Dose evaluation indices for total body irradiation using TomoDirect with different numbers of ports: A comparison with the TomoHelical method.

TomoDirect has been reported to have some advantages over TomoHelical in delivering total body irradiation (TBI). This study aimed to investigate the relationships between the number of ports and the dose evaluation indices in low-dose TBI in TomoDirect mode using 2-12 ports and to compare these data with those for the TomoHelical mode in a simulation study. Thirteen patients underwent low-dose TBI in TomoHelical mode from June 2015 to June 2016. We used the same computed tomography data sets for these patients to create new treatment plans for upper-body parts using TomoDirect mode with 2-12 beam angles as well as TomoHelical mode. The prescription was 4 Gy in two equal fractions. For the TomoDirect data, we generated plans with 2-12 ports with approximately equally spaced angles; the modulation factor, field width, and pitch were 2.0, 5.0 cm, and 0.500, respectively. For the TomoHelical plans, the modulation factor, field width, and pitch were 2.0, 5.0 cm, and 0.397, respectively. D2, D98, D50, and the homogeneity index (HI) were evaluated to compare TomoDirect plans having 2-12 ports with the TomoHelical plan. Using TomoDirect plans, D2 with four ports or fewer, D98 with 10 ports or fewer, D50 with four ports or fewer and HI with five ports or fewer showed statistically significantly worse results than the TomoHelical plan. With the TomoDirect plans, D2 with seven ports or more, D50 with eight ports or more, and HI with eight ports or more showed statistically significant improvement compared with the TomoHelical plan. All of the dose evaluation indices of the TomoDirect plans showed a tendency to improve as the number of ports increased. TomoDirect plans showed statistically significant improvement of D2, D50, and HI compared with the TomoHelical plan. Therefore, we conclude that TomoDirect can provide better dose distribution in low-dose TBI with TomoTherapy.

Relationships between thermal dose parameters and the efficacy of definitive chemoradiotherapy plus regional hyperthermia in the treatment of locally advanced cervical cancer: data from a multicentre randomised clinical trial.

PURPOSE: To evaluate the contribution of the thermal dose parameters during regional hyperthermia (HT) treatment to the clinical outcomes in patients with cervical carcinoma (CC) who received chemoradiotherapy (CRT) plus HT. MATERIALS AND METHODS: Data from a multicentre randomised clinical trial of concurrent CRT + HT vs. CRT alone were used to evaluate the efficacy and safety of this combination therapy in the CC patients. The intrarectal temperatures of patients undergoing HT were recorded. The complete thermal data of 47 (92%) of the 51 patients in the CRT + HT group were available for the thermal analysis. Thus, 47 patients who received CRT + HT were included in the present study. RESULTS: Among the patients who received CRT + HT, a higher CEM43T90 (≥1 min) value (a thermal dose parameter) was significantly associated with better local relapse-free survival in both univariate (p = 0.024) and multivariate (p = 0.0097) analyses. The disease-free survival of the patients with higher CEM43T90 (≥1 min) values tended to be better in comparison to patients with lower CEM43T90 (<1 min) value (p = 0.071). A complete response tended to be associated with the CEM43T90 (p = 0.056). Disease-free survival, local relapse-free survival and complete response rate for patients with higher CEM43T90 (≥1) were significantly better than those for patients with CRT alone (p = 0.036, p = 0.036 and p = 0.048). CONCLUSIONS: Dose-effect relationships between thermal dose parameters and clinical outcomes were confirmed in the CC patients treated with a combination of CRT + HT. This study also confirmed that HT with lower CEM43T90 is insufficient to achieve a significant hyperthermic sensitisation to CRT.

A multicentre randomised clinical trial of chemoradiotherapy plus hyperthermia versus chemoradiotherapy alone in patients with locally advanced cervical cancer.

PURPOSE: To evaluate the effectiveness of whole-pelvic hyperthermia (HT) added to standard chemoradiotherapy (CRT) in locally advanced cervical cancer (CC), by investigating the clinical response and survival of patients treated with cisplatin-based CRT vs. CRT with HT (CRT + HT). MATERIALS AND METHODS: This study was conducted at five hospitals in Japan between September 2001 and March 2015 in patients with the International Federation of Gynecology and Obstetrics stage IB (bulky)-IVA CC undergoing definitive CRT. After giving a written informed consent, patients were randomly allocated to two treatment groups: CRT and CRT + HT group. Overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS), complete response (CR) rate and tolerability were evaluated. RESULTS: In total, 101 patients were treated. Patient characteristics, total dose of cisplatin and radiotherapy were similar for both groups. Although not statistically significant, the 5-year OS, DFS and LRFS in the CRT + HT group (77.8%, 70.8% and 80.1%, respectively) were better than those in the CRT group (64.8%, 60.6% and 71.0%, respectively). CR was significantly more likely to be achieved in patients in the CRT + HT group than in the CRT group (88% vs. 77.6%; adjusted odds ratio, 3.993; 95% confidence interval, 1.018-15.67; p = .047). CRT + HT was well tolerated and caused no additional acute or long-term toxicity compared with CRT alone. CONCLUSIONS: HT combined with CRT improved the CR rate of CRT in patients with locally advanced CC, however, could not improve survival outcomes. Further studies in larger samples are warranted.

Deep regional hyperthermia for the whole thoracic region using 8 MHz radiofrequency-capacitive heating device: relationship between the radiofrequency-output power and the intra-oesophageal temperature and predictive factors for a good heating in 59 patients.

PURPOSE: To assess the relationship between the radiofrequency (RF) output power and the intra-oesophageal temperature for hyperthermia of the whole thoracic region, and also to evaluate the patients' characteristics associated with adequate heating. MATERIALS AND METHODS: Fifty-nine patients with thoracic cancer treated with radiotherapy plus hyperthermia were retrospectively analysed. The 8-MHz RF capacitive heating device was applied, both the upper and lower electrodes were 300 mm in diameter, placed on opposite sides of the whole thoracic region. All the patients also underwent intra-oesophageal temperature measurements. RESULTS: All thermal parameters, T(min), T(max), T(ave), and %T ≥ 41°C, of the intra-oesophageal temperature highly correlated with the median RF output power (p < 0.0001), and the relations were independent in the multivariable analyses including clinical characteristics (p < 0.01). The performance status showed a statistically significant association on T(max), T(ave) and %T ≥ 41°C (p < 0.05). The patient age and subcutaneous fat at some levels were inversely correlated with the thermal parameters (p < 0.05). CONCLUSION: The RF output power was significantly correlated with the intra-oesophageal temperature; it could be used as a promising parameter to assess the efficacy of hyperthermia for the whole thoracic region. Higher intra-oesophageal temperature may be achieved in patients with good performance status, younger age and thinner subcutaneous fat.

The prognosis and the impact of radiotherapy in clinically regional lymph node-positive prostate cancer: Which patients are candidates for local therapy with radiation?

BACKGROUND: This study aimed to identify the prognostic and predictive factors of local radiotherapy in clinically regional lymph node-positive prostate cancer. PATIENTS AND METHODS: This study includes patients who were newly diagnosed with regional lymph node-positive prostate cancer between 2008 and 2017. We investigated the prognostic value of clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) as well as the differential prognostic impact of radiotherapy by subgroup analysis. RESULTS: Among the 93 men enrolled as patients, 48 (51.6 %) were treated with radiotherapy. The biopsy positive core rate and biopsy Gleason score were associated with PFS, and the number of lymph node metastases was associated with both PFS and OS. Patients who underwent radiotherapy showed better PFS and OS. High-risk features (at least 2 criteria among ≥75% biopsy positive core rate, Gleason score ≥9, and ≥2 positive lymph nodes) were especially associated with improved outcomes after undergoing radiotherapy. CONCLUSION: We identified prognostic factors for clinically regional lymph node-positive prostate cancer and showed the benefits of local radiation therapy. Patients with high-risk features may be especially suitable candidates for radiotherapy.

Variation of clinical target volume definition among Japanese radiation oncologists in external beam radiotherapy for prostate cancer.

BACKGROUND: We investigated the interobserver variation in the prostate target volume and the trend toward the use of diagnostic computed tomography (CT) or magnetic resonance (MR) images for treatment planning. METHODS: Twenty-five radiation oncologists were asked to draw the external contour of the prostate on CT images (0.3 cm spacing) of a patient with localized prostate cancer. They also answered a questionnaire regarding the use of diagnostic CT or MR images for the contouring. RESULTS: Of the 25 physicians, 28% rarely or never referred to the diagnostic CT images. In contrast, the physicians tended to refer to the MR images more frequently. Approximately 50% of the physicians believed in the usefulness of contrast-enhanced images for the delineation of the prostate. As for the variation of the prostate contouring, the median craniocaudal prostate length was 36 mm (range, 21-54 mm), and the median prostate volume was 43.5 cm(3) (range, 23.8-98.3 cm(3)). The interobserver variability was not significant in the duration as a radiation oncologist, the board certification status as radiation oncologists, and the number of treatment plans developed for prostate cancer during the last 1 year. CONCLUSION: A wide variety of the definitions of the prostate was found among Japanese radiation oncologists.

Breath-hold monitoring and visual feedback for radiotherapy using a charge-coupled device camera and a head-mounted display: system development and feasibility.

PURPOSE: The aim of this study was to present the technical aspects of the breath-hold technique with respiratory monitoring and visual feedback and to evaluate the feasibility of this system in healthy volunteers. METHODS AND MATERIALS: To monitor respiration, the vertical position of the fiducial marker placed on the patient's abdomen was tracked by a machine vision system with a charge-coupled device camera. A monocular head-mounted display was used to provide the patient with visual feedback about the breathing trace. Five healthy male volunteers were enrolled in this study. They held their breath at the end-inspiration and the end-expiration phases. They performed five repetitions of the same type of 15-s breath-holds with and without a head-mounted display, respectively. A standard deviation of five mean positions of the fiducial marker during a 15-s breath-hold in each breath-hold type was used as the reproducibility value of breath-hold. RESULTS: All five volunteers well tolerated the breath-hold maneuver. For the inspiration breath-hold, the standard deviations with and without visual feedback were 1.74 mm and 0.84 mm, respectively (P = 0.20). For the expiration breath-hold, the standard deviations with and without visual feedback were 0.63 mm and 0.96 mm, respectively (P = 0.025). CONCLUSION: Our newly developed system might help the patient achieve improved breath-hold reproducibility.

Reproducibility of the abdominal and chest wall position by voluntary breath-hold technique using a laser-based monitoring and visual feedback system.

PURPOSE: The voluntary breath-hold (BH) technique is a simple method to control the respiration-related motion of a tumor during irradiation. However, the abdominal and chest wall position may not be accurately reproduced using the BH technique. The purpose of this study was to examine whether visual feedback can reduce the fluctuation in wall motion during BH using a new respiratory monitoring device. METHODS AND MATERIALS: We developed a laser-based BH monitoring and visual feedback system. For this study, five healthy volunteers were enrolled. The volunteers, practicing abdominal breathing, performed shallow end-expiration BH (SEBH), shallow end-inspiration BH (SIBH), and deep end-inspiration BH (DIBH) with or without visual feedback. The abdominal and chest wall positions were measured at 80-ms intervals during BHs. RESULTS: The fluctuation in the chest wall position was smaller than that of the abdominal wall position. The reproducibility of the wall position was improved by visual feedback. With a monitoring device, visual feedback reduced the mean deviation of the abdominal wall from 2.1 +/- 1.3 mm to 1.5 +/- 0.5 mm, 2.5 +/- 1.9 mm to 1.1 +/- 0.4 mm, and 6.6 +/- 2.4 mm to 2.6 +/- 1.4 mm in SEBH, SIBH, and DIBH, respectively. CONCLUSIONS: Volunteers can perform the BH maneuver in a highly reproducible fashion when informed about the position of the wall, although in the case of DIBH, the deviation in the wall position remained substantial.

Treatment of early tongue carcinoma with brachytherapy: results over a 25-year period.

BACKGROUND: Brachytherapy for patients with early tongue cancer is an accepted method of treatment. PATIENTS AND METHODS: The records of 409 patients with T1/2N0M0 tongue cancer treated with brachytherapy between 1978 and 2004 were reviewed. RESULTS: The overall and disease-free 5-year survival rates were 82.3% and 64.6% for patients with T1 disease, and 72.2% and 56.0% for patients with T2 disease, respectively. The 5-year nodal metastasis-free survival rates for patients treated between 1978 and 1986, 1987 and 1996, and 1997 and 2004 were 64.8%, 74.8% and 81.3% for patients with T1 disease (p=0.22), and 47.4%, 70.4% and 76.4% for patients with T2 disease (p=0.0011), respectively. The 5-year local recurrence-free survival rates for patients treated between 1978 and 1986, 1987 and 1996, and 1997 and 2004 were 91.0%, 84.0% and 96.9% for patients with T1 disease (p=0.31), and 87.6%, 83.3% and 85.8% for patients with T2 disease (p=0.90), respectively. CONCLUSION: The incidence rate of nodal metastasis in patients with early tongue cancer improved over the 25-year period studied, while the local recurrence-free survival rates remained stable.

Radiation therapy for recurrent esophageal cancer after surgery: clinical results and prognostic factors.

OBJECTIVE: To evaluate the outcome of radiotherapy for recurrent esophageal cancer after surgery and to determine the prognostic factors. METHODS: From 1987 through 2002, 82 patients treated with radiotherapy for loco-regional recurrences of esophageal cancer after surgery were retrospectively reviewed. The stage at initial surgery was I in 16, II in 41, III or higher in 24 and unknown in 1. The median size of recurrent tumors was 3.5 cm in diameter. Fifty-two patients were treated with radiotherapy alone, and 30 were treated with radiotherapy combined with chemotherapy. The median total dose of external radiotherapy given was 50.4 Gy in 28 fractions. RESULTS: The median survival period after recurrence was 7.0 months. The 2- and 5-year overall survival rate for all patients was 22 and 11%, respectively. In univariate analysis, the patients with performance status (PS) = 0-1, or tumor size <3.5 cm, and those treated with total dose >/=50 Gy showed a better survival outcome than each the other groups. The patients with a history of previous radiotherapy showed a poorer survival outcome in univariate analysis than each the other groups. In multivariate analysis, tumor size, PS and radiation dose were independent prognostic factors for overall survival. CONCLUSION: The prognosis of patients with post-operative loco-regional recurrence of esophageal cancer is poor. However, a long-term survival may be expected by definitive radiotherapy for the patients with small-size tumors and with a good PS.

Erythema multiforme and Stevens-Johnson syndrome following radiotherapy.

Erythema multiforme (EM) and Stevens-Johnson syndrome (SJS) are thought to be hypersensitivity syndromes with various causes, and radiotherapy might be one of the causes of these syndromes. We herein report two cases of EM/SJS following radiotherapy. The first case was a 63-year-old woman with breast cancer. At the end of postoperative radiotherapy with 60 Gy, severe pruritic erythema appeared in the irradiated area and spread over the whole body. She was diagnosed with EM by a skin biopsy. The second case was a 77-year-old woman with uterine cervical cancer who underwent postoperative radiotherapy. At a dose of 30.6 Gy, pruritic redness appeared in the irradiated area and the precordial region, and it became widespread rapidly with polymorphic transformation. Although without any histological confirmation, SJS was strongly suspected because of her pruritic conjunctivitis. Because both patients were given medicines during irradiation, radiotherapy may not be the only cause of EM/SJS. However, it should be noted that radiotherapy might trigger EM/SJS.

Low pre-radiotherapy prostate-specific antigen level is a significant predictor of treatment success for postoperative radiotherapy in patients with prostate cancer.

BACKGROUND: The optimal role of postoperative radiotherapy for patients with prostate cancer remains undefined. MATERIALS AND METHODS: The medical records of 70 patients (median age: 66 years), who had received radical radiotherapy (RT) between the years 1996 and 2004 after radical prostatectomy (RP), were analyzed. Fifteen patients had received immediate adjuvant RT, while the other 55 patients had received salvage therapy. Hormonal therapy had been performed in 28 patients before RT and continued in two of them concurrently with RT. A median dose of 60 Gy was delivered to the prostate bed. Pelvic node irradiation was performed in all patients. RESULTS: After a median follow-up period of 23 months, 21 patients had experienced biochemical failure. Actuarial 3- and 5-year biochemical relapse-free survival estimates were 67.4%. No patient had local failure, although distant metastases with biochemical failure were found in five patients. On univariate analysis, the following were significant for biochemical failures: seminar vesicle involvement, serum PSA level >1 ng/ml before RT, pathological pelvic node involvement, RT indication (adjuvant vs. salvage) and Gleason score. However, only the serum PSA level before RT was significant on multivariate analysis. CONCLUSION: Postoperative RT with a pre-RT PSA level <0.1 ng/ml seemed to be effective in patients with prostate cancer.

Long-term local control of recurrent adenoid cystic carcinoma in the parotid gland with radiotherapy and intraarterial infusion chemotherapy.

We report a case of postoperative recurrence of adenoid cystic carcinoma in the left parotid gland treated with radiotherapy and arterial infusion chemotherapy. A 52-year-old woman had a history of surgical resection for an adenoid cystic carcinoma arising from the left parotid gland 25 years before. Despite two reoperations for local recurrence after the initial surgery, she had a third local recurrence in the remnant of the left parotid gland. The patient was treated with a concurrent combination of radiotherapy (60 Gy/30F) and intraarterial infusion chemotherapy with carboplatin (750 mg/30 days) from which she obtained a complete response. The patient has remained free of local progression 54 months after treatment. Radiotherapy and arterial infusion chemotherapy is effective treatment for local recurrence of adenoid cystic carcinoma in the head and neck.

Chemoradiation therapy with or without salvage surgery for early squamous cell carcinoma of the hypopharynx.

PURPOSE: Early squamous cell carcinoma of the hypopharynx is a rare clinical entity. Our objective was to analyze the outcome of patients with early hypopharyngeal cancer treated with curative radiotherapy or the combination of preoperative radiotherapy with surgery. METHODS AND MATERIALS: Forty-three patients with Stage I-II hypopharyngeal cancer were initially treated with 30-40 Gy of irradiation with or without chemotherapy. Thirty-two patients (74.4%) who demonstrated a complete response continued to receive further radiotherapy, with a median total dose of 61.2 Gy. Eleven other patients (25.6%) received surgery. RESULTS: Local control with laryngeal voice preservation was achieved in 8 (88.9%) of 9 patients with Stage I disease, and in 23 (67.6%) of 34 patients with Stage II disease. The overall and disease-specific 5-year survival rates for all patients were 70.4% and 89.5%, respectively. The disease-specific survival rates according to the T-category were 100% for patients with T1 disease and 87.2% for patients with T2 disease (p = 0.32). Twenty patients (46.5%) had synchronous or metachronous cancers. Four patients died of hypopharyngeal cancer, and 5 died of second-primary esophageal cancer. CONCLUSIONS: A majority of patients with early hypopharyngeal cancer was curable. However, second malignancies influenced the overall outcome of patients with early hypopharyngeal cancer.

Angiosarcoma of the scalp treated with curative radiotherapy plus recombinant interleukin-2 immunotherapy.

PURPOSE: To evaluate the effectiveness of curative radiotherapy (RT) plus recombinant interleukin-2 (rIL-2) immunotherapy regarding the treatment results for angiosarcoma of the scalp. Curative resection of angiosarcoma of the scalp is usually difficult because of the diffuse, clinically undetectable local spread. RT is a rational therapeutic approach, because a wide region of the dermis can be treated, while sparing the underlying normal tissues. Recently, the effectiveness of immunotherapy with rIL-2 has also been reported in the treatment of angiosarcoma of the scalp. METHODS AND MATERIALS: The data of 20 patients with angiosarcoma of the scalp treated with curative RT plus rIL-2 immunotherapy between January 1988 and June 2002 were retrospectively analyzed. The total radiation dose was 70.3 +/- 6.9 Gy. The fractions were 2-3 Gy daily, given 5 d/wk. rIL-2 immunotherapy was performed by transcatheter arterial administration in 10 patients, systemic administration in 11 during the course of RT, and intratumoral injection in 10 during and/or after RT; 12 patients received a combination of two. Five patients underwent limited surgery, and concomitant pacilitaxel chemotherapy was also used in 2 patients. RESULTS: The median survival time for overall, local recurrence-free, and distant metastasis-free survival was 36.2, 11.1, and 17.8 months, respectively. Local recurrence developed in 7 patients (35%), 4 of whom also had evidence of distant metastases. An additional 7 patients (35%) developed distant metastases alone. Recurrence within the radiation field was recognized in 2 patients with systemic rIL-2 administration alone (p < 0.05). Arterial or intratumoral administration combined with systemic administration of rIL-2 resulted in better distant metaststasis-free survival rates (p < 0.05). CONCLUSION: Curative RT plus rIL-2 immunotherapy provided an efficient, effective means of treating angiosarcoma of the scalp. Arterial or intratumoral administration combined with systemic administration of rIL-2 may prolong survival. Additional studies with detailed treatment protocols are recommended.

Stage I and II non-Hodgkin's lymphoma: results of combined of THP-COP chemotherapy and radiotherapy.

PURPOSE: We evaluated the usefulness of radiotherapy plus THP-COP chemotherapy consisting of cyclophosphamide, vincristine, pirarubicin (tetrahydropyranyl adriamycin, THP), and prednisone for stage I and II non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Between October 1998 and October 2001, 32 patients with Stage I or II NHL were treated with THP-COP plus radiotherapy. The patients consisted of 19 men and 13 women with a median age of 60 years (range, 23-81 years). The histological type was intermediate grade in 29, high in one, and unclassified in two. The number of cycles of THP-COP ranged from three to six (median, three cycles). Doses of irradiation ranged from 18.0 to 46.5 Gy (median, 40.0 Gy). The median length of follow-up was 19 months (range, 1-47 months). RESULTS: The 3-year overall survival rate and progression-free survival rate were 81.3% and 74.9%, respectively. Leukopenia of grade 3-4 was documented in 24 patients (75%) and thrombopenia of grade 3-4 in four (12.5%). CONCLUSION: THP-COP plus radiotherapy appeared to be feasible for stage I and II NHL patients. However, further evaluation is needed to determine the usefulness of this treatment.

Stereotactic radiotherapy for lung and liver tumors using a body cast system: setup accuracy and preliminary clinical outcome.

PURPOSE: To evaluate the feasibility and treatment outcomes of stereotactic radiotherapy (SRT) using a newly developed simple body cast system for lung and liver tumors. MATERIALS AND METHODS: From April 2003 to July 2004, 20 patients were treated with SRT at the Kyushu University Hospital. Thirteen patients had primary lung cancer, 5 had metastatic lung cancer, and 2 had hepatocellular carcinoma. All patients were fixed with a thermoplastic body cast combined with a vacuum pillow, arm and leg support, and a carbon plate. SRT was given in 5-8 fields with an isocenter dose of 48-60 Gy in 4-10 fractions. Target verification was performed by computed tomography (CT) during the first session, and by anterior-posterior (A-P) and lateral portal images during the second and subsequent sessions. RESULTS: The average setup errors and deviation in the first treatment session were 1.4 +/- 1.2, 1.1 +/- 1.0, and 3.3 +/- 2.8 mm in the lateral, A-P, and cranio-caudal (C-C) directions, respectively. The setup errors in the second and subsequent sessions were 2.4 +/- 0.5, 1.4 +/- 1.8, and 3.7 +/- 2.6 mm in the lateral, A-P, and C-C directions, respectively. The patient's movement during a treatment session was within 5 mm in any direction. Despite the short follow-up periods (1-15 months), complete response was shown in 4 lesions, and partial response was shown in 15 lesions. Neither local progression nor serious complication was observed in any patient. CONCLUSION: SRT using our body cast system was a safe and reliable treatment method for extracranial tumors.

A machine vision system with CCD cameras for patient positioning in radiotherapy: a preliminary report.

PURPOSE: To determine positioning accuracy of a machine vision system in radiotherapy. MATERIALS AND METHODS: The machine vision system was composed of 640 x 480 pixel CCD cameras and computerized control systems. For image acquisition, the phantom was set up for the reference position and a single CCD camera was positioned 1.5 m from the isocenter. The image data of the fiducial marker with 1.5 mm lead pellet on the lateral surface of the phantom was captured onto the CCD, and then the position of the marker was accurately calculated. The phantom was moved 0.25, 0.50, 0.75, 1.00, 2.00, and 3.00 mm from the reference position, using a micrometer head. The position of the fiducial marker was analyzed using a kilo-voltage fluoroscopic imaging system and a machine vision system. RESULTS: Using fluoroscopic images, the discrepancy between the actual movement of the phantom by micrometer heads and the measurement was found to be 0.12 +/- 0.05 mm (mean +/- standard deviation). In contrast, the detection of the movement by the machine vision system coincided with the discrepancy of 0.0067 +/- 0.0048 mm. CONCLUSION: This study suggests that the machine vision system can be used to measure small changes in patient position with a resolution of less than 0.1 mm.

Adult rhabdomyosarcoma in the nasal and paranasal sinuses showing complete local response to a combination of chemotherapy and radiotherapy using 3D-CRT and IMRT.

We report on a 69-year-old woman with rhabdomyosarcoma arising from the nasal and paranasal sinuses. She was referred to our hospital with a reduced ability to smell and impaired bilateral vision, narrowing of the visual field, and left facial pain. Computed tomography (CT) revealed a large tumor in the nasal and left paranasal sinuses invading the left orbital cavity and anterior skull base, and lymph node swellings in the submental and left accessory nerve areas. A biopsy specimen from the nasal tumor was diagnosed histologically as a rhabdomyosarcoma, alveolar type. Because the intracranial direct invasion and distant metastases to the thoracic spine were suspected by pretreatment examination, our case was determined to be inoperable by a head and neck surgeon. Radiotherapy with a total dose of 60 Gy was carried out to control the primary disease. The three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques were used in order to reduce the doses to risk organs. Combined with radiotherapy, chemotherapy was also performed for the treatment of lymph-node metastases and distant diseases. After the treatment was completed, the primary tumor and lymph-node metastases disappeared completely; there was no sign of re-growth during the follow-up period. Chemoradiotherapy may be an effective treatment also for inoperable adult rhabdomyosarcoma in the head and neck region. Furthermore, the 3D-CRT and IMRT techniques are both useful methods of radiotherapy for this disease.

[A case of advanced esophageal cancer with multiple lymph node metastases successfully treated with induction chemotherapy consisting of nedaplatin and 5-FU followed by chemoradiotherapy].

A 61-year-old male patient had esophageal carcinoma with multiple mediastinal and right supraclavicular lymph node metastases. Chemotherapy consisting of infusion of nedaplatin and continuous infusion of 5-fluorouracil was performed. After three courses of the chemotherapy, the patient was treated with a combination of cisplatin and 5-FU and radiotherapy. However, only radiotherapy was performed after 18 Gy because of grade 3 leukocytonenia during the chemoradiotherapy. The patient achieved a partial response (nearly complete response) for 9 months after the initiation of the treatment. In conclusion, chemotherapy with NDP and 5-FU followed by chemoradiotherapy is effective and safe for patients with esophageal carcinoma with multiple lymph node metastases.