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Yamazaki H.,Kyoto Prefectural University of Medicine | Nakamura S.,Kyoto Prefectural University of Medicine | Nishimura T.,Ujitakeda Hospital | Kodani N.,Kyoto Prefectural University of Medicine | And 7 more authors.
Anticancer Research | Year: 2013

Reirradiation is a challenging field in the treatment of recurrent brain metastases. Because of the elevated risk of radiation toxicity due to previous irradiation, only a limited dose is prescribed. To enhance radiosensitivity, in the present analysis six patients received hypofractionated stereotactic radiotherapy (hSRT) with daily oral administration of the hypoxic sensitizer AK-2123 (sanazole) for progressive brain metastases after previous radiotherapy. The patients received daily oral administration of 1.0 g/day sanazole up to 2 h before radiotherapy. Three partial and three stable responses were observed, with no sanazole-related toxicity, except for a case of mild nausea. Brain failure with subsequent death occurred in one patient. The other patients maintained good performance status until disease progression in other lesions. hSRT with a hypoxic radiation sensitizer appears to have the potential to enhance the efficacy of radiotherapy.


Aibe N.,Kyoto Prefectural University of Medicine | Aibe N.,Ujitakeda Hospital | Yamazaki H.,Kyoto Prefectural University of Medicine | Yamazaki H.,Ujitakeda Hospital | And 8 more authors.
Journal of Radiation Research | Year: 2014

To analyze outcomes and toxicities of stereotactic body radiotherapy with helical tomotherapy (HT-SBRT) for inoperable lung tumors, the medical records of 30 patients with 31 lung tumors treated with HT-SBRT were reviewed. The 3-year local control, cause-specific survival and overall survival rates (LC, CCS and OS, respectively) were analyzed using the Kaplan-Meier method. Toxicities were graded using Common Terminology Criteria for Adverse Events ver. 4. To investigate the factors associated with Grade 5 radiation pneumonitis (G5 RP), several parameters were analyzed: (i) patient-specific factors (age, gross tumor volume and PTV, and the interstitial pulmonary shadow on pretreatment CT); and (ii) dosimetry-specific factors (conformity index, homogeneity index, mean lung dose, and V5, V10, V15, V20 and V25 of the total lungs). The median duration of observation for all patients was 36.5 months (range, 4-67 months). The 3-year LC, CCS and OS were 82, 84 and 77%, respectively. Regarding Grade 3 or higher toxicities, two patients (6.7%) developed G5 RP. GTV was significantly associated with G5 RP (P = 0.025), and there were non-significant but slight associations with developing G5 RP for V5 (P = 0.067) and PTV (P = 0.096). HT-SBRT led to standard values of LC, CCS and OS, but also caused a markedly higher incidence of G5 RP. It is essential to optimize patient selection so as to avoid severe radiation pneumonitis in HT-SBRT. © 2014 The Author 2014. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.


Iwama K.,Ujitakeda Hospital | Yamazaki H.,Ujitakeda Hospital | Yamazaki H.,Kyoto Prefectural University of Medicine | Nishimura T.,Ujitakeda Hospital | And 8 more authors.
Anticancer Research | Year: 2013

Aim: To analyze an intrafractional organ motion for patients with prostate cancer using soft tissue matching by megavolt computed tomography (MVCT) images during the course of image-guided intensity-modulated radiotherapy (IGRT-IMRT) using helical tomotherapy. Patients and Methods: Data from a total of 10 patients with prostate cancer who received IGRT-IMRT were analyzed, and MVCT images were acquired before and after radiation therapy. Intrafractional movement and PTV margins for soft tissue matching were calculated by comparing treatment planning images with 740 MVCT images for right-left (RL), superior-inferior (SI), and anteroposterior (AP) dimensions. A total of 74 Gy/37 fractions were administered. A margin to compensate for these variations was calculated using the van Herk's equation. Results: The intrafractional motion was 0.03 (-1.3 to 1.4) ±0.39 mm in the RL dimension, 0.08 (-1.8 to 0.28) ±0.73 mm in the SI dimension, and 0.52 (-1.8 to 1.8) ±0.63 mm in the AP dimension. The required PTV margin was 0.60 mm, 1.10 mm, and 0.78 mm in the RL, SI, and AP dimensions, respectively. Only one patient exhibited a deviation greater than 5 mm only once in 37 fractions (1/370=0.2%) caused by anal contraction. Conclusion: The PTV margin in soft tissue matching IGRT-IMRT by helical tomotherapy for a patient with prostate cancer was 3 mm or less, and our tentative PTV margin of 3-5 mm is sufficient for most patients, if adequate instruction for avoiding anal contraction is given.


Nishimura T.,Ujitakeda Hospital | Yamazaki H.,Ujitakeda Hospital | Yamazaki H.,Kyoto Prefectural University of Medicine | Iwama K.,Ujitakeda Hospital | And 10 more authors.
Anticancer Research | Year: 2013

Aim: To evaluate an appropriate planning target volume (PTV) margin in for one to three vertebral metastases using megavolt computed tomography (MVCT) images during the course of image-guided and stereotactic intensitymodulated radiotherapy (IGRT-IMRT) by use of helical tomotherapy. Patients and Methods: A total of 25 lesions in 24 patients with vertebral metastases who received IGRTIMRT were analyzed. MVCT images were acquired before and after radiation therapy. Intra-fractional movement and PTV margin were calculated by comparing treatment planning images and these 310 MVCT images for right-left (RL), superior-inferior (SI), and anteroposterior (AP) dimensions. Five patients were treated by 35 Gy/5 fractions, 17 by 30 Gy/5 fractions, one by 25 Gy/5 fractions, and one by 60 Gy/30 fractions. A margin to compensate for these variations was calculated with the formula of vanHerk's equation. Results: The intra-fractional motion was 0.02 (-1.3 to 1.4) ± 0.34 mm in the RL direction, -0.09 (-1.8 to 0.28) ± 0.44 mm in the SI direction, and 0.20 (-1.8 to 1.8) ± 0.36 mm in the AP direction. The required PTV margin was 0.98 mm in the RL direction, 0.69 mm in the SI direction, and 1.26 mm in the AP direction. No patient showed a deviation greater than 2 mm. Conclusion: The PTV margin in hypofractionated IGRT-IMRT, using helical tomotherapy for a few vertebral metastases, was 2 mm or less and our tentative PTV margin of 5 mm was sufficient and reducible.


Miura H.,Kyoto Prefectural University of Medicine | Yamagami T.,Kyoto Prefectural University of Medicine | Terayama K.,Kyoto Prefectural University of Medicine | Terayama K.,Ujitakeda Hospital | And 4 more authors.
Acta Radiologica | Year: 2010

Background: Various treatments for hepatocellular carcinoma (HCC) beneath the diaphragm have been reported. Transpulmonary radiofrequency (TPRF) ablation for HCC beneath the diaphragm has been developed as a safe treatment, but pneumothorax has been reported as the most common complication of TPRF ablation. Purpose: To evaluate the relationship between the incidence of pneumothorax and various variables after TPRF ablation. Material and Methods: Seventy-six TPRF ablation sessions for unresectable HCC were performed in 66 patients (19 women, 47 men; mean age 69.6 years) under computed tomography (CT)-fluoroscopic guidance between November 2005 and April 2009. All patients had HCC beneath the diaphragm, not visible by ultrasonography. In 62 of the 76 sessions, the number of transpulmonary approaches was one as adequate, while multiple transpulmonary approaches were performed in 14 of the 76 sessions. The rate of pneumothorax and risk factors for pneumothorax were investigated. Results: Among the 76 sessions, pneumothorax was detected in 51 sessions (67.1%). Among the 14 sessions with multiple transpulmonary passages, pneumothorax was detected in 13 (92.9%), while in the 62 sessions with a single transpulmonary passage, pneumothorax occurred in 38 sessions (61.3%). Hence, the number of transpulmonary approaches was a significant factor (P0.0232). Among 13 variables investigated for the 62 sessions with a single transpulmonary approach, the only significant factor correlated with the occurrence of pneumothorax was the length of the needle trajectory through the aerated lung (P0.0014). The incidence of chest tube placement was 7.9%. Conclusion: Pneumothorax occurred frequently after TPRF ablation for HCC. The main risk factors for pneumothorax after TPRF ablation for HCC were increased length of needle trajectory through the aerated lung and multiple transpulmonary approaches in one session. Even if pneumothorax occurred, pneumothorax disappeared spontaneously or with simple treatment such as manual aspiration in most cases. © 2010 Informa UK Ltd.


Nishimura T.,Ujitakeda Hospital | Yamazaki H.,Kyoto Prefectural University of Medicine | Aibe N.,Kyoto Prefectural University of Medicine | Nakamura S.,Kyoto Prefectural University of Medicine | And 2 more authors.
Anticancer Research | Year: 2013

Aim: To evaluate the incidence of rectal toxicity in patients undergoing hypofractionated (2.2 Gy) image-guided intensity-modulated radiotherapy (IG-IMRT) for prostate cancer. Patients and Methods: We examined 117 consecutive patients with prostate cancer who underwent IG-IMRT from June 2007 to July 2009. The median follow-up time was 32 months (range 20-42 months). The clinical target volume (CTV) consisted of the prostate and seminal vesicles, and the planning target volume (PTV) consisted of the CTV plus a 5-mm expansion, not avoiding the rectum. The PTV received a dose of 72.6-74.8 Gy in 33-34 fractions (2.2 Gy/fraction). Megavoltage computed tomographic (MVCT) scans were performed before each treatment and corrected to the registered position for planning CT scans using prostate soft tissue matching. Results: Late rectal bleeding of grades 1, 2, and 3 (Common Terminology Criteria for Adverse Events v3.0) occurred in 19 (16%), five (4%), and four (3%) patients, respectively. Late urinary toxicities of grades 1 and 2 occurred in five (4.3%) and eight (6.8%) patients, respectively. We found a paradoxically increased risk of rectal bleeding with more accurate irradiation of the rectum using soft tissue matching, whereas only a small percentage was reported in other IMRT series. Conclusion: IG-IMRT using daily MVCT scans allowed for exact dose delivery, which resulted in an increased rectal dose and exceptionally high incidence of rectal toxicity. Therefore, careful PTV contouring and dose schedule settings are important for safe administration of IG-IMRT.


PubMed | Osaka Medical College, Kyoto Prefectural University of Medicine and Ujitakeda Hospital
Type: Journal Article | Journal: Anticancer research | Year: 2014

To investigate the frequency and characteristics of interfractional rectal displacement in patients with prostate cancer treated with image-guided intensity-modulated radiation therapy (IG-IMRT) using helical tomotherapy.Data for a total of 256 patients were analyzed. Megavoltage computed tomography (MVCT) images were acquired before radiation therapy and interfractional rectal displacement was assessed with soft-tissue matching by comparing treatment planning images within 9,445 fractions. Anterior rectal region displacement larger than 5 mm, requiring repeated precaution, was defined as the action level of rectal displacement (ARD).ARD was identified in 676 (7.2%) out of 9,445 fractions and at least once in 75% (190/256) of patients. Univariate analysis identified three predisposing factors for ARD: body mass index (BMI), rectal volume and prostate volume. Multivariate logistic regression analysis revealed that lower BMI and large rectal volume were statistically significant predictors of ARD. The highest incidence of ARD (13.6% and 9.1%) was found during the initial two weeks of treatment (first five and next five fractions), after which the incidence decreased to 5.96% (p<0.0001).ARD was identified in 7.9% of fractions and in 74.8% of patients and was most likely to occur in patients with a low BMI and/or large rectal volume. ARD occurred predominantly during the initial two weeks of treatment and became less likely over time.


PubMed | Osaka Medical College, Kyoto Prefectural University of Medicine and Ujitakeda Hospital
Type: Journal Article | Journal: Anticancer research | Year: 2014

To analyze intrafractional organ motion in patients with lung cancer treated with image-guided stereotactic body radiotherapy using helical tomotherapy (SBRT-HT).Data from 25 patients with lung cancer who received 50 Gy/5 fractions of SBRT-HT were analyzed. Slow-scan megavoltage computed tomography (MVCT) images were acquired before (pre-MVCT) and after (post-MVCT) each fraction. We analyzed the imaging quality of the 124 post-MVCT images to identify tumor contours using low-density settings. Next we examined tumor contour deviations from the planning target volume (PTV) in post-MVCT images for intrafractional tumor displacement.Image quality was determined as good in 111/124 images from 22 patients (92%). None of the upper lung tumor images were of poor quality (74 images in 15 patients), whereas lower lung tumors yielded 14 poor-quality images out of the 50 images (3/10 patients). The difference in image quality between upper and lower lung tumors was statistically significant (p<0.01), especially when accompanied by interstitial lung shadows. Deviations in tumor position in post-MVCT images were analyzed in 110 images from 23 patients and revealed 99 images (90%) with tumor contours confined to PTV. In upper lung tumors, 4/74 images in 15 patients (5.4%) showed tumor contour deviations outside PTV. Lower lung tumors showed a higher rate of deviation with 7/36 images in 8 patients (19.4%) showing tumor contour deviations outside PTV (p<0.05). The maximum deviation was 1 mm for upper lung tumors and 2 mm for lower lung tumors.Upper lung tumors are good candidates for MVCT image-guided SBRT-HT. However, lower lung tumors, especially those adjacent to the diaphragm or pleura, can be difficult to assess, warranting precise dose delivery by MVCT image-guided SBRT-HT.


To evaluate the incidence of rectal toxicity in patients undergoing hypofractionated (2.2 Gy) image-guided intensity-modulated radiotherapy (IG-IMRT) for prostate cancer.We examined 117 consecutive patients with prostate cancer who underwent IG-IMRT from June 2007 to July 2009. The median follow-up time was 32 months (range 20-42 months). The clinical target volume (CTV) consisted of the prostate and seminal vesicles, and the planning target volume (PTV) consisted of the CTV plus a 5-mm expansion, not avoiding the rectum. The PTV received a dose of 72.6-74.8 Gy in 33-34 fractions (2.2 Gy/fraction). Megavoltage computed tomographic (MVCT) scans were performed before each treatment and corrected to the registered position for planning CT scans using prostate soft tissue matching.Late rectal bleeding of grades 1, 2, and 3 (Common Terminology Criteria for Adverse Events v3.0) occurred in 19 (16%), five (4%), and four (3%) patients, respectively. Late urinary toxicities of grades 1 and 2 occurred in five (4.3%) and eight (6.8%) patients, respectively. We found a paradoxically increased risk of rectal bleeding with more accurate irradiation of the rectum using soft tissue matching, whereas only a small percentage was reported in other IMRT series.IG-IMRT using daily MVCT scans allowed for exact dose delivery, which resulted in an increased rectal dose and exceptionally high incidence of rectal toxicity. Therefore, careful PTV contouring and dose schedule settings are important for safe administration of IG-IMRT.


To evaluate an appropriate planning target volume (PTV) margin in for one to three vertebral metastases using megavolt computed tomography (MVCT) images during the course of image-guided and stereotactic intensity-modulated radiotherapy (IGRT-IMRT) by use of helical tomotherapy.A total of 25 lesions in 24 patients with vertebral metastases who received IGRT-IMRT were analyzed. MVCT images were acquired before and after radiation therapy. Intra-fractional movement and PTV margin were calculated by comparing treatment planning images and these 310 MVCT images for right-left (RL), superior-inferior (SI), and anteroposterior (AP) dimensions. Five patients were treated by 35 Gy/5 fractions, 17 by 30 Gy/5 fractions, one by 25 Gy/5 fractions, and one by 60 Gy/30 fractions. A margin to compensate for these variations was calculated with the formula of vanHerks equation.The intra-fractional motion was 0.02 (-1.3 to 1.4) 0.34 mm in the RL direction, -0.09 (-1.8 to 0.28) 0.44 mm in the SI direction, and 0.20 (-1.8 to 1.8) 0.36 mm in the AP direction. The required PTV margin was 0.98 mm in the RL direction, 0.69 mm in the SI direction, and 1.26 mm in the AP direction. No patient showed a deviation greater than 2 mm.The PTV margin in hypofractionated IGRT-IMRT, using helical tomotherapy for a few vertebral metastases, was 2 mm or less and our tentative PTV margin of 5 mm was sufficient and reducible.

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