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Yamazaki H, Suzuki G, Aibe N, Nakamura S, Yoshida K, Oh R. A surveillance study of patterns of reirradiation practice using external beam radiotherapy in Japan. J Radiat Res 2021; 62:285-293. [PMID: 33341887 PMCID: PMC7948832 DOI: 10.1093/jrr/rraa112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/28/2020] [Revised: 10/07/2020] [Accepted: 11/07/2020] [Indexed: 06/12/2023]
Abstract
The aim of this study was to survey the present status and patterns of reirradiation (Re-RT) practice using external beam radiotherapy in Japan. We distributed an e-mail questionnaire to the Japanese Society for Radiation Oncology partner institutions, which consisted of part 1 (number of Re-RT cases in 2008-2012 and 2013-2018) and part 2 (indications and treatment planning for Re-RT and eight case scenarios). Of the 85 institutions that replied to part 1, 75 (88%) performed Re-RTs. However, 59 of these 75 institutions (79%) reported difficulty in obtaining Re-RT case information from their databases. The responses from 37 institutions included the number of Re-RT cases, which totaled 508 in the period from 2009 to 2013 (institution median 3; 0-235), and an increase to 762 cases in the period from 2014 to 2018 (12.5; 0-295). A total of 47 physicians responded to part 2 of the survey. Important indications for Re-RT that were considered were age, performance status, life expectancy, absence of distant metastases and time interval since previous radiotherapy. In addition to clinical decision-making factors, previous total radiation dose, volume of irradiated tissue and the biologically equivalent dose were considered during Re-RT planning. From the eight site-specific scenarios presented to the respondents, >60% of radiation oncologists agreed to perform Re-RT. Re-RT cases have increased in number, and interest in Re-RT among radiation oncologists has increased recently due to advances in technology. However, several problems exist that emphasize the need for consensus building and the establishment of guidelines for practice and prospective evaluation.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Gen Suzuki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, Hirakata 573-1010, Japan
| | - Ken Yoshida
- Department of Radiology, Kansai Medical University, Hirakata 573-1010, Japan
| | - Ryoongjin Oh
- Department of Radiation Oncology, Miyakojima IGRT Clinic
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2
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Kaneyasu Y, Fujiwara H, Nishimura T, Sakurai H, Kazumoto T, Ikushima H, Uno T, Tokumaru S, Harima Y, Gomi H, Toita T, Kita M, Noda SE, Takahashi T, Kato S, Ohkawa A, Tozawa-Ono A, Ushijima H, Hasumi Y, Hirashima Y, Niibe Y, Nakagawa T, Akita T, Tanaka J, Ohno T. A multi-institutional survey of the quality of life after treatment for uterine cervical cancer: a comparison between radical radiotherapy and surgery in Japan. J Radiat Res 2021; 62:269-284. [PMID: 33415337 PMCID: PMC7973450 DOI: 10.1093/jrr/rraa107] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/04/2020] [Indexed: 05/14/2023]
Abstract
This study aimed to research the post-treatment quality of life (QOL) between radiotherapy (RT)- and operation (OP)-treated early cervical cancer survivors, using separate questionnaires for physicians and patients. We administered an observational questionnaire to patients aged 20-70 years old with Stages IB1-IIB cervical cancer who had undergone RT or OP and without recurrence as outpatients for ≥6 months after treatment. We divided 100 registered patients equally into two treatment groups (n = 50 each). The average age was 53 and 44 years in the RT and OP groups, respectively. The RT group included 34 and 66% Stage I and II patients, respectively, whereas the OP group included 66 and 34% Stage I and II patients, respectively. The OP group included 58% of patients with postoperative RT. Combination chemotherapy was performed in 84 and 48% of patients in the RT and OP groups, respectively. On the physicians' questionnaire, we observed significant differences in bone marrow suppression (RT) and leg edema (OP). On the patients' questionnaire, significantly more patients had dysuria and leg edema in the OP group than in the RT group, and severe (Score 4-5) leg edema was significantly higher in the post-operative RT group than in the OP only group. The frequency of sexual intercourse decreased after treatment in both groups. On the patients' questionnaire, there were no significant differences between the two groups regarding sexual activity. These findings are useful to patients and physicians for shared decision-making in treatment choices. The guidance of everyday life and health information including sexual life after treatment is important.
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Affiliation(s)
- Yuko Kaneyasu
- Corresponding author. Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima, 720-8520 Japan. Tel: +81-84-922-0001; Fax: +81-84-931-3969;
| | - Hisaya Fujiwara
- Department of Obstetrics and Gynecology, Chugoku Rosai Hospital, Hiroshima, Japan
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tetsuo Nishimura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
| | - Tomoko Kazumoto
- Department of Radiation Oncology, Fukaya Red Cross Hospital, Saitama, Japan
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School, Tokushima, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sunao Tokumaru
- Hyogo Ion Beam Medical Center, Hyogo, Japan
- Department of Radiology, Saga University, Saga, Japan
| | - Yoko Harima
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Hiromichi Gomi
- Radiation Oncology Center, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Okinawa, Japan
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Midori Kita
- Department of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical University Saitama Medical Center, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ayako Ohkawa
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Akiko Tozawa-Ono
- Department of Gynecology, St. Marianna University School of Medicine, Toyoko Hospital, Tokyo, Japan
| | - Hiroki Ushijima
- Department of Radiation Oncology, Saitama Cancer Center, Saitama, Japan
| | - Yoko Hasumi
- Department of Obstetrics and Gynecology, Mitsui Memorial Hospital, Tokyo, Japan
- Department of Gynecology, Saitama Cancer Center, Saitama, Japan
| | | | - Yuzuru Niibe
- Department of Public Health, Kurume University School of Medtioicine, Fukuoka, Japan
| | - Tomio Nakagawa
- Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, Hiroshima, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate school of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate school of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
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Okamoto H, Kito S, Tohyama N, Yonai S, Kawamorita R, Nakamura M, Fujimoto T, Tani S, Yomoda A, Isobe T, Furukawa H, Kotaka K, Itami J, Ikushima H, Dokiya T, Shioyama Y. Radiation protection in radiological imaging: a survey of imaging modalities used in Japanese institutions for verifying applicator placements in high-dose-rate brachytherapy. J Radiat Res 2021; 62:58-66. [PMID: 33074329 PMCID: PMC7779356 DOI: 10.1093/jrr/rraa088] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/02/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
Institutional imaging protocols for the verification of brachytherapy applicator placements were investigated in a survey study of domestic radiotherapy institutions. The survey form designed by a free on-line survey system was distributed via the mailing-list system of the Japanese Society for Radiation Oncology. Survey data of 75 institutions between August 2019 and October 2019 were collected. The imaging modalities used were dependent on resources available to the institutions. The displacement of a brachytherapy applicator results in significant dosimetric impact. It is essential to verify applicator placements using imaging modalities before treatment. Various imaging modalities used in institutions included a computed tomography (CT) scanner, an angiography X-ray system, a multi-purpose X-ray system and a radiotherapy simulator. The median total exposure time in overall treatment sessions was $\le$75 s for gynecological and prostate cancers. Some institutions used fluoroscopy to monitor the brachytherapy source movement. Institutional countermeasures for reducing unwanted imaging dose included minimizing the image area, changing the imaging orientation, reducing the imaging frequency and optimizing the imaging conditions. It is worth noting that half of the institutions did not confirm imaging dose regularly. This study reported on the usage of imaging modalities for brachytherapy in Japan. More caution should be applied with interstitial brachytherapy with many catheters that can lead to potentially substantial increments in imaging doses for monitoring the actual brachytherapy source using fluoroscopy. It is necessary to share imaging techniques, standardize imaging protocols and quality assurance/quality control among institutions, and imaging dose guidelines for optimization of imaging doses delivered in radiotherapy should be developed.
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Affiliation(s)
- Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Satoshi Kito
- Department of Radiotherapy, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koutoubashi, Sumida-ku Tokyo, 130-8575, Japan
- Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18 Honkomagome, Bunkyo-ku Tokyo, 113-8677, Japan
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University 53 Shogoin-Kawaharacho, Sakyo-ku Kyoto, Kyoto, 606-8507, Japan
| | - Naoki Tohyama
- Division ofMedical Physics,Tokyo Bay Advanced Imaging & Radiation Oncology Makuhari Clinic, 1-17 Toyosuna, Mihama-ku Chiba, Chiba, 261-0024, Japan
| | - Shunsuke Yonai
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku Chiba, Chiba, 263-8555, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, 1-12-21 Kujyouminami, Nishi-ku Osaka, Osaka, 550-0025, Japan
| | - Masaru Nakamura
- Department of Radiology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku Kyoto, Kyoto, 606-8507, Japan
| | - Syoji Tani
- Department of Medical Technology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku Osaka, Osaka, 558-8558, Japan
| | - Akihiro Yomoda
- Technical Section, Medical Equipment Business, Chiyoda Technol Corporation, 1-7 Yushima, Bunkyo-ku Tokyo, 101-0021, Japan
| | - Toru Isobe
- Oncology Product Marketing Manager, Elekta K.K, 3-9-1 Shibaura, Minato-ku Tokyo, 108-0023, Japan
| | - Hiroshi Furukawa
- Japan Medical Imaging and Radiological Systems Industries Association, 2-2-23 Koraku, Bunkyo-ku, Tokyo, 112-0004, Japan
| | - Kikuo Kotaka
- Nuclear Safety Technology Center, 5-1-3-101 Hakusan, Bunkyo-ku, Tokyo, 112-8604, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045 Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Takushi Dokiya
- Department of Radiology, Kyoundo Hospital, 1-8 Kandasurugadai, Chiyoda-ku Tokyo, 101-0062, Japan
| | - Yoshiyuki Shioyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, Fukuoka, 812-8582, Japan
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Suzuki R, Yoshida M, Oguchi M, Yoshioka Y, Tokumasu K, Osako T, Ono S, Ueno T, Miyagi Y. Efficacy of radiation boost after breast-conserving surgery for breast cancer with focally positive, tumor-exposed margins. J Radiat Res 2020; 61:440-446. [PMID: 32163143 PMCID: PMC7299253 DOI: 10.1093/jrr/rraa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/13/2019] [Revised: 01/03/2020] [Accepted: 01/28/2020] [Indexed: 05/26/2023]
Abstract
Many patients with positive margins following breast-conserving surgery (BCS) undergo re-excisions that aim to remove residual disease from the breast, which brings a tremendous emotional burden in addition to financial consequences. We sought to determine whether re-excisions could be safely avoided without compromising local control and survival by using whole-breast radiation therapy (WBRT) with a tumor bed boost in patients with early-stage breast cancer with focally positive, tumor-exposed margins after BCS. All patients with ductal carcinoma in situ (DCIS) and/or invasive breast cancer (IBC) who had pathologically tumor-exposed margins following BCS, without re-excision and treated with WBRT with tumor bed boost between March 2005 and December 2011, were included. The radiotherapy consisted of WBRT at a dose of 50 Gy in 25 fractions, followed by a tumor bed boost with an additional dose of 16 Gy in eight fractions. A total of 125 patients fulfilled the eligibility criteria; of the 125 patients, 1 had bilateral breast cancer, resulting in 126 cases. Invasive disease was found in 102 (81%) cases and purely ductal carcinoma in situ (DCIS) disease in 24 (19%) cases. The 10-year ipsilateral breast tumor recurrence (IBTR) -free survival, progression-free survival (PFS), and 10-year overall survival (OS) rates were 95%, 92.5% and 96%, respectively. Patients with early-stage breast cancer who receive BCS and have focally positive, tumor-exposed margins can avoid re-excision by undergoing WBRT followed by a sufficient dose of tumor bed boost, without negatively impacting local control and survival.
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Affiliation(s)
- Ryoko Suzuki
- Department of Radiation Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masahiko Oguchi
- Department of Radiation Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Kenji Tokumasu
- Department of Radiation Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Tomo Osako
- Department of Pathology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Shinji Ono
- Department of Breast Oncology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Takayuki Ueno
- Department of Breast Oncology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Yumi Miyagi
- Department of Breast Oncology Center, The Cancer Institute Hospital of JFCR, Tokyo, Japan
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Ricardi U, Badellino S, Filippi AR. Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach. J Radiat Res 2016; 57:i58-i68. [PMID: 26962198 PMCID: PMC4990103 DOI: 10.1093/jrr/rrw006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Oligometastases from solid tumors are currently recognized as a distinct clinical entity, corresponding to an intermediate state between local and widespread disease. It has been suggested that local ablative therapies (including surgery, radiofrequency ablation and radiation therapy) play an important role in this setting, in combination or not with systemic therapies, particularly in delaying disease progression and hopefully in increasing the median survival time. Stereotactic body radiation therapy (SBRT) rapidly emerged in recent years as one of the most effective and less toxic local treatment modalities for lung, liver, adrenal, brain and bone metastases. The aim of this review was to focus on its clinical role for oligometastatic disease in four major cancer subtypes: lung, breast, colorectal and prostate. On the basis of the available evidence, SBRT is able to provide high rates of local tumor control without significant toxicity. Its global impact on survival is uncertain; however, in specific subpopulations of oligometastatic patients there is a trend towards a significant improvement in progression-free and overall survival rates; these important data might be used as a platform for clinical decision-making and establish the basis for the current and future prospective trials investigating its role with or without systemic treatments.
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Affiliation(s)
- Umberto Ricardi
- Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Serena Badellino
- Department of Oncology, University of Torino, Via Genova 3, 10126 Torino, Italy
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