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1.
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
2.
J Appl Clin Med Phys ; 20(1): 220-228, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30548791

RESUMO

PURPOSE: For scanning particle beam therapy, interference between scanning patterns and interfield organ motion may result in suboptimal dose within target volume. In this study, we developed a simple offline correction technique for uniform scanning proton beam (USPB) delivery to compensate for the interplay between scanning patterns and respiratory motion and demonstrate the effectiveness of our technique in treating liver cancer. METHODS: The computed tomography (CT) and respiration data of two patients who had received stereotactic body radiotherapy for hepatocellular carcinoma were used. In the simulation, the relative beam weight delivered to each respiratory phase is calculated for each beam layer after treatment of each fraction. Respiratory phases with beam weights higher than 50% of the largest weight are considered "skipped phases" for the next fraction. For the following fraction, the beam trigger is regulated to prevent beam layers from starting irradiation in skipped phases by extending the interval between each layer. To calculate dose-volume histogram (DVH), the dose of the target volume at end-exhale (50% phase) was calculated as the sum of each energy layer, with consideration of displacement due to respiratory motion and relative beam weight delivered per respiratory phase. RESULTS: For a single fraction, D1% , D99% , and V100% were 114%, 88%, and 32%, respectively, when 8 Gy/min of dose rate was simulated. Although these parameters were improved with multiple fractions, dosimetric inhomogeneity without motion management remained even at 30 fractions, with V100% 86.9% at 30 fractions. In contrast, the V100% values with adaptation were 96% and 98% at 20 and 30 fractions, respectively. We developed an offline correction technique for USPB therapy to compensate for the interplay effects between respiratory organ motion and USPB beam delivery. CONCLUSIONS: For liver tumor, this adaptive therapy technique showed significant improvement in dose uniformity even with fewer treatment fractions than normal USPB therapy.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Terapia com Prótons/métodos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Carcinoma Hepatocelular/patologia , Tomografia Computadorizada Quadridimensional , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Hepáticas/patologia , Movimento , Órgãos em Risco/efeitos da radiação , Dosagem Radioterapêutica , Respiração , Tomografia Computadorizada por Raios X/métodos
3.
Low Urin Tract Symptoms ; 11(2): O127-O134, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30010254

RESUMO

OBJECTIVE: The aim of the present study was to collect data on the characteristics, degree, and natural course of urinary complications, as well as self-care for such complications, in patients during and after prostate intensity-modulated radiation therapy (IMRT). METHODS: Quality of life data were collected retrospectively for all eligible patients who underwent IMRT. In all eligible patients, urinary symptoms were evaluated using questionnaires and face-to-face interview. Participants were asked to respond to a self-administered questionnaire concerning the core lower urinary tract symptom score during the course of IMRT and up to 12 months after the completion of IMRT. RESULTS: In all, 29 eligible patients were included in the study. The frequency of urinary symptoms increased over of the course of IMRT, decreased at ≥3 months after completion of IMRT, and disappeared 6 months after IMRT. Responses to the questionnaire revealed a variety of approaches to self-care and adaptations by patients to manage urinary symptoms. CONCLUSIONS: During and after IMRT for localized prostate cancer, patients often developed more frequent urination and urgency than at the start of IMRT, and recovered 3-6 months after the completion of IMRT. Based on the present study, clinicians and nurses could help convey this information to patients and thus offer better support.


Assuntos
Sintomas do Trato Urinário Inferior/etiologia , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Humanos , Entrevistas como Assunto , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos , Autocuidado , Inquéritos e Questionários , Urodinâmica
4.
Anticancer Res ; 38(7): 4207-4212, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29970552

RESUMO

BACKGROUND/AIM: The long-term efficacy and safety of moderately hypofractionated intensity-modulated radiation therapy (MH-IMRT) in prostate cancer remains uncertain. This study aimed to evaluate MH-IMRT regimen of 72 Gy in 30 fractions in patients with prostate cancer. PATIENTS AND METHODS: The outcomes of 412 consecutive prostate cancer patients, who received MH-IMRT between May 2007 and December 2012, were retrospectively reviewed. The median patient age was 70.9 (range=50-84) years. Late gastrointestinal (GI) and genitourinary (GU) toxicity rates were evaluated according to the CTCAE ver. 3.0. The overall survival, biochemical relapse-free survival rate (bRFS), late GI toxicity, and GU toxicity rates were analyzed with the Kaplan-Meier method. RESULTS: The median follow-up was 71.5 (range, 1.4-124.8) months. The 5-year bRFS rate was 93.2%. The 5-year grade ≥2 late GI and GU toxicity rates were 3.3% and 4.5%, respectively. CONCLUSION: MH-IMRT regimen of 72 Gy in 30 fractions was effective and safe for prostate cancer patients.


Assuntos
Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/métodos , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/mortalidade , Radioterapia de Intensidade Modulada/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
5.
Gan To Kagaku Ryoho ; 45(2): 371-373, 2018 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-29483451

RESUMO

A 70's man had been treated with gemcitabine(GEM)and nab-paclitaxel(nabPTX)combination for advanced pancreatic tail cancer with splenic invasion and liver metastases. However, the primary lesion was not controlled, then intensity-modulat- ed radiation therapy(76.5 Gy/17 Fr)was performed for primary lesion. Three grown hypovascular liver metastases were detected by follow-up EOB-MRI and PET-computed tomography(CT)imaging with 18F-FDG. Unfortunately, these lesions were not detected by intravenous injection of contrast media with CT nor ultrasonography. Radiofrequency ablation(RFA) under computed tomography during arterial portography(CTAP)guidance was performed. The patient has been alive for 1 year after RFA with no recurrence. CTAP could be a feasible image guidance for the treatment of hypovascular liver metastases with RFA.


Assuntos
Neoplasias Hepáticas/cirurgia , Neoplasias Pancreáticas/patologia , Idoso , Albuminas/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Capecitabina/administração & dosagem , Ablação por Cateter , Terapia Combinada , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Paclitaxel/administração & dosagem , Neoplasias Pancreáticas/tratamento farmacológico , Tomografia Computadorizada por Raios X
6.
Acta Otolaryngol ; 138(8): 750-758, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29468910

RESUMO

PURPOSE: To analyze the outcomes following re-irradiation for local recurrence of rare head and neck tumors. MATERIAL AND METHODS: We retrospectively analyzed 11 patients who had received intensity-modulated radiation therapy (IMRT) for recurrent tumors in the head and neck except for laryngopharynx. RESULTS: Primary tumor sites included the maxillary sinus, nasal cavity, and external ear canal in six, three, and two patients, respectively. The median follow-up times were 13 (range, 3-54) months. The median survival time was 17 months with 1- and 2-year survival rates of 63.64 and 39.77%, respectively. Among 11 patients, five experienced local failure in the follow-up period. The 1- and 2-year local control rates were 58 and 47%, respectively. Patients who had received a radiation dose of ≥3 Gy per fraction showed significantly better local control than those receiving less (p = .0419). One patient experienced Grade 3 facial pain as acute toxicity. Late toxicities included radiographic findings of partial central nervous system necrosis in three patients and Grade 3 osteonecrosis and Grade 3 facial nerve disorder in one patient. CONCLUSIONS: Re-irradiation of rare head and neck tumors using IMRT for loco-regional recurrence may be an acceptable treatment option.


Assuntos
Carcinoma/radioterapia , Estesioneuroblastoma Olfatório/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Radioterapia de Intensidade Modulada , Estudos Retrospectivos
7.
Anticancer Res ; 38(2): 945-954, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29374726

RESUMO

BACKGROUND: This study aimed to assess the need to consider microscopic invasion in terms of treatment planning in stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma and elucidate the appropriate clinical target volume (CTV) margin. PATIENTS AND METHODS: A total of 121 patients (with 146 liver tumors) who underwent SBRT between July 2007 and August 2016 were analyzed, regarding overall survival and local control (LC). RESULTS: The 2- and 5-year LC rates were 91.5% and 89.8%, respectively. Planning target volume (PTV) margin <8 mm was associated with poor LC. Of the 77 patients with PTV margin of <8 mm, age <75 years was associated with poor LC, while alpha-fetoprotein (AFP) ≤20 ng/ml was associated with good LC. CONCLUSION: In patients with high AFP levels, there is a possibility of microscopic invasion around the tumor, suggesting that LC may be improved by adding an additional clinical target volume margin to the gross tumor volume.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Neoplasia Residual/patologia , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasia Residual/metabolismo , Neoplasia Residual/cirurgia , Prognóstico , Dosagem Radioterapêutica , Taxa de Sobrevida , alfa-Fetoproteínas/metabolismo
9.
Oncol Lett ; 14(1): 453-460, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28693191

RESUMO

Metastatic liver tumors (MLTs) from colorectal cancer (CRC) are often treated with stereotactic body radiation therapy (SBRT). The present study aimed to examine the predictive factors for response of MLTs to SBRT. A total of 39 MLTs from 24 patients with CRC were retrospectively analyzed. Radiotherapy for MLT was typically performed with a prescribed dose equivalent to a biologically effective dose (BED)10 of 100 Gy. The median follow-up period was 16 months (range, 5-64 months). The median prescribed dose and total BED10 were 56 Gy (range, 45-72 Gy) and 97.5 Gy (range, 71.7-115.5 Gy), respectively, in a median of 8 fractions (range, 4-33 fractions). The 1- and 2-year local control rates were 67.2 and 35.9%, respectively. For patients with MLT treated with ablative SBRT (BED10 ≥100 Gy in ≤5 fractions), the 1- and 2-year local control rates were 83.3 and 62.5%, respectively. Univariate analysis showed that primary tumor location (left-sided colon), maximum tumor diameter (≤30 mm) and ablative SBRT (BED10 ≥100 Gy in ≤5 fractions) were significantly associated with improved local control (P=0.0058, P=0.0059 and P=0.0268, respectively). Multivariate analysis showed that tumor diameter was significantly associated with improved local control (P=0.0314). In addition, patients who received ablative SBRT had significantly prolonged overall survival times compared with those treated with non-ablative SBRT (P=0.0261). To conclude, tumors ≤30 mm that can be treated with ablative SBRT are associated with good local control rates. The primary tumor location may affect the radiosensitivity of MLTs.

10.
Mol Clin Oncol ; 6(6): 871-875, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28588780

RESUMO

The present study aimed to describe the clinical results of re-irradiation (Re-RT) for spine or pelvic bone metastasis at the same initial irradiated area. Between April 2010 and March 2014, cases involving 98 patients with spine or pelvic bone metastasis who had undergone Re-RT at five institutions were reviewed. The clinical outcomes following Re-RT were evaluated, including overall survival (OS) and severe adverse events. The median time interval from initial radiation therapy (RT) to Re-RT was 439 days (range, 23-4,993 days), and the median duration of patient follow-up was 256 days (range, 11-2,284 days). The median biological effective dose for the Re-RT was 150 Gy2 (range, 17-240 Gy2; α/ß = 2). Severe late adverse events occurred in two patients who underwent three-dimensional conformal radiotherapy for lumbar spine or pelvic bone metastases, which may be associated with tumor progression. The median survival time following Re-RT was 255 days, and the actuarial OS rate at 1 year was 36%. The interval between initial RT and Re-RT, and their performance statuses (PS) were significant independent prognostic factors for OS rates in multivariate analysis. Re-RT for spine or pelvic bone metastases is a relatively acceptable option with low risk of anticipated severe adverse events, particularly for patients with good PS following a long disease-free interval.

11.
Rep Pract Oncol Radiother ; 22(4): 303-309, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28507460

RESUMO

AIM: The purpose of this study was to determine the optimal mean liver biologically effective dose (BED) to prevent radiation-induced liver disease (RILD) in stereotactic body radiation therapy (SBRT). BACKGROUND: The actual mean doses appropriate for liver irradiation in modern radiotherapy techniques have not been adequately investigated, although SBRT is sometimes alternatively performed using fractionated regimens. MATERIALS AND METHODS: SBRT treatment plans for liver tumors in 50 patients were analyzed. All distributions of the physical doses were transformed to BED2 using the linear-quadratic model. The relationship between physical doses and the BED2 for the liver were then analyzed, as was the relationship between the mean BED2 for the liver and the planning target volume (PTV). RESULTS: A significantly positive correlation was observed between the mean physical dose for the background liver and the mean BED2 for the whole liver (P < 0.0001, r = 0.9558). Using the LQ model, a mean BED2 of 73 and 16 Gy for the whole liver corresponded to the hepatic tolerable mean physical dose of 21 and 6 Gy for Child-Pugh A- and B-classified patients, respectively. Additionally, the PTV values were positively correlated with the BEDs for the whole liver (P < 0.0001, r = 0.8600), and the background liver (P < 0.0001, r = 0.7854). CONCLUSION: A mean BED2 of 73 and 16 Gy for the whole liver appeared appropriate to prevent RILD in patients with Child-Pugh classes A and B, respectively. The mean BED2 for the liver correlated well with the PTV.

12.
J Radiat Res ; 58(3): 386-396, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-27811199

RESUMO

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.


Assuntos
Neoplasias da Coroide/radioterapia , Melanoma/radioterapia , Radioterapia de Intensidade Modulada/instrumentação , Idoso , Relação Dose-Resposta à Radiação , Movimentos Oculares , Estudos de Viabilidade , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
13.
J Radiat Res ; 57(3): 294-300, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26983986

RESUMO

The purpose of the present study was to investigate the threshold dose for focal liver damage after stereotactic body radiation therapy (SBRT) in cirrhotic and normal livers using magnetic resonance imaging (MRI). A total of 64 patients who underwent SBRT for liver tumors, including 54 cirrhotic patients with hepatocellular carcinoma (HCC) and 10 non-cirrhotic patients with liver metastases, were analyzed. MRI was performed 3-6 months after SBRT, using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced T1-weighted sequences. All MRI datasets were merged with 3D dosimetry data. All dose distributions were corrected to the biologically effective dose using the linear-quadratic model with an assumed α/ß ratio of 2 Gy. The development of liver dysfunction was validly correlated with isodose distribution. The median biologically effective dose (BED2) that provoked liver dysfunction was 57.3 (30.0-227.9) and 114.0 (70.4-244.9) Gy in cirrhotic and normal livers, respectively (P = 0.0002). The BED2 associated with a >5% risk of liver dysfunction was 38.5 in cirrhotic livers and 70.4 Gy in normal livers. The threshold BED2 for liver dysfunction was not significantly different between Child-Pugh A and B patients (P = 0.0719). Moreover, the fractionation schedule was not significantly correlated with threshold BED2 for liver dysfunction in the cirrhotic liver (P = 0.1019). In the cirrhotic liver, fractionation regimen and Child-Pugh classification did not significantly influence the threshold BED2 for focal liver damage after SBRT. We suggest that the threshold BED2 for liver dysfunction after SBRT is 40 and 70 Gy in the cirrhotic and normal liver, respectively.


Assuntos
Cirrose Hepática/fisiopatologia , Fígado/fisiopatologia , Imagem por Ressonância Magnética/métodos , Radiocirurgia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade
14.
Mol Clin Oncol ; 4(1): 83-88, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26870363

RESUMO

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.

15.
J Radiat Res ; 56(4): 727-34, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25887042

RESUMO

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.


Assuntos
Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Pneumonite por Radiação/mortalidade , Radiocirurgia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Feminino , Humanos , Japão/epidemiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prevalência , Radiocirurgia/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida
16.
J Radiat Res ; 56(2): 332-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25504640

RESUMO

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.


Assuntos
Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Lesões por Radiação/epidemiologia , Radiocirurgia/estatística & dados numéricos , Fraturas das Costelas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Relação Dose-Resposta à Radiação , Feminino , Humanos , Incidência , Japão/epidemiologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico , Dosagem Radioterapêutica , Fraturas das Costelas/diagnóstico , Fatores de Risco , Resultado do Tratamento
17.
Gan To Kagaku Ryoho ; 42(12): 1611-3, 2015 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-26805113

RESUMO

A 60-year-old male patient underwent curative surgical resection for gastric cancer. After the surgery, the patient was diagnosed with T4b, N3b, ly3, v2, CY0, fStageⅢc gastric cancer, and adjuvant systemic chemotherapy using S-1 and CDDP was administered. However, follow-up computed tomography (CT) scan examination taken 2 months after surgery revealed a pancreatic fistula and retroperitoneal abscess, and percutaneous drainage was performed. After 1 month, the enhanced CT scan detected liver metastasis measuring 25 mm in diameter at segment 7. The CT-guided percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) procedure was performed on the liver metastasis using degradable starch microspheres (DSM). Two months after the RFA, a follow-up CT scan revealed local recurrence of the lesion in the medial side of the ablated area in segment 7. A second CT-guided RFA, which was combined with DSM-TACE, was performed on the recurrent lesion. The patient has since survived more than 2 years after the second treatment without any further recurrences. This case report suggests that RFA treatment combined with DSM-TACE might be a safe and feasible treatment for liver metastasis from gastric cancer.


Assuntos
Neoplasias Hepáticas/terapia , Neoplasias Gástricas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ablação por Cateter , Quimioembolização Terapêutica , Cisplatino/administração & dosagem , Terapia Combinada , Combinação de Medicamentos , Humanos , Neoplasias Hepáticas/secundário , Masculino , Ácido Oxônico/administração & dosagem , Amido , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Tegafur/administração & dosagem
18.
Med Phys ; 41(11): 111704, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25370618

RESUMO

PURPOSE: Four-dimensional computed tomography (4DCT) is widely used for evaluating moving tumors, including lung and liver cancers. For patients with unstable respiration, however, the 4DCT may not visualize tumor motion properly. High-speed magnetic resonance imaging (MRI) sequences (cine-MRI) permit direct visualization of respiratory motion of liver tumors without considering radiation dose exposure to patients. Here, the authors demonstrated a technique for evaluating internal target volume (ITV) with consideration of respiratory variation using cine-MRI. METHODS: The authors retrospectively evaluated six patients who received stereotactic body radiotherapy (SBRT) to hepatocellular carcinoma. Before acquiring planning CT, sagittal and coronal cine-MRI images were acquired for 30 s with a frame rate of 2 frames/s. The patient immobilization was conducted under the same condition as SBRT. Planning CT images were then acquired within 15 min from cine-MRI image acquisitions, followed by a 4DCT scan. To calculate tumor motion, the motion vectors between two continuous frames of cine-MRI images were calculated for each frame using the pyramidal Lucas-Kanade method. The target contour was delineated on one frame, and each vertex of the contour was shifted and copied onto the following frame using neighboring motion vectors. 3D trajectory data were generated with the centroid of the contours on sagittal and coronal images. To evaluate the accuracy of the tracking method, the motion of clearly visible blood vessel was analyzed with the motion tracking and manual detection techniques. The target volume delineated on the 50% (end-exhale) phase of 4DCT was translated with the trajectory data, and the distribution of the occupancy probability of target volume was calculated as potential ITV (ITV Potential). The concordance between ITV Potential and ITV estimated with 4DCT (ITV 4DCT) was evaluated using the Dice's similarity coefficient (DSC). RESULTS: The distance between blood vessel positions determined with motion tracking and manual detection was analyzed. The mean and SD of the distance were less than 0.80 and 0.52 mm, respectively. The maximum ranges of tumor motion on cine-MRI were 2.4 ± 1.4 mm (range, 1.0-5.0 mm), 4.4 ± 3.3 mm (range, 0.8-9.4 mm), and 14.7 ± 5.9 mm (range, 7.4-23.4 mm) in lateral, anterior-posterior, and superior-inferior directions, respectively. The ranges in the superior-inferior direction were larger than those estimated with 4DCT images for all patients. The volume of ITV Potential was 160.3% ± 13.5% (range, 142.0%-179.2%) of the ITV 4DCT. The maximum DSC values were observed when the cutoff value of 24.7% ± 4.0% (range, 20%-29%) was applied. CONCLUSIONS: The authors demonstrated a novel method of calculating 3D motion and ITV Potential of liver cancer using orthogonal cine-MRI. Their method achieved accurate calculation of the respiratory motion of moving structures. Individual evaluation of the ITV Potential will aid in improving respiration management and treatment planning.


Assuntos
Tomografia Computadorizada Quadridimensional/métodos , Neoplasias Hepáticas/patologia , Fígado/patologia , Imagem Cinética por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Radiocirurgia/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem Tridimensional , Movimento (Física) , Reconhecimento Automatizado de Padrão , Probabilidade , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Respiração , Estudos Retrospectivos , Software
19.
J Radiat Res ; 55(3): 502-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24706996

RESUMO

Swept source optical coherence tomography (SS-OCT) is a convenient method for precise, early-stage detection of choroidal metastatic lesions, involving assessment of tumor response, and for regular follow-up studies. Using information obtained with SS-OCT, we performed intensity-modulated radiotherapy (IMRT) for a patient with choroidal metastasis from breast cancer with more accuracy than had been previously possible. We made replanning adaptive radiotherapy (ART) three times based on the rapid tumor shrinkage detected by weekly assessments with SS-OCT. Accordingly, the planning target volume (PTV) decreased from 1.6 cm(3) to 0.61 cm(3) (38%), with 0.95 cm(3) (59%) and 0.75 cm(3) (46%) as intermediate values during the treatment course. The D0.1 cm3 of the right optic nerve was also reduced from 1.70 Gy/fraction to 0.69 Gy/faction, with 1.41 Gy/fraction and 1.29 Gy/fraction as intermediate values. Adaptive replanning IMRT made it possible to perform locally curative treatment of the metastatic choroidal lesion with a higher dose for the PTV, and a lower dose for organs at risk (OARs).


Assuntos
Neoplasias da Coroide/radioterapia , Neoplasias da Coroide/secundário , Melanoma/radioterapia , Melanoma/secundário , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia de Coerência Óptica/métodos , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Coroide/patologia , Feminino , Humanos , Melanoma/patologia , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Resultado do Tratamento
20.
J Appl Clin Med Phys ; 15(1): 4202, 2014 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-24423832

RESUMO

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.


Assuntos
Neoplasias Pulmonares/cirurgia , Método de Monte Carlo , Radiocirurgia , Planejamento da Radioterapia Assistida por Computador , Algoritmos , Seguimentos , Tomografia Computadorizada Quadridimensional , Humanos , Imagens de Fantasmas , Dosagem Radioterapêutica , Estudos Retrospectivos
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