Ōsaka, Japan
Ōsaka, Japan

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PubMed | Toho University, Miyakojima IGRT Clinic, Edogawa Hospital, Tokyo Electron and Keio University
Type: | Journal: Journal of vascular and interventional radiology : JVIR | Year: 2016

To evaluate clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis resistant to conservative treatments.This study comprised 25 patients (18 women and 7 men; mean age, 53.8 y; range, 39-68 y) with adhesive capsulitis resistant to conservative treatments. TAE was performed, and adverse events (AEs), pain visual analog scale (VAS) score changes, range of motion (ROM), and American Shoulder and Elbow Surgeons (ASES) scores were assessed.Abnormal vessels were identified in all patients. No major AEs were associated with TAE. One patient was lost to follow-up. The remaining 24 patients were available for final follow-up (mean, 36.1 months; range, 30-44 months). Of the 24 patients, 16 (67%) experienced quick improvement of nighttime pain (ie, VAS scores decreased > 50% from baseline) within 1 week, and 21 (87%) improved within 1 month. In terms of mean overall pain (ie, pain at its worst), VAS scores significantly decreased at 1, 3, and 6 months after treatment (82 mm before treatment vs 52, 19, and 8 mm after treatment; P < .001). ASES scores significantly improved at 1, 3, and 6 months after treatment (16.1 before treatment vs 41.4, 69.1, and 83.5 after treatment; P < .001). No symptom recurrence or late-onset AEs were observed. Shoulder ROM and function further improved during midterm follow-up.TAE is a possible treatment option for patients with adhesive capsulitis that has failed to improve with conservative treatments.


PubMed | Yokohama CyberKnife Center, Nagoya City University, Proton Therapy, Suzukake Central Hospital and Miyakojima IGRT Clinic
Type: Journal Article | Journal: Technology in cancer research & treatment | Year: 2016

We investigated the dose uncertainty caused by errors in real-time tracking intensity-modulated radiation therapy (IMRT) using the CyberKnife Synchrony Respiratory Tracking System (SRTS). Twenty lung tumors that had been treated with non-IMRT real-time tracking using CyberKnife SRTS were used for this study. After validating the tracking error in each case, we did 40 IMRT planning using 8 different collimator sizes for the 20 patients. The collimator size was determined for each planning target volume (PTV); smaller ones were one-half, and larger ones three-quarters, of the PTV diameter. The planned dose was 45 Gy in 4 fractions prescribed at 95% volume border of the PTV. Thereafter, the tracking error in each case was substituted into calculation software developed in house and randomly added in the setting of each beam. The IMRT planning incorporating tracking errors was simulated 1000 times, and various dose data on the clinical target volume (CTV) were compared with the original data. The same simulation was carried out by changing the fraction number from 1 to 6 in each IMRT plan. Finally, a total of 240 000 plans were analyzed. With 4 fractions, the change in the CTV maximum and minimum doses was within 3.0% (median) for each collimator. The change in D99 and D95 was within 2.0%. With decreases in the fraction number, the CTV coverage rate and the minimum dose decreased and varied greatly. The accuracy of real-time tracking IMRT delivered in 4 fractions using CyberKnife SRTS was considered to be clinically acceptable.


Akino Y.,Osaka University | Oh R.-J.,Miyakojima IGRT Clinic | Masai N.,Miyakojima IGRT Clinic | Shiomi H.,Miyakojima IGRT Clinic | Inoue T.,Miyakojima IGRT Clinic
Medical Physics | Year: 2014

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 (ITVPotential). The concordance between ITVPotential and ITV estimated with 4DCT (ITV4DCT) 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 ITVPotential was 160.3%±13.5% (range, 142.0%-179.2%) of the ITV4DCT. 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 ITVPotential of liver cancer using orthogonal cine-MRI. Their method achieved accurate calculation of the respiratory motion of moving structures. Individual evaluation of the ITVPotential will aid in improving respiration management and treatment planning. © 2014 American Association of Physicists in Medicine.


Inoue T.,Miyakojima IGRT Clinic | Shiomi H.,Miyakojima IGRT Clinic | Oh R.-J.,Miyakojima IGRT Clinic
Journal of Radiation Research | Year: 2015

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. © The Author 2015.


Miura H.,Miyakojima IGRT clinic.
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2014

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.


Of 127 lung cancer patients treated with stereotactic body radiation therapy over 4 years, 35 patients (58 ribs) experienced radiation associated rib fractures (RARF) that developed in second through eighth ribs. Three-year estimated incidence of G1 RARF was 40%. Out of eight factors examined, site of primary tumors was significant by both uni- and multivariate analyses. Patient instruction such as fall prevention and avoidance of twist motion should be necessary to prevent the G2 RARF.


Miura H.,Miyakojima IGRT Clinic | Masai N.,Miyakojima IGRT Clinic | Oh R.-J.,Miyakojima IGRT Clinic | Shiomi H.,Miyakojima IGRT Clinic | And 3 more authors.
Journal of Applied Clinical Medical Physics | Year: 2014

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.


PubMed | Miyakojima IGRT Clinic.
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016

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, fStagec 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.


Inoue T.,Miyakojima IGRT Clinic | Oh R.-J.,Miyakojima IGRT Clinic | Shiomi H.,Miyakojima IGRT Clinic
Strahlentherapie und Onkologie | Year: 2011

Purpose: To perform aggressive radiotherapy for vertebral metastases. Using very steep dose gradients from intensity-modulated radiotherapy (IMRT), a protocol based on the concept of partial volume dose to the spinal cord was evaluated. Patients and Methods: 50 patients with vertebral metastases were treated using IMRT. In previously unirradiated cases, where a prescribed dose of 80 Gy (BED 10) was delivered, the constraint to the spinal cord should be less than 100 Gy (BED 2). For previously irradiated cases, on the other hand, the dose is the same as in the previously unirradiated case; however, constraints for the spinal cord are a cumulative BED 2 of less than 150 Gy, BED 2 of less than 100 Gy in each instance, and a treatment gap of more than 6 months. There were 6 patients considered for a partial volume dose to the spinal cord. They all received higher BED 2, ranging from 51-157 Gy of D 1cc. Results: Among the 24 patients who survived longer than 1 year, there was 1 case of transient radiation myelitis. There were no other cases of spinal cord sequelae. Conclusions: Based on the present results, we recommend a BED 2 of 100 Gy or less at D 1cc as a constraint for the spinal cord in previously unirradiated cases, and a cumulative BED 2 of 150 Gy or less at D 1cc in previously irradiated cases, when the interval was not shorter than 6 months and the BED 2 for each session was 100 Gy or less. The prescribed BED 10 of 80 Gy could be safely delivered to the vertebral lesions. © Urban & Vogel.


Oh R.,Miyakojima IGRT Clinic
Japanese Journal of Clinical Radiology | Year: 2016

In recent decades, the number of long-term cancer survivors has increased. This has caused increasing requests for the delivery of a second course of radiation to recurrent tumors that occurred in previous radiotherapy fields. Most radiation oncologists are reluctant to offer reirradiation due to a lack of experience and potential toxicity. We reviewed our experience during 6 years and analyzed the outcome which indicates the low toxicity of reirradiation by using modern techniques should allow the delivery of higher doses and, as a consequence, lead to an improvement in the reirradiation outcome.

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