T. Nishikawa

A prospective clinical trial of tumor hypoxia imaging with 18F-fluoromisonidazole positron emission tomography and computed tomography (F-MISO PET/CT) before and during radiation therapy

To visualize intratumoral hypoxic areas and their reoxygenation before and during fractionated radiation therapy (RT), 18F-fluoromisonidazole positron emission tomography and computed tomography (F-MISO PET/CT) were performed. A total of 10 patients, consisting of four with head and neck cancers, four with gastrointestinal cancers, one with lung cancer, and one with uterine cancer, were included. F-MISO PET/CT was performed twice, before RT and during fractionated RT of approximately 20 Gy/10 fractions, for eight of the 10 patients. F-MISO maximum standardized uptake values (SUVmax) of normal muscles and tumors were measured. The tumor-to-muscle (T/M) ratios of F-MISO SUVmax were also calculated. Mean SUVmax ± standard deviation (SD) of normal muscles was 1.25 ± 0.17, and SUVmax above the mean + 2 SD (≥1.60 SUV) was regarded as a hypoxic area. Nine of the 10 tumors had an F-MISO SUVmax of ≥1.60. All eight tumors examined twice showed a decrease in the SUVmax, T/M ratio, or percentage of hypoxic volume (F-MISO ≥1.60) at approximately 20 Gy, indicating reoxygenation. In conclusion, accumulation of F-MISO of ≥1.60 SUV was regarded as an intratumoral hypoxic area in our F-MISO PET/CT system. Most human tumors (90%) in this small series had hypoxic areas before RT, although hypoxic volume was minimal (0.0–0.3%) for four of the 10 tumors. In addition, reoxygenation was observed in most tumors at two weeks of fractionated RT.

A Two-step Intensity-modulated Radiation Therapy Method for Nasopharyngeal Cancer: The Kinki University Experience

OBJECTIVE The aim of this study was to analyze the clinical results of our adaptive radiation therapy scheme of a two-step intensity-modulated radiotherapy (IMRT) method for nasopharyngeal cancer (NPC) at Kinki University Hospital. METHODS Between 2000 and 2007, 35 patients with Stage I-IVB NPC treated by IMRT were included. For all patients, treatment-planning computed tomography was done twice before and during IMRT to a total dose of 60-70 Gy/28-35 fractions (median 68 Gy). Chemotherapy (cisplatin 80 mg/m(2)/3 weeks x 1-3 courses) was given concurrently with IMRT for 31 patients. RESULTS The 3- and 5-year overall survival rates for the 31 patients treated with concurrent chemotherapy were 88% and 83%, respectively. The 3- and 5-year loco-regional control rates for the 31 patients were 93% and 87%, respectively. Planning target volume delineation for the primary site or involved nodes was insufficient for three early cases, resulting in marginal recurrence in the three patients (9%). Except for one patient with early death, xerostomia scores at 1-2 years were: Grade 0, 11; Grade 1, 17; Grade 2, 5; Grade 3, 1. CONCLUSIONS Excellent overall survival and loco-regional control rates were obtained by a two-step IMRT method with concurrent chemotherapy for NPC, although marginal recurrence was noted in some early cases.

Definitive Radiation Therapy for Moderately Advanced Laryngeal Cancer: Effects of Accelerated Hyperfractionation

OBJECTIVE The purpose of this retrospective study was to analyze the results of accelerated hyperfractionation for patients with moderately advanced (T2 and T3) laryngeal cancer. METHODS Between 1998 and 2007, 9 supraglottic carcinomas (6 T2N0M0, 2 T2N2M0, 1 T3N0M0), 30 glottic carcinomas (25 T2N0M0, 5 T3N0M0), and 1 T2N0M0 subglottic carcinoma were treated with definitive radiotherapy using accelerated hyperfractionation without concurrent chemotherapy. The dose-fractionation for 35 patients was 72.8 Gy/56 fractions/5.6 weeks, and that for four patients treated between 1998 and 2001 was 72 Gy/60 fractions/6 weeks. One patient who had been treated with steroid therapy for systemic lupus erythematosus was treated by 67.8 Gy/44 fractions/4.4 weeks. RESULTS The local control and overall survival probabilities at 5 years for supraglottic carcinomas were 75% and 86%, respectively. Those for glottic carcinomas were 80% and 92%, respectively. The 5-year local control probabilities for T2 and T3 tumors were 85% and 56%, respectively. This excellent local control rate especially for T2 laryngeal carcinomas may be attributable to the effect of accelerated hyperfractionation. No late toxicities of grade 2 or more was noted among the 39 patients treated with 72.8 Gy/56 fractions or 72 Gy/60 fractions. CONCLUSION Accelerated hyperfractionation of 72.8 Gy/56 fractions/5.6 weeks using 1.3 Gy/fraction seems a safe and effective dose-fractionation for patients with moderately advanced laryngeal carcinomas.

Randomized clinical trial of postoperative strontium-90 radiation therapy for pterygia: treatment using 30 Gy/3 fractions vs. 40 Gy/4 fractions.

Background and Purpose:Postoperative adjuvant treatment with strontium-90 radiation therapy (RT) is a proven technique for reducing the recurrence of pterygium. This randomized trial was conducted to evaluate whether a total dose of 40 Gy provides a better local control rate than a total dose of 30 Gy for surgically resected pterygia.Patients and Methods:A single institutional randomized trial was conducted. Between 1999 and 2003, 74 pterygia in 71 patients were randomly allocated to 30 Gy/3 fractions/15 days (arm A) or to 40 Gy/4 fractions/22 days (arm B). Only primary pterygia for which RT could be started within 3 days of surgical resection were included. Postoperative RT was given by a strontium-90 eye applicator, and a dose of 10 Gy per fraction was delivered in weekly fractions (day 1, 8, 15, 22).Results:Of the 74 pterygia treated, 73 in 70 patients were analyzed. Of the 73 pterygia, 41 were allocated to arm A, and the remaining 32 to arm B. The 2-year local control rates for arm A and arm B were 85% and 75%, respectively, without significant difference. No serious acute and late complications were noted in either arm.Conclusion:Our new standard fractionation for postoperative RT for pterygia is 30 Gy/3 fractions.Ziel:Die postoperative adjuvante Behandlung mit Strontium-90-Strahlentherapie ist eine anerkannte Methode, um das Wiederauftreten von Pterygien zu vermeiden. Anhand der vorliegenden randomisierten Studie sollte untersucht werden, ob bei operativ entferntem Ptergium eine Dosis von 40 Gy eine bessere Kontrollrate als eine Dosis von 30 Gy bietet.Patienten und Methodik:Eine einzelinstitutionelle, randomisierte Untersuchung wurde durchgeführt. Zwischen 1999 und 2003 wurden 74 Pterygien bei 71 Patienten stichprobenartig entweder mit 30 Gy/3 Fraktionen/15 Tage (Gruppe A) oder 40 Gy/ 4 Fraktionen/22 Tage (Gruppe B) behandelt. Es wurden nur primäre Pterygien berücksichtigt, bei denen innerhalb von 3 Tagen nach der operativen Entfernung mit der RT begonnen werden konnte. Die postoperative RT wurde mit einem Strontium-90-Augenapplikator durchgeführt, und zwar in Dosen von 10 Gy pro wöchentlicher Teilbehandlung (Tag 1, 8, 15, 22).Ergebnisse:Von den 74 behandelten Pterygien wurden 73 von 70 Patienten analysiert. Von diesen 73 gehörten 41 zu Gruppe A, die übrigen 32 zu Gruppe B. Die 2-Jahres-Kontrollraten für Gruppe A und Gruppe B lagen bei 85% und 75% ohne signifikanten Unterschied. Bei keiner der beiden Gruppen wurden ernsthafte akute oder spätere Komplikationen festgestellt.Schlussfolgerung:Unsere neue Standardfraktionierung für postoperative Strahlentherapien beträgt 30 Gy/3 Fraktionen.

Randomized Clinical Trial of Postoperative Strontium-90 Radiation Therapy for Pterygia

Background and Purpose:Postoperative adjuvant treatment with strontium-90 radiation therapy (RT) is a proven technique for reducing the recurrence of pterygium. This randomized trial was conducted to evaluate whether a total dose of 40 Gy provides a better local control rate than a total dose of 30 Gy for surgically resected pterygia.Patients and Methods:A single institutional randomized trial was conducted. Between 1999 and 2003, 74 pterygia in 71 patients were randomly allocated to 30 Gy/3 fractions/15 days (arm A) or to 40 Gy/4 fractions/22 days (arm B). Only primary pterygia for which RT could be started within 3 days of surgical resection were included. Postoperative RT was given by a strontium-90 eye applicator, and a dose of 10 Gy per fraction was delivered in weekly fractions (day 1, 8, 15, 22).Results:Of the 74 pterygia treated, 73 in 70 patients were analyzed. Of the 73 pterygia, 41 were allocated to arm A, and the remaining 32 to arm B. The 2-year local control rates for arm A and arm B were 85% and 75%, respectively, without significant difference. No serious acute and late complications were noted in either arm.Conclusion:Our new standard fractionation for postoperative RT for pterygia is 30 Gy/3 fractions.Ziel:Die postoperative adjuvante Behandlung mit Strontium-90-Strahlentherapie ist eine anerkannte Methode, um das Wiederauftreten von Pterygien zu vermeiden. Anhand der vorliegenden randomisierten Studie sollte untersucht werden, ob bei operativ entferntem Ptergium eine Dosis von 40 Gy eine bessere Kontrollrate als eine Dosis von 30 Gy bietet.Patienten und Methodik:Eine einzelinstitutionelle, randomisierte Untersuchung wurde durchgeführt. Zwischen 1999 und 2003 wurden 74 Pterygien bei 71 Patienten stichprobenartig entweder mit 30 Gy/3 Fraktionen/15 Tage (Gruppe A) oder 40 Gy/ 4 Fraktionen/22 Tage (Gruppe B) behandelt. Es wurden nur primäre Pterygien berücksichtigt, bei denen innerhalb von 3 Tagen nach der operativen Entfernung mit der RT begonnen werden konnte. Die postoperative RT wurde mit einem Strontium-90-Augenapplikator durchgeführt, und zwar in Dosen von 10 Gy pro wöchentlicher Teilbehandlung (Tag 1, 8, 15, 22).Ergebnisse:Von den 74 behandelten Pterygien wurden 73 von 70 Patienten analysiert. Von diesen 73 gehörten 41 zu Gruppe A, die übrigen 32 zu Gruppe B. Die 2-Jahres-Kontrollraten für Gruppe A und Gruppe B lagen bei 85% und 75% ohne signifikanten Unterschied. Bei keiner der beiden Gruppen wurden ernsthafte akute oder spätere Komplikationen festgestellt.Schlussfolgerung:Unsere neue Standardfraktionierung für postoperative Strahlentherapien beträgt 30 Gy/3 Fraktionen.

Sarcoidosis or sarcoid-like reaction developed during the follow-up of malignant tumors: difficulties in differentiation from recurrent or metastatic diseases

Abstract Sarcoidosis or sarcoid-like reaction can occur or manifest several years after completion of treatment during the long-term follow-up of malignant tumors, often creating difficulty in differentiating these lesions from recurrent or metastatic malignant tumors on imaging studies. In recent years, CT and positron-emission tomography (PET) have been widely used in follow-up of malignant tumors; and findings in these studies are similar for sarcoidosis/sarcoid-like reaction and recurrent/metastatic diseases, special caution is needed in diagnosing either of these disorders. In patients who show results incompatible with recurrent or metastatic disease clinically and in imaging studies, even if increased FDG uptake on PET images is noted, biopsy should be performed, thereby allowing unnecessary treatments to be avoided.

Randomized Clinical Trial of Postoperative Strontium-90 Radiation Therapy for Pterygia@@@Eine randomisierte klinische Studie zur postoperativen Strontium-90-Strahlentherapie für Pterygien: 30 Gy/ 3 Fraktionen versus 40 Gy/4 Fraktionen: Treatment Using 30 Gy/3 Fractions vs. 40 Gy/4 Fractions

Background and Purpose:Postoperative adjuvant treatment with strontium-90 radiation therapy (RT) is a proven technique for reducing the recurrence of pterygium. This randomized trial was conducted to evaluate whether a total dose of 40 Gy provides a better local control rate than a total dose of 30 Gy for surgically resected pterygia.Patients and Methods:A single institutional randomized trial was conducted. Between 1999 and 2003, 74 pterygia in 71 patients were randomly allocated to 30 Gy/3 fractions/15 days (arm A) or to 40 Gy/4 fractions/22 days (arm B). Only primary pterygia for which RT could be started within 3 days of surgical resection were included. Postoperative RT was given by a strontium-90 eye applicator, and a dose of 10 Gy per fraction was delivered in weekly fractions (day 1, 8, 15, 22).Results:Of the 74 pterygia treated, 73 in 70 patients were analyzed. Of the 73 pterygia, 41 were allocated to arm A, and the remaining 32 to arm B. The 2-year local control rates for arm A and arm B were 85% and 75%, respectively, without significant difference. No serious acute and late complications were noted in either arm.Conclusion:Our new standard fractionation for postoperative RT for pterygia is 30 Gy/3 fractions.Ziel:Die postoperative adjuvante Behandlung mit Strontium-90-Strahlentherapie ist eine anerkannte Methode, um das Wiederauftreten von Pterygien zu vermeiden. Anhand der vorliegenden randomisierten Studie sollte untersucht werden, ob bei operativ entferntem Ptergium eine Dosis von 40 Gy eine bessere Kontrollrate als eine Dosis von 30 Gy bietet.Patienten und Methodik:Eine einzelinstitutionelle, randomisierte Untersuchung wurde durchgeführt. Zwischen 1999 und 2003 wurden 74 Pterygien bei 71 Patienten stichprobenartig entweder mit 30 Gy/3 Fraktionen/15 Tage (Gruppe A) oder 40 Gy/ 4 Fraktionen/22 Tage (Gruppe B) behandelt. Es wurden nur primäre Pterygien berücksichtigt, bei denen innerhalb von 3 Tagen nach der operativen Entfernung mit der RT begonnen werden konnte. Die postoperative RT wurde mit einem Strontium-90-Augenapplikator durchgeführt, und zwar in Dosen von 10 Gy pro wöchentlicher Teilbehandlung (Tag 1, 8, 15, 22).Ergebnisse:Von den 74 behandelten Pterygien wurden 73 von 70 Patienten analysiert. Von diesen 73 gehörten 41 zu Gruppe A, die übrigen 32 zu Gruppe B. Die 2-Jahres-Kontrollraten für Gruppe A und Gruppe B lagen bei 85% und 75% ohne signifikanten Unterschied. Bei keiner der beiden Gruppen wurden ernsthafte akute oder spätere Komplikationen festgestellt.Schlussfolgerung:Unsere neue Standardfraktionierung für postoperative Strahlentherapien beträgt 30 Gy/3 Fraktionen.