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Igari M, Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Hirai R, Kumazaki Y, Noda S, Kato S. Learning curve of lung dose optimization in intensity-modulated radiotherapy for locally advanced non-small cell lung cancer. Thorac Cancer 2023; 14:2642-2647. [PMID: 37466172 PMCID: PMC10493474 DOI: 10.1111/1759-7714.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) has been increasingly used for patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, there are some barriers to implementing IMRT for LA-NSCLC, including the complexity of treatment plan optimization. This study aimed to evaluate the learning curve of lung dose optimization in IMRT for LA-NSCLC and identify the factors that affect the degree of achievement of lung dose optimization. METHODS We retrospectively evaluated 40 consecutive patients with LA-NSCLC who received concurrent chemoradiotherapy at our institution. These 40 patients were divided into two groups: 20 initially treated patients (earlier group) and 20 subsequently treated patients (later group). Patient and tumor characteristics were compared between the two groups. The dose-volume parameter ratio between the actually delivered IMRT plan and the simulated three-dimensional conformal radiotherapy plan was also compared between the two groups to determine the learning curve of lung dose optimization. RESULTS The dose-volume parameter ratio for lung volume to receive more than 5 Gy (lung V5) and mean lung dose (MLD) significantly decreased in later groups. The spread of the beam path and insufficient optimization of dose coverage of planning target volume (PTV) might cause poor control of lung V5, MLD. CONCLUSIONS A learning curve for lung dose optimization was observed with the accumulation of experience. Appropriate techniques, such as restricting the beam path and ensuring dose coverage of PTV during the optimization process, are essential to control lung dose in IMRT for LA-NSCLC.
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Affiliation(s)
- Mitsunobu Igari
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Shin‐ei Noda
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
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Hirai R, Ohta T, Igari M, Kumazaki YU, Iino M, Aoshika T, Ryuno Y, Saito S, Abe T, Noda SE, Kato S. Optimal Number of Needle Applicators Inserted in Combined Intracavitary and Interstitial Brachytherapy for Cervical Cancer. Anticancer Res 2023; 43:3265-3271. [PMID: 37351988 DOI: 10.21873/anticanres.16501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM Combined intracavitary and interstitial brachytherapy (IC/IS-BT) is an effective treatment for extensive and bulky cervical cancer. However, the optimum number of interstitial needle applicators ("needles") inserted in IC/IS-BT can be difficult to determine. To examine the number of needles required for adequate dose coverage of cervical tumors, we retrospectively analyzed IC/IS-BT plans. PATIENTS AND METHODS IC/IS-BT plans for cervical cancer patients treated from January 2014 to January 2021 were analyzed. All tumors were controlled locally at the time of analysis (August 2022). The relationship between the number of needles and several volumetric parameters of high-risk clinical target volume (CTVHR) were analyzed, including maximum diameter, maximum cross-sectional area, and the volume of CTVHR Spearman's rank correlation coefficients (r) were used to evaluate correlations. RESULTS Eighty-two plans in 32 patients were analyzed. The median maximum cross-sectional area and volume of CTVHR were 18.9 (12.3-42.5) cm2 and 53.8 (30.1-152.2) cm3, respectively. The mean D90% and D98% of CTVHR at each BT session were 7.0±0.8 Gy and 5.9±0.8 Gy, respectively. There was a positive correlation between the number of needles and the maximum cross-sectional area of CTVHR (r=0.53). The average numbers of needles were 1.3, 1.9, 2.2, 3.1, and 4.0 when the maximum cross-sectional area of CTVHR were ≤15 cm2, 15-20 cm2, 20-25 cm2, 25-30 cm2, and >30 cm2, respectively. CONCLUSION The optimal number of needles can be determined from the maximum cross-sectional area of CTVHR.
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Affiliation(s)
- Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Misaki Iino
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki YU, Miura YU, Kaira K, Kagamu H, Noda SE, Kato S. Comparison of the Efficacy and Toxicity of Concurrent Chemoradiotherapy and Durvalumab and Concurrent Chemoradiotherapy Alone for Locally Advanced Non-small Cell Lung Cancer With N3 Lymph Node Metastasis. Anticancer Res 2023; 43:675-682. [PMID: 36697072 DOI: 10.21873/anticanres.16205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM Efficacy and toxicity of concurrent chemoradiotherapy (CCRT) and durvalumab for locally advanced non-small cell lung cancer (LA-NSCLC) with N3 lymph node metastasis remain unclear. We aimed to evaluate the clinical outcomes of patients who received CCRT and durvalumab (durvalumab cohort) and compare their outcomes with those of patients who received CCRT alone (CCRT-alone cohort). PATIENTS AND METHODS The data of patients who had received treatment between November 2008 and February 2022 and were followed up for at least 3 months were retrospectively analyzed. Local control, progression-free survival, and overall survival were evaluated using Kaplan-Meier analysis and compared using the log-rank test. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events version 5.0. RESULTS The data of 29 patients were analyzed (median follow-up period: 22 months). Among them, 17 received CCRT alone and 12 received CCRT and durvalumab. There were 14 patients with stage IIIB and 15 with stage IIIC LA-NSCLC. The durvalumab cohort (89%) had a significantly higher 1-year local control rate than the CCRT-alone cohort (47%; p=0.035). No significant difference was observed in either progression-free or overall survival between the two cohorts. Grade ≥2 pneumonitis was observed in 6 (50%) and 7 (41%) patients in the durvalumab and CCRT-alone cohorts, respectively. CONCLUSION CCRT with durvalumab may be effective against LA-NSCLC with N3 lymph node metastasis. The incidence of grade 2 pneumonitis was slightly higher in the durvalumab cohort than in the CCRT-alone cohort, suggesting the need for careful patient monitoring after treatment.
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Affiliation(s)
- Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan;
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Y U Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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Aoshika T, Noda SE, Abe T, Kumazaki Y, Hirai R, Igari M, Saito S, Ryuno Y, Iino M, Ohta T, Kato S. Results of computer tomography-based adaptive brachytherapy in combination with whole-pelvic- and central-shielding-external beam radiotherapy for cervical cancer. Brachytherapy 2022; 21:783-791. [PMID: 35927196 DOI: 10.1016/j.brachy.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate treatment results and investigate predictors of local control. METHODS AND MATERIALS In this retrospective study of 236 patients with cervical cancer, we administered CT-based adaptive brachytherapy (BT) in combination with whole- pelvic (WP)- and central shielding (CS)- external beam radiotherapy (EBRT) with or without chemotherapy. The study cohort comprised patients with cervical cancer treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy between June 2013 and March 2019. Local control (LC), overall survival (OS), and late toxicity were evaluated. Predictive factors for LC were analyzed by univariate and multivariate analyses. RESULTS Median doses of WP- and CS-EBRT and BT were 30.6 GyEQD2, 19.8 GyEQD2, and 40.3 GyEQD2, respectively. The 3-year LC rates for T1b2, T2a, T2b, T3b, and T4 were 100%, 100%, 97.3%, 86.9%, and 91.7%, respectively (p = 0.346). The 3-year OS for Stages IB, IIB, IIIB, IIIC, and IVA were 100%, 94.8%, 82.5%, 81.7%, and 74.6%, respectively (p = 0.037). Rates of Grade 3-4 gastrointestinal and genitourinary toxicities were 3.8% and 1.7%, respectively. Multivariate analysis showed that T3-4, nonsquamous cell histology, and high-risk clinical target volume (CTVHR) D90 of BT < 36GyEQD2 were independently associated with significantly poorer LC. CONCLUSIONS The combination of WP- and CS-EBRT and CT-based IGBT with or without concurrent chemotherapy produced favorable LC outcomes with low rates of late toxicities for patients with small or medium-sized tumors. However, LC was less favorable for patients who had large T3 disease, and the use of CS requires caution in these patients.
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Affiliation(s)
- Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
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Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda S, Kato S. Simple method for evaluating achievement degree of lung dose optimization in individual patients with locally advanced non-small cell lung cancer treated with intensity modulated radiotherapy. Thorac Cancer 2022; 13:2890-2896. [PMID: 36054298 PMCID: PMC9575059 DOI: 10.1111/1759-7714.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background In this study, we developed a simple method for evaluating achievement degree of lung dose optimization in individual patients with locally advanced non‐small cell lung cancer (NSCLC) treated with intensity modulated radiotherapy (IMRT). Methods Data of 28 patients with stage IIB to IIIC NSCLC were retrospectively analyzed. All patients were treated with IMRT and a simulated three‐dimensional conformal radiotherapy (3D‐CRT) plan created for them. Dose‐volume parameters of lung were analyzed for their correlation with radiation pneumonitis (RP). Results Over a median follow‐up of 14 months, grade 1 pneumonitis was diagnosed in 14 patients (50%), grade 2 pneumonitis in 11 (39%), and grade 3 pneumonitis in one (4%). Two patients did not develop pneumonitis. None of the patients developed grade 4 or 5 pneumonitis. Regarding dose‐volume parameter ratios between IMRT and simulated 3D‐CRT, receiver operating characteristic analysis showed that mean lung dose (MLD)IMRT/MLD3D‐CRT had the largest area under curve (0.750). Cumulative 6‐month incidences of grade 2 or greater RP were 78.4% versus 19.5% (MLDIMRT/MLD3D‐CRT, ≥1.0 or less); this difference was significant (p < 0.05). Conclusions We found that cutoff values for dose volume parameter ratios significantly predict grade 2 or greater RP. We believe that these parameter ratios could be useful in assisting evaluation of achievement degree of lung dose optimization in IMRT for LA‐NSCLC.
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Affiliation(s)
- Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shinei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
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Ryuno Y, Abe T, Iino M, Saito S, Aoshika T, Oota T, Igari M, Hirai R, Kumazaki Y, Kaira K, Kagamu H, Ishida H, Noda SE, Kato S. High-dose stereotactic body radiotherapy using CyberKnife® for stage I peripheral lung cancer: a single-center retrospective study. Radiat Oncol 2022; 17:128. [PMID: 35854333 PMCID: PMC9297648 DOI: 10.1186/s13014-022-02094-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/29/2022] [Indexed: 12/25/2022] Open
Abstract
Background This retrospective study was performed to evaluate the efficacy and toxicity of high-dose stereotactic body radiotherapy (SBRT) using a CyberKnife® for patients with stage I peripheral non-small cell lung cancer (NSCLC). Methods Ninety-six patients with stage I peripheral NSCLC who were treated with SBRT using a CyberKnife® from August 2010 to June 2019 were identified and included in this study. Local control (LC), local progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS), and late toxicity were evaluated. Potential risk factors associated with LC, LPFS, PFS, or OS were investigated by univariate analyses. Results Data of 96 patients were examined. The prescribed dose to the tumor was 54 Gy in 3 fractions in 91 patients and 60 Gy in 3 fractions in 5 patients. The median follow-up duration was 27 months. The 2-year LC, LPFS, PFS, and OS rates were 97%, 88%, 84%, and 90%, respectively. The T factor was significantly correlated with LC, LPFS, and PFS. The 2-year LC rate for patients with T1a/T1b and T1c/T2a disease was 100% and 90%, respectively (p < 0.05), and the 2-year PFS rate for the corresponding patients was 95% and 65%, respectively (p < 0.001). One patient (1%) developed grade 3 radiation pneumonitis. Conclusions High-dose SBRT using a CyberKnife® for stage I peripheral NSCLC produced favorable treatment outcomes with acceptable late toxicity. Further studies are needed to improve the treatment outcomes for patients with T1c/T2a disease.
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Affiliation(s)
- Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomohiro Oota
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hironori Ishida
- Department of General Thoracic Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
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Abe T, Ryuno Y, Iino M, Saito S, Aoshika T, Ohta T, Igari M, Hirai R, Kumazaki Y, Kaira K, Kagamu H, Ishida H, Noda SE, Kato S. A 54 Gy in three fractions of stereotactic body radiotherapy using CyberKnife for T1b-2aN0M0 pathologically confirmed non-small cell lung cancer. Jpn J Clin Oncol 2021; 51:1723-1728. [PMID: 34580722 DOI: 10.1093/jjco/hyab154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Optimal dose-fractionation regimen of stereotactic body radiotherapy for peripheral early-stage non-small cell lung cancer remains unclear. We retrospectively investigated outcomes of stereotactic body radiotherapy using CyberKnife at 54 Gy in three fractions in 26 patients (median age: 76 years) with pathologically confirmed T1b-T2aN0M0 non-small cell lung cancer. METHODS A 54 Gy in three fractions was prescribed to cover the 99% of gross tumor volume. We estimated cumulative local control, progression-free survival and overall survival rates (Kaplan-Meier method), and toxicity (Common Toxicity Criteria for Adverse Events, version 5.0). RESULTS All the tumors were located at peripheral area of lung. Mean distance from chest wall to tumor was 6.5 mm (range: 0-32 mm). The patients' pathological diagnoses were: adenocarcinoma: n = 18, squamous cell carcinoma: n = 7 and non-small cell carcinoma: n = 1. Their stages were T1b: n = 9, T1c: n = 14 and T2a: n = 3. Median follow-up was 24 months (range: 6-54). Cumulative 2-year effect rates were local control: 100%, progression-free survival 70% and overall survival: 92%. Twenty patients developed grade one radiation pneumonitis, but grade 2 or greater radiation pneumonitis was not observed. CONCLUSIONS We found CyberKnife-stereotactic body radiotherapy for pathologically confirmed T1b-T2aN0M0 non-small cell lung cancer to be effective and safe. However, these results should be validated with a larger patient cohort and prospective follow-up monitoring.
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Affiliation(s)
- Takanori Abe
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yasuhiro Ryuno
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Misaki Iino
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomohiro Ohta
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Kumazaki
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hironori Ishida
- General Thoracic Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda SE, Kato S. Feasibility of intensity modulated radiotherapy with involved field radiotherapy for Japanese patients with locally advanced non-small cell lung cancer. J Radiat Res 2021; 62:894-900. [PMID: 34260719 PMCID: PMC8438249 DOI: 10.1093/jrr/rrab063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Indexed: 06/13/2023]
Abstract
The feasibility of intensity modulated radiotherapy (IMRT) with involved field radiotherapy (IFRT) for Japanese patients with locally advanced non-small cell lung cancer (LA-NSCLC) remains unclear. Here we reviewed our initial experience of IMRT with IFRT for Japanese patients with LA-NSCLC to evaluate the feasibility of the treatment. Twenty LA-NSCLC patients who were treated with IMRT with IFRT during November 2019 to October 2020 were retrospectively analyzed. All patients received 60 Gy in 30 fractions of IMRT and were administered concurrent platinum-based chemotherapy. The median patient age was 71 years old and the group included 15 men and 5 women. The patient group included 2 patients with stage IIB, 11 patients with stage IIIA, 5 patients with stage IIIB, and 2 patients with stage IIIC disease. Histological diagnosis was squamous cell carcinoma in 14 patients, adenocarcinoma in 5 patients, and non-small cell lung cancer in 1 patient. The median follow-up period was 8 months. The incidence of grade 3 or greater pneumonitis was 5%, and grade 3 or greater esophagitis was not observed. None of the patients developed regional lymph node, with only recurrence reported so far. These findings indicate that IMRT with IFRT for Japanese patients with LA-NSCLC is feasible in terms of acute toxicity. Further study with a larger number of patients and longer follow-up to clarify the effect of treatment on patient prognosis is required.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/radiotherapy
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/radiotherapy
- Combined Modality Therapy
- Dose-Response Relationship, Radiation
- Feasibility Studies
- Female
- Humans
- Japan
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Multimodal Imaging
- Neoplasm Metastasis
- Organoplatinum Compounds/administration & dosage
- Organs at Risk/radiation effects
- Paclitaxel/administration & dosage
- Radiation Pneumonitis/etiology
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Conformal
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Retrospective Studies
- User-Computer Interface
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Affiliation(s)
- Takanori Abe
- Corresponding author. Takanori Abe, Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan. E-mail: ; Tel: +81429844136, Fax: +81429844136
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
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9
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Saito S, Abe T, Iino M, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Yamaguchi O, Kaira K, Kagamu H, Noda SE, Kato S. Incidence and risk factors for pneumonitis among patients with lung cancer who received immune checkpoint inhibitors after palliative thoracic radiotherapy. J Radiat Res 2021; 62:669-675. [PMID: 34121123 PMCID: PMC8273801 DOI: 10.1093/jrr/rrab051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study is to analyze the incidence and risk factors for pneumonitis when immune checkpoint inhibitors (ICIs) are combined with palliative thoracic radiotherapy (RT) for lung cancer. We retrospectively evaluated 29 patients with lung cancer who received ICIs after palliative thoracic RT (30 Gy in 10 fractions). Their ICIs were pembrolizumab (n = 17), nivolumab (n = 8) and atezolizumab (n = 4). Median follow-up period was 10 months. The median interval between starting RT and starting ICI was 25 days. Pneumonitis events were grade 1 (n = 10; 34%), grade 2 (n = 4; 14%) and grade 3 (n = 3; 10%). Obstructive pneumonia was significantly associated with grade ≥ 2 pneumonitis (P = 0.036). Age, sex, ICI agent, interval between RT and ICI and history of ICI before RT were not associated with grade ≥ 2 pneumonitis. Tumor volume; Brinkman index; dosimetric factors, such as lung V5, V10, V20, V30 and mean lung dose (MLD); lactate dehydrogenase; and C-reactive protein did not significantly differ between the grade ≤ 1 and grade ≥ 2 pneumonitis groups. Levels of sialylated carbohydrate antigen KL-6 were evaluated in 27 patients before RT; they significantly differed between patients with grade ≤ 2 pneumonitis (mean: 431 U/ml) and those with grade ≥ 3 pneumonitis (mean: 958 U/ml; P < 0.001). Patients who receive ICI after palliative thoracic RT should be carefully followed-up, especially those who have had obstructive pneumonia or high KL-6 levels.
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Affiliation(s)
| | - Takanori Abe
- Corresponding author: Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan. Fax: +81 42 984 4136; E-mail:
| | - Misaki Iino
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Aoshika
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yasuhiro Ryuno
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomohiro Ohta
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Mitsunobu Igari
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Ryuta Hirai
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Yu Kumazaki
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Ou Yamaguchi
- Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Kyoichi Kaira
- Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Kagamu
- Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shin-ei Noda
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kato
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
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10
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Hirai R, Ohkubo YU, Igari M, Kumazaki YU, Aoshika T, Ryuno Y, Saito S, Abe T, Noda SE, Kato S. Time Dependence of Intra-fractional Motion in Spinal Stereotactic Body Radiotherapy. In Vivo 2021; 35:2433-2437. [PMID: 34182527 DOI: 10.21873/invivo.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Positional uncertainty in spinal stereotactic body radiotherapy (SBRT) may cause fatal error, therefore, we investigated the intra-fractional spinal motion during SBRT and its time dependency. PATIENTS AND METHODS Thirty-one patients who received SBRT using CyberKnife were enrolled in the study. 2D kV X-ray spine images in two directions were taken before and during treatment. Image acquisition intervals during treatment were set at 35-60 sec. Automatic image matchings were performed between the reference digital reconstructed radiography (DRR) and live images, and the spinal position displacements were logged in six translational and rotational directions. If the displacements exceeded 2 mm or 1 degree, the treatment beam delivery was interrupted and the patient position was corrected by moving couch, and the couch adjustments were also logged. Based on the information, the time-dependent accumulated translational and rotational displacements without any couch adjustments were calculated. RESULTS Spinal position displacements in all translational and rotational directions were correlated with elapsed treatment time. Especially, Right-Left displacements of >1 mm and >2 mm were observed at 4-6 and 8-10 min after treatment initiation, respectively. Rotational displacements in the Yaw direction >1° were observed at 10-15 min after treatment initiation. CONCLUSION The translational and rotational displacements systematically increased with elapsed treatment time. It is suggested that the spine position should be checked at least every 4-6 min or the treatment time should be limited within 4-6 minutes to ensure the irradiation accuracy within the millimeter or submillimeter range.
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Affiliation(s)
- Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan;
| | - Y U Ohkubo
- Department of Radiation Oncology, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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11
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Abe T, Saito S, Iino M, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Ebihara Y, Nakahira M, Sugasawa M, Noda SE, Kato S. Results of definitive radiotherapy with concurrent chemotherapy for maxillary sinus carcinomas with neck lymph node metastasis. J Radiat Res 2021; 62:104-109. [PMID: 33280040 PMCID: PMC7779343 DOI: 10.1093/jrr/rraa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/01/2020] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to describe the results of definitive radiotherapy (RT) with concurrent chemotherapy for maxillary sinus carcinomas (MSCs) with neck lymph node metastasis to clarify its limitation. Local control (LC), progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and were compared between subgroups using the log rank test. Toxicity was classified using common terminology criteria of adverse events version 5.0. Eighteen patients with inoperable MSC with neck lymph node metastasis including 12 men and 6 women with a median age of 67 years were analyzed. The histologic diagnoses were as follows: 16 patients had squamous cell carcinomas and 2 had other histology. Four patients had stage T3 MSC, 6 had T4a and 8 had T4b. Among 18 patients, 7 received concurrent systemic chemotherapy and 11 received selective arterial chemo-infusion. The median follow-up period was 17 months. The 2-year LC, PFS and OS rates for the entire cohort were 34, 31 and 46%, respectively. No significant differences were observed for LC, PFS and OS rates between systemic chemotherapy and selective arterial chemo-infusion cohorts. Grade 3 or higher acute toxicity, including both non-hematological and hematological, was observed in nine patients (50%), while no grade 3 or higher late toxicity was observed. In conclusion, we described the results of definitive RT for MSCs with neck lymph node metastasis. Local recurrence of primary tumor was a frequent pattern of failure and it should be addressed in future study.
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Affiliation(s)
- Takanori Abe
- Corresponding author. Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan. Tel: +81429844136; Fax: +81429844136;
| | | | | | | | | | | | | | | | | | - Yasuhiro Ebihara
- Head and Neck Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsuhiko Nakahira
- Head and Neck Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Masashi Sugasawa
- Head and Neck Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
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12
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Abe T, Saito S, Iino M, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda SE, Kato S. Effect of durvalumab on local control after concurrent chemoradiotherapy for locally advanced non-small cell lung cancer in comparison with chemoradiotherapy alone. Thorac Cancer 2020; 12:245-250. [PMID: 33289347 PMCID: PMC7812072 DOI: 10.1111/1759-7714.13764] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Durvalumab after concurrent chemoradiotherapy (CCRT) for locally advanced non‐small cell lung cancer (LA‐NSCLC) has been found to significantly improve overall survival (OS). However, the effect of durvalumab on local control remains unclear. Here, we evaluated the effect of the durvalumab on local control in comparison with the clinical result of patients treated with CCRT alone. Methods A total of 120 LA‐NSCLC patients including 76 patients with CCRT alone and 44 patients with CCRT followed by durvalumab were analyzed. Baseline patient characteristics of CCRT alone cohort and durvalumab cohort were compared with student's t test or Mann–Whitney U test for continuous variables and with chi‐squared test for categorical variables. Local control (LC), progression free survival (PFS) and OS rates were estimated using the Kaplan–Meier method and compared with the log‐rank test. Results There were 19 patients with stage II disease and 101 patients with stage III disease. Age, sex, histopathological type, T classification, N classification, clinical stage, tumor volume and dose fractionation schedule were not significantly different between the CCRT alone and durvalumab cohorts. The one‐year LC rate was significantly higher in the durvalumab cohort (86%) compared with the CCRT alone cohort (62%) (P = 0.005), whereas no significant difference was observed in either PFS (P = 0.864) or OS (P = 0.443) between the CCRT and durvalumab cohorts. Conclusions The one‐year LC rate was significantly higher in the durvalumab cohort compared with the CCRT alone cohort. Although the follow‐up period was too short to draw definitive conclusions, the study revealed that durvalumab might have a significant effect on LC. Key points Significant findings of the study Effect of durvalumab on local control after chemoradiotherapy for locally advanced non‐small cell lung cancer is unclear What this study adds The one‐year local control rate of chemoradiotherapy followed by durvalumab was significantly higher compared with chemoradiotherapy alone.
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Affiliation(s)
- Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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13
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Abe T, Ryuno Y, Saito S, Aoshika T, Igari M, Hirai R, Kumazaki Y, Kaira K, Kagamu H, Ishida H, Noda SE, Kato S. Stereotactic body radiation therapy using CyberKnife for T1N0M0 lung cancer patients with severe pulmonary dysfunction. J Radiat Res 2020; 61:903-907. [PMID: 32880653 PMCID: PMC7674703 DOI: 10.1093/jrr/rraa075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/10/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
We retrospectively investigated the efficacy and safety of stereotactic body radiotherapy (SBRT) for T1N0M0 lung cancer using CyberKnife (CK) among 13 patients with severe pulmonary dysfunction which was defined as forced expiratory volume in 1 s (FEV1.0) of <1 L. The prescribed dose was 54 Gy in 3 fractions but adjusted for some patients if their tumors were in close proximity to the organs at risk (54 Gy/3 fractions: n = 11; 50 Gy/5 fractions: n = 1; 60 Gy/8 fractions: n = 1). During follow up (median follow-up: 27 months), we evaluated local control, overall survival and toxicity, using diagnostic imaging and laboratory tests. The patients' median FEV1.0 was 0.84 L. Of the 13 patients, 3 were diagnosed as having lung cancer histologically and 10 diagnosed clinically. Their 2-year rates for overall survival and local control were 89 and 100%, respectively. So far, we have seen no adverse effects of grade 2 or higher. We concluded that CK-SBRT is effective and well tolerated for T1N0M0 lung cancer, even in patients with severe pulmonary dysfunction, but should be further evaluated with a larger cohort and longer follow-up periods.
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Affiliation(s)
- Takanori Abe
- Corresponding author: Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan. Tel: +81-429844136; Fax: +81-429844136;
| | - Yasuhiro Ryuno
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Kumazaki
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Departments of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Departments of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hironori Ishida
- Departments of General Thoracic Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-ei Noda
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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Kumazaki Y, Hirai R, Igari M, Kobayashi N, Okazaki S, Abe T, Tamaki T, Noda SE, Kato S. Development of an HDR-BT QA tool for source position verification. J Appl Clin Med Phys 2020; 21:84-89. [PMID: 33136313 PMCID: PMC7769398 DOI: 10.1002/acm2.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/07/2020] [Accepted: 09/20/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE This study aimed to develop a high-dose-rate brachytherapy (HDR-BT) quality assurance (QA) tool for verification of source positions, and to report on its effectiveness. METHODS We fabricated a cuboid phantom measuring 30 × 30×3 cm3 with spaces to embed Fletcher-Williamson tandem and ovoid applicators. Lead-based, cylindrically shaped radiopaque markers, which scatter radiation and blacken the Gafchromic® RTQA2 films placed on the applicators, were inserted into the phantom to determine the applicator tip and reference source positions. A three-dimensional image-guided brachytherapy (3D-IGBT) plan was generated, and the source positions on the film and radiation treatment planning system (RTPS) were verified with the tool. Source position errors were evaluated as the distance in the applicator axis direction between the source position and the center position of two radiopaque marker pairs. RESULTS Source position errors on the film and RTPS were in good agreement with one another and were all within 0.5 mm for all applicators. Offset values of each applicator were in good agreement with the value determined in treatment planning (6 mm). The expanded measurement uncertainty of our QA tool was estimated to be 0.87 mm, with a coverage factor k of 2. CONCLUSIONS Our new HDR-BT QA tool developed for comprehensive source position verification will be useful for cross checking actual source positions and planned source positions on the RTPS.
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Affiliation(s)
- Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Nao Kobayashi
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Fukushima Medical University, Fukushima, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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15
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Hirai R, Tamaki T, Igari M, Kumazaki YU, Noda SE, Kato S. Plan-Optimization Method for Central-shielding Pelvic Volumetric-modulated Arc Therapy for Cervical Cancer. In Vivo 2020; 34:3611-3618. [PMID: 33144475 DOI: 10.21873/invivo.12206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022]
Abstract
AIM To establish a method of plan optimization in pelvic volumetric-modulated arc therapy (VMAT) for cervical cancer using the central-shielding (CS) principle. PATIENTS AND METHODS We created external beam VMAT plans for eight cases with non-bulky stage I-IIb using the CS principle based on the Japanese standard guideline. Clinical target volumes (CTVs) for whole-pelvis (WP) irradiation were created using published guidelines, and CTVs for CS irradiation were created by subtracting the uterus corpus and 4 cm-wide regions centered at the cervix and vagina from the CTVs for WP irradiation. For plan optimization of CS irradiation, a 4-cm diameter cylindrical volume centered in the cervix and vagina was created as the volume receiving a high dose in brachytherapy, and the volume overlapping with the rectum was defined as the Ant-Rectum. Dose-volume histogram (DVH) parameters of two CS VMAT plans with and without (VMATOPT/VMATNO) dose optimization to the Ant-Rectum were compared. RESULTS VMATOPT plans resulted in significantly lower DVH parameters of the Ant-Rectum and rectum compared to VMATNO plans. These were comparable to the DVH parameters of three-dimensional conformal radiotherapy (3DCRT) plans. Both VMAT plans resulted in significantly better coverage of planning target volumes than did the 3DCRT plans. CONCLUSION In the implementation of IMRT/VMAT as the standard treatment for cervical cancer in Japan, our optimization method may be an essential step toward fully benefitting from the CS principle.
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Affiliation(s)
- Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomoaki Tamaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Radiation Oncology, Fukushima Medical University, Fukushima, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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16
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Kobayashi N, Abe T, Noda SE, Kumazaki YU, Hirai R, Igari M, Aoshika T, Saito S, Ryuno Y, Kato S. Stereotactic Body Radiotherapy for Pulmonary Oligometastasis from Colorectal Cancer. In Vivo 2020; 34:2991-2996. [PMID: 32871842 DOI: 10.21873/invivo.12130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIM A retrospective study was conducted to evaluate the safety and efficacy of stereotactic body radiotherapy (SBRT) for pulmonary oligometastasis from colorectal cancer (CRC). PATIENTS AND METHODS Patients with pulmonary oligometastasis from CRC who were treated with SBRT between April 2010 and October 2018 were enrolled in this study. All patients underwent SBRT using Cyberknife® with a dose of 54-60 Gy in 3 fractions to 99% of the clinical target volume. The treatment efficacy was evaluated by the local control (LC) and overall survival (OS) rates. The toxicity was evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.0. RESULTS Twenty-six lesions in 20 patients were treated with SBRT. The median follow-up duration was 19 months (range=6-98 months). Local recurrence occurred in 6 of 26 lesions with a median follow-up of 12 months. The 2-year LC and OS rates were 65.8% and 88.6%, respectively. No patient developed ≥ grade 2 toxicity in the lung and other sites. CONCLUSION Although very high doses were delivered to the tumors with SBRT, the LC of pulmonary metastasis from CRC was not satisfactory when compared to that for stage I primary non-small cell lung cancer reported in the literature.
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Affiliation(s)
- Nao Kobayashi
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan.,Department of Radiation Oncology, Gunma University Hospital, Gunma, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University, International Medical Center, Saitama, Japan
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17
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Yamauchi R, Igari M, Kasai Y, Hariu M, Suda Y, Kawachi T, Katayose T, Mizuno N, Miyasaka R, Saitoh H. Estimation of the cable effect in megavoltage photon beam by measurement and Monte Carlo simulation. Med Phys 2020; 47:5324-5332. [PMID: 32786073 DOI: 10.1002/mp.14450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 05/12/2020] [Accepted: 08/05/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Ionization chambers are widely used for dosimetry with megavoltage photon beams. Several properties of ionization chambers, including the cable effect, polarity effect, and ion recombination loss, are described in standard dosimetry protocols. The cable effect is categorized as the leakage current and Compton current, and careful consideration of these factors has been described not only in reference dosimetry but also in large fields. However, the mechanism of Compton current in the cable has not been investigated thoroughly. The cable effect of ionization chambers in 6 MV X-ray beam was evaluated by measurement, and the mechanism of Compton current was investigated by Monte Carlo simulation. MATERIALS AND METHODS Four PTW ionization chambers (TM30013, TM31010, TM31014, and TM31016) with the same type of mounted cable, but different ionization volumes, were used to measure output factor (OPF) and cable effect measurement. The OPF was measured to observe any variation resulting from the cable effect. The cable effect was evaluated separately for the leakage current and Compton current, and its charge per absorbed dose to water per cable length was estimated by a newly proposed method. The behavior of electrons and positrons in the core wire was analyzed and the Compton current for the photon beam was estimated by Monte Carlo simulation. RESULTS In OPF measurement, the difference in the electrometer readings by polarity became obvious for the mini- or microchamber and its difference tended to be larger for a chamber with a smaller ionization volume. For the cable effect measurement, it was determined that the contribution of the leakage current to the cable effect was ignorable, while the Compton current was dominant. The charge due to the Compton current per absorbed dose to water per cable length was estimated to be 0.36 ± 0.03 pC Gy-1 cm-1 for PTW ionization chambers. As a result, the contribution of the Compton current to the electrometer readings was estimated to be 0.002% cm-1 for the Farmer-type, 0.011% cm-1 for the scanning, and 0.088% cm-1 for microchambers, respectively. By the simulation, it was determined that the Compton current for MV x-ray could be explained by not only recoil electrons due to Compton scattering but also positron due to pair production. The Compton current estimated by the difference in outflowing and inflowing charge was 0.45 pC Gy-1 cm-1 and was comparable with the measured value. CONCLUSION The cable effect, which includes the leakage current and Compton current, was quantitatively estimated for several chambers from measurements, and the mechanism of Compton current was investigated by Monte Carlo simulation. It was determined that the Compton current is a dominant component of the cable effect and its charge is consistently positive and nearly the same, irrespective of the ionization chamber volume. The contribution of Compton current to the electrometer readings was estimated for chambers. The mechanism of Compton current was analyzed and it was confirmed that the Compton current can be estimated from the difference in outflowing and inflowing charge to and from the core wire.
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Affiliation(s)
- Ryohei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo, 116-0012, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka-City, Saitama, 350-1298, Japan
| | - Yuya Kasai
- Division of Radiation, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-City, Tokyo, 204-8585, Japan
| | - Masatsugu Hariu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Yuhi Suda
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo, 116-0012, Japan.,Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Toru Kawachi
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Tetsurou Katayose
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Norifumi Mizuno
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Ryohei Miyasaka
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo, 116-0012, Japan.,Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Hidetoshi Saitoh
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo, 116-0012, Japan
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18
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Abe T, Kobayashi N, Aoshika T, Ryuno Y, Saito S, Igari M, Hirai R, Kumazaki YU, Miura YU, Kaira K, Kagamu H, Noda SE, Kato S. Pattern of Local Failure and its Risk Factors of Locally Advanced Non-small Cell Lung Cancer Treated With Concurrent Chemo-radiotherapy. Anticancer Res 2020; 40:3513-3517. [PMID: 32487652 DOI: 10.21873/anticanres.14339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The treatment outcome of locally advanced non-small cell lung cancer (LA-NSCLC) has been improved over the past years but local failure is still common for these patients. The purpose of this study is to analyze the pattern of local failure and its risk factor of concurrent chemo-radiotherapy (CCRT) for locally advanced LA-NSCLC. PATIENTS AND METHODS We evaluated 77 patients treated with CCRT for LA-NSCLC from July 2007 to December 2017 at our institution. Most of the patients were treated with 60 Gy in 30 fractions of radiotherapy and concurrent chemotherapy. The median follow-up time was 26 months. RESULTS Among the 77 patients, 50 developed progressive disease during follow-up, including 14 with only local recurrence (LR), 10 with only distant metastasis and 26 with both. Of the 14 patients with only LR, 12 had primary tumor recurrence and 2 had recurrence in lymph nodes. A primary tumor volume of 50 cm3 was identified as the optimal cut-off value that was significantly correlated with primary tumor recurrence and overall survival. CONCLUSION Primary tumor recurrence without lymph node and distant metastasis was observed in 12 patients (16%). Primary tumor volume of 50 cm3 was the optimal cut-off value for the prediction of primary tumor recurrence.
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Affiliation(s)
- Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Nao Kobayashi
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Y U Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Y U Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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Saito S, Abe T, Kobayashi N, Aoshika T, Ryuno Y, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda SE, Kato S. Incidence and dose-volume relationship of radiation pneumonitis after concurrent chemoradiotherapy followed by durvalumab for locally advanced non-small cell lung cancer. Clin Transl Radiat Oncol 2020; 23:85-88. [PMID: 32529055 PMCID: PMC7283100 DOI: 10.1016/j.ctro.2020.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background and purpose We investigated the incidence and dose-volume relationships of radiation pneumonitis (RP) after concurrent chemoradiotherapy (CCRT) followed by durvalumab for locally advanced non-small-cell lung cancer (LA-NSCLC). Materials and methods We retrospectively analyzed records of 36 patients with LA-NSCLC who underwent CCRT followed by durvalumab. Incidence of RP was analyzed for correlations with clinical factors and dose-volume parameters of lung in radiotherapy. Results All patients received 60 Gy in 30 fractions of radiotherapy with concurrent chemotherapy. Over a median follow-up period of 7 months, incidence of grade ≥2 RP was 36% (including grade 3 RP: 5% and grade 5 RP: 3%). Age, sex, Brinkman index, and blood test results did not significantly differ between patients with grade ≥2 RP and grade ≤1 RP. Dose-volume parameters (lung volumes that received 5 Gy, 10 Gy, 20 Gy, 30 Gy, 40 Gy, 50 Gy, and mean lung dose) were significantly higher among patients with grade ≥2 RP compared with patients with grade ≤1 RP. Conclusion Incidence of grade ≥2 RP was 36% after CCRT followed by durvalumab for LA-NSCLC, but did not significantly differ from those of patients treated with CCRT alone. Lung dose-volume parameters were significantly correlated with RP.
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Affiliation(s)
- Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Nao Kobayashi
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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20
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Okazaki S, Murata K, Noda SE, Kumazaki Y, Hirai R, Igari M, Abe T, Komatsu S, Nakano T, Kato S. Dose-volume parameters and local tumor control in cervical cancer treated with central-shielding external-beam radiotherapy and CT-based image-guided brachytherapy. J Radiat Res 2019; 60:490-500. [PMID: 31111896 PMCID: PMC6640900 DOI: 10.1093/jrr/rrz023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/22/2019] [Indexed: 05/20/2023]
Abstract
Definitive radiotherapy for cervical cancer consists of external-beam radiotherapy (EBRT) and brachytherapy. In EBRT, a central shield (CS) reduces the dose to the rectum and bladder. The combination of whole-pelvic (WP)- and CS-EBRT and brachytherapy is the standard radiotherapy protocol in Japan. Despite clinical studies, including multi-institutional clinical trials, showing that the Japanese treatment protocol yields favorable treatment outcomes with low rates of late radiation toxicities, dose-volume parameters for the Japanese treatment protocol remain to be established. We conducted a retrospective dose-volume analysis of 103 patients with uterine cervical cancer treated with the Japanese protocol using computed tomography-based adaptive brachytherapy. The 2-year overall survival and 2-year local control rates according to FIGO stage were 100% and 100% for Stage I, 92% and 94% for Stage II, and 85% and 87% for Stage III-IV, respectively. Late adverse effects in the rectum and bladder were acceptable. Receiver operating characteristic analysis discriminated recurrence within the high-risk clinical target volume (HR-CTV) (n = 5) from no local recurrence (n = 96), with the optimal response obtained at a dose of 36.0 GyEQD2 for HR-CTV D90 and 28.0 GyEQD2 for HR-CTV D98. These values were used as cut-offs in Fisher exact tests to show that high HR-CTV D90 and HR-CTV D98 doses for brachytherapy sessions were significantly associated with tumor control within the HR-CTV. These data suggest a contribution of brachytherapy to local tumor control in WP- and CS-EBRT and brachytherapy combination treatment, warranting validation in multi-institutional prospective studies.
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Affiliation(s)
- Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Kazutoshi Murata
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Shuichiro Komatsu
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
- Corresponding author. Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan. Tel: +81-42-984-4531; Fax: +81-42-984-4741;
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21
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Tamaki T, Hirai R, Igari M, Kumazaki Y, Noda SE, Suzuki Y, Kato S. Dosimetric comparison of three-dimensional conformal radiotherapy versus volumetric-arc radiotherapy in cervical cancer treatment: applying the central-shielding principle to modern technology. J Radiat Res 2018; 59:639-648. [PMID: 30053184 PMCID: PMC6151642 DOI: 10.1093/jrr/rry054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Indexed: 05/05/2023]
Abstract
This study evaluated the feasibility of applying volumetric-arc radiotherapy (VMAT) in standard curative radiotherapy for non-bulky cervical cancer using the central-shielding principle. Whole-pelvis irradiation of 20 Gy and central-shielding pelvis irradiation of 30 Gy, both in 2 Gy fractions, were created using 3D conformal radiotherapy (3DCRT) with a standard midline block or VMAT. Composite dose distributions and DVH parameters were compared first in a simple phantom model and then in 10 clinical cases of Stage I-II cervical cancer. Whole-pelvis clinical target volumes (CTVs) were created from published guidelines for primary disease and lymph node regions, and CTVs for central-shielding irradiation were created by subtracting uterus corpus and 4 cm-wide regions centered at the cervical canal and vagina. In a phantom model, VMAT provided adequate dose coverage to the PTVs without excessive doses to the rectum or bladder compared with the 3DCRT plan. In the clinical cases, VMAT plans resulted in slightly but significantly better coverage of PTVs. The DVH parameters for the rectum and bladder were equivalent or lower for VMAT plans compared with the 3DCRT plans. In the bowel, V30Gy, V40Gy, and V50Gy were significantly lower in VMAT plans compared with in the 3DCRT plans (47.6% vs 61.0%, 29.8% vs 56.2% and 6.8% vs 21.1%, respectively). Based on these results, VMAT may be used in external-beam radiotherapy for early-stage cervical cancer by adopting the principle of central-shielding pelvis irradiation. Furthermore, VMAT is likely to reduce doses to the small bowel and may reduce gastrointestinal toxicities for these patients.
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Affiliation(s)
- Tomoaki Tamaki
- Department of Radiation Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, Japan
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka, Saitama, Japan
- Corresponding author. Department of Radiation Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960–1295 Japan. Tel: +81-24-547-1630; Fax: +81-24-547-1631;
| | - Ryuta Hirai
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka, Saitama, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka, Saitama, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka, Saitama, Japan
| | - Yoshiyuki Suzuki
- Department of Radiation Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka, Saitama, Japan
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Hu S, Igari M, Walle N, Steffes M, Beland M, Collins S, Gohh R. Kidney Transplant Donor Glomerular Filtration Rate by Iohexol Clearance During Computerized Tomographic Angiography of the Kidneys. Transplant Proc 2013; 45:3229-33. [DOI: 10.1016/j.transproceed.2013.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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23
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Igari M, Takagi M, Imaizumi K, Sato Y, Endo M, Ishii K, Nagaoka K, Miyamoto H, Kan K, Teranishi Y, Watanabe K, Hatae S. P17.11 Effects on the use of specific anti-microbial drugs and the rate of drug-resistant of organism following the introduction of notification system. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Imaizumi K, Sato Y, Igari M, Ishii K, Endo M, Kan K, Teranishi Y, Hatae S, Takagi M, Miyamoto H. P11.11 The effectiveness of a hospital environment maintenance aimed at the infection prevention against Pseudomonas aeruginosa in Japan. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Horigome H, Hamada H, Sohda S, Igari M, Nagata M, Okuno S, Wada A, Kubo T. Large placental chorioangiomas as a cause of cardiac failure in two fetuses. Fetal Diagn Ther 1997; 12:241-3. [PMID: 9354885 DOI: 10.1159/000264476] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report 2 cases of fetal heart failure associated with large placental chorioangiomas. One fetus exhibited serious hydrops on the initial fetal echocardiogram and was ultimately stillborn. The fetus in the other case exhibited cardiomegaly. Following the premature termination of the pregnancy, the fetus received medical treatment and recovered in 7 days. Monitoring the fetal cardiac size with ultrasonography is recommended to determine the optimal time of delivery in cases of large placental angioma that are diagnosed prenatally.
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Affiliation(s)
- H Horigome
- Department of Pediatrics, University of Tsukuba, Japan.
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