Kana Ito

An investigation of anxiety about radiotherapy deploying the Radiotherapy Categorical Anxiety Scale

BackgroundRadiotherapy is one of the major methods for treating cancer, but many patients undergoing radiotherapy have deep concerns about receiving radiation treatment. This problem is not generally appreciated and has not been adequately studied.MethodsThe objective of this investigation was to empirically investigate the anxieties that cancer patients feel towards radiotherapy by using questionnaires to classify and quantitatively measure their concerns. A preliminary interview to develop a questionnaire was carried out with 48 patients receiving radiotherapy to discover their anxieties about on-going treatments. Subsequently, a main study was performed using a questionnaire with 185 patients to classify their types of anxiety and to ascertain the reliability and validity of the responses. Confirmatory factor analysis was then carried out with a 17-item Radiotherapy Categorical Anxiety Scale.ResultsThree anxiety factors were abstracted by factor analysis: (1) adverse effects of radiotherapy, (2) environment of radiotherapy, and (3) treatment effects of radiotherapy. Reliability, content validity, and concurrent validity were obtained. The adequacy of the three-factor model of anxiety concerning radiotherapy was confirmed.ConclusionA 17-item Radiotherapy Categorical Anxiety Scale was formulated to quantitatively measure the specific types of anxiety among cancer patients receiving radiotherapy.

Effect of dose fractionation on pulmonary complications during total body irradiation.

Total body irradiation (TBI) is an important component of conditioning regimens for Allogeneic bone marrow transplantation (BMT). Interstitial pneumonitis (IP) and other pulmonary disorders are known regimen-related complications. The incidence of IP is related to the dose rate and dose fractionation; however, there is a paucity of clinical data regarding the optimal dose fractionation. This retrospective study evaluated patients to determine the influence of dose fractionation during TBI in preparation for allogeneic BMT on the subsequent development of IP and other pulmonary complications. Fifty-six patients were treated with TBI followed by BMT at our institute. All patients received a total TBI dose of 12 Gy given in 6 fractions over 3 days or in 4 fractions over 2 days. The prevalence of unrelated donors in the 4-fraction group was higher than that in the 6-fraction group. The overall and freedom from progression rates for patients in the 4-fraction group were better than those for patients in the 6-fraction group, but the difference did not reach significance. Clinically significant lung complications occurred in 19 (10: infectious and 9: non-infectious diseases) of 33 patients in the 6-fraction group and 12 (7: infectious and 5: non-infectious diseases) of 23 in the 4-fraction group. There was no significant difference between the two groups. There was no significant difference in pulmonary complications between patients treated with a TBI dose of 12 Gy in 6 fractions over 3 days and patients treated with a TBI dose of 12 Gy in 4 fractions over 2 days.

Comparison of 4 MV photon surface dose among Varian, Siemens, and Elekta linear accelerators for tangential breast treatment: a phantom study

PurposeWe have compared the differences in a 4-MV photon surface dose among Varian, Siemens, and Elekta linear accelerators (linacs) with wedges for tangential breast treatment.Materials and methodsThe wedge factor and the surface dose were measured using a solid water phantom and an ion chamber for each linear accelerator with various field sizes and wedge angles. A tangential treatment plan was applied to an elliptical hollow cylinder water phantom with a radiochromic film placed thereon. A dose was delivered to a simulated target in the phantom, and the resulting dose distribution was analyzed using a film scanner.ResultsVarians wedges resulted in the highest wedge factors, ranging from 0.37 to 0.75 depending on the wedge angles. Varians wedges led to the highest normalized skin doses, ranging between 0.40 and 0.73 depending on the wedge angles and field sizes. In the cylinder phantom test with two tangential beams, the Varian linac provided a nearly 20% higher maximum dose than the Siemens and Elekta linacs.ConclusionThe Varian linac resulted in the highest surface doses, and the Elekta linac led to the lowest for nearly all the measurement conditions we employed, including open beams.

Full-dose capecitabine with local radiotherapy: one of the treatment options for inoperable T4 breast cancer

A 48-year-old woman presented with a 15-cm diameter tumor in her left breast with fixation to the chest wall and palpable axillary lymph nodes. Pathology study showed pure-type mucinous carcinoma. Pretreatment staging investigations showed multiple lung metastases, which resulted in the diagnosis of T4N2M1 breast cancer. Four cycles of cyclophosphamide 700 mg/m2/epirubicin 70 mg/m2 (CE) were performed initially, but the tumors decreased only within the treatment response criteria of stable disease (SD). The second regimen of docetaxel could not continue due to drug allergy. Two more cycles of CE did not improve the situation. Then, treatment was continued with full-dose capecitabine with local radiotherapy. She received radiotherapy to the left breast and axillary region with 60 Gy/30 fractions/6 weeks and concomitant capecitabine 2400 mg/body twice daily for 21 days; the cycles were repeated every 28 days. After radiotherapy, tumors decreased in size, and the skin ulceration disappeared. She continued to receive capecitabine on the same schedule. She now has no palpable tumor in her left breast and no tumor in the axilla or lung on CT. She is alive and well 6 years after radiotherapy.

Comparing size evaluation methods for acoustic neuroma after stereotactic radiosurgery

PurposeAcoustic neuroma tumor size may be evaluated using several methods. Here we investigate the variations among measuring techniques.Materials and methodsA retrospective analysis of pre- and posttreatment magnetic resonance (MR) scans was performed on 15 acoustic neuroma patients with a history of stereotactic radiosurgery who had been followed for more than 2 years. Tumor size was measured on each MR scan using three methods, where the extracanalicular (EX) and intracanalicular (IN) portions were measured separately. We collected data on the largest diameter (M1), the square root of the product of the maximum anteroposterior and mediolateral diameter (M2), and the average for the maximum anteroposterior, mediolateral, and superoinferior diameters (M3). Size differences between follow-up MR scans separated by more than 2 years were calculated for each method, and we evaluated whether the tumors progressed, remained stable, or regressed.ResultsA total of 154 follow-up pairs of EX and 115 follow-up pairs of IN showed a statistically significant difference for the number of each category among the three methods (P = 0.03, P < 0.01, respectively). The greatest category agreement was observed between the M2 and M3 methods.ConclusionA significant difference between the tumor size measuring methods was observed. To strengthen specificity when evaluating tumor size difference, a measuring method using two or more parameters is recommended.