Yoshio Hishikawa

Radiotherapy of esophageal carcinoma: Role of high-dose-rate intracavitary irradiation

A total of 119 patients with squamous cell carcinoma of the esophagus who were seen during a 10-year period were analyzed retrospectively in terms of survival rate and local control rate in relation to treatment method and disease stage. All patients were treated with radiotherapy alone: 43 patients were treated with external irradiation plus high-dose-rate intracavitary irradiation (Group 1), 46 with external irradiation only, to 50 Gy or more (Group 2), and 30 with external irradiation to less than 50 Gy (Group 3). All patients of Group 3 died within 8 months (mean 3.5 months) after the initiation of radiotherapy. In Group 1, the 2-year survival rate was 27.9% for the patients in all disease stages and 44.0% for those in Stage 1 and Stage 2 in contrast to Group 2, with a 2-year survival rate of 4.3% for the patients in all stages and 9.1% for those in Stage 1 and 2. The local control rate was 62.8% in Group 1, significantly higher than 19.6% in Group 2. It is concluded that high-dose-rate intracavitary irradiation following external irradiation is an effective treatment modality for esophageal carcinoma, especially in a limited stage.

High-dose-rate intraluminal brachytherapy for esophageal cancer: 10 years experience in Hyogo College of Medicine☆

From May 1980 through December 1989, 148 patients with thoracic esophageal cancer were treated with high-dose-rate intraluminal brachytherapy (HDRIBT) following external radiotherapy (ERT). The standard treatment protocol was 60 Gy/6 weeks of ERT and 12 Gy/1 week of HDRIBT. The patients were divided into two groups according to disease stage. Sixty-six patients had limited disease (LD), and 82 patients had extensive disease (ED). The 2-year survival rate was 37% in LD group, and 7% in ED group. The 5-year survival rate of LD group was 18%. The 1- and 2-year actuarial local control rate was 66% and 64% in LD group, and 49% and 45% in ED group, respectively. In the total patients, ulceration, stricture, and fistula were found in 42 (28%), 15 (10%) and 6 (4%) patients, respectively; however, major complication defined as one resulting in a second hospitalization or requiring surgical intervention was 3 of the 42 patients with ulceration, 1 of the 15 patients with stricture, and all of the six patients with fistula. As to cause of death, local failure, local failure with distant metastasis, distant metastasis, intercurrent disease, and unknown reason was 14, 6, 15, 16 and 0 in LD group, and 13, 24, 30, 9 and 1 in ED group, respectively. The technique and method of combined treatment are described in detail.

High-dose-rate intraluminal brachytherapy (HDRIBT) for esophageal cancer☆

High-dose-rate intraluminal brachytherapy (HDRIBT) for patients with esophageal cancer has been performed with and without external radiotherapy (ERT) in our department since May 1980. From May 1980 through December 1986, 92 patients with esophageal squamous cell carcinoma were treated with HDRIBT following ERT. These patients were divided into a limited disease (LD) group and an extensive disease (ED) group. Complete response and partial response rates after treatment were 48% and 38% in the LD group, and 9% and 65% in the ED group, respectively. The median survival time and 2-year survival rate was 13 months and 39% in the LD group, and 8.5 months and 7% in the ED group, respectively. The 5-year survival was 17% in the LD group. HDRIBT without ERT was used to treat six patients with small, superficial esophageal squamous cell carcinoma from August 1987 through July 1988. No patients were candidates for surgery because of coexisting medical problems. Each patient received 6 Gy per treatment, twice weekly with a total of 24 Gy; five of the six patients were treated on an outpatient basis. The tumor had disappeared completely in all six patients at the time of first follow-up endoscopic study less than 1 month after treatment, and no local recurrence had occurred after 11 to 22 months in five of the six patients. Five of the six patients were alive after 11 to 22 months, and one died with mediastinal metastasis at 15 months.

External beam radiotherapy alone or combined with high-dose-rate intracavitary irradiation in the treatment of cancer of the esophagus: Autopsy findings in 35 cases

Autopsy findings of 35 patients, treated with radiotherapy for an esophageal carcinoma, were reviewed. A residual tumor was seen at autopsy in 7 of 16 patients treated with high-dose-rate intracavitary irradiation following external irradiation, in 13 of 14 patients treated with external irradiation of 50 Gy or more, and in all 5 patients treated with external irradiation of less than 50 Gy. Incidence on lymph node metastasis, at autopsy, did not differ between the combined radiotherapy group and the external irradiation groups. However, it correlated with disease stage. It was observed in 11 of 17 patients with Stage 1 and Stage 2 disease, compared to 17 of 18 patients with Stage 3 and Stage 4 disease. Distant organ metastasis, at autopsy, also did not differ between the combined radiotherapy group and the external irradiation groups, and was also correlated with disease stage. It was found in 8 of 17 patients of the patients with Stage 1 and Stage 2 disease, compared to all 18 patients with Stage 3 and Stage 4 disease. Mean (average) survival was different between the patients treated by high-dose-rate intracavitary irradiation following external irradiation and those treated by external irradiation alone; 11.3 months in the 16 patients treated with combined therapy, as compared to 6.9 months in the 14 patients who received external irradiation of 50 Gy or more, and 3.6 months in the 5 patients who received external irradiation of less than 50 Gy.

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.

Radiotherapy for carcinoma of the esophagus in patients aged eighty or older

Between 1980 and 1988, 206 patients with esophageal cancer were treated initially with radiotherapy. The patients were classified into three groups according to age. Ninety-four patients aged 43-69 years comprised Group A, 83 patients aged 70-79 years comprised Group B, and 29 patients aged 80-86 years comprised Group C. There were no statistically significant differences in background factors between Groups A, B, and C, except for the sex ratio. The male:female ratio was 7.5:1 in Group A, 3.9:1 in Group B, and 1.9:1 in Group C, with the difference between Groups A and C being statistically significant (p less than 0.05). High-dose-rate intracavitary irradiation (HDRII) with or without external irradiation (EI) was performed in 64%, 69%, and 83% of the patients from Groups A, B, and C, respectively. Patients in Groups A, B, and C achieved CR in 23%, 24%, and 34% of cases following radiotherapy. Two- and 5-year survival rates were 16.7% and 6.7% in Group A, 17.2% and 6.0% in Group B, and 27.1% and 20.3% in Group C. No significant differences were found in the patterns of failure and in the radiation-induced injuries between the three groups. Our data suggested that radiotherapy was the treatment of first choice for patients 80 years old and older.

Esophageal ulceration following high-dose-rate intraluminal brachytherapy for esophageal cancer

Prophylaxis of esophageal ulceration was studied in 78 esophageal carcinoma patients after high-dose-rate intraluminal brachytherapy. Before the standard treatment regimen of radiotherapy was established, 15/17 patients developed ulcers. This decreased to 19/38 with the standard treatment regimen, and to 9/23 when antiulcer therapy was added (p < 0.01).

Personal computer-based small PACS for radiotherapy - analog image filing system for radiotherapy

The purpose of this study is to evaluate the usefulness of a personal computer-based small PACS using analog video images. The analog video recorder, personal computer, and display monitor constitute our system. An analog video recorder is composed of a laser disk recorder for still images and a video cassette recorder for moving images. The acquired video images are managed by a personal computer and database software. The serial communication ports of the personal computer and a video recorder are connected with the reverse cable, and the video recorder is controlled by the personal computer using our program. This system enables filing of multi-modality images including moving images and is used for following up and treatment planning of the patients who received radiotherapy.

Histopathological Assessment in Rectal Carcinoma with Preoperative High -Dose- Rate Intraluminal Brachytherapy

We investigated the histopathological effects of preoperative high-dose-rate intraluminal brachytherapy (HDRIBT) in 76 rectal carcinomas to know whether pathologic findings about the qualitive and quantitive assessment reflect local recurrence. The down-staging of invasion after HDRIBT was shown in 27 tumors (36.0%). There was, however, no significant difference about local recurrence rate between with and without downstaging. The proportion of residual tumor nest to stroma, which was analyzed by image analyzing system (IBAS-20, Zeis, Germany) could be better predictive factor of local recurrence than qualitive assessment in our series. When the proportion of residual tumors to stroma was less than 33%, a good local control for rectal cancer might be achieved after preoperative HDRIBT.

High-dose-rate intraluminal brachytherapy for bile duct carcinoma after surgery

Five patients with recurrent or residual bile duct carcinoma after surgery were treated with high-dose-rate intraluminal brachytherapy (HDRIBT) using a remote afterloader. External radiotherapy was also given in three cases. HDRIBT is considered to be an effective mode of radiotherapy for residual or recurrent bile duct tumors.