Local radiotherapy for chemotherapy-refractory Kaposi's sarcoma in an HIV-infected patient: A case report and literature review.

Human immunodeficiency virus-associated Kaposi's sarcoma (HIV-KS) is a well-documented vascular tumor with a pathogenesis involving human herpesvirus-8 (HHV-8) infection. While antiretroviral therapy (ART) and chemotherapy are effective for treating most KS cases, some become refractory. In this report, we present a case of a 58-year-old man with refractory HIV-KS treated with ART and chemotherapy. Chemotherapy was eventually discontinued due to an adverse reaction, and the patient presented with painful plantar lesions that impaired ambulation. With the exclusion of visceral metastases, localized radiotherapy was administered, which resulted in significant cosmetic and functional improvements. The patient regained ambulation and lived independently, receiving additional radiotherapy as needed. This case underscores the potential use of radiotherapy for the treatment of ART-resistant KS, particularly when the patient is unresponsive to conventional chemotherapy. It also highlights the need for future research in this area.

External Beam Radiotherapy in Advanced Pheochromocytoma and Paraganglioma: An Observation of a Rare Abscopal Effect.

Metastatic pheochromocytoma and paraganglioma are incurable, and effective treatment of systemic symptoms resulting from catecholamine excess and local symptoms from tumor growth are crucial to prolong survival and improve quality of life. We report the first case of metastatic pheochromocytoma wherein external beam radiotherapy (EBRT) demonstrated efficacy in both target and nontarget lesions, demonstrating the "abscopal effect." EBRT reduced tumor volume and catecholamine secretion and improved catecholamine excess-related complications, including glycemic control. EBRT is an effective treatment option for metastatic pheochromocytoma and paraganglioma because of its minimal invasiveness, safety, and potential for the rare abscopal effect.

Prostate-specific antigen doubling time predicts the efficacy of site-directed therapy for oligoprogressive castration-resistant prostate cancer.

Background: In recent years, site-directed therapies (SDTs) targeting progressive lesions in patients with oligometastatic prostate cancer have attracted attention. However, whether they effectively treat oligoprogressive castration-resistant prostate cancer (CRPC) remains unclear. Here, we investigated the efficacy of SDT in patients with oligoprogressive CRPC and identified prognostic factors. Methods: We reviewed 59 patients with oligoprogressive CRPC who underwent SDT targeting prostate or metastatic lesions between April 2014 and March 2022. We evaluated the associations between several pretreatment clinical variables and treatment procedures and a >50% prostate-specific antigen (PSA) response, progression-free survival (PFS), and time to next treatment (TTNT). Results: A PSA response of >50% was observed in 66% of patients. The median PFS and TTNT were 8.3 months and 9.9 months, respectively. Patients with PSA doubling time ≥6 months showed a higher >50% PSA response rate (87% vs. 45%; P < 0.001), longer PFS (median, 15.0 vs. 5.0 months; P < 0.001), and longer TTNT (median, 16.3 vs. 5.9 months; P < 0.001) than patients with PSA doubling time <6 months. In multivariate analyses, a PSA doubling time of ≥6 months independently predicted a >50% PSA response, favorable PFS, and TTNT (P = 0.037, 0.025, and 0.017, respectively). Conclusion: PSA doubling time of ≥6 months may be a key indicator of the favorable efficacy of SDT for oligoprogressive CRPC.

The efficacy profiles of concurrent chemoradiotherapy with intensity-modulated radiotherapy followed by durvalumab in patients with unresectable stage III non-small cell lung cancer: A multicenter retrospective cohort study.

Purpose: Intensity-modulated radiotherapy (IMRT) is currently used more commonly than 3-dimensional conformal radiation for definitive thoracic radiation. We examined the efficacy profiles of concurrent chemoradiotherapy (CCRT) with IMRT after durvalumab became clinically available. Methods: We reviewed the clinical records of patients with stage III non-small cell lung cancer (NSCLC) treated with CCRT and IMRT at seven centers in Japan and investigated relapse and survival from May 2018 to December 2019. The primary endpoint of this report was progression-free survival (PFS). Results: Among 107 patients enrolled in the study, 87 were sequentially administered durvalumab. From CCRT commencement, patients were followed up for a median period of 29.7 months. The median PFS at the end of the CCRT was 20.7 months. Among the 87 patients, 58 experienced disease relapses, of whom 36 (62.1 %) had distant metastases. Multivariate Cox regression analysis revealed that a favorable response to CCRT, a radiation dose ≥ 62 Gy, and stage IIIA NSCLC were associated with prolonged PFS (all P = 0.04). Multivariate logistic regression by landmark analysis revealed that mortality risk factors were durvalumab treatment duration ≤ 11.7 months, a lower maximum grade of immune-related adverse events, FEV1 < 2805 mL, and radiation dose < 62 Gy (P = 0.01, 0.01, 0.03, and 0.04, respectively). Conclusions: In patients with NSCLC receiving CCRT using IMRT, long PFS was associated with a better response to CCRT, stage IIIA NSCLC, and an increased radiation dose. The duration of durvalumab consolidation also played an essential role in the survival of patients receiving CCRT with IMRT. (250 words).

Change in cancer diagnosis during the COVID-19 pandemic: Trends estimated from FDG-PET/CT.

The aim of this study is to clarify changes in the circumstances of cancer diagnoses during the COVID-19 pandemic in Tokyo, Japan, estimated from [18F]-2-fluoro-2-deoxy-D-glucose (FDG) -positron emission tomography/ computed tomography (PET/CT) for cancer patients. Cancer diagnosis in pandemic status (PANS) was evaluated by retrospective review of the findings of FDG-PET/CT examinations performed between 11 March 2020 and 28 December 2021 for initial staging and restaging for malignancy. Evaluation of cancer diagnosis in pre-pandemic status (pPANS) was conducted similarly in FDG-PET/CT examinations performed between 4 January 2018 and 10 March 2020. Of these, patients with malignant lymphoma (ML), lung cancer, esophageal cancer, and colorectal cancer who had a pathologically proven diagnosis or clinical diagnosis following therapy of the disease were selected for analysis. Initial cancer staging was determined by the diagnostic report of FDG-PET/CT. Change in cancer stage and in the number of FDG-PET/CT examinations performed was evaluated between pPANS and PANS, and according to term of the pandemic and vaccination status. The COVID-19 epidemic influenced the number of cancer patients who underwent FDG-PET/CT. There was a marked decrease in the number of cancer patients receiving FDG-PET/CT in Terms 1-3 (March 2020 to February 2021), but it recovered in Terms 4-6 (March 2021 to December 2021). There was no significant difference between PANS and pPANS in terms of the initial stage of cancer, but Stage IV ML and Stage II esophageal cancer were more frequent in PANS. Initial staging of ML, lung cancer, and esophageal cancer revealed more advanced cancer stages in Terms 4-6 compared with Terms 1-3. The number of patients receiving FDG-PET/CT in Tokyo was influenced by the COVID-19 epidemic. Staging based on FDG-PET/CT shifted to more advanced cancer stage during the pandemic compared with pre-pandemic.

Proton therapy for patients with esophageal cancer: History, characteristics, clinical outcome and future direction of proton beam therapy.

After the second war, Wilson who participated in development of the atomic bomb in Los Alamos studied peaceful use of atomic energy and proposed a property of proton beam that has potential to treat cancer. According to his proposal, the first patient was treated with proton beam therapy at the University of California Berkley in 1954. The first series of proton beam therapy for patients with esophageal cancer was reported from Japan in 1993. After that many proton facilities in Japan reported the clinical outcome of patients with esophageal cancer. Many dosimetric and clinical studies showed proton beam therapy for esophageal cancer was less toxic than photon beam therapy, however there is a paucity of randomized trials and evidence that proton beam therapy has clearly superior survival compared to photon therapy. Only one randomized trial has been conducted to study less toxicity for proton beam compared with intensity modulated radiotherapy (IMRT), which was stopped early because toxicities of IMRT were higher. A phase III study comparing overall survival between proton beam therapy and IMRT is now activated. A cost reduction for proton therapy is necessary to facilitate patient care and establishment of clinical evidence.

Intensity-modulated radiation therapy with concurrent chemotherapy followed by durvalumab for stage III non-small cell lung cancer: A multi-center retrospective study.

BACKGROUND AND PURPOSE: Intensity-modulated radiation therapy (IMRT) is increasingly applied in concurrent chemoradiotherapy (CCRT) for locally-advanced non-small cell lung cancer (NSCLC), with improvement of target coverage and better sparing of normal tissue. IMRT tends to have a larger low-dose irradiation volume than 3D conformal radiotherapy, but the incidence of and risk factors for pneumonitis remain unclear, especially following the approval of durvalumab. MATERIALS AND METHODS: We retrospectively reviewed the records of NSCLC patients treated by CCRT using IMRT at seven Japanese institutions. Primary outcomes were incidence of symptomatic pneumonitis and progression-free survival (PFS). Multivariate logistic regression analysis was used to identify risk factors for ≥grade 2 pneumonitis. RESULTS: Median follow-up from the start of CCRT was 14.3 months (n = 107 patients; median age 70 years, 29% female). Median lung V5 and V20 was 49.2% and 19.5%, respectively. Durvalumab was administered to 87 patients (81%). Pneumonitis developed in 95 (89%) patients of which 53% had grade 1, 28% grade 2, 6.5% grade 3, and 0.9% grade 4. Durvalumab had been discontinued in 16 patients (18.4%) due to pneumonitis. By multivariate analysis, age ≥70 years, male sex, and V5 ≥58.9% were identified as significantly associated with ≥grade 2 pneumonitis (p = 0.0065, 0.036 and 0.0013 respectively). The median PFS from the start of CCRT was not reached (95% CI, 14.2 months to not reached) in patients receiving durvalumab. CONCLUSION: CCRT using IMRT followed by durvalumab was generally effective and tolerable; V5 <60% would be recommended to avoid symptomatic pneumonitis.

Surgical strategies for treatment of clinical T4 esophageal cancer in Japan.

Definitive chemoradiation (dCRT) is the mainstay treatment for cStage IVa esophageal squamous cell carcinoma (ESCC) with good performance status (PS), according to standard practice guidelines. Salvage surgery may incur operation complications and risk of mortality. According to the esophageal cancer practice guidelines outlined by the Japan Esophageal Society, when a tumor is residual and recurrent, chemotherapy and palliative symptomatic treatment is continued. However, salvage operation has been selected as a therapeutic option for recurrent or residual tumors after dCRT. There is weak evidence for not recommending surgery for cStage IVa ESCC exhibiting residual disease following dCRT. It has been reported that during salvage surgery the only prognostic factor that is thought to be performed is complete resection (R0), but at the same time, salvage esophagectomy increases the incidence of postoperative complications and mortality. The phase II chemoselection study by Yokota T et al. in Japan showed that multidisciplinary treatment initiated by induction therapy, in which docetaxel is added to cisplatin and 5-fluorouracil, resulted in a good prognosis in the short term. In this review, we discuss the surgical strategy and future of unresectable clinical T4 (cT4) ESCC.

Risk of radiation pneumonitis in patients with emphysema after stereotactic body radiotherapy for non-small cell lung cancer assessed by quantitative CT.

Quantitative CT assessment of patients with pulmonary emphysema is used to measure pulmonary function. The present study evaluated whether the quantitative CT value can accurately estimate the risk of radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC) in patients with and without emphysema. A total of 80 patients with stage I NSCLC receiving SBRT at a dose of 50 or 60 Gy in five fractions at our hospital between November 2003 and October 2015 were included in the analysis. A total of 33 (41%) patients were diagnosed with emphysema on CT examination. Dosimetric parameters, quantitative CT percentage value of low attenuation area (LAA%) in the whole lung, and average whole lung CT density values were used to examine the risk of RP. Among the 80 patients, 26 (33%) and 3 (4%) experienced Grade 1 and Grade 2 RP, respectively, during the median observation period of 18.8 (1.8-106.8) months. The RP rate for patients with a LAA% (<-910 HU) of ≤25% was significantly higher than that of subjects with LAA% (<-910 HU) >25% (P=0.037). The RP rate in subjects with an average HU value of >-790 HU was significantly higher compared with that of patients with ≤-790 HU (P=0.036). Age (hazard ratio [HR]=2.46; P=0.03) and average HU (HR=3.39; P=0.02) were significantly associated with RP, whereas mean lung dose was not identified to be significant in multivariate analysis. The quantitative CT value was associated with RP after SBRT.

[Impact of Respiratory Waveform on Gate Signal Generation on Respiratory Gated Irradiation and Evaluation Method of Respiratory Waveform to Be Used].

PURPOSE: The respiratory gated irradiation using the real-time position management system (RPM) was used to clarify the generation of the gated signal when the respiration waveform changed, and also the evaluation method of the respiration waveform was also examined. METHODS: The respiratory waveform was changed using a moving phantom. Respiratory waveform was analyzed from the data recorded in RPM, and the out-of-phase gated rate was examined. Analysis was made by focusing on the coefficient of variation of the respiratory wavelength in the evaluation of respiratory waveform. RESULTS: Immediately after the change of respiratory wavelength from the short cycle to the long cycle, a gated signal was generated at a phase before the set gated phase, and a maximum advance of 1.259 ± 0.212 s occurred. Immediately after the change of respiratory wavelength from the long cycle to the short cycle, the gated signal was generated at the phase exceeding the set gated phase, and a delay of 0.997 ± 0.180 s occurred at the maximum. As the value of the coefficient of variation increased, the gated rate which was out of setting also increased. CONCLUSION: In respiratory gated irradiation using RPM, it became clear that the gated signal is generated out of the phase set by the respiratory waveform change. Coefficient of variation of the respiratory wavelength is considered to be an indicator for evaluating the respiratory waveform to be used in the respiratory gated irradiation.

Carbon 11-choline positron emission tomography/computed tomography and palliative local therapy for castration-resistant prostate cancer.

PURPOSE: Carbon 11-choline positron emission tomography/computed tomography (11C-choline PET/CT) and subsequent local therapy for oligometastatic prostate cancer have been reported to be effective, but their effectiveness in castration-resistant prostate cancer (CRPC) remains unclear. Here, we evaluated the findings of 11C-choline PET/CT in CRPC patients and the efficacy of local treatments in correspondence of the pathologic choline uptake. METHODS: We collected 12 cases of CRPC patients who underwent 11C-choline PET/CT between 2014 and 2016. The outcomes assessed included age, the prostate-specific antigen (PSA) value, the findings of 11C-choline PET/CT, the subsequent treatments, the PSA response following the treatments, and the progression-free survival (PFS). RESULTS: Seven of 12 cases (median PSA, 3.29 ng/mL) had local prostate cancer and/or one or two metastatic lesions detected by the choline PET/CT. These localized lesions were treated with radiotherapy or lymphadenectomy. PSA decreased in all the seven cases and median PSA response was 86% (range, 23-100%). Median PFS was 8.5 months (range, 2.8-25.3 months). The other five cases (median PSA, 7.41 ng/mL) had multiple metastases and systemic therapies were continued in those cases. CONCLUSIONS: 11C-choline PET/CT and the correspondent local treatments may play an important role in the treatment sequence of CRPC in selected patients.

Phase II study of compensator-based non-coplanar intensity-modulated radiotherapy for Stage I non-small-cell lung cancer.

We conducted a Phase II study to evaluate the usefulness of compensator-based non-coplanar intensity-modulated radiotherapy (ncIMRT) for patients with surgically inaccessible Stage I non-small-cell lung cancer (NSCLC). Patients with pathologically proven or clinically diagnosed surgically inaccessible Stage I NSCLC were enrolled in this study from May 2011 to April 2014. These patients underwent ncIMRT of 75 Gy in 30 fractions regardless of the tumor location. The primary end point was 3-year overall survival, and the secondary end points were local control rate and treatment-related toxicities. A total of 48 patients (50 tumors) were enrolled in this study. Of the 50 tumors, the Stage T1 to T2 ratio was 31 to 19, and the ratio of tumors located in the central to peripheral areas was 11 to 39. During the median follow-up time of 35.9 months, the 3-year actuarial local progression-free and overall survival rates were 82.6% and 87.1%, respectively. No patients experienced toxicities of Grade 3 or greater. Standard-fractionated ncIMRT was effective and safe for patients with surgically inaccessible stage I NSCLC, regardless of the tumor location.

[Multileaf Collimator Position Accuracy of Respiratory Gated VMAT].

Respiratory gated VMAT (volumetric modulated arc therapy) repeats rapid stop and go operations of a MLC (multileaf collimator) by turning the beam on and off by respiratory gating. The rapid stop and go operations of the MLC during respiratory gated irradiation may induce position error of the MLC and may affect output error and dose distribution. The purpose of this study was to clarify the relationship between the MLC position accuracy of the respiratory gated VMAT and the VMAT parameters. In the method, 1 arc, 2 arcs, and 4 arcs plan were created for the virtual target and irradiation was performed without the gated respiration and with the gated respiration. The respiratory gated system used a RPM (real-time position management system). The MLC position error, gap size error, and the MLC leaf speed were calculated from a log-file. In the histogram of the gap size error, the frequency of falling within the error range up to 0.2 mm was about 12 percentage points higher for the gated respiration. The MLC position error increased with increasing the MLC leaf speed. The correlation coefficient between the MLC leaf speed and the MLC position error exceeded 0.96, showing a strong correlation. Dose rate of VMAT parameters decreased with increasing arc number with the gated respiration and without the gated respiration. Gated irradiation was temporarily stopped, and it decreased by about 27% with respect to the dose rate without the gated respiration. The gantry rotation speed repeated the stop and re-rotation operations when gated irradiation was performed. For all arcs, the rotation speed decreased by about 30% compared with the rotation speed without the gated respiration. The pass rate of gamma analysis for each arc plan was about 95%. No effect on gated irradiation dose distribution was observed. Respiratory gated irradiation reduced dose rate change and gantry rotation speed of the VMAT. Reduction of the MLC leaf speed occurred, and the MLC position error and gap size error decreased. The MLC positional accuracy was secured, and it was confirmed that there was no effect on dose distribution by the respiratory gated VMAT.

Association between rectal bleeding and the absolute dose volume of the rectum following image-guided radiotherapy for patients with prostate cancer.

The association between rectal bleeding and the received dose relative to the volume of the rectum is well established in prostate cancer patients who have undergone radiotherapy. The relative volume of the rectum is affected by the rectal anatomical volume, which depends on the definition of rectal length. Compared with the relative rectal volume, the absolute volume of the rectum may be more associated with rectal bleeding. The present study investigated the absolute volume of the rectum that may be used to predict late rectal bleeding following intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT). The cases of 82 patients of prostate cancer, who underwent IMRT and IGRT, were retrospectively evaluated by evaluating dose volume histograms. The median patient age was 73.4 years (range, 51.3-85.9 years). The median total prescribed dose was 76 Gy given in 38 fractions. The absolute and relative dose volumes of the rectum were evaluated by multivariate analysis, and the optimal dose to prevent rectal bleeding was determined. The actuarial ≥grade 1 rectal bleeding rate at 4 years was 4.5% (95% confidence interval, 1.5-13.4%) with a median observation period of 45.3 months. The absolute rectal volume (ml) treated with 60 Gy was the only significant risk factor for rectal bleeding (P<0.05), but the relative rectal volume (%) was not identified as a significant factor by the multivariate analysis. When the rectal volume of 5 or 10 ml received 60 Gy (D5cc and D10cc), rectal bleeding was expected to occur in 3.3 and 7.3% of the patients, respectively. Rectal D5cc ≤60 Gy is recommended to prevent late ≥grade 1 rectal bleeding in IGRT.

[Effects of Low MU in Respiratory Gated IMRT on MLC Position Accuracy and Dose Distribution].

PURPOSE: The purpose of this research is to clarify the effects of low monitor unit (MU) on multileaf collimator (MLC) position accuracy and dose distribution in intensity modulated radiotherapy (IMRT) using respiratory gated. METHOD: In the phantom experiment, irradiation without respiratory gated and respiratory gated with low MU (3, 5, and 7 MU) were performed, and positional accuracy and dose distribution of MLC were analyzed. MLC positional accuracy was calculated from the log-files and the MLC position error, gap size error, MLC leaf speed were calculated and compared with the planned value. Gamma analysis of the dose distribution obtained from the irradiated films and the dose distribution of the treatment plans were carried out. RESULTS: Without respiratory gated and respiratory gated, the frequency of gap size error that did not exceed 0.2 mm were more than 93% under all conditions. MLC position error increased with increasing MLC leaf speed. The determination coefficient of respiratory gated irradiation was lower by about 20% compared with that without respiratory gated, and variation from the approximate straight line occurs. The output difference due to low MU irradiation during respiratory gated was within 1% of the planned value. Although, the pass rate of gamma analysis differed in tumor size, the dose distribution well conformity at 96% or more for both without respiratory gated and respiratory gated. However, in the comparison of the profile in the MLC movement direction, respiratory gated irradiation at 3 MU showed a difference of about 9% at the edge of the irradiated field and about 6% at the point where the dose rapidly changed. CONCLUSION: It was shown that MLC position accuracy due to stop and go of MLC leaf can be secured even with low MU irradiation of about 3 MU. However, attention should be paid to the dose of risk organs adjacent to the tumor margin.

Is severe emphysema, as defined by quantitative CT measurement, a negative risk factor of radiation fibrosis?

OBJECTIVE: To investigate whether patients with emphysema, as evaluated by quantitative CT image measurement, are at risk of developing radiation pneumonitis (RP) after radiotherapy (RT) for non-small cell lung cancer (NSCLC). METHODS: Between March 2011 and June 2015, 68 consecutive patients with Stage I NSCLC treated with a RT dose of 75 Gy given in 30 fractions were enrolled. The median age was 79 years and there were 45 males and 23 females. The number of patients with T1 and T2 were 49 and 19, respectively. The severity of emphysema was evaluated by the percentages of the low attenuation area (LAA) of ≤-860 or -950 Hounsfield unit (HU) and average HU in the whole lung. RESULTS: The mean difference percentages of LAA of ≤-860 (p = 0.0004) or -950 HU (p = 0.005) and average HU (p = 0.001) in patients with RP were significantly lower than those in patients without RP. The area under curve (AUC) of average HU was significantly higher than AUC of LAA of ≤-860 (p < 0.0001) or -950 HU (p < 0.0001). The RP rate after RT was significantly lower when the average HU values were ≤-850 HU (p = 0.0003). CONCLUSION: Patients with emphysema evaluated by average HU (≤-850 HU) in the whole lung were found to be at low risk of RP after RT. Advances in Knowledge: Quantitative measurement of average HU from CT images was predicted of RP after RT.

Target volume dose and clinical outcome in radiotherapy for primary marginal zone lymphoma of the ocular adnexa.

The aim of the present study was to determine the optimal dose and optimal target volume for marginal zone lymphoma of the ocular adnexa. Between January, 2008 and December, 2013, 40 patients with histologically proven primary marginal zone lymphoma of the ocular adnexa who underwent radiotherapy at the Tokyo Medical University were evaluated. The prescribed dose was 30 Gy in 15 fractions to the iso-center. Doses to the gross tumor volume (GTV), conjunctiva, bulbus oculi, retina and retrobulbar space were investigated, and the association between dose-volume factors and clinical outcome was analyzed. The overall and local progression-free survival rates at 3 and 5 years were 100% during a median observation period of 32 months. Two patients relapsed in the contralateral ocular adnexa. The progression-free survival rates at 3 and 5 years were 100 and 93.3%, respectively. The mean dose was 2.0 and 1.9 Gy for targets receiving 95% of the GTV dose (D95). The minimum dose was 0.9-2.0 Gy (median, 1.8 Gy). Thus, primary marginal zone lymphoma of the ocular adnexa favorably responded to lower doses of radiation, compared with prescribed doses to the iso-center. A radiation dose of 27 Gy in 15 fractions at D95 of GTV appeared to be optimal.

Clinical outcome and dose volume evaluation in patients who undergo brachytherapy for angiosarcoma of the scalp and face.

The present study was conducted to retrospectively evaluate survival and local control with definitive brachytherapy in patients with cutaneous angiosarcoma of the scalp and/or face, and to determine the optimal radiation dose and irradiated volume. Between November, 2009 and January, 2015, 9 consecutive patients with histologically proven angiosarcoma of the scalp and/or face who received image-guided brachytherapy were retrospectively evaluated. The median age of the patients was 83.4 years (range, 67.7-91.9 years). Of the 9 patients, 8 had no lymph node metastasis and 1 patient had cervical lymph node metastasis. The patients were irradiated with a dose of 3 Gy three times per week for varying lengths of time; 4 patients received a total dose of 60 Gy, 1 received 48 Gy and the 4 remaining patients received 45 Gy. The patient who received 48 Gy also underwent additional electron therapy of 16 Gy in 8 fractions. The overall survival, progression-free survival and local progression-free rates at 3 years were 50.8% [95% confidence interval (CI): 15.6-78.1%], 37.0% (95% CI: 6.8-69.3%) and 77.8% (95% CI: 36.5-93.9%), respectively. The local progression-free rate in the 4 patients who received a total of ≥60 Gy was statistically significantly better compared with that in the 5 patients who received a dose of <60 Gy (P=0.027). A total of 7 patients had grade 2 radiation dermatitis, whereas the remaining 2 patients had grade 3 dermatitis. All the patients had grade 2 alopecia. Local disease control achieved by radiotherapy resulted in higher survival. Therefore, prescribing ≥60 Gy in 20 fractions for the gross tumor volume is recommended for angiosarcoma of the scalp and face.

A phase II trial of neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy combined with gemcitabine and S-1 for borderline-resectable pancreatic cancer with arterial involvement.

PURPOSE: Chemoradiotherapy using intensity-modulated radiotherapy (IMRT) is expected to provide a powerful alternative to conventional chemotherapy with a low incidence of adverse events. This study evaluated the efficacy of intensity modulated radiotherapy in combination with gemcitabine and S-1 as neoadjuvant chemoradiotherapy (NACRT) for borderline-resectable pancreatic cancer with arterial involvement (BR-A). METHODS: A total of 27 patients with BR-A were enrolled in this study between February 2012 and September 2015. IMRT was administered at 50.4 Gy in 28 fractions with concurrent gemcitabine at a dose of 600 mg/m2 and S-1 at a dose of 60 mg. RESULTS: Only one patient (3.5%) experienced gastrointestinal adverse events at grade 3 or higher. Nineteen patients (70.3%) underwent resection, and R0 resection was achieved in 18 patients (94.7%). Thirteen patients (68.4%) developed distant metastasis at the initial site of recurrence after resection. Local recurrence developed in only one of these patients (7.7%). The median overall survival and 1-year survival rates were 22.4 months and 81.3%, respectively. CONCLUSIONS: Concurrent IMRT with gemcitabine and S-1 for patients is feasible as NACRT for BR-A with low gastrointestinal toxicity. IMRT can be employed as a standard radiotherapy to provide more effective NACRT with powerful chemotherapy drugs.

Feasibility of intensity-modulated radiotherapy combined with gemcitabine and S-1 for patients with pancreatic cancer.

The aim of the present study was to establish whether intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine and S-1 is a feasible treatment option for patients with locally advanced pancreatic ductal adenocarcinoma. Patients with pancreatic ductal adenocarcinoma were prospectively enrolled. An IMRT dose of 50.4 Gy in 28 fractions with concurrent gemcitabine at a dose of 600 mg/m2 and S-1 at a dose of 60 mg were administrated. Adverse events and associated dosimetric factors were assessed. Between February 2012 and January 2014, 17 patients with borderline resectable and 4 with unresectable pancreatic cancer were enrolled. None of the patients experienced grade 3 or worse nausea and vomiting. The planning target volume (≥200 vs. <200 ml) was a statistically significant predictive factor for neutrocytopenia (≥500 vs. 500/µl, P=0.02). Concurrent IMRT with gemcitabine and S-1 for patients with locally advanced pancreatic cancer is feasible, with tolerable hematological toxicities and low gastrointestinal toxicities.