Influence of a multidisciplinary cancer board on treatment decisions.

BACKGROUND: To clarify how a multidisciplinary cancer board (CB) influences treatment decisions. METHODS: From March 2010 to June 2011, a total of 475 cases were discussed at our CB and the minutes of the board were reviewed for this study. RESULTS: Of the 475 patients, minor changes in treatment methods were made in 42 patients (9 %) and major changes were made in 28 patients (6 %). Further diagnostic procedures, further publication surveys and reconfirmation of patient's wishes were recommended in 80 patients (17 %). In the 392 patients for whom treatment was recommended, the CB's recommendation was realized in 349 patients (89 %) and was not realized in 20 (5 %) patients. CONCLUSIONS: It is obvious that a CB has a great influence on cancer treatment decisions, but the effectiveness of the CB in our hospital should be verified in the future by analyzing treatment outcomes.

A phase I trial of S-1 with concurrent radiotherapy in patients with locally recurrent rectal cancer.

BACKGROUND: The purpose of this phase I trial of S-1 chemotherapy in combination with pelvic radiotherapy for locally recurrent rectal cancer was to determine the maximum tolerated dose (MTD), recommended dose (RD), and dose-limiting toxicity (DLT) of S-1. METHODS: We enrolled 9 patients between April 2005 and March 2009. Radiotherapy (total dose, 60 Gy in 30 fractions) was given to the gross local recurrent tumor and pelvic nodal metastases using three-dimensional radiotherapy planning. We administered oral S-1 twice a day on days 1-14 and 22-35 during radiotherapy. The dose of S-1 was initially 60 mg/m(2)/day and was increased to determine the MTD and RD for this regimen. RESULTS: DLT appeared at dose level 2 (70 mg/m(2)/day) in 2 patients, who experienced grade 3 enterocolitis and consequently required suspension of S-1 administration for longer than 2 weeks. Hematological toxicity was mild and reversible. At the initial evaluation, complete regression and partial regression were seen in 1 patient (11%) and 2 patients (22%), respectively. CONCLUSION: This phase I trial of S-1 chemotherapy with pelvic radiotherapy for locally recurrent rectal cancer revealed that the MTD for S-1 was 70 mg/m(2)/day and the RD was 60 mg/m(2)/day.

Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report.

INTRODUCTION: Many patients with endometriosis are treated with medication or by surgical approaches. However, a small number of patients do not respond to medication and are inoperable because of comorbidities. This case report shows the effectiveness of radiotherapy for refractory endometriosis and includes a time series of serum estradiol levels. CASE PRESENTATION: A 47-year-old Asian woman presented to our facility with uncontrolled endometriosis refractory to medication. Our patient was considered inoperable because of severe idiopathic thrombocytopenic purpura, and underwent radiotherapy for massive genital bleeding requiring blood transfusions. A radiation dose of 20Gy in 10 fractions was delivered to the pelvis, including the bilateral ovaries, uterus, and myomas. An additional 10Gy in five fractions was delivered to the endometrium to control residual bleeding. Genital bleeding was completely inhibited on day 46 after radiotherapy. Hormonal analysis revealed that radiotherapy induced post-menopausal status. Two years after radiotherapy, atypical genital bleeding had not recurred and has been well controlled without side effects. CONCLUSIONS: Disrupted ovarian function is an adverse effect of radiotherapy. However, radiotherapy can be useful for inducing menopause. In cases of medication-refractory or inoperable endometriosis, radiotherapy would be an effective treatment option.

Inverse-direction scanning improves the image quality of whole carotid CT angiography with 64-MDCT.

PURPOSE: The purpose of this prospective study was to clarify whether reducing the incidence of perivenous artifacts through craniocaudal scanning improves the quality of 64-multidetecter computed tomography (MDCT) angiography images of the whole carotid artery. METHODS: Forty patients underwent MDCT angiography in the caudocranial (n=20) or craniocaudal (n=20) direction in 2007. All patients were injected with 75 ml of contrast media followed by a 35-ml saline chaser bolus at 4.0 ml/s in the right antecubital vein. Maximum intensity projection (MIP) images were scored according to image quality on a scale of 1-5. Bilateral arterial and venous attenuation was measured on 10 separated slices. We compared the mean image quality score of the two groups (i.e. those scanned caudocranially and those scanned craniocaudally). We analyzed the correlation between vascular attenuation and mean image quality. RESULTS: Compared with the caudocranial group, the craniocaudal group had higher image quality scores (median, 3.70 vs. 3.40; 95% CI, 3.50-3.96 vs. 3.06-3.60; p<0.05), higher arterial attenuation (median, 550 HU vs. 489 HU; range, 270-686 vs. 302-574; p<0.05), and lower maximum venous attenuation (median, 436 vs. 1452 HU; range, 250-617 vs. 377-2044; p<0.01). Multiple regression analysis revealed that the most significant correlation factor with image quality was minimum arterial attenuation (R2=0.42, p<0.001) measured near the brachiocephalic artery. In the caudocranial group only, there was a negative correlation between right brachiocephalic venous attenuation and minimum arterial attenuation. CONCLUSIONS: Compared with conventional caudocranial scanning, craniocaudal scanning improves the image quality of 64-MDCT angiography images of the whole carotid artery.