Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 115
Filtrar
1.
Med Dosim ; 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32014379

RESUMO

User-guided deformable image registration (DIR) has allowed users to actively participate in the DIR process and is expected to improve DIR accuracy. The purpose of this study was to evaluate the time required for and effect of user-guided DIR on registration accuracy for thoracic images among users. In this study, 4-dimensional computed tomographic images of 10 thoracic cancer patients were used. The dataset for these patients was provided by DIR-Lab (www.dir-lab.com) and included a coordinate list of anatomical landmarks (300 bronchial bifurcations). Four medical physicists from different institutions performed DIR between peak-inhale and peak-exhale images with/without the user-guided DIR tool, Reg Refine, implemented in MIM Maestro (MIM software, Cleveland, OH). DIR accuracy was quantified by using target registration errors (TREs) for 300 anatomical landmarks in each patient. The average TREs with user-guided DIR in the 10 images by the 4 medical physicists were 1.48, 1.80, 3.46, and 3.55 mm, respectively, whereas the TREs without user-guided DIR were 3.28, 3.45, 3.56, and 3.28 mm, respectively. The average times taken by the 4 physicists to use the user-guided DIR were 10.0, 6.7, 7.1, and 8.0 min, respectively. This study demonstrated that user-guided DIR can improve DIR accuracy and requires only a moderate amount of time (<10 min). However, 2 of the 4 users did not show much improvement in DIR accuracy, which indicated the necessity of training prior to use of user-guided DIR.

2.
Esophagus ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31912332

RESUMO

BACKGROUND: In definitive chemoradiotherapy (CRTx) for esophageal cancer, a radiotherapy (RT) dose of 50.4 Gy in 28 fractions has been the standard in many countries, while 60 Gy in 30 fractions has been frequently used in Japan. To clarify the optimal RT dose in CRTx for esophageal cancer, we compared clinical outcomes with the two doses using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES). METHODS: Of the patients enrolled in the registry for 2015-2017 surveys (patients treated between 2009 and 2011), 996 patients who received definitive CRTx with 50.4 Gy or 60 Gy for thoracic esophageal cancer were eligible for analysis. RESULTS: The complete response (CR) rates in the 50.4 Gy and 60 Gy groups were 49.1% and 46.4%, respectively (p = 0.5851). The 5-year overall survival (OS) rates in the 50.4 Gy group and 60 Gy group for stages I, II/III and IV were 64.2% and 57.2%, 35.0% and 27.0%, and 18.0% and 15.3%, respectively. Since no significant difference was found between the two groups, the 50.4 Gy group was not inferior to the 60 Gy group with regard to OS. CONCLUSIONS: The analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan.

3.
Anticancer Res ; 40(1): 393-399, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892592

RESUMO

AIM: This study was performed to confirm the superior overall survival (OS) after pulmonary oligo-recurrence compared to pulmonary sync-oligometastases in a large nationwide study. PATIENTS AND METHODS: Patients that met the following criteria were included: 1 to 5 lung-only metastases at the beginning of stereotactic body radiation therapy (SBRT) was performed between January 2004 and June 2015, and the biological effective dose (BED) of SBRT was 75 Gy or more. The parameters included in the analyses were age, gender, ECOG PS, primary lesion, pathology, oligoetastatic state, SBRT date, chemotherapy before SBRT, chemotherapy concurrent SBRT, chemotherapy after SBRT, maximum tumor diameter, number of metastases, field coplanarity, dose prescription, BED10, OTT of SBRT. RESULTS: In total, 1,378 patients with 1,547 tumors were enrolled. Oligo-recurrence occurred in 1,016 patients, sync-oligometastases in 118, and unclassified oligometastases in 121. The three-year OS was 64.0% for oligo-recurrence and 47.5% for sync-oligometastasis (p<0.001). In the multivariate analysis, the hazard ratio (HR) for sync-oligometastases versus oligo-recurrence was 1.601 (p=0.014). Adverse events of Grade 5 were occurred in 3 patients. CONCLUSION: This is the first nationwide to indicate that the OS of patients with pulmonary oligo-recurrence is better than that of patients with sync-oligometastases.


Assuntos
Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Radiocirurgia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
4.
Biochem Biophys Res Commun ; 521(3): 668-673, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31679687

RESUMO

BACKGROUND: Presence of unperfused regions containing cells under hypoxia and nutrient starvation; contributes to radioresistance in solid human tumors. We have previously reported that cultured cells; under nutrient starvation show resistance to ionizing radiation compare with cells under normal; condition, and that nutrient starvation increases ATM activity, which causes cellular resistance to; ionizing radiation (Murata et al., BBRC2018). For further investigation of molecular mechanisms; underlying radioresistance of cells under nutrient starvation, effects of nutrient starvation on activity; of DNA-PKcs have been investigated because both DNA-PKcs and ATM belong to the PIKK family; and are required for DNA DSBs repair. In addition to DNA-PKcs, effects of nutrient starvation on; activities of FoxO3a and its regulators Akt, MST1 and AMPK have been investigated because FoxO3a; mediates cellular responses to stress and is activated under nutrient starvation. METHODS: A human glioblastoma cell line, T98G was used to examine the effects of nutrient starvation on activities and expression of DNA-PKcs, Akt, MST1, FoxO3a, NDR1, and AMPK. To elucidate; signal transduction pathways for FoxO3a activation under nutrient starvation, we examined effects of; specific inhibitors or siRNA for DNA-PKcs or Akt on activities and expression of MST1, FoxO3, NDR1, andAMPK. RESULTS: Under nutrient starvation, phosphorylations of DNA-PKcs at Ser2056, Akt at Ser473, MST at Thr183, FoxO3a at Ser413, NDR1 at Ser281 and Thr282, and AMPK at Thr172 were increased, which suggests their activation. Nutrient starvation did not affect expression of DNA-PKcs, Akt, MST1, or NDR1, with decreased expression of FoxO3a and increased expression of AMPK. Inhibition; of DNA-PK suppressed phosphorylation of Akt under nutrient starvation. Inhibition of DNA-PK or; Akt suppressed phosphorylations of MST1, FoxO3a, and NDR1 under nutrient starvation, which; suggests DNA-PKcs and Akt activate MST1, FoxO3a, and NDR1. Inhibition of DNA-PK did not; suppress phosphorylation ofAMPK under nutrient starvation. CONCLUSION: Our data suggest that DN-PKcs is activated under nutrient starvation and activates AktMST1, FoxO3a, and NDR1.

5.
Esophagus ; 17(1): 25-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31473871

RESUMO

BACKGROUND: Although esophagectomy is the standard treatment for resectable esophageal cancer, chemoradiotherapy or radiotherapy alone is also selected for some cases. However, there have been very few detailed studies conducted on a large scale on the efficacy of these treatments in Japan. METHODS: Of the patients enrolled in the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society for the 2015-2017 surveys (patients treated between 2009 and 2011), the data of 388 patients treated by definitive radiotherapy alone (RTx) and 1964 patients treated by definitive chemoradiotherapy (CRTx) were analyzed. RESULTS: The median age of the patients was 78 years in the RTx group and 69 years in the CRTx group; thus, the proportion of elderly patients was significantly higher in the RTx group than in the CRTx group (p < 0.0001). With regard to the rates of treatment by the two modalities according to the depth of invasion, extent of lymph node metastasis, and disease stage, the treatment rate by CRTx increased more significantly than that by RTx as the disease progressed (p < 0.0001). With regard to the distribution of the total irradiation dose, 11.4% and 2.3% of patients in the RTx and CRTx groups, respectively, received a dose of 67 Gy or more; thus, the RTx group received significantly higher total irradiation doses (p < 0.0001). In the RTx group, the 5-year overall survival rate was 23.2%, and the rates in patients with cStage 0-I, II, III, and IV disease were 41.8%,18.5%, 9.3%, and 13.9%, respectively. In the patients of the RTx group showing complete response (CR), the 5-year overall survival rate was 46.6% and the rates in patients with cStage 0-I, II, III, and IV disease were 54.8%, 39.6%, 32.4%, and 38.9%, respectively. In the CRTx group, the 5-year overall survival rate was 30.6% and the rates in patients with cStage 0-I, II, III, and IV disease were 57.8%, 47.8%, 23.4%, and 13.0%, respectively. In the patients of the CRTx group showing CR, the 5-year overall survival rate was 59.2% and the rates in patients with cStage 0-I, II, III, and IV disease were 67.9%, 59.5%, 56.5%, and 39.6%, respectively. CONCLUSION: This study revealed the current status of treatment of esophageal cancer in Japan, and we think that we have been able to establish the grounds for explaining to patients with esophageal cancer and their families the treatment decisions made for them in daily clinical practice.

6.
Anticancer Res ; 39(8): 4279-4283, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366518

RESUMO

BACKGROUND/AIM: To determine whether concurrent chemotherapy with radiotherapy should be performed in elderly patients with esophageal cancer. PATIENTS AND METHODS: A total of 185 patients aged 80 years or older who were treated with definitive radiotherapy alone or combined with chemoradiotherapy for esophageal cancer at seven institutions were enrolled. In order to compare survival rates of patients treated with chemoradiotherapy with those of patients treated with radiotherapy alone, propensity score matching was performed to homogenize the two populations. RESULTS: For the whole patient cohort, the 3-year overall survival (OS) rate was 52.6% and the median survival was 42.5 months. After propensity score matching, the 3-year OS rate for the chemoradiotherapy group was not significantly better than that for the group treated with radiotherapy alone (53.7% vs. 59.9%, p=0.876). CONCLUSION: Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older did not have significant OS benefit over radiotherapy alone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimiorradioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Idoso de 80 Anos ou mais , Cisplatino/administração & dosagem , Terapia Combinada , Intervalo Livre de Doença , Neoplasias Esofágicas/patologia , Feminino , Fluoruracila/administração & dosagem , Humanos , Estimativa de Kaplan-Meier , Masculino
7.
Radiol Phys Technol ; 12(3): 351-356, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364005

RESUMO

We evaluated an anthropomorphic head and neck phantom with tissue heterogeneity, produced using a personal 3D printer, with quality assurance (QA), specific to patients undergoing intensity-modulated radiation therapy (IMRT). Using semi-automatic segmentation, 3D models of bone, soft tissue, and an air-filled cavity were created based on computed tomography (CT) images from patients with head and neck cancer treated with IMRT. For the 3D printer settings, polylactide was used for soft tissue with 100% infill. Bone was reproduced by pouring plaster into the cavity created by the 3D printer. The average CT values for soft tissue and bone were 13.0 ± 144.3 HU and 439.5 ± 137.0 HU, respectively, for the phantom and 12.1 ± 124.5 HU and 771.5 ± 405.3 HU, respectively, for the patient. The gamma passing rate (3%/3 mm) was 96.1% for a nine-field IMRT plan. Thus, this phantom may be used instead of a standard shape phantom for patient-specific QA in IMRT.


Assuntos
Cabeça , Pescoço , Imagens de Fantasmas , Impressão Tridimensional , Garantia da Qualidade dos Cuidados de Saúde , Radioterapia de Intensidade Modulada/instrumentação , Cabeça/diagnóstico por imagem , Humanos , Pescoço/diagnóstico por imagem , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Tomografia Computadorizada por Raios X
8.
J Radiat Res ; 60(5): 685-693, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31322704

RESUMO

The purpose of the study was to compare a 3D convolutional neural network (CNN) with the conventional machine learning method for predicting intensity-modulated radiation therapy (IMRT) dose distribution using only contours in prostate cancer. In this study, which included 95 IMRT-treated prostate cancer patients with available dose distributions and contours for planning target volume (PTVs) and organs at risk (OARs), a supervised-learning approach was used for training, where the dose for a voxel set in the dataset was defined as the label. The adaptive moment estimation algorithm was employed for optimizing a 3D U-net similar network. Eighty cases were used for the training and validation set in 5-fold cross-validation, and the remaining 15 cases were used as the test set. The predicted dose distributions were compared with the clinical dose distributions, and the model performance was evaluated by comparison with RapidPlan™. Dose-volume histogram (DVH) parameters were calculated for each contour as evaluation indexes. The mean absolute errors (MAE) with one standard deviation (1SD) between the clinical and CNN-predicted doses were 1.10% ± 0.64%, 2.50% ± 1.17%, 2.04% ± 1.40%, and 2.08% ± 1.99% for D2, D98 in PTV-1 and V65 in rectum and V65 in bladder, respectively, whereas the MAEs with 1SD between the clinical and the RapidPlan™-generated doses were 1.01% ± 0.66%, 2.15% ± 1.25%, 5.34% ± 2.13% and 3.04% ± 1.79%, respectively. Our CNN model could predict dose distributions that were superior or comparable with that generated by RapidPlan™, suggesting the potential of CNN in dose distribution prediction.

9.
Jpn J Radiol ; 37(8): 612-618, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31201593

RESUMO

PURPOSE: To evaluate the effectiveness of radiation therapy and steroids for Asian patients with Graves' ophthalmopathy using the clinical activity score (CAS), and changes in external ocular muscles and eye proptosis determined by magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed 48 patients who received combined orbital radiation and systemic glucocorticoids in our hospital. MRI was performed both before and 1 month after treatment in all patients. We calculated the areas of five extraocular muscles and the degree of proptosis on transverse sections, and we evaluated the activity of the disease using CAS before and 1 month after treatment and toxicity. RESULTS: The areas of external ocular muscles, the length of eye prominence and CAS were significantly improved by the combination of orbital radiation and steroids. The change in the area of the medial rectus muscle had a significant correlation with the change in CAS (P < 0.05). Graves' ophthalmopathy progressed again in 4 of the 48 patients; however, there were no patients with serious side effects in a median observation period of 41.5 months. CONCLUSION: Treatment with the combination of orbital radiation and systemic glucocorticoids is subjectively and objectively effective for Asian Graves' ophthalmopathy without severe toxicity.


Assuntos
Olho/diagnóstico por imagem , Glucocorticoides/uso terapêutico , Oftalmopatia de Graves/tratamento farmacológico , Oftalmopatia de Graves/radioterapia , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Ásia , Terapia Combinada , Olho/efeitos dos fármacos , Olho/efeitos da radiação , Feminino , Oftalmopatia de Graves/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Asian J Urol ; 6(2): 192-199, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31061806

RESUMO

Objective: To retrospectively investigate the treatment outcomes of external beam radiotherapy with androgen deprivation therapy (ADT) in high-risk prostate cancer in three radiotherapy dose groups. Methods: Between 1998 and 2013, patients with high-risk prostate cancer underwent three-dimensional conformal radiotherapy or intensity-modulated radiotherapy of 66 Gy, 72 Gy, or 78 Gy with ADT. Prostate-specific antigen (PSA) relapse was defined using the Phoenix definition. PSA relapse-free survival (PRFS) was evaluated in each radiotherapy dose group. Moreover, high-risk patients were divided into H-1 (patients with multiple high-risk factors) and H-2 (patients with a single high-risk factor) as risk subgroups. Results: Two hundred and eighty-nine patients with a median follow-up period of 77.3 months were analyzed in this study. The median duration of ADT was 10.1 months. Age, Gleason score, T stage, and radiotherapy dose influenced PRFS with statistical significance both in univariate and multivariate analyses. The 4-year PRFS rates in Group-66 Gy, Group-72 Gy and Group-78 Gy were 72.7%, 81.6% and 90.3%, respectively. PRFS rates in the H-1 subgroup differed with statistical significance with an increasing radiotherapy dose having a more favorable PRFS, while PRFS rates in H-2 subgroup did not differ with increase in radiotherapy dose. Conclusion: Dose escalation for high-risk prostate cancer in combination with ADT improved PRFS. PRFS for patients in the H-1 subgroup was poor, but dose escalation in those patients was beneficial, while dose escalation in the H-2 subgroup was not proven to be effective for improving PRFS.

11.
J Radiat Res ; 60(4): 509-516, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31034572

RESUMO

Small cell carcinoma of the bladder is extremely rare, accounting for <1% of all malignant tumours in the urinary tract. Thus, no standard therapy modality for this malignancy has been established. This study aimed to retrospectively analyse the clinical outcomes associated with definitive radiotherapy for small cell carcinoma of the bladder. A questionnaire-based survey of patients with pathologically proven small cell carcinoma of the bladder treated with definitive radiation therapy between 1990 and 2010 was conducted by the Japanese Radiation Oncology Study Group. The clinical records of 12 eligible patients were collected from nine institutions. The median age of the patients was 70.5 years (range: 44-87 years), and the median follow-up period was 27.3 months (range: 3.3-117.8 months). The median prescribed dose was 60 Gy (range: 50.0-61.0 Gy), and a median of 2.0 Gy (range: 1.2-2.0 Gy) was administered per fraction. Systemic chemotherapy combined with radiotherapy was performed in eight cases (66.7%). The 3- and 5-year overall survival rates were 50.0% and 33.3%, respectively. And the 3- and 5-year local control rates were 66.7% and 55.6%, respectively. Chemotherapy significantly improved overall survival and relapse-free survival (P = 0.006 and 0.001, respectively). No serious adverse events occurred in the observation period. All patients who achieved local control maintained functional bladders. In conclusion, radiotherapy is a potential local treatment option and has an important role in maintaining quality of life. Systemic chemotherapy combined with local radiotherapy seems to be effective in improving survival.

12.
Phys Med ; 58: 141-148, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30824145

RESUMO

Robust feature selection in radiomic analysis is often implemented using the RIDER test-retest datasets. However, the CT Protocol between the facility and test-retest datasets are different. Therefore, we investigated possibility to select robust features using thoracic four-dimensional CT (4D-CT) scans that are available from patients receiving radiation therapy. In 4D-CT datasets of 14 lung cancer patients who underwent stereotactic body radiotherapy (SBRT) and 14 test-retest datasets of non-small cell lung cancer (NSCLC), 1170 radiomic features (shape: n = 16, statistics: n = 32, texture: n = 1122) were extracted. A concordance correlation coefficient (CCC) > 0.85 was used to select robust features. We compared the robust features in various 4D-CT group with those in test-retest. The total number of robust features was a range between 846/1170 (72%) and 970/1170 (83%) in all 4D-CT groups with three breathing phases (40%-60%); however, that was a range between 44/1170 (4%) and 476/1170 (41%) in all 4D-CT groups with 10 breathing phases. In test-retest, the total number of robust features was 967/1170 (83%); thus, the number of robust features in 4D-CT was almost equal to that in test-retest by using 40-60% breathing phases. In 4D-CT, respiratory motion is a factor that greatly affects the robustness of features, thus by using only 40-60% breathing phases, excessive dimension reduction will be able to be prevented in any 4D-CT datasets, and select robust features suitable for CT protocol of your own facility.


Assuntos
Tomografia Computadorizada Quadridimensional , Processamento de Imagem Assistida por Computador/métodos , Radiografia Torácica , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Carga Tumoral
13.
Medicine (Baltimore) ; 98(8): e14363, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813135

RESUMO

Esophageal small cell carcinoma (E-SmCC) and basaloid squamous cell carcinomas (BSCCs) are both highly aggressive malignancies, but their detailed differences in clinical behaviors have remained virtually unknown. In addition, treatment strategies of the patients with E-SmCC have not been established. 29 cases of E-SmCC and 39 with BSCC were examined in this study to clarify the clinical features and outcome of the patients with E-SmCC and to compare the findings with those of BSCC. E-SmCCs presented a more advanced status than BSCC (TNM Stage: P = .002). Esophagectomy was performed in 15 small cell carcinoma patients and 14 were treated with non-surgical/systemic therapy. The clinical outcome of the small cell carcinoma cases was significantly worse than those with BSCC (P = .001), but results of a stage-stratified analysis revealed that the Stage I small cell carcinoma patients presented favorable prognosis (3-year survival rate 100%, n = 4). In contrast, among those with Stage II-IV, clinical outcome tended to be better in the systemic therapy group (3-year survival rate 49%, n = 13) than the surgically treated group (3-year survival rate 0%, n = 12). E-SmCC was a more aggressive neoplasm than BSCC. However, early detection could possibly improve the clinical outcome of patients with E-SmCC. Systemic therapy could also benefit the patients with advanced disease (Stage II-IV).


Assuntos
Carcinoma Basoescamoso/patologia , Carcinoma de Células Pequenas/patologia , Neoplasias Esofágicas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Basoescamoso/tratamento farmacológico , Carcinoma Basoescamoso/cirurgia , Carcinoma de Células Pequenas/tratamento farmacológico , Carcinoma de Células Pequenas/cirurgia , Quimioterapia Adjuvante , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Análise de Sobrevida
14.
Med Dosim ; 44(4): 394-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30827765

RESUMO

The purpose of this study was to evaluate and compare the dosimetric effects of HyperArc-based stereotactic radiosurgery (SRS) and a robotic radiosurgery system-based planning using CyberKnife for multiple cranial metastases. In total, 11 cancer patients with multiple cranial metastases (3 to 5 tumors) treated with CyberKnife were examined. These patients were replanned using HyperArc (Varian Medical Systems, Palo Alto, USA). HyperArc plan were designed using 4 noncoplanar arc single-isocenter VMAT in 6 MV flattening filter free mode for simulated delivery with the True beam STx (Varian). The prescription dose was 23 Gy at single fraction. Dosimetric differences and blinded clinician scoring differences were evaluated. Conformity index (CI) and gradient index (GI) were 0.60 ± 0.11 and 3.94 ± 0.74, respectively, for the CyberKnife plan and 0.87 ± 0.08 and 5.31 ± 1.42, respectively, for the HyperArc plan (p < 0.05). Total brain V12-gross tumor volumes (GTVs) for the CyberKnife and HyperArc plans were 5.26 ± 2.83 and 4.02 ± 1.71 cm3, respectively. These results indicate that HyperArc plan showed better CI and total brain V12-GTV, while CyberKnife plan showed better GI. A blinded physician scoring evaluation did not show significant differences between CyberKnife and HyperArc plans. The HyperArc-based SRS plan is comparable with the CyberKnife plan, suggesting a greater potential to emerge as a suitable tool for SRS of multiple brain metastases.

15.
Int J Clin Oncol ; 24(8): 927-933, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30863993

RESUMO

BACKGROUND: In Japan, positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) has been covered by the national health insurance for esophageal cancer since 2006. FDG-PET is commonly performed in advanced esophageal cancer. The aim of this study was to determine the effect of FDG-PET on survival in patients with locally advanced inoperable esophageal cancer. METHODS: We retrospectively reviewed all patients with cT4 and without M1 esophageal cancer on CT in our institution between 2000 and 2014, and data for 78 patients who meet the eligibility criteria described below were used for analysis in this study. The eligibility criteria included (1) cT4 esophageal cancer without distant metastases or M1 lymph node metastasis (UICC 2002), (2) histologically proven squamous cell carcinoma, (3) 20-79 years of age, (4) having undergone at least 1 cycle of concomitant chemotherapy, (5) having been irradiated with 50 Gy or more, and (6) no other active malignant tumor during treatment. RESULTS: Two patients were excluded because abdominal lymph node metastases or neck lymph node metastases were detected by FDG-PET. In 78 eligible patients, FDG-PET was not performed before treatment in 41 of the 78 patients and was performed in the other patients. The median observation period was 68 months. The 3-year and 5-year overall survival rates in 78 patients were 36.9% and 30.8%, respectively. There was no significant difference in overall survival or progression-free survival between patients in whom FDG-PET was performed and those in whom FDG-PET was not performed (12.0 months vs. 11.0 months, p = 0.920 and 6.0 months vs. 6.0 months, p = 0.844, respectively). CONCLUSIONS: Compared with only CT, additional information from FDG-PET is not associated with improving survival in patients with locally advanced esophageal cancer. Our results suggest that FDG-PET might not have much meaning for survival in locally advanced esophageal cancer.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Quimiorradioterapia/mortalidade , Neoplasias Esofágicas/mortalidade , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
16.
Eur Thyroid J ; 8(1): 24-30, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30800638

RESUMO

Background: Anaplastic thyroid carcinoma (ATC) is a rare cancer and has a poor prognosis. Several radiation protocols have been reported, but the results were not satisfactory. Objective: The aim of this study was to determine the effect of hypofractionated radiotherapy. Methods: Thirty-three patients who received radiotherapy for ATC between January 2000 and December 2014 were retrospectively included. We defined hypofractionated radiotherapy as a single dose ≥5 Gy. Results: Nineteen patients were treated with hypofractionated radiotherapy. Twenty-eight patients died, and 27 of those patients died from ATC. Sixteen patients died from distant metastasis and 6 from local recurrence. In the hypofractionated radiotherapy group, local recurrence occurred in 5 patients and 1 of them died from active bleeding from a local tumor. There was local recurrence in 7 patients who received the other protocol, and 5 of them died from asphyxiation, active bleeding, or uncontrollable growth of a local tumor on the neck. The median overall survival (OS) was 5 months. In multivariate analysis, patients who received an equivalent dose in 2-Gy fractions (EQD2) ≥50 Gy had significantly better OS (p = 0.016). In univariate analysis, patients who received hypofractionated radiotherapy did not have significantly better OS (p = 0.872) or local control (p = 0.090). The χ2 test showed that significantly fewer patients died from local recurrence in the hypofractionated radiotherapy group (p = 0.025). Conclusions: Multivariate analysis showed that an EQD2 ≥50 Gy resulted in better OS, and hypofractionated radiotherapy decreased the rate of mortality from local recurrence.

17.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 74(12): 1396-1405, 2018 12.
Artigo em Japonês | MEDLINE | ID: mdl-30568089

RESUMO

This study aimed to develop and evaluate field shape optimization technique based on dose calculation using daily cone-beam computed tomography (CBCT) to compensate for interfractional anatomic changes in three-dimensional conformal radiation therapy (3D-CRT) for prostate cancer. For each of 10 patients, 9-10 CBCT images were obtained throughout the treatment course. The prostate, seminal vesicles, and rectum were manually contoured in all CBCT images. Subsequently, plan adaptation was performed with a program developed in-house. This program calculates dose distributions on CBCT images and optimizes field shape to minimize rectal dose while keeping the target at the optimal dose coverage (the planning target volume D95% receives 95% of the prescription dose). To evaluate the adaptive planning approach, we re-calculated dose distributions on CBCT images based on the conventional and adaptive plans. For the entire cohort, plan adaptation improved rectal V50 Gy, V60 Gy, V65 Gy, and V70 Gy by -7.71±8.43%, -8.30±8.90%, -7.91±8.51% and -7.03±7.70% on average (±SD), respectively. Our results demonstrate that adaptive planning approach is superior to the conventional planning approach for optimizing dose distribution, and this adaptive approach can optimize field shape in 3 min. The proposed approach can be an effective solution for the problem of interfractional anatomic changes in 3D-CRT for prostate cancer.


Assuntos
Neoplasias da Próstata , Planejamento da Radioterapia Assistida por Computador , Tomografia Computadorizada de Feixe Cônico , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica
18.
J Radiat Res ; 59(6): 789-793, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30321392

RESUMO

Breast cancer is the most common malignant disease among older women, and the number of new older patients per year is increasing year by year. Radiotherapy has been confirmed as an important treatment after breast conservation for the reduction of local recurrence and mortality for all patients, including node-positive cases. However, there are fewer clinical trials evaluating the toxicity and benefits of radiotherapy for older patients. Whether radiotherapy can provide substantial benefit for older patients after breast-conserving surgery is controversial. This systematic review will focus on the key aspects of this controversial issue.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Radioterapia , Idoso , Comportamento de Escolha , Feminino , Humanos , Radioterapia/efeitos adversos , Fatores de Risco
19.
PLoS One ; 13(10): e0204734, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30286105

RESUMO

PURPOSE: Radiographic severity of radiation-induced lung injury (RILI) has not been well-studied. The goal of this study was to assess the CT appearance pattern and severity of RILI without consideration of the clinical presentation. MATERIAL AND METHODS: A total of 49 patients, 41 with primary lung cancer and 8 with metastatic lung cancer, were treated by 4-fraction stereotactic body radiotherapy (SBRT). RILI after SBRT was separately assessed by two observers. The early and late CT appearance patterns and CT-based severity grading were explored. RESULTS: The median follow-up period was 39.0 months. In the early CT findings of observers 1 and 2, there was diffuse consolidation in 15 and 8, diffuse ground glass opacity (GGO) in 0 and 0, patchy consolidation and GGO in 17 and 20, patchy GGO in 3 and 3, and no changes in 10 and 14, respectively (kappa = 0.61). In late CT findings of observer 1 and 2, there were modified conventional pattern in 28 and 24, mass-like pattern in 8 and 11, scar-like pattern in 12 and 12, and no changes in 1 and 2, respectively (kappa = 0.63). In the results of the CT-based grading by observers 1 and 2, there were grade 0 in 1 and 2, grade 1 in 10 and 14, grade 2 in 31 and 29, grade 3 in 7 and 4, and none of grade 4 or more, respectively (kappa = 0.66). According to multivariate analyses (MVA), the significant predicting factors of grade 2 or more CT-based RILI were age (p = 0.01), oxygen dependence (p = 0.03) and interstitial shadow (p = 0.03). CONCLUSIONS: The agreement of the CT appearance and CT-based grading between two observers was good. These indicators may be able to provide us with more objective information and a better understanding of RILI.


Assuntos
Lesão Pulmonar/diagnóstico , Lesão Pulmonar/patologia , Neoplasias Pulmonares/radioterapia , Lesões por Radiação/diagnóstico , Lesões por Radiação/patologia , Radioterapia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
20.
Technol Cancer Res Treat ; 17: 1533033818803597, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30352542

RESUMO

In recent years, the concept of oligometastases has become accepted and reports on stereotactic body radiotherapy as a treatment method have been published. Lesions in the brain, lung, and liver have been reported as target lesions. However, lymph node oligometastases could be a good candidate for stereotactic body radiotherapy as well. In this study, the usability of stereotactic body radiotherapy for oligometastases to lymph nodes is assessed by researching for each primary site. As a result, we could consider that stereotactic body radiotherapy could be almost well applied for lymph node oligometastases from the breast, gynecological organs, and prostate. However, doubts remain concerning the usefulness of stereotactic body radiotherapy for cervical node metastases from head and neck cancer or for mediastinal node metastases from lung or esophageal cancer since late toxicities have occurred with a large radiation dose at hypofractionation to major vessels or the central respiratory tract, especially in patients with irradiation histories. In addition, high-dose irradiation is required to control lymph node metastases from colorectal cancer due to its radioresistance, and severe late adverse events would therefore occur in adjacent organs such as the gastrointestinal tract. In cases of lymph node oligometastases with a primary tumor in the stomach or esophagus, stereotactic body radiotherapy should be used limitedly at present because this patient population is not so large and these metastases are often located close to organs at risk. Because of the varied status of recurrence and varied conditions of patients, it is difficult to determine the optimal dose for tumor control. It might be reasonable to determine the treatment dose individually based on dose constraints of adjacent organs. The oligometastatic state is becoming more frequently identified with more sensitive methods of detecting such oligometastases. In addition, there seems to be another type of oligometastases, so-called induced oligometastases, following successful systemic treatment. To determine the optimal indication of stereotactic body radiotherapy for lymph node oligometastases, further investigation about the mechanisms of oligometastases and further clinical studies including a phase III study are needed.


Assuntos
Linfonodos/patologia , Neoplasias/diagnóstico , Neoplasias/radioterapia , Radiocirurgia , Ensaios Clínicos como Assunto , Diagnóstico por Imagem , Humanos , Metástase Linfática , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA