Purpose: With the aim of improving the results of treatment of esophageal cancer, we designed this multi-institutional, randomized trial to establish the optimal irradiation method in radical ...radiation therapy for esophageal cancer by clinically evaluating external irradiation alone and in combination with intraluminal brachytherapy.
Methods and Materials: The study population consisted of patients with squamous cell carcinoma who were expected to be successfully treated with radical radiation therapy. The patients who could be given intraluminal brachytherapy at the end of external irradiation of 60 Gy were stratified into 2 groups. Patients assigned to receive external irradiation alone received boost irradiation of 10 Gy/week on a schedule similar to the previous one, and with the same or smaller irradiation field. Intraluminal brachytherapy was performed, as a rule, with the reference dose point set at a depth of 5 mm of the esophageal submucosa, and a total of 10 Gy was irradiated at a daily dose of 5 Gy, on a once-weekly schedule with low-dose-rate or high-dose-rate brachytherapy equipment.
Results: A total of 103 patients were registered, 94 of whom were analyzable, with 8 ineligible, and 1 for whom complete information was unavailable. The overall cumulative survival rate was 20.3% at 5 years. The cause-specific survival rate was 31.8% at 5 years. The cause-specific survival rate at 5 years was 27% in the external irradiation alone group and 38% in intraluminal brachytherapy combined group. There was no significant difference between the 2 groups (
p = 0.385). However, in the patients with 5 cm or less tumor length, the cause-specific survival rate was 64% at 5 years in the intraluminal brachytherapy combined group, which showed a significant improvement over 31.5% in the external irradiation alone group (
p = 0.025). In the patients with Stage T1 and T2 disease, cause-specific survival rates tended to be better in the intraluminal brachytherapy combined group than in the external irradiation alone group (
p = 0.088). In the patients with more than 5 cm tumor length or Stage T3–4 disease, there were no significant differences between the two groups by treatment methods (
p = 0.290). The incidence of early and late complications did not differ according to whether intraluminal brachytherapy was used.
Conclusion: For the purpose of establishing the usefulness of intraluminal brachytherapy, further prospective randomized studies are necessary to evaluate the efficacy in tumors with short length and those with shallow invasion, or to assess the usefulness of intraluminal brachytherapy, as additional irradiation in large advanced tumors have been shown to have disappeared by diagnostic imaging after chemoradiotherapy with 60 Gy/6w external irradiation.
To establish dosimetric predictors of radiation esophagitis (RE) in patients treated with a combination of carboplatin, paclitaxel, and radiotherapy.
Three-dimensional radiotherapy plans of 26 ...patients with non-small-cell lung cancer who received 50-60 Gy of radiotherapy concurrently with weekly administration of carboplatin (AUC 2) and paclitaxel (40-45 mg/m(2)) were reviewed in conjunction with RE. The factors analyzed included the following: percentages of organ volumes receiving >40 Gy (V40), >45 Gy (V45), >50 Gy (V50), and >55 Gy (V55); the length of esophagus (total circumference) treated with >40 Gy (LETT40), >45 Gy (LETT45), >50 Gy (LETT50), and >55 Gy (LETT55); the maximum dose in the esophagus (Dmax); and the mean dose in the esophagus (Dmean). Data were obtained on the basis of superposition algorithm.
All factors except Dmax showed statistical correlation with RE. Good correlations were shown between RE and LETT45 (rho = 0.714) and V45 (rho = 0.686).
LETT45 and V45 appear to be useful dosimetric predictors of RE. It is also suggested that Dmax does not predict RE.
Status of the clinical work at Hyogo Hishikawa, Yoshio; Oda, Yasue; Mayahara, Hiroshi ...
Radiotherapy and oncology,
12/2004, Letnik:
73
Journal Article
Recenzirano
On April 1, 2001, the Hyogo Ion Beam Medical Center (HIBMC) was opened as the first facility in the world to provide ion beam therapy using 2 types of beams, protons and carbon-ions. We will ...introduce the HIBMC, and report the results of the clinical study and general practice.
The ion beam treatment in the Hyogo Ion Beam Medical Center (HIBMC) is carried out with a comprehensive system that consists of an irradiation system, a treatment planning system and a treatment ...verification system. The treatment verification system consists of a positron emission tomography (PET) camera. As charged particles produce short-lived positron-emitting isotopes in tissues, the treated site can be verified by images taken immediately after irradiation using a PET camera. A technician sets up an immobilizing device fitted to an individual patient using plastic materials, and takes CT and MRI images of the treatment target site. Treatment planning is carried out using the 3-D treatment planning system. At this time CT and MRI fusion images are used for treatment planning. Before treatment, a rehearsal is done and on the day of treatment, the positioning is performed in the same way as the rehearsal. After positioning, ion beam therapy is started. A respiratory gating system is used for patients with lung or liver cancer. On April 1, 2001, HIBMC was opened as the world's first facility to provide both proton and carbon-ion radiotherapy. We have treated more than 950 patients with a variety of malignant tumors including skull base, head and neck, lung, liver and prostate tumors. Excellent local control for these tumors has been obtained with minimum side effects. Experience of clinical trial and general practice, showed that radio-resistant tumors in the head and neck region like mucosal malignant melanoma and adenoid cystic carcinoma could be locally controlled with proton beam therapy. In the future we will analyze the difference between two beams for the patient with head and neck cancer.
Hyogo Ion Beam Medical Center is a new ion beam treatment facility which was opened in April 2001. Ion beam treatment at this center comprises an irradiation system, a treatment planning system and a ...treatment verification system. The irradiation system consists of huge machines that might seem to play a major role in ion beam therapy, however, two other systems also play absolutely important role. Holistic and highly precise functions of these three systems are essential and cooperative work among radiation oncologists, medical physicists, radiological technologists and nurses is more important than anything else in performing this highly sophisticated treatment.
Between 1980 and 1988, 206 patients with esophageal cancer were treated initially with radiotherapy. The patients were classified into three groups according to age. Ninety-four patients aged 43-69 ...years comprised Group A, 83 patients aged 70-79 years comprised Group B, and 29 patients aged 80-86 years comprised Group C. There were no statistically significant differences in background factors between Groups A, B, and C, except for the sex ratio. The male:female ratio was 7.5:1 in Group A, 3.9:1 in Group B, and 1.9:1 in Group C, with the difference between Groups A and C being statistically significant (p less than 0.05). High-dose-rate intracavitary irradiation (HDRII) with or without external irradiation (EI) was performed in 64%, 69%, and 83% of the patients from Groups A, B, and C, respectively. Patients in Groups A, B, and C achieved CR in 23%, 24%, and 34% of cases following radiotherapy. Two- and 5-year survival rates were 16.7% and 6.7% in Group A, 17.2% and 6.0% in Group B, and 27.1% and 20.3% in Group C. No significant differences were found in the patterns of failure and in the radiation-induced injuries between the three groups. Our data suggested that radiotherapy was the treatment of first choice for patients 80 years old and older.
Prophylaxis of esophageal ulceration was studied in 78 esophageal carcinoma patients after high-dose-rate intraluminal brachytherapy. Before the standard treatment regimen of radiotherapy was ...established, 15/17 patients developed ulcers. This decreased to 19/38 with the standard treatment regimen, and to 9/23 when antiulcer therapy was added (p < 0.01).
Subcutaneous fibrosis after whole neck irradiation Hirota, Saeko; Tsujino, Kayoko; Oshitani, Takashi ...
International journal of radiation oncology, biology, physics,
03/2002, Letnik:
52, Številka:
4
Journal Article
Recenzirano
Purpose: To identify the risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation.
Methods and Materials: We analyzed 233 cases of patients who had undergone whole neck ...irradiation with 4-MV X-ray or 8–10-MeV electrons, or both, and had been followed with regard to their skin condition for at least 1 year. The prescribed dose to the whole neck ranged from 19.2 to 72.4 Gy (median 50). The skin-absorbed dose was specified as that at a depth of 4.1 mm (d4.1-mmdepth), and a biologically equivalent dose (BED) of d4.1-mmdepth was also estimated (BED1.8 4.1-mmdepth).
Results: Univariate analysis revealed that previous neck dissection, concurrent chemotherapy, corticosteroid administration as a part of chemotherapy, fractionation, and BED1.8 4.1-mmdepth were significant prognostic variables. Multivariate analysis showed that BED1.8 4.1-mmdepth and previous neck dissection were the only prognostic variables for moderate to severe subcutaneous fibrosis.
Conclusion: A high dose to a 4.1-mm depth of the skin and a history of neck dissection were identified as the predominant risk factors for moderate to severe subcutaneous fibrosis after whole neck irradiation. A subcutaneous dose should be considered in radiotherapy treatment planning involving the whole neck, especially in cases in which patients have undergone previous neck dissection.
Radiotherapy clinical records of 7, 057 cases were collected from 208 hospitals in the period from 1992 to 1997 as recorded in the Radiation Oncology Greater Area Database (ROGAD) under the Japanese ...Society for Therapecutic Radiology and Oncology JASTRO, and their statistical analysis was carried out. A portion of these are presented in this paper. Case distribution in terms of ICD-O code for primary tumor region expressed by 286 tables and 286 figures were worked out, but only 26 figures were selected for presentation here. Chronological variation of cases distribution during those six years were found and stated as follow as examples. Primary response in “head and neck” and “ungs and bronchus” showed improvement both in terms of complete response (CR) and partial response (PR) in those 6 years. As for female genital organs, both CR and “alive with cancer” showed improvement. The averaged figures for all topographical regions for these 7, 057 cases reveal that CR, CR+PR, “alive with cancer” and “alive without cancer” increased relatively, and we can state that total contribution of radiotherapy itself is increasing. The rate of chemotherapy combined with radiotherapy had increased and that of surgery combined with radiotherapy had decreased in the primary tumor region of both esophagus and female genital organs. Cases of radiotherapy alone without any other treatment have a tendency to incerase in lungs and bronchus. Ratios of primary regions of lungs and bronchus, liver, biliary tract and pancreas, bones and hematopoietic systems, breast and stomach and colon compared with that of total topographic regions involving other regions are found to have increased. In contrast, female genital organs and head and neck regions decreaced on a relative basis. Change of performance status between at radiotherapy start and at radiotherapy termination for primary regions of lungs and bronchus and breast searched in 1996 tells that radiotherapy contributed to improve PS as far as the primary response is concerned. But change of PS from the time of radiotherapy termination of treatment in the two topographical regions mentioned above in February of 1996 to the time of follow up survey in June of 1997, which was 16 months after radiotherapy termination, does not indicate any improvement. One record for irradiated topographical region in radiotherapy treatment is composed of 13 items with 48 fields, and one record for follow up investigation is composed of 5 items with 7 fields. Consequently, various combinations of logical and clinical interest in data retrieval and statistics can be worked out. Further findings and interpretations of statistics extracted from this database ROGAD can be sent to ROGAD subscribers. We plan to deliver user friendly software packages that are capable of conducting statistics and database subsets to any subscriber. However, the most important thing is that intensive effort is paid to maintain confidence level for clinical data registration at sites of database subscribers in every radiotherapy facility anywhere in Japan.
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