Masashi Chatani

Radiation therapy for early glottic cancer (tlnomo): II. Prospective randomized study concerning radiation field

A prospective randomized study to determine the effect of radiation field on the local control of early glottic cancer was performed. From May 1982 through December 1985, a total of 87 patients with early glottic cancer (T1N0M0) were treated at our department with an individualized wedge filter technique using a shell to improve the dose distribution and immobilization during radiotherapy with 4 MV X ray. Patients were randomly allocated to either treatment group A (radiation field size: 5 x 5 cm2) or B (6 x 6 cm2) using bilateral parallel opposed portals. Total radiation dose administered was 60 Gy in 30 fractions over a 6-week period. The 3-year recurrence-free survival rates were 93% in group A and 96% in group B (no significant difference). Comparison with historical control showed that both arms achieved better results. These results were mainly due to the improved local control of whole-length lesions of single vocal cords. Acute mucosal reaction (p less than 0.05) and persistent arytenoid edema lasting more than 6 months (p less than 0.02) were more frequently observed in group B than in group A. It is concluded that the critical factor in getting optimal results in the treatment of early glottic cancer is careful attention to the technique of treatment.

High-dose rate intracavitary therapy for carcinoma of the uterine cervix: II. Risk factors for rectal complication.

From August 1978 through December 1982, a total of 267 patients with carcinoma of the uterine cervix were treated using remote afterloading high-dose rate intracavitary therapy (RALS) with non-rigid applicator at our department. The data from 199 previously untreated patients with standard application out of 267 were available for this analysis of rectal complication. The incidence of moderate to severe rectal complication (Kottmeiers grade 2 and 3) was 7% (13/199). Coxs regression model was used for the analysis of risk factors for rectal complication in which even minor injuries (grade 1) were included. By using this method, it was clear that the first significant risk factor was z-coordinates of weighted geometric center (WGC-z) (p = 0.0007) and the second corresponding factor was rectal TDF (p = 0.0082), the sum of the rectal dose measured by semiconductor dosimeter (ICD-5) and the dose of external whole pelvic irradiation. From the analysis of application pattern of intracavitary sources, WGC-z indicated the approximation of intracavitary sources to the anterior wall of rectum quantitatively and three-dimensionally. The significance of rectal TDF also implied that the monitoring of rectal dose by ICD-5 had an important role for the prediction and prevention of rectal complication after RALS.

High-dose rate intracavitary therapy for carcinoma of the uterine cervix: I. general figures of survival and complication

From August 1978 through December 1982, a total of 200 patients with previously untreated carcinoma of the uterine cervix were treated using remote afterloading high-dose rate intracavitary therapy (RALS) at our department. According to the staging of UICC (1978), 8 patients were classified into Stage Ia, 22 Ib, 22 IIa, 53 IIb, 85 III, and 10 IV. Actuarial 5-year survival rates by Stage were 100% in Stage Ia, 86% Ib, 67% IIa, 72% IIb, 41% III, and 20% IV (p = 0.0001). Significant prognostic factors in Stage II were the value of hemoglobin (p = 0.0115) and age (p = 0.0431) by logrank test. Corresponding factors in Stage III were the value of hemoglobin (p = 0.0005) and total protein (p = 0.0036). Late complications after RALS developed in 22 patients (11%), that is, rectum 14 (7%), bladder 6 (3%), small intestine 4 (2%) and sigmoid colon 1 (1%). Severe complications requiring surgery were noted in 7 patients (4%). There was no fatal case attributable to complication. It is concluded that RALS is one of the most effective and safe means for the treatment of carcinoma of the uterine cervix based on our results.

Adjuvant radiotherapy after radical hysterectomy of the cervical cancer

AimTo investigate prognostic factors and complications after radical hysterectomy followed by postoperative radiotherapy for carcinoma of the uterine cervix.Patients and MethodsOne hundred twenty-eight patients with Tlb-2b carcinoma of the uterine cervix following radical hysterectomy with bilateral pelvic lymphadenectomy and postoperative radiation therapy were reviewed. Pathologic and treatment variables were assessed by multivariate analysis for local recurrence, distant metastases and cause specific survival.ResultsThe number of positive nodes (PN) in the pelvis was the strongest predictor of pelvic recurrence and distant metastases. These 2 failure patterns independently affect the cause specific survival. The 5-year cumulative local and distant failure were PN(0): 2% and 12%, PN(1–2): 23% and 25%, PN(2<): 32% and 57%, respectively (p=0.0029 and p=0.0051). The 5-year cause specific survival rates were PN(0): 90%, PN(1–2): 59% and PN(2<): 42% (p=0.0001). The most common complication was lymphedema of the foot experienced by one-half of the patients (5-year: 42%, 10-year: 49%).ConclusionThese results suggest that patients with pathologic Tlb-T2b cervix cancer with pelvic lymph node metastases are at high risk of recurrence or metastases after radical hysterectomy with pelvic lymphadenectomy and postoperative irradiation.ZusammenfassungZielUntersuchung der prognostischen Faktoren und Komplikationen der adjuvanten Radiotherapie nach radikaler Hysterektomie bei Patienten mit Zervixkarzinom.Patienten und MethodenIn dieser Studie wurden 128 Patientinnen mit Zervixkarzinom untersucht, bei denen die pathologische Untersuchung nach radikaler Hysterektomie mit gleichzeitiger bilateraler pelvischer Lymphadenektomie und postoperativer Radiotherapie die Klassifikation als Tlb-T2b-Karzinome ergab. Dabei wurden pathologische und therapeutische Parameter auf der behandelten Seite mit Hilfe der Multivarianzanalyse auf lokale Rezidive und Fernmetastasen beeinflussende Faktoren hin untersucht.ErgebnisseDie Zahl der metastatischen pelvischen Lymphknoten (PN) war der wichtigste Indikator fur die Wahrscheinlichkeit für das Auftreten von lokalen Rezidiven und Fernmetastasen, wobei beide Parameter die Überlebensrate der Grundkrankheit fast unabhängig voneinander beeinflußten. Die kumulativen Fünf-Jahres-Raten für lokale Rezidive und Fernmetastasen waren jeweils bei PN(0): 2% und 12%, PN(1–2): 23% und 25% und PN(2<): 32% und 57% (p=0,0029 und p=0,0051). Die Fünf-Jahres-Überlebensraten für die Grundkrankheit waren jeweils bei PN(0): 90%, PN(1–2): 59%, PN(2<): 42% (p=0,0001). Die häufigste Komplikation waren Lymphödeme der Füße, die bei etwa der Hälfte der Patienten auftraten (fünf Jahre: 42%, zehn Jahre: 49%).Schlußfolgerung enDiese Ergebnisse deuten darauf hin, daß bei Patientinnen mit pathologisch als Tlb-T2b klassifizierten Zervixkarzinomen mit Lymphknotenmetastasen ein hohes Risiko von Rezidiven oder Metastasen nach radikaler Hysterektomie mit pelvischer Lymphadenektomie und postoperativer Bestrahlung besteht.

Radiation therapy for nasopharyngeal carcinoma. Retrospective review of 105 patients based on a survey of Kansai Cancer Therapist Group

One hundred five patients with nasopharyngeal carcinoma were treated with radiation therapy combined with or without chemotherapy at 16 of the participating institutes in Kansai Cancer Therapist Group, Japan, from January 1978 to December 1980. The study comprised 77 males and 28 females; their ages ranged from 15 to 80 years (mean, 53 years). Five‐year survival rates according to stage were as follows: Stage I, 100%; Stage II, 67%; Stage III, 44%; and Stage IV, 34%. As far as Stage IV disease was concerned, the radiation therapy only group showed significantly poorer prognosis than the combined radiation and chemotherapy group (P < 0.05). Cancer 57:2267–2271, 1986.

Radiation therapy for early glottic cancer (TlN0M0): I. Results of conventional open field technique

From November 1977 through April 1982, a total of 91 patients with glottic cancer (T1N0M0) were treated with the open field technique of 4 MV X ray using bilateral parallel-opposed fields. Total radiation dose administered was 60 Gy in 30 fractions over a 6-week period. Actuarial 5-year disease-free survival rate was 89%. Significant prognostic factors of local control were tumor length (p = 0.021), tumor width (p = 0.001), tumor type (p = 0.004), tumor response to irradiation at 40 Gy (p = 0.000) and 60 Gy (p = 0.000) by chi-square test. Ultimate local control rate by radiation therapy and salvage surgery was 97% and voice preservation rate was 91%.

External-Beam Radiotherapy for Clinically LocalizedProstate Cancer in Osaka, Japan, 1995–2006

Purpose:To establish an initial database of external-beam radiotherapy (EBRT) for clinically localized prostate cancer used in Osaka, Japan, and, by analyzing the results of the Osaka multicenter cooperative study, to determine time trends, outcome, and applicability of existing and the authors’ original risk stratification methods.Patients and Methods:Data of 652 patients with clinically localized prostate cancer (T1–4 N0 M0) were accrued from July to December 2007. These patients had been treated from 1995 through 2006 with consecutive definitive EBRT of ≥ 60 Gy at eleven institutions, mainly in Osaka. Altogether, 436 patients were eligible for analysis using several risk stratification methods, namely, those of D’Amico et al., the National Comprehensive Cancer Network (NCCN), and Seattle, as well as the authors’ original Prostate Cancer Risk Index (PRIX).Results:The number of patients showed a tenfold increase over 10 years, together with a rapid spread of the use of Gleason Score from 0% to > 90% of cases. The dominant RT dose fractionation was 70 Gy/35 fractions (87%). Hormone therapy had been administered to 95% of the patients and the higher PRIX corresponded to the higher rate of hormone usage. 3- and 5-year biochemical relapse-free survival (bRFS) rates were 85% and 70%, respectively. The D’Amico (p = 0.132), NCCN (p = 0.138), Seattle (p = 0.041) and PRIX (p = 0.044) classifications showed weak or no correlation with bRFS, while the own modified three-class PRIX (PRIX 0, 1–5, 6) showed a strong correlation (p = 0.002).Conclusion:The use of prostate EBRT in Japan is still in its infancy, but is rapidly expanding. The short-term outcomes have been satisfactory considering the moderate RT dose. A very high rate of hormone usage may affect the outcome favorably, but also may compromise the usefulness of current risk stratification.Ziel:Erstellung einer ersten Datenbank zur perkutanen Strahlentherapie (EBRT) bei klinisch lokalisiertem Prostatakrebs in Osaka, Japan, und Ermittlung der zeitlichen Entwicklung, Resultate und Anwendbarkeit der existierenden und der eigenen Risikostratifikationsmethoden mittels Analyse der Ergebnisse der multizentrischen kooperativen Osaka-Studie.Patienten und Methodik:Daten von 652 Patienten mit klinisch lokalisiertem Prostatakrebs (T1–4 N0 M0) wurden von Juli bis Dezember 2007 erfasst. Diese Patienten waren zwischen 1995 und 2006 in elf Einrichtungen, vorwiegend in Osaka, mit konsekutiver definitiver EBRT von ≥ 60 Gy behandelt worden. Insgesamt 436 Patienten qualifizierten sich für die Analyse mittels mehrerer Risikostratifikationsmethoden, namentlich jener von D’Amico et al., National Comprehensive Cancer Network (NCCN) und Seattle sowie des eigenen Prostatakrebsrisikoindex (PRIX).Ergebnisse:Die Anzahl der Patienten stieg binnen 10 Jahren um das Zehnfache, und gleichzeitig kam es zu einem rasch zunehmenden Einsatz des Gleason-Scores von 0% auf > 90% der Fälle. Die dominante RT-Dosisfraktionierung betrug 70 Gy/35 Frak tionen (87%). Eine Hormontherapie war 95% der Patienten verabreicht worden, und der höhere PRIX entsprach der höheren Rate des Hormoneinsatzes. Die 3- und 5-Jahres-Raten des biochemisch rezidivfreien Überlebens (bRFS) lagen bei 85% bzw. 70%. Die Klassifikationen von D’Amico et al. (p = 0,132), NCCN (p = 0,138), Seattle (p = 0,041) und PRIX (p = 0,044) zeigten eine schwache Korrelation mit dem bRFS, wogegen der eigene modifizierte Drei-Klassen-PRIX (PRIX 0, 1–5, 6) eine starke Korrrelation (p = 0,002) ergab.Schlussfolgerung:Der Einsatz der Prostata-EBRT in Japan ist noch in der Anfangsphase begriffen, breitet sich aber rasch aus. Angesichts moderater RT-Dosen sind zufriedenstellende kurzfristige Resultate erzielt worden. Eine sehr hohe Rate von Hormonverabreichungen mag die Ergebnisse günstig beeinflussen, könnte aber auch die Nützlichkeit der gegenwärtigen Risikostratifikation gefährden.

External-beam radiotherapy for clinically localized prostate cancer in Osaka, Japan, 1995-2006: time trends, outcome, and risk stratification.

Purpose:To establish an initial database of external-beam radiotherapy (EBRT) for clinically localized prostate cancer used in Osaka, Japan, and, by analyzing the results of the Osaka multicenter cooperative study, to determine time trends, outcome, and applicability of existing and the authors’ original risk stratification methods.Patients and Methods:Data of 652 patients with clinically localized prostate cancer (T1–4 N0 M0) were accrued from July to December 2007. These patients had been treated from 1995 through 2006 with consecutive definitive EBRT of ≥ 60 Gy at eleven institutions, mainly in Osaka. Altogether, 436 patients were eligible for analysis using several risk stratification methods, namely, those of D’Amico et al., the National Comprehensive Cancer Network (NCCN), and Seattle, as well as the authors’ original Prostate Cancer Risk Index (PRIX).Results:The number of patients showed a tenfold increase over 10 years, together with a rapid spread of the use of Gleason Score from 0% to > 90% of cases. The dominant RT dose fractionation was 70 Gy/35 fractions (87%). Hormone therapy had been administered to 95% of the patients and the higher PRIX corresponded to the higher rate of hormone usage. 3- and 5-year biochemical relapse-free survival (bRFS) rates were 85% and 70%, respectively. The D’Amico (p = 0.132), NCCN (p = 0.138), Seattle (p = 0.041) and PRIX (p = 0.044) classifications showed weak or no correlation with bRFS, while the own modified three-class PRIX (PRIX 0, 1–5, 6) showed a strong correlation (p = 0.002).Conclusion:The use of prostate EBRT in Japan is still in its infancy, but is rapidly expanding. The short-term outcomes have been satisfactory considering the moderate RT dose. A very high rate of hormone usage may affect the outcome favorably, but also may compromise the usefulness of current risk stratification.Ziel:Erstellung einer ersten Datenbank zur perkutanen Strahlentherapie (EBRT) bei klinisch lokalisiertem Prostatakrebs in Osaka, Japan, und Ermittlung der zeitlichen Entwicklung, Resultate und Anwendbarkeit der existierenden und der eigenen Risikostratifikationsmethoden mittels Analyse der Ergebnisse der multizentrischen kooperativen Osaka-Studie.Patienten und Methodik:Daten von 652 Patienten mit klinisch lokalisiertem Prostatakrebs (T1–4 N0 M0) wurden von Juli bis Dezember 2007 erfasst. Diese Patienten waren zwischen 1995 und 2006 in elf Einrichtungen, vorwiegend in Osaka, mit konsekutiver definitiver EBRT von ≥ 60 Gy behandelt worden. Insgesamt 436 Patienten qualifizierten sich für die Analyse mittels mehrerer Risikostratifikationsmethoden, namentlich jener von D’Amico et al., National Comprehensive Cancer Network (NCCN) und Seattle sowie des eigenen Prostatakrebsrisikoindex (PRIX).Ergebnisse:Die Anzahl der Patienten stieg binnen 10 Jahren um das Zehnfache, und gleichzeitig kam es zu einem rasch zunehmenden Einsatz des Gleason-Scores von 0% auf > 90% der Fälle. Die dominante RT-Dosisfraktionierung betrug 70 Gy/35 Frak tionen (87%). Eine Hormontherapie war 95% der Patienten verabreicht worden, und der höhere PRIX entsprach der höheren Rate des Hormoneinsatzes. Die 3- und 5-Jahres-Raten des biochemisch rezidivfreien Überlebens (bRFS) lagen bei 85% bzw. 70%. Die Klassifikationen von D’Amico et al. (p = 0,132), NCCN (p = 0,138), Seattle (p = 0,041) und PRIX (p = 0,044) zeigten eine schwache Korrelation mit dem bRFS, wogegen der eigene modifizierte Drei-Klassen-PRIX (PRIX 0, 1–5, 6) eine starke Korrrelation (p = 0,002) ergab.Schlussfolgerung:Der Einsatz der Prostata-EBRT in Japan ist noch in der Anfangsphase begriffen, breitet sich aber rasch aus. Angesichts moderater RT-Dosen sind zufriedenstellende kurzfristige Resultate erzielt worden. Eine sehr hohe Rate von Hormonverabreichungen mag die Ergebnisse günstig beeinflussen, könnte aber auch die Nützlichkeit der gegenwärtigen Risikostratifikation gefährden.

Proper use of serum antibody titres against Epstein-Barr virus in nasopharyngeal carcinoma: IgA/virus capsid antigen for diagnosis and EBV-related nuclear antigen-2 for follow-up.

Sera from patients with nasopharyngeal carcinoma (NPC) show high titres of IgA antibodies to Epstein-Barr viral capsid antigen (IgA/VCA). We reported previously that the serum titres for Epstein-Barr virus-related nuclear antigen-2 (EBNA2) correlated with NPC patients? prognosis. To investigate which is better for diagnosing NPC and predicting patient prognosis, the titration of serum IgA/VCA or EBNA2, we examined the same serum titres. Sixteen cases of NPC in which serum EBNA2 antibody titres had been tested, were investigated for the serum IgA/VCA antibody titres before and after radiation treatment. All NPC cases showed positive reactions with indirect immunofluorescence staining, and the median titre was 252. Twelve normal controls, 5 mesopharyngeal carcinoma patients, 4 hypopharyngeal carcinoma patients, 4 laryngeal carcinoma patients and 6 malignant lymphoma were also examined, but they showed negative or relatively low titres. A follow-up study revealed that IgA/VCA titres remained mostly stable. These results indicate a close relationship between IgA/VCA and NPC, however, prognosis correlated better with EBNA2 titres than with IgA/VCA titres.

Antibody response against the epstein-barr virus-coded nuclear antigen2 (EBNA2) in nasopharyngeal carcinoma

Specific antibody responses against the Epstein‐Barr virus‐coded nuclear antigen2 (EBNA2) were evaluated. Thirty‐five sera from pretreatment patients of nasopharyngeal carcinoma (NPC) and 12 from healthy adults were tested. Although the anti‐EBNA2 response did not show any correlation with T stage, overall stage, or histopathology, it showed a correlation with the N stage of the disease. In a se‐rological follow‐up study, 17 (85%) of 20 patients showed a correlation on the change of antibody levels to EBNA2 and clinical progression. This suggests that EBNA2 serology might represent a useful marker relative to tumor status.