Early intervention using high-precision radiotherapy preserved visual function for five consecutive patients with optic nerve sheath meningioma.

BACKGROUND: There has been a paradigm shift in the treatment for optic nerve sheath meningioma (ONSM) from surgery to fractionated stereotactic radiotherapy (FSRT) in other countries. However, FSRT has seldom been performed in Japan. The purpose of this retrospective study is to reconfirm the effectiveness of early intervention with precision radiotherapy for ONSM reported in our previous study. METHODS: Five consecutive patients with ONSM were retrospectively analyzed. All patients underwent intensity-modulated radiotherapy (IMRT) or FSRT. They received the early interventions between 1.5 and 7 months after deterioration of the disease. The median dose was 52.8 Gy (range 46.0-59.4 Gy) and the median number of fractions was 25 (range 22-33). RESULTS: All patients experienced reestablishment of vision at the median follow-up time of 36 months (range 18-54 months). Four of them noted early improvement of visual deficits during the treatment course (range 2-4 weeks) and the remaining patient improved 3 weeks after completion of IMRT. The median tumor reduction was 53% (range 39-75%). One patient with diabetes mellitus developed retinal bleeding as a result of radiation retinopathy 16 months after IMRT, although the doses were acceptable. The remaining 4 patients have no late toxicity at the follow-up time of 31-54 months. CONCLUSIONS: A paradigm shift is necessary from surgery to early intervention using precision radiotherapy for the treatment of ONSM in Japan.

[Disorder of Gastric Myoelectric Activity in Patients with Cerebral Infarction:Electrogastrographic Assessment].

In this study, gastric myoelectric activity in patients with acute cerebral infarction was investigated using electrogastrography. The patients were divided into four groups; those with mild brainstem infarction(group A, n=13, men:8, women:5, 75±2 years old), severe brainstem infarction(group B, n=6, men:4, women:2, 79±4 years old), mild non-brainstem infarction(group C, n=14, men:7, women:7, 76±3 years old), and severe non-brainstem infarction(group D, n=9, men:3, women:6, 87±2 years old). In group B, the% ratio of normogastria(2.4-3.6 cycles per minute)was significantly lower in the fasting period. The dominant power(DP)significantly increased after the meal in group C, but did not in group A, compared to before the meal. The DP increased in all patients in group C after the meal, whereas it increased in only five of ten patients in group A. The possibility of gastric dysfunction should be considered in patients with brainstem infarction.

Clinical introduction of Monte Carlo treatment planning for lung stereotactic body radiotherapy.

The purpose of this study was to investigate the impact of Monte Carlo (MC) calculations and optimized dose definitions in stereotactic body radiotherapy (SBRT) for lung cancer patients. We used a retrospective patient review and basic virtual phantom to determine dose prescriptions. Fifty-three patients underwent SBRT. A basic virtual phantom had a gross tumor volume (GTV) of 10.0 mm with equivalent water density of 1.0 g/cm3, which was surrounded by equivalent lung surrounding the GTV of 0.25 g/cm3. D95 of the planning target volume (PTV) and D99 of the GTV were evaluated with different GTV sizes (5.0 to 30.0 mm) and different lung densities (0.05 to 0.45 g/cm3). Prescribed dose was defined as 95% of the PTV should receive 100% of the dose (48 Gy/4 fractions) using pencil beam (PB) calculation and recalculated using MC calculation. In the patient study, average doses to the D95 of the PTV and D99 of the GTV using the MC calculation plan were 19.9% and 10.2% lower than those by the PB calculation plan, respectively. In the phantom study, decreased doses to the D95 of the PTV and D99 of the GTV using the MC calculation plan were accompanied with changes GTV size from 30.0to 5.0 mm, which was decreased from 8.4% to 19.6% for the PTV and from 17.4%to 27.5% for the GTV. Similar results were seen with changes in lung density from 0.45 to 0.05 g/cm3, with doses to the D95 of the PTV and D99 of the GTV were decreased from 12.8% to 59.0% and from 7.6% to 44.8%, respectively. The decrease in dose to the PTV with MC calculation was strongly dependent on lung density. We suggest that dose definition to the GTV for lung cancer SBRT be optimized using MC calculation. Our current clinical protocol for lung SBRT is based on a prescribed dose of 44 Gy in 4 fractions to the GTV using MC calculation.

New approach for treatment of vertebral metastases using intensity-modulated radiotherapy.

PURPOSE: To perform aggressive radiotherapy for vertebral metastases. Using very steep dose gradients from intensity-modulated radiotherapy (IMRT), a protocol based on the concept of partial volume dose to the spinal cord was evaluated. PATIENTS AND METHODS: 50 patients with vertebral metastases were treated using IMRT. In previously unirradiated cases, where a prescribed dose of 80 Gy (BED10) was delivered, the constraint to the spinal cord should be less than 100 Gy (BED2). For previously irradiated cases, on the other hand, the dose is the same as in the previously unirradiated case; however, constraints for the spinal cord are a cumulative BED2 of less than 150 Gy, BED2 of less than 100 Gy in each instance, and a treatment gap of more than 6 months. There were 6 patients considered for a partial volume dose to the spinal cord. They all received higher BED2, ranging from 51-157 Gy of D1cc. RESULTS: Among the 24 patients who survived longer than 1 year, there was 1 case of transient radiation myelitis. There were no other cases of spinal cord sequelae. CONCLUSION: Based on the present results, we recommend a BED2 of 100 Gy or less at D1cc as a constraint for the spinal cord in previously unirradiated cases, and a cumulative BED2 of 150 Gy or less at D1cc in previously irradiated cases, when the interval was not shorter than 6 months and the BED2 for each session was 100 Gy or less. The prescribed BED10 of 80 Gy could be safely delivered to the vertebral lesions.

The rapid improvement in visual field defect observed with weekly perimetry during intensity-modulated radiotherapy for optic nerve sheath meningioma.

During precision radiotherapy to treat optic nerve sheath meningioma, early improvement in visual function has been seen. This has been difficult to explain biologically. In the present study, we aimed to investigate this rapid improvement in visual function. To this end, we prospectively tested a single patient's visual field (VF) using Humphrey automated perimetry at weekly intervals. The patient exhibited significant stepwise improvement in VF during an intensity-modulated radiotherapy course.

Rapid recovery of vision following early intervention with fractionated stereotactic radiotherapy for optic nerve sheath meningioma.

PURPOSE: To report the outcomes of early intervention with fractionated stereotactic radiotherapy (FSRT) in a patient with primary optic nerve sheath meningioma (ONSM). PATIENT AND METHODS: A male patient in his early 40s underwent 5-beam FSRT at a prescribed dose of 50 Gy in 25 fractions over 35 days. The patient had an 11-month history of progressive visual impairment at the time of FSRT. RESULTS: On day 14 of treatment, the patient reported early improvement in his vision. Two weeks after the completion of FSRT, his left eye visual acuity and field recovered completely. However, the tumor regressed only slightly in the 2 years of follow-up. CONCLUSION: Early intervention with FSRT for optic nerve sheath meningioma resulted in a rapid response and complete improvement of visual impairment.

Patterns of care study of breast-conserving therapy in Japan: comparison of the treatment process between 1995 1997 and 1999 2001 surveys.

BACKGROUND: The Japan Patterns of Care Study (JPCS) conducted two national surveys to identify changes associated with the treatment process of care for patients undergoing breast-conserving therapy (BCT). Between the two national surveys, the Japanese Breast Cancer Society published its treatment guideline for BCT. METHOD: The first survey collected data on 865 patients treated between 1995 and 1997 (JPCS-1), and the second on 746 patients treated between1999 and 2001 (JPCS-2) by extramural audits. RESULTS: There was a shift to an older age distribution in JPCS-2 compared with JPCS-1. In JPCS-2, the average patient age was 53.9 compared with 51.5 in JPCS-1 (P < 0.001). There was a reduction in the extent of breast surgery and the proportion of the patients who received quadrantectomy was 57.0% in JPCS-1 and 30.3% in JPCS-2 (P < 0.001). In JPCS-2, a cast or shell for immobilization was used at a significantly higher rate of 52.9% compared with 32.6% for JPCS-1 (P < 0.001). The rate of boost irradiation was increased in JPCS-2, especially for patients with a positive surgical margin; it was significantly increased to 83.5% in JPCS-2 compared with 53.9% in JPCS-1 (P < 0.001). CONCLUSIONS: The second survey revealed a rapid change in the trend of the treatment of BCT in Japan and represented high compliance of the treatment guideline for BCT published by the Japanese Breast Cancer Society (JBCS) in 1999.

Feasibility study of a non-invasive eye fixation and monitoring device using a right-angle prism mirror for intensity-modulated radiotherapy for choroidal melanoma.

We aimed to describe the feasibility and efficacy of a novel non-invasive fixation and monitoring (F-M) device for the eyeballs (which uses a right-angle prism mirror as the optic axis guide) in three consecutive patients with choroidal melanoma who were treated with intensity-modulated radiotherapy (IMRT). The device consists of an immobilization shell, a right-angle prism mirror, a high magnification optical zoom video camera, a guide lamp, a digital voice recorder, a personal computer, and a National Television System Committee standard analog video cable. Using the right-angle prism mirror, the antero-posterior axis was determined coincident with the optic axis connecting the centers of the cornea and pupil. The axis was then connected to the guide light and video camera installed on the couch top on the distal side. Repositioning accuracy improved using this method. Furthermore, the positional error of the lens was markedly reduced from ±1.16, ±1.68 and ±1.11 mm to ±0.23, ±0.58 and ±0.26 mm in the horizontal direction, and from ±1.50, ±1.03 and ±0.48 mm to ±0.29, ±0.30 and ±0.24 mm in the vertical direction (Patient #1, #2 and #3, respectively). Accordingly, the F-M device method decreased the planning target volume size and improved the dose-volume histogram parameters of the organ-at-risk via IMRT inverse planning. Importantly, the treatment method was well tolerated.

High-dose-rate interstitial brachytherapy for mobile tongue cancer: influence of the non-irradiated period.

BACKGROUND: It has been demonstrated that the outcome of primary radiotherapy in squamous cell carcinomas of the head and neck is strongly influenced by overall treatment time. The purpose of this study was to evaluate the results of high-dose-rate (HDR) interstitial brachytherapy (ISBT) for early mobile tongue cancer and to examine whether the non-irradiated period affected treatment results. MATERIALS AND METHODS: Seventy-one patients with early mobile tongue cancer (T1-T2N0M0) were treated with HDR ISBT alone. The total dose was 54-60 Gy/9-10 fractions/5-9 days. All patients were classified into 4 groups: R0, maximum non-irradiated period (NIP) was less than 24 h (n=16); R1, maximum NIP was from 24 to 48 h (n=24); R2, maximum NIP was from 48 to 72 h (n=26); R3, maximum NIP was from 72 to 96 h (n=5). RESULTS: The 3-year local control rate was 94% in R0, 83% in R1, 85% in R2 and 100% in R3. The 3-year overall survival rate was 84% in R0, 92% in R1, 71% in R2 and 80% in R3. There was no significant difference in the local control rate, overall survival rate, or complications among the 4 groups. CONCLUSION: In HDR ISBT for early mobile tongue cancer, the non-irradiated period did not affect the treatment results or complications.

Intracavitary brachytherapy for carcinoma of the uterine cervix--comparison of HDR (Ir-192) and MDR (Cs-137).

PURPOSE: To compare the results of high dose rate (HDR) (Ir-192) and medium dose rate (MDR) (Cs-137) intracavitary brachytherapy (ICRT) for carcinoma of the uterine cervix. MATERIALS AND METHODS: Between May 1991 and March 2001, a total of 206 patients with Stage I-IVA previously untreated cervical cancer were treated with ICRT combined with external beam radiotherapy (EBRT). HDR was administered to a total of 135 patients: 22 patients in Stage I, 49 in Stage II, 56 in Stage III, and eight in Stage IVA. MDR was administered to a total of 71 patients: six patients in Stage I, 27 in Stage II, 33 in Stage III, and five in Stage IVA. The MDR at point A was 30 Gy/hour for HDR and 1.7 Gy/hour for MDR treatment, and the corresponding median follow-up periods for survivors were 55 and 68 months. RESULTS: For the HDR group, 5-year cause-specific survival rates were 90%, 78%, 53% and 33% for Stages I, II, III, and IVA, respectively. For the MDR group, the corresponding rates were 100%, 76%, 51%, and 40%. In the HDR group, 19 patients (14%) developed Grade 2 or higher late complications, and, in the MDR group, four patients (6%) did. CONCLUSIONS: There was no statistically significant difference in cause-specific survivals between the results of HDR and MDR brachytherapy for cervical cancer. The incidence of late complications tended to be higher for the HDR group than for the MDR group, but did not show a statistically significant difference (p=0.07).

Outcomes and toxicity of radiotherapy for refractory bone and soft tissue sarcomas.

Surgical resection is a well-established treatment option for sarcoma. However, anatomical barriers often hamper radical surgical procedures. The treatment of unresectable sarcoma, including local or distant failures following initial treatment, is challenging. The aim of the present study was to analyze the outcome of radiotherapy (RT) for refractory sarcoma, including unresectable, metastatic and recurrent disease, following radical treatment. We retrospectively reviewed a total of 67 tumors in 28 patients who were treated with RT between 2007 and 2014. Clinical target volume (CTV) was generally not defined in a preventive manner; therefore, in the majority of the cases, CTV equaled the gross tumor volume. The total delivered dose, number of fractions and biological equivalent dose were 52 (range, 40-69), 10 (range, 4-24) and 92.2 (range, 56-119.6) Gy, respectively. Only 1 patient developed local failure, with a median follow-up of 11 months (range, 1-59 months). Therefore, the 12-month progression-free survival rate for 67 sites was 96.8%. The overall survival rates at 12 and 36 months were 75.8 and 30.2%, respectively. A total of 2 patients developed grade >2 toxicities, including grade 3 mucositis and grade 4 pericardial effusion. Our results demonstrated that radical RT using modern techniques is highly feasible, achieves excellent local control, and may be an effective treatment option for refractory sarcoma.

The patterns of care study for breast-conserving therapy in Japan: analysis of process survey from 1995 to 1997.

PURPOSE: To present the results of a process survey on breast-conserving therapy (BCT) in Japan from 1995 to 1997. METHODS AND MATERIALS: From September 1998 to December 1999, data on the treatment process of 865 randomly selected BCT patients were collected by extramural audits. RESULTS: For primary surgery, wide excision or tumorectomy was performed in 372 patients (43.0%), and quadrantectomy or segmental mastectomy was performed in 493 patients (57%). The extent of axillary dissection was equal or beyond Level II in 590 patients (68.2%). Systemic chemotherapy was administered to 103 of 160 node-positive patients (64.4%) and 180 of 569 node-negative patients (31.6%). Tamoxifen was administered to 234 of 323 hormone receptor-positive patients (72.5%) and 68 of 130 hormone receptor-negative patients (52.3%). Photon energy of 10 MV was administered for whole breast irradiation in 38 patients (4.4%) without bolus. CONCLUSIONS: The extent of surgical resection for BCT was large in Japan. Pathologic assessment and the technique of radiation therapy were apparently suboptimal in some cases. Information on prognostic/predictive factors was not fully utilized to individualize systemic adjuvant therapy. Establishment and widespread use of guidelines for BCT for in Japan are desirable. Repeated surveys will demonstrate how such guidelines affect clinical practices.

Urinary 8-hydroxy-2'-deoxyguanosine excretion as a biomarker for estimating DNA oxidation in patients undergoing external radiotherapy and/or brachytherapy.

Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) is considered to be a biomarker of cellular oxidative stress and to be associated with carcinogenesis. To estimate the oxidative stress caused by radiotherapy, we used the enzyme-linked immunosorbent assay (ELISA) to monitor urinary 8-OHdG levels in 72 patients undergoing radiotherapy. Subjects consisted of 23 breast cancer patients undergoing post-operative external radiotherapy for breast conserving therapy, 12 tongue and seven prostate cancer patients undergoing interstitial radiotherapy, 19 esophageal cancer patients undergoing external radiotherapy and chemotherapy, and 11 cervical cancer patients undergoing external radiotherapy and brachytherapy with or without chemotherapy. Before radiotherapy, cervical cancer patients showed a higher urinary 8-OHdG level (16.0+/-8.8 ng/mg) than breast cancer patients (5.3+/-5.5 ng/mg, p=0.001). In the other three groups, urinary 8-OHdG levels were in the medium range (prostate cancer patients: 6.6+/-6.3 ng/mg; esophageal cancer patients: 8.8+/-11.1 ng/mg; tongue cancer patients: 10.2+/-6.7 ng/mg). Radiotherapy did not cause changes in the excretion level of urinary 8-OHdG in patients with breast, esophageal and tongue cancer. However, radiotherapy reduced 8-OHdG excretion levels in patients with cervical cancer, whereas interstitial radiotherapy transiently increased these levels in patients with prostate cancer.

Pelvic irradiation-induced eosinophilia is correlated to prognosis of cervical cancer patients and transient elevation of serum interleukin 5 level.

PURPOSE: To determine the significance of eosinophilia and serum interleukin 5 (IL-5) levels induced by radiotherapy in patients with gynecological cancer. MATERIALS AND METHODS: First, we examined changes in the number of eosinophils before and during radiotherapy in 145 patients with cervical cancer who underwent external radiotherapy and brachytherapy. Eosinophilia was defined as > or =10% eosinophils or > or =500 eosinophils/mm3. Next, we determined serum IL-5 levels prospectively in 20 patients, comprising 18 cases of cervical cancer, one of uterine corpus cancer, and one of vaginal cancer. RESULTS: Eosinophilia was seen in 88 patients (61%). Patients with advanced disease stage IV showed 32% eosinophila, lower than those of stage I (63%), II (69%), and III (65%) disease patients (p=0.03). The 5-year cause-specific survival rate was 76% for patients with eosinophilia (+) and 53% for patients without eosinophilia (p=0.0003). Thus, eosinophilia correlates to stage classification and a good prognosis. Of the 20 patients studied prospectively, the six with elevated serum IL-5 level at one week (6/20=30%) all showed eosinophilia (100%), whereas only six of the other 14 patients had eosinophilia (43%, p=0.04). CONCLUSION: Radiotherapy induced transient elevation of serum IL-5 levels and is related with eosinophilia, which is correlated to prognosis.

Stereotactic body radiotherapy for Stage I lung cancer with chronic obstructive pulmonary disease: special reference to survival and radiation-induced pneumonitis.

This retrospective study aimed to evaluate radiation-induced pneumonitis (RIP) and a related condition that we define in this report--prolonged minimal RIP (pmRIP)--after stereotactic body radiotherapy (SBRT) for Stage I primary lung cancer in patients with chronic obstructive pulmonary disease (COPD). We assessed 136 Stage I lung cancer patients with COPD who underwent SBRT. Airflow limitation on spirometry was classified into four Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, with minor modifications: GOLD 1 (mild), GOLD 2 (moderate), GOLD 3 (severe) and GOLD 4 (very severe). On this basis, we defined two subgroups: COPD-free (COPD -) and COPD-positive (COPD +). There was no significant difference in overall survival or cause-specific-survival between these groups. Of the 136 patients, 44 (32%) had pmRIP. Multivariate analysis showed that COPD and the Brinkman index were statistically significant risk factors for the development of pmRIP. COPD and the Brinkman index were predictive factors for pmRIP, although our findings also indicate that SBRT can be tolerated in early lung cancer patients with COPD.

Differences in rates of radiation-induced true and false rib fractures after stereotactic body radiation therapy for Stage I primary lung cancer.

The purpose of this study was to analyze the dosimetry and investigate the clinical outcomes of radiation-induced rib fractures (RIRFs) after stereotactic body radiotherapy (SBRT). A total of 126 patients with Stage I primary lung cancer treated with SBRT, who had undergone follow-up computed tomography (CT) at least 12 months after SBRT and who had no previous overlapping radiation exposure were included in the study. We used the Mantel-Haenszel method and multiple logistic regression analysis to compare risk factors. We analyzed D(0.5 cm(3)) (minimum absolute dose received by a 0.5-cm(3) volume) and identified each rib that received a biologically effective dose (BED) (BED3, using the linear-quadratic (LQ) formulation assuming an α/ß = 3) of at least 50 Gy. Of the 126 patients, 46 (37%) suffered a total of 77 RIRFs. The median interval from SBRT to RIRF detection was 15 months (range, 3-56 months). The 3-year cumulative probabilities were 45% (95% CI, 34-56%) and 3% (95% CI, 0-6%), for Grades 1 and 2 RIRFs, respectively. Multivariate analysis showed that tumor location was a statistically significant risk factor for the development of Grade 1 RIRFs. Of the 77 RIRFs, 71 (92%) developed in the true ribs (ribs 1-7), and the remaining six developed in the false ribs (ribs 8-12). The BED3 associated with 10% and 50% probabilities of RIRF were 55 and 210 Gy to the true ribs and 240 and 260 Gy to the false ribs. We conclude that RIRFs develop more frequently in true ribs than in false ribs.

Crystal structure of human ISG20, an interferon-induced antiviral ribonuclease.

ISG20 is an interferon-induced antiviral exoribonuclease that acts on single-stranded RNA and also has minor activity towards single-stranded DNA. It belongs to the DEDDh group of RNases of the DEDD exonuclease superfamily. We have solved the crystal structure of human ISG20 complexed with two Mn2+ ions and uridine 5'-monophosphate (UMP) at 1.9 A resolution. Its structure, including that of the active site, is very similar to those of the corresponding domains of two DEDDh-group DNases, the epsilon subunit of Escherichia coli DNA polymerase III and E. coli exonuclease I, strongly suggesting that its catalytic mechanism is identical to that of the two DNases. However, ISG20 also has distinctive residues, Met14 and Arg53, to accommodate hydrogen bonds with the 2'-OH group of the UMP ribose, and these residues may be responsible for the preference of ISG20 for RNA substrates.

Process of care and preliminary outcome in limited-stage small-cell lung cancer: results of the 1995-1997 patterns of care study in Japan.

PURPOSE: To evaluate the practice process using the national average (NA); to compare differences in the process of care by age group; and to provide a preliminary outcome data for limited-stage small-cell lung cancer in Japan. METHODS AND MATERIALS: The Patterns of Care Study conducted a nationwide survey of the care process for Stage I-III small-cell lung cancer in Japan. Patients were divided into three age groups: <65 years (younger group, n = 73); between 65 and 74 years (intermediate group, n = 81); and >or=75 years (elderly group, n = 20). RESULTS: The NA for the total dose was 49.0 Gy, and for use of photon energy >or=6 MV, chemotherapy, and prophylactic cranial irradiation was 77.3%, 93.2%, and 1.69%, respectively. Age stratification had no impact on the variables of radiotherapy (RT) such as total dose and field size. Only 37% of patients received chemotherapy and thoracic RT concurrently. The proportion of patients who received chemotherapy and RT concurrently was 44%, 27%, and 25% of the younger, intermediate, and elderly groups, respectively (p = 0.029). Etoposide and cisplatin were less frequently used in the elderly group (>or=75 years old). Overall survival at 3 years for the entire group was 26%. The 3-year survival rate was 30% in the younger group, 28% in the intermediate group, and 9% in the elderly group. Variables found to have a significant impact on survival by multivariate analysis were the use of chemotherapy (p = 0.030), age (p = 0.032), and T stage (p = 0.042). CONCLUSION: Calculated NAs showed that the results of clinical study had favorably penetrated into the practice process in Japan. The results demonstrated that patient age significantly influenced the process of chemotherapy such as the use of etoposide and cisplatin for limited-stage small-cell lung cancer in Japan. More concurrent chemotherapy and thoracic RT and the application of prophylactic cranial irradiation for complete responders need to be investigated in the future.

An optimization algorithm of dose distribution using attraction-repulsion model (application to low-dose-rate interstitial brachytherapy).

PURPOSE: To optimize dose distribution for prostate cancer in low-dose-rate interstitial brachytherapy, we have developed a new algorithm named the Attraction-Repulsion Model. The purpose was to find the optimal source configuration. METHODS AND MATERIALS: The Attraction-Repulsion Model is used to optimize the dose distribution by finding the best seed configuration. We arranged grids at intervals of a certain space inside and established target and critical organs as areas of interest. We can make an attribute for grids, and the grids show attraction or repulsion depending on dose delivered from source. Source position is changed by the forces that the grids impose to the sources. A calculation was done repeatedly until the attraction and repulsion forces reached a balance. The optimal configuration was established when the sources reached a stable distribution in time. To evaluate the optimization plan, dose-volume histograms were used. RESULTS: Source configuration can be optimized automatically. The calculation time was approximately 5 min. The V100, V150, V200, and D90 of the target were 95%, 39%, 9%, and 157 Gy, respectively. V150 of the urethra and V80 of the rectum were 2% and 0%, respectively. CONCLUSION: This method can optimize the dose distribution objectively.

The Patterns of Care Study and Regional Cancer Registry for non-small-cell lung cancer in Japan.

PURPOSE: We examined whether the data registered in the Japanese Patterns of Care Study (PCS) for patients with non-small-cell lung cancer (NSCLC) represent the actual situation of radiotherapy in Japan. The Osaka Cancer Registry (OCR) data, forming the largest database of a regional cancer registry in Japan, were adopted for use as a benchmark against the national condition. PATIENTS AND METHODS: We examined 906 patients of the PCS treated between 1995 and 1997 and 845 patients of the OCR registered between 1988 and 1992. The investigation was made by descriptive statistical methods to measure age, stage, combined treatments, type of treated hospitals, and prognosis. Furthermore, the national averages (NAs) of the PCS process (PCS NA) were also calculated to compensate for the imbalance in the PCS data sampling. RESULTS: The mean age was 67.3 +/- 10.1 in PCS and 64.4 +/- 11.0 in OCR (p < 0.001), 67.2 in PCS NA. The male ratio was 84.2% in PCS and 84.0% in OCR (p = 0.411), 84.1% in PCS NA. The ratio of the patients at the localized stage was 24.2% in PCS and 15.6% in OCR (p = 0.001), 21.1% in PCS NA. The ratio of surgery combined was 24.2% in PCS and 28.9% in OCR (p = 0.026), 25.3% in PCS NA. The ratio of chemotherapy combined was 50.1% in PCS and 67.5% in OCR (p = 0.001), 47.4% in PCS NA. Because the definitions of institution classification and period of prognostic inquiry were different between the two databases, the 3-year survival rates were calculated for reference. In the nonsurgery group, it was 20.3% in PCS and 11.3% in OCR (p = 0.001), and in the surgery group it was 52.5% in PCS and 42.2% in OCR (p = 0.057). RESULTS: Ages in the two databases were inconsistent. Sex distributions were consistent. Surgery and chemotherapy were more frequently performed for the OCR patients, and more patients at more advanced stages were also observed in OCR. The PCS NAs of sex, stage, and ratio of surgery combined were at the midpoints between those of PCS and OCR. The survival rate of NSCLC patients in the OCR was significantly inferior to that in the PCS. The follow-up rate of the PCS was lower than that of the OCR. The general features of PCS data showed similarity to OCR data, and the results of the PCS NAs suggested the effectiveness of this method to adjust the sampling imbalance in PCS.