例を対象とした. 内訳は照射単独群16例, 化学療法併用群35例. 心拡大については照射前の心胸郭比 (CTR) と照射後最大のCTRの差, および10%以上の増加例 (有意な心拡大) について検討した. 胸水については中等量以上の貯留例を検討した. また, 心臓に対する照射面積と標的線量の積を心臓面積線量と定義し, CTRの変化との関連についても検討した.<BR>【結果】いずれの治療群でも照射前に比して照射後にはCTRの有意な増加が認められた. 有意な心鉱大は全体で18%. 照射単独例で6%, 化学療法併用例では23%であり, 化学療法併用例で高頻度であった. 心臓面積線量0.4m<SUP>2</SUP>・Gy以上の症例では0.4m<SUP>2</SUP>・Gy未満の症例に比して有意にCTR増加が大きかった. 中等量以上の胸水貯留は5例 (10%) にみられ, 全例化学療法併用群であった.CTRの増加と共に胸水が増加する例が3例, 更にCTRの増加が胸水貯留に先行する症例が2例見られたことから, 胸水跡留には慢性心外膜炎に伴う心タンポナーデの関与が示唆された. 加えて, 右側のみの群留例がなく全例が左側あるいは両側性であったことから, 胸膜に対する照射の直接的な影響も推察された.<BR>【結語】食道癌の放射線治療後, CTRが10%以上増加する例は重8%あり, 心臓に対する照射量と化学療法の併用が影響していた.中等量以上の胸水貯留は10%にみられ, 慢性心外膜炎に伴う心タンポナーデ及び放射線胸膜炎の関与が示唆された.

DOI： 10.11182/jastro1989.14.153

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11182/jastro1989.12.229

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本肺癌学会  

今回我々は,肺小型腺癌の組織構築に関するNoguchi分類の術前診断の可能性を検討するため,切除された肺腺癌で術前にCTガイド下経度肺生検を施行されていた17症例について,生検組織と切除標本組織の組織構築をNoguchi分類に準じてretrospectiveに比較検討した.生検標本のNoguchi分類が切除標本のNoguchi分類と一致したのは17例中7例(41.2%)であり,現時点ではCTガイド下経度肺生検でNoguchi分類を術前に診断するのは困難で,術中迅速病理診断が必要と思われた.また検討症例中に,生検により線維化を生じたと思われる症例があり,Noguchi分類の判定の際に留意すべきと考えられた.

DOI： 10.2482/haigan.38.99

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記述言語：日本語   出版者・発行元：Japanese Society for Therapeutic Radiology and Oncology  

低線量率192Ir線源を用いた気管, 気管支の腔内照射が施行された症例を3施設から集計し検討した. 治療方法・症例<BR>1987年4月から1996年11月までに133例149病巣の気管気管支に病巣のある癌に対し腔内照射が施行されていた.<BR>1例を除いて, すべて肺癌であった. 治療の目的は, 根治から姑息例まで多岐にわたっていたが, 内視鏡的肺門部早期癌 (早期癌), 肺癌手術後の気管気管支壁内再発例 (手術後再発例), 早期癌を除く肺癌 (進行癌) の症例が多かった.<BR>放射線治療は外照射と腔内照射の併用を原則としていた. 外照射はライナック4～10MVX線, 腔内照射は<SUP>192</SUP>Ir thin wire (1480 MBq) を使用, 多くの症例の一回線量は外照射1.8～2.2Gy, 腔内照射4.0～6.0Gyで施行されていた. 総線量は施設, 症例ごとにばらつきがあった.<BR>結果<BR>治療線量と再発率, 生存率に有意差はなかったが, 早期癌では腫瘍径が20mmを越す症例で再発が有意に多かった.<BR>放射線障害としては, 放射線肺炎, 気管支狭窄, 粘膜潰瘍, 出血などがあり, 致死的障害は2例であった.<BR>早期癌では腔内照射線量<25Gy, 外照射線量>40Gy, 総線量>65Gyで障害の発生が有意に高かった.<BR>早期癌の5年overall survival 52.1%, cause specifi csurvival 85.8%, disease free rate 82.2%であり, 手術後再発例の手術施行時からおよび本治療開始時からの5年overall survivalはそれぞれ54.7%, 29.3%, cause specinc survivalは62.1%, 39.4%, 進行癌では3年overall survival, 20.1%, cause specific survival 38.4%であった.<BR>まとめ<BR>本治療法は早期癌や手術後再発例のように病巣が小さく, 気管, 気管支壁周囲に限局している症例には良い適応と思われた.<BR>早期癌について再発, 障害について有意差のある結果が示されたが, 投与線量の偏り, 障害の評価などの問題があり, また, 手術後再発例や進行癌については治療数が少く, それぞれの症例群について線量と再発, 放射線障害などを十分に検討することができなかった. 投与線量, 障害の評価についての基準を設け, prospectiveな検討が必要である.

DOI： 10.11182/jastro1989.10.135

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