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Takano S, Tomita N, Takaoka T, Niwa M, Torii A, Kita N, Okazaki D, Uchiyama K, Nakanishi-Imai M, Ayakawa S, Iida M, Tsuzuki Y, Otsuka S, Manabe Y, Nomura K, Ogawa Y, Miyakawa A, Miyamoto A, Takemoto S, Yasui T, Hiwatashi A. Late genitourinary toxicity in salvage radiotherapy for prostate cancer after radical prostatectomy: impact of daily fraction doses. Br J Radiol 2024; 97:1050-1056. [PMID: 38466928 DOI: 10.1093/bjr/tqae055] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/31/2023] [Accepted: 03/07/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To evaluate the impact of daily fraction doses on late genitourinary (GU) toxicity after salvage radiotherapy (SRT) for prostate cancer. METHODS This multi-institutional retrospective study included 212 patients who underwent SRT between 2008 and 2018. All patients received image-guided intensity-modulated SRT at a median dose of 67.2 Gy in 1.8-2.3 Gy/fraction. The cumulative rates of late grade ≥2 GU and gastrointestinal (GI) toxicities were compared using Gray test, stratified by the ≤2.0 Gy/fraction (n = 137) and ≥2.1 Gy/fraction groups (n = 75), followed by multivariate analyses. The total dose was represented as an equivalent dose in 2-Gy fractions (EQD2) with α/β = 3 Gy. RESULTS After a median follow-up of 63 months, the cumulative rates of 5-year late grade ≥2 GU and GI toxicities were 14% and 2.5%, respectively. The cumulative rates of 5-year late grade ≥2 GU toxicity in the ≥2.1 Gy/fraction and ≤2.0 Gy/fraction groups were 22% and 10%, respectively (P = .020). In the multivariate analysis, ≥2.1 Gy/fraction was still associated with an increased risk of late grade ≥2 GU toxicity (hazard ratio, 2.37; 95% confidence interval, 1.12-4.99; P = .023), while the total dose was not significant. CONCLUSION The present results showed that ≥2.1 Gy/fraction resulted in a higher incidence of late grade ≥2 GU toxicity in SRT. ADVANCES IN KNOWLEDGE The impact of fraction doses on late GU toxicity after SRT remains unknown. The results suggest that higher fraction doses may increase the risk of late GU toxicity in SRT.
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Affiliation(s)
- Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Kaoru Uchiyama
- Department of Radiology, Kariya Toyota General Hospital, Kariya, Aichi 448-8505, Japan
| | - Mikiko Nakanishi-Imai
- Department of Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi 466-8650, Japan
| | - Shiho Ayakawa
- Department of Radiology, Japan Community Health care Organization Chukyo Hospital, Nagoya, Aichi 457-8510, Japan
| | - Masato Iida
- Department of Radiation Oncology, Suzuka General Hospital, Suzuka, Mie 513-0818, Japan
| | - Yusuke Tsuzuki
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Aichi 462-8508, Japan
| | - Shinya Otsuka
- Department of Radiology, Okazaki City Hospital, Okazaki, Aichi 444-8553, Japan
| | - Yoshihiko Manabe
- Department of Radiation Oncology, Nanbu Tokushukai General Hospital, Shimajiri, Okinawa 901-0493, Japan
| | - Kento Nomura
- Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Aichi 462-8508, Japan
| | - Yasutaka Ogawa
- Department of Radiation Oncology, Kasugai Municipal Hospital, Kasugai, Aichi 486-8510, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi 460-0001, Japan
| | - Akihiko Miyamoto
- Department of Radiation Oncology, Hokuto Hospital, Obihiro, Hokkaido 080-0833, Japan
| | - Shinya Takemoto
- Department of Radiation Oncology, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka 426-8662, Japan
| | - Takahiro Yasui
- Department of Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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Takano S, Tomita N, Kuno M, Niwa M, Torii A, Takaoka T, Kita N, Okazaki D, Yamamoto S, Kawai T, Sugie C, Ogawa Y, Matsumoto K, Uchiyama K, Otsuka S, Matsui T, Miyakawa A, Mizuno T, Iida M, Tanikawa M, Mase M, Hiwatashi A. Simultaneous boost radiotherapy versus conventional dose radiotherapy for patients with newly diagnosed glioblastoma: a multi-institutional analysis. Sci Rep 2024; 14:9283. [PMID: 38654028 PMCID: PMC11039761 DOI: 10.1038/s41598-024-60154-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
We compared survival outcomes of high-dose concomitant boost radiotherapy (HDCBRT) and conventional dose radiotherapy (CRT) for newly diagnosed glioblastoma (GB). Patients treated with intensity-modulated radiation therapy for newly diagnosed GB were included. In HDCBRT, specific targets received 69, 60, and 51 Gy in 30 fractions, while 60 Gy in 30 fractions was administered with a standard radiotherapy method in CRT. Overall survival (OS) and progression-free survival (PFS) were compared using the Log-rank test, followed by multivariate Cox analysis. The inverse probability of treatment weighting (IPTW) method was also applied to each analysis. Among 102 eligible patients, 45 received HDCBRT and 57 received CRT. With a median follow-up of 16 months, the median survival times of OS and PFS were 21 and 9 months, respectively. No significant differences were observed in OS or PFS in the Kaplan-Meier analyses. In the multivariate analysis, HDCBRT correlated with improved OS (hazard ratio, 0.49; 95% confidence interval, 0.27-0.90; P = 0.021), and this result remained consistent after IPTW adjustments (P = 0.028). Conversely, dose suppression due to the proximity of normal tissues and IMRT field correlated with worse OS and PFS (P = 0.008 and 0.049, respectively). A prospective study with a stricter protocol is warranted to validate the efficacy of HDCBRT for GB.
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Affiliation(s)
- Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan.
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi, 491-8558, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Shintaro Yamamoto
- Department of Radiology, Japan Community Health Care Organization Chukyo Hospital, 1-1-10 Sanjo, Minami-Ku, Nagoya, Aichi, 457-8510, Japan
| | - Tatsuya Kawai
- Department of Radiology, Nagoya City University Midori Municipal Hospital, 1-77 Shiomigaoka, Midori-Ku, Nagoya, Aichi, 458-0037, Japan
| | - Chikao Sugie
- Department of Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-Cho, Showa-Ku, Nagoya, Aichi, 466-8650, Japan
| | - Yasutaka Ogawa
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-Cho, Kasugai, Aichi, 486-8510, Japan
| | - Kenichi Matsumoto
- Department of Radiation Oncology, Hokuto Hospital, 7-5 Kisen, Inada-Cho, Obihiro, Hokkaido, 080-0833, Japan
| | - Kaoru Uchiyama
- Department of Radiology, Kariya Toyota General Hospital, 5-15 Sumiyoshi-Cho, Kariya, Aichi, 448-8505, Japan
| | - Shinya Otsuka
- Department of Radiology, Okazaki City Hospital, 3-1 Goshoai, Koryuji-Cho, Okazaki, Aichi, 444-8553, Japan
| | - Tooru Matsui
- Department of Radiology, Konan Kosei Hospital, 137 Oomatsubara, Takaya-Cho, Konan, Aichi, 483-8704, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Tomoki Mizuno
- Department of Radiation Oncology, Suzuka General Hospital, 1275-53 Yamanoue, Yasuzuka-Cho, Suzuka, Mie, 513-0818, Japan
| | - Masato Iida
- Department of Radiology, Toyokawa City Hospital, Yawata-Cho Noji 23, Toyokawa, Aichi, 442-8561, Japan
| | - Motoki Tanikawa
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan
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Takaoka T, Yanagi T, Takahashi S, Shibamoto Y, Imai Y, Okazaki D, Niwa M, Torii A, Kita N, Takano S, Tomita N, Hiwatashi A. Comparing different boost concepts and beam configurations for proton therapy of pancreatic cancer. Phys Imaging Radiat Oncol 2024; 30:100583. [PMID: 38711921 PMCID: PMC11070341 DOI: 10.1016/j.phro.2024.100583] [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: 10/30/2023] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
Background and Purpose Interfractional geometrical and anatomical variations impact the accuracy of proton therapy for pancreatic cancer. This study investigated field-in-field (FIF) and simultaneous integrated boost (SIB) concepts for scanned proton therapy treatment with different beam configurations. Materials and Methods Robustly optimized treatment plans for fifteen patients were generated using FIF and SIB techniques with two, three, and four beams. The prescribed dose in 20 fractions was 60 Gy(RBE) for the internal gross tumor volume (IGTV) and 46 Gy(RBE) for the internal clinical target volume. Verification computed tomography (vCT) scans was performed on treatment days 1, 7, and 16. Initial treatment plans were recalculated on the rigidly registered vCTs. V100% and D95% for targets and D2cm3 for the stomach and duodenum were evaluated. Robustness evaluations (range uncertainty of 3.5 %) were performed to evaluate the stomach and duodenum dose-volume parameters. Results For all techniques, IGTV V100% and D95% decreased significantly when recalculating the dose on vCTs (p < 0.001). The median IGTV V100% and D95% over all vCTs ranged from 74.2 % to 90.2 % and 58.8 Gy(RBE) to 59.4 Gy(RBE), respectively. The FIF with two and three beams, and SIB with two beams maintained the highest IGTV V100% and D95%. In robustness evaluations, the ΔD2cm3 of stomach was highest in two beams plans, while the ΔD2cm3 of duodenum was highest in four beams plans, for both concepts. Conclusion Target coverage decreased when recalculating on CTs at different time for both concepts. The FIF with three beams maintained the highest IGTV coverage while sparing normal organs the most.
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Affiliation(s)
- Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Yanagi
- Department of Radiation Oncology, Narita Memorial Proton Center, Toyohashi, Japan
| | - Shinsei Takahashi
- Department of Radiation Oncology, Narita Memorial Proton Center, Toyohashi, Japan
| | - Yuta Shibamoto
- Department of Radiation Oncology, Narita Memorial Proton Center, Toyohashi, Japan
| | - Yuto Imai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Radiation Oncology, Narita Memorial Proton Center, Toyohashi, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Tomita N, Hayashi N, Mizuno T, Kitagawa Y, Yasui K, Saito Y, Sudo S, Takano S, Kita N, Torii A, Niwa M, Okazaki D, Takaoka T, Kawakita D, Iwasaki S, Hiwatashi A. Dosimetric and radiobiological analyses of a de-escalation strategy for elective nodal regions in human papillomavirus-associated oropharyngeal cancer. Tech Innov Patient Support Radiat Oncol 2023; 28:100221. [PMID: 37886016 PMCID: PMC10598397 DOI: 10.1016/j.tipsro.2023.100221] [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: 06/02/2023] [Revised: 09/24/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction In this simulation study, we examined the effects of a de-escalation strategy with a reduced dose to subclinical nodal regions in patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma (OPC). Methods We created two patterns of intensity-modulated radiotherapy for 16 patients with HPV-associated OPC. In the standard and de-escalation plans, the initial field including elective nodal regions received 46 and 30 Gy, followed by 20 and 36 Gy to the cutdown field, respectively. Comparison metrics were set for each organ at risk (OAR). We compared these metric values and the probability of adverse effects based on the normal tissue complication probability (NTCP) model between the two plans. Results Both plans generally met the dose constraints for the targets and all OAR. Among the comparison metrics, the mean doses to the brain, pharyngeal constrictor muscle, thyroid, and skin and the dose to a 1 % volume of the skin were higher in the standard plan than in the de-escalation plan (P = 0.031, 0.007, < 0.001, < 0.001, and 0.006, respectively). NTCP analyses revealed that the probability of adverse effects in the ipsilateral parotid gland and thyroid was higher in the standard plan than in the de-escalation plan (standard vs. de-escalation plans: ipsilateral parotid gland, 6.4 % vs. 5.0 %, P = 0.016; thyroid, 3.3 % vs. 0.5 %, P < 0.001). Conclusions A de-escalation strategy with elective nodal regions is a promising treatment to prevent a decline in the quality of life in patients with HPV-associated OPC, particularly xerostomia, dysphagia, and hypothyroidism.
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Affiliation(s)
- Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Naoki Hayashi
- Division of Medical Physics, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Tomoki Mizuno
- Department of Radiology, Toyokawa City Hospital, 23 Yawatachonoji, Toyokawa, Aichi 442-8561, Japan
| | - Yuto Kitagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Keisuke Yasui
- Division of Medical Physics, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Yasunori Saito
- Department of Radiology, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Shuo Sudo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Daisuke Kawakita
- Department of Otolaryngology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Kita N, Tomita N, Takaoka T, Matsuura A, Okazaki D, Niwa M, Torii A, Takano S, Mekata Y, Niimi A, Hiwatashi A. Symptomatic radiation-induced rib fractures after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Clin Transl Radiat Oncol 2023; 43:100683. [PMID: 37790583 PMCID: PMC10543765 DOI: 10.1016/j.ctro.2023.100683] [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: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Background and purpose The present study investigated the relationships between the risk of radiation-induced rib fractures (RIRF) and clinical and dosimetric factors in stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). We also examined dosimetric parameters associated with symptomatic or asymptomatic RIRF and the dosimetric threshold for symptomatic RIRF. Materials and methods We reviewed 244 cases of early-stage NSCLC treated with SBRT. Gray's test and the Fine-Gray model were performed to examine the relationships between clinical and dosimetric factors and grade ≥ 2 (i.e., symptomatic) RIRF. The effects of each dose parameter on grade ≥ 1 and ≥ 2 RIRF were assessed with the Fine-Gray model. The t-test was used to compare each dose parameter between the grade 1 and grade ≥ 2 groups. Optimal thresholds were tested using receiver operating characteristic (ROC) curves. Results With a median follow-up period of 48 months, the 4-year cumulative incidence of grade ≥ 1 and grade ≥ 2 RIRF were 26.4 % and 8.0 %, respectively. Regarding clinical factors, only age was associated with the development of grade ≥ 2 RIRF (p = 0.024). Among dosimetric parameters, only V40Gy significantly differed between the grade 1 and grade ≥ 2 groups (p = 0.015). The ROC curve analysis of grade ≥ 2 RIRF showed that the optimal diagnostic thresholds for D3cc, D4cc, D5cc, and V40Gy were 45.86 Gy (area under the curve [AUC], 0.706), 39.02 Gy (AUC, 0.705), 41.62 Gy (AUC, 0.702), and 3.83 cc (AUC, 0.730), respectively. These results showed that V40Gy ≤ 3.83 cc was the best indicator of grade ≥ 2 RIRF. The 4-year incidence of grade ≥ 2 RIRF in the V40Gy ≤ 3.83 cc vs. > 3.83 cc groups was 1.8 % vs. 14.2 % (p = 0.001). Conclusion The present results recommend V40Gy ≤ 3.83 cc as the threshold for grade ≥ 2 RIRF in SBRT.
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Affiliation(s)
- Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akane Matsuura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Yuji Mekata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Sudo S, Torii A, Tomita N, Takaoka T, Horie R, Takano S, Kita N, Niwa M, Okazaki D, Imai Y, Niwa M, Nakashima Y, Osumi K, Tsuzuki Y, Kuno M, Hiwatashi A. [Case of Long-Term Response to Radiotherapy for Intramedullary Spinal Cord Metastasis from Ovarian Cancer after Surgery]. Gan To Kagaku Ryoho 2023; 50:1219-1221. [PMID: 38056879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Intramedullary spinal cord metastasis(ISCM)often causes spinal cord neuropathy and should be treated as an oncologic emergency. However, it recurs in most cases after treatment, ISCM is a disease with a very unfavorable prognosis. Herein, we report a successfully treated case of ISCM with emergent and high-dose radiotherapy. A 53-year-old woman had difficulty walking without assistance 2 years after surgery for ovarian cancer. She received emergent radiotherapy at a total dose of 50 Gy in 25 fractions. Her neurological symptoms dramatically improved over 3 weeks after radiotherapy. ISCM has been controlled using the imaging tests at 5 years after radiotherapy. We believe that both emergent and high-dose radiotherapy were effective for ISCM.
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Affiliation(s)
- Shuou Sudo
- Dept. of Radiology, Nagoya City University Graduate School of Medical Sciences
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Kita N, Tomita N, Takaoka T, Mekata Y, Okazaki D, Niwa M, Torii A, Takano S, Hiwatashi A. Risk Factors for Symptomatic Radiation Pneumonitis after Stereotactic Body Radiotherapy (SBRT) for Early-Stage Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e30. [PMID: 37785097 DOI: 10.1016/j.ijrobp.2023.06.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To identify risk factors for symptomatic radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) in patients with early-stage lung cancer. MATERIALS/METHODS We reviewed patients with clinical stage IA1-IIA non-small cell lung cancer treated by SBRT in our institution. The primary endpoint was grade ≥ 2 RP. To evaluate the relationship between clinical risk factors and grade ≥ 2 RP, the Gray test was used for univariate analysis and the Fine-Gray model for multivariate analysis. Dose parameters were univariate analyzed using the Fine-Gray model. Optimal thresholds for dose parameters were tested using receiver operating characteristic (ROC) curves. RESULTS Among a total of 244 patients analyzed. The median age of patients was 77 years. The median follow-up period was 48 months. The 4-year cumulative incidence of grade ≥ 2 RP was 15.3% for all patients. In univariate analysis, tumor size (p = 0.01), central tumor (p < 0.001), interstitial pneumonia (p = 0.002), biological effective dose (BED, α/β ratio of 10 Gy) (p = 0.017), lung volume (%) receiving at least 8 Gy (V8) (p = 0.012), V10 (p = 0.011), V20 (p = 0.022) and mean lung dose (MLD) (p = 0.014) were significantly associated with the risk of grade ≥ 2 RP. In multivariate analysis, central tumor (hazard ratio [HR], 3.77; 95% confidence interval [CI], 1.88-7.55; p < 0.001) and interstitial pneumonia (HR, 4.88; 95% CI, 1.77-13.43; p = 0.002) were significantly associated with the risk of grade ≥ 2 RP. ROC curve analysis showed that the optimal diagnostic thresholds for lung V8, V10, V20, and MLD were 19.5% (the area under the curve [AUC]-0.629), 16.7% (AUC-0.629), 7.9% (AUC-0.621), and 5.2 Gy (AUC-0.623). The incidence of RP2 was found to be significantly high for values higher than the ROC threshold. The 4-year cumulative incidence of grade ≥ 2 RP in the V10 ≤ 16.7% vs V10 > 16.7% groups were 10% vs. 27% (p = 0.0013). CONCLUSION Central tumor and interstitial pneumonia were significant risk factors for RP2 after SBRT. We recommend that lung V10 be kept below 16.7%.
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Affiliation(s)
- N Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - N Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Y Mekata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - D Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - M Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - A Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - A Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Takano S, Tomita N, Niwa M, Torii A, Takaoka T, Okazaki D, Kita N, Uchiyama K, Imai M, Ayakawa S, Iida M, Tsuzuki Y, Otsuka S, Manabe Y, Nomura K, Ogawa Y, Miyakawa A, Miyamoto A, Yasui T, Hiwatashi A. Effects of Radiation Doses on Clinical Recurrence in Patients with Biochemically Recurrent Prostate Cancer after Prostatectomy. Int J Radiat Oncol Biol Phys 2023; 117:e444. [PMID: 37785436 DOI: 10.1016/j.ijrobp.2023.06.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Salvage radiotherapy (SRT) to the prostate bed is the only curative treatment for patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Although several systematic reviews indicated that a dose escalation in the range of 60-70 Gy improved biochemical control, the effects of radiation doses on clinical relapse after SRT remain unclear. Our aim was to investigate the relationship between radiation doses and clinical relapse-free survival (cRFS) after SRT. MATERIALS/METHODS We identified 295 eligible patients receiving SRT for biochemically recurrent prostate cancer after RP between 2005 and 2018 at 15 institutions. Sixteen patients (5%) received short-term (< 6 months) androgen deprivation therapy (ADT) following RP and/or concurrently with SRT. SRT was delivered to the prostate and seminal vesicle bed using photon beams at a median (range) dose of 66 Gy (61-85) in 1.8-3.0 Gy fractions. The primary outcome was cRFS. Clinical relapse was identified on radiological imaging and/or biopsy and included local recurrence, lymph node metastasis, and distant metastasis. In all analyses, doses were recalculated as an equivalent dose in 2-Gy fractions (EQD2) with α/β = 1.5 Gy. Clinical RFS between the EQD2 ≥ 66 Gy (n = 229) and EQD2 < 66 Gy (n = 66) groups were compared using the Log-rank test, followed by univariate and multivariate Cox regression analyses and a subgroup analysis. RESULTS The median follow-up duration was 73 months. Among patients with BCR (n = 119), 79 of 96 (82%) in the EQD2 ≥ 66 Gy group and 21 of 23 (91%) in the EQD2 < 66 Gy group received second salvage ADT (p = 0.36). Among all patients (n = 295), clinical relapse was identified in 22 (7%) patients after SRT. Six-year biochemical relapse-free survival (bRFS), cRFS, cancer-specific survival (CSS), and overall survival (OS) rates were 58%, 93%, 98%, and 94%, respectively. Six-year cRFS rates were 94% (95% confidence interval [CI], 90-97) in the EQD2 ≥ 66 Gy group and 87% (95% CI, 75-93) in the EQD2 < 66 Gy group (p = 0.020). The multivariate analysis revealed that EQD2 < 66 Gy, Gleason score ≥ 8, seminal vesicle involvement, and PSA at BCR ≥ 0.5 ng/ml correlated with clinical relapse (p = 0.0016, 0.014, 0.011, and 0.027, respectively). The subgroup analysis showed the consistent benefit of EQD2 ≥ 66 Gy in patients across most subgroups including PSA at BCR after RP, extracapsular extension, and age at SRT. CONCLUSION This large multi-institutional observational study demonstrated that a higher SRT dose (EQD2 ≥ 66 Gy) resulted in superior cRFS. The present result supports the dose recommendations in the 2023 National Comprehensive Cancer Network guidelines (64-72 Gy) even in terms of clinical relapse. Prospective trial is warranted to investigate an upper threshold for optimal SRT dose.
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Affiliation(s)
- S Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - N Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - M Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - A Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - D Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - N Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - K Uchiyama
- Department of Radiology, Kariya-Toyota general hospital, Nagoya, Japan
| | - M Imai
- Department of Radiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - S Ayakawa
- Department of Radiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - M Iida
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Radiation Oncology, Suzuka General Hospital, Suzuka, Japan
| | - Y Tsuzuki
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - S Otsuka
- Department of Radiology, Okazaki City Hospital, Okazaki, Japan
| | - Y Manabe
- Department of Radiation Oncology, Nanbu Tokushukai Hospital, Okinawa, Japan
| | - K Nomura
- Department of Radiotherapy, Nagoya City West Medical Center, Nagoya, Japan
| | - Y Ogawa
- Department of Radiation Oncology, Kasugai Municipal Hospital, Kasugai, Japan
| | - A Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - A Miyamoto
- Department of Radiation Oncology, Hokuto Hospital, Obihiro, Japan
| | - T Yasui
- Department of Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - A Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Iida M, Murai T, Kuno M, Osumi K, Nakanishi-Imai M, Okazaki D, Murase T, Kawakita D, Iwasaki S, Inagaki H, Tomita N, Shibamoto Y, Hiwatashi A. Importance of the Number and Location of Lymph Node Metastasis in Oropharyngeal Cancer. In Vivo 2023; 37:2210-2218. [PMID: 37652496 PMCID: PMC10500500 DOI: 10.21873/invivo.13321] [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: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM The 8th edition of the American Joint Committee on Cancer staging system classifies oropharyngeal cancer (OPC) by the expression of p16. The discrepancy observed in this system between pathological and clinical N-stages in p16-positive OPC has provoked controversy. Therefore, this study investigated prognostic factors not included in the new staging system for p16-positive OPC patients. PATIENTS AND METHODS Patients with non-metastatic OPC receiving radiotherapy were reviewed. Clinical lymph node statuses were reassessed based on contrast-enhanced computed tomography and fluorodeoxyglucose positron emission tomography. Overall survival (OS) and cause-specific survival (CSS) were analyzed using multivariate analyses to adjust baseline imbalances. RESULTS In total, 166 OPC patients were reviewed. Among them, 81 patients with p16-positive were analyzed. Three or more lymph node metastases (LNM) were observed in 21 p16-positive OPCs. Retropharyngeal lymph node metastasis (Rp) was found in 12. Three-year OS, CSS, and progression-free survival rates in p16-positive patients were 76, 88, and 81%, respectively. In multivariate analyses of p16-positive OPC, LNM ≥3 was a prognostic factor of OS (hazard ratio=9.30, p<0.001) and CSS (hazard ratio=17.80, p=0.005). Rp was associated with poor CSS (hazard ratio=8.73, p=0.03). In N0-1 p16-positive patients, LNM ≥3 trended to be associated with poor OS (hazard ratio=3.93, p=0.06). CSS in patients with Rp was unfavorable (hazard ratio=70.16, p=0.05). CONCLUSION LNM ≥3 and Rp may be predictive of OS and CCS in p16-positive OPC. These are also possibly used to subcategorize p16-positive cN0-1 OPC. Further validation of lymph node staging is needed to refine the clinical staging system.
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Affiliation(s)
- Masato Iida
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;
- Department of Radiology, Toyokawa City Hospital, Toyokawa, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Mayu Kuno
- Department of Radiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Kenshiro Osumi
- Department of Radiology, Kariya Toyota General Hospital, Kariya, Japan
| | - Mikiko Nakanishi-Imai
- Department of Radiology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Radiation Oncology, Chukyo Hospital, Nagoya, Japan
| | - Takayuki Murase
- Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinichi Iwasaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Inagaki
- Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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10
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Niwa M, Tomita N, Takaoka T, Takano H, Makita C, Matsuo M, Adachi S, Oshima Y, Yamamoto S, Kuno M, Miyakawa A, Okazaki D, Torii A, Kita N, Takano S, Nakamura M, Kato H, Morita A, Hiwatashi A. Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study. Cancers (Basel) 2023; 15:3696. [PMID: 37509356 PMCID: PMC10378060 DOI: 10.3390/cancers15143696] [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: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Angiosarcoma of the scalp and face (ASF) is a rare, aggressive tumor often treated with multimodal therapy, including radiation therapy (RT). This study assessed RT outcomes for ASF and identified prognostic factors. Data from 68 non-metastatic ASF patients undergoing RT with or without other therapies were analyzed. Median radiation dose was 66 Gy in 33 fractions (interquartile range (IQR) 60-70 Gy in 28-35 fractions). Local control (LC), progression-free survival (PFS), and overall survival (OS) rates were calculated using Kaplan-Meier analysis. Multivariate analyses and adverse event evaluation were conducted. Median patient age was 75 years (IQR 71-80 years), with a median follow-up of 17 months (IQR 11-42 months). One-/three-year LC rates were 57/37%, PFS rates were 44/22%, and OS rates were 81/44%. Multivariate analyses showed that an equivalent dose in a 2 Gy fraction (EQD2) >66 Gy correlated with improved LC (HR 2.35, 95% CI 1.03-5.32, p = 0.041). Combining chemotherapy (HR 2.43, 95% CI 1.08-5.46, p = 0.032) or surgery (HR 2.41, 95% CI 1.03-5.59, p = 0.041) improved PFS. No factors influenced OS. Late grade 3+ toxicities occurred in 1%, with one patient developing a grade 4 skin ulcer. These findings suggest that EQD2 > 66 Gy and combining chemotherapy or surgery can enhance LC or PFS in ASF. Further prospective studies are needed to determine the optimal treatment strategy for this rare malignancy, particularly in elderly patients.
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Affiliation(s)
- Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hirota Takano
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Chiyoko Makita
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Masayuki Matsuo
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Sou Adachi
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Yukihiko Oshima
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Shintaro Yamamoto
- Department of Radiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya 457-8510, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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11
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Kita N, Tomita N, Takaoka T, Okazaki D, Niwa M, Torii A, Takano S, Mekata Y, Niimi A, Hiwatashi A. Clinical and dosimetric factors for symptomatic radiation pneumonitis after stereotactic body radiotherapy for early-stage non-small cell lung cancer. Clin Transl Radiat Oncol 2023; 41:100648. [PMID: 37346273 PMCID: PMC10279771 DOI: 10.1016/j.ctro.2023.100648] [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: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
Background and purpose The present study attempted to identify risk factors for symptomatic radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) in patients with early-stage non-small cell lung cancer (NSCLC). Materials and methods We reviewed 244 patients with early-stage NSCLC treated with SBRT. The primary endpoint was the incidence of grade ≥2 RP. Gray's test was performed to examine the relationship between clinical risk factors and grade ≥2 RP, and the Fine-Gray model was used for a multivariate analysis. The effects of each dose parameter on grade ≥2 RP were evaluated with the Fine-Gray model and optimal thresholds were tested using receiver operating characteristic (ROC) curves. Results With a median follow-up period of 48 months, the 4-year cumulative incidence of grade ≥2 RP was 15.3%. Gray's test revealed that tumor size, a central tumor, interstitial pneumonia, and the biologically effective dose correlated with RP. In the multivariate analysis, a central tumor and interstitial pneumonia remained significant factors (p < 0.001, p = 0.002). Among dose parameters, the total lung volume (%) receiving at least 8 Gy (V8), V10, V20, and the mean lung dose correlated with RP (p = 0.012, 0.011, 0.022, and 0.014, respectively). The results of the Fine-Gray model and ROC curve analyses showed that V10 >16.7% was the best indicator of symptomatic RP among dose parameters. Conclusion The present results suggest that a central tumor and interstitial pneumonia are independent risk factors for symptomatic RP and lung V10 ≤16.7% is recommended as the threshold in SBRT.
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Affiliation(s)
- Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Yuji Mekata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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12
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Torii A, Tomita N, Kuno M, Nishio M, Yamada Y, Takaoka T, Okazaki D, Niwa M, Kita N, Takano S, Murao T, Ogawa Y, Hiwatashi A. Intensity-modulated radiation therapy with the central shielding technique for patients with uterine cervical cancer†. J Radiat Res 2023:rrad039. [PMID: 37321676 DOI: 10.1093/jrr/rrad039] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/25/2023] [Indexed: 06/17/2023]
Abstract
We aimed to examine outcomes and toxicities of intensity-modulated radiation therapy (IMRT) with the central shielding (CS) technique for patients with uterine cervical cancer. This retrospective study included 54 patients with International Federation of Gynecology and Obstetrics IB-IVA cancer. Whole pelvic radiotherapy or extended-field radiotherapy were performed at the dose of 50.4 Gy in 28 fractions with helical tomotherapy (HT). Six patients had para-aortic lymph node metastases. The CS technique with HT was utilized after a total dose of 28.8-41.4 Gy to reduce doses to the rectum and bladder. The prescribed dose of intracavitary brachytherapy was mainly 18-24 Gy in three or four fractions at point A. Concurrent chemotherapy was used for 47 patients (87%). Median follow-up time was 56 months. Seventeen patients (31%) developed recurrence. The recurrence of the cervix was observed in two patients (4%). The 5-year rates of the locoregional control, progression-free survival (PFS) and overall survival were 79, 66 and 82%, respectively. Among several factors evaluated, histological type of adenocarcinoma was only a significantly worse prognostic factor for PFS by multivariate analysis (hazard ratio, 4.9 [95% confidence interval, 1.3-18], P = 0.018). Grade 2 or higher late toxicities were observed in nine patients (17%). Two patients (4%) each had grade 3 proctitis and grade 3 ileus, respectively. No grade 4 toxicity or treatment-related death was observed. The results suggest that IMRT with the CS technique allows a high local control without increasing the risk of complications for cervical cancer patients.
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Affiliation(s)
- Akira Torii
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan
| | - Masahiro Nishio
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Yuki Yamada
- Department of Radiation Oncology, Konan Kosei Hospital, 137 Ohmatsubara, Takaya-cho, Konan, Aichi 483-8704, Japan
| | - Taiki Takaoka
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Nozomi Kita
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Takayuki Murao
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan
| | - Yasutaka Ogawa
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Akio Hiwatashi
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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13
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Kita N, Tomita N, Takaoka T, Sudo S, Tsuzuki Y, Okazaki D, Niwa M, Torii A, Takano S, Niimi A, Hiwatashi A. Comparison of Recurrence Patterns between Adenocarcinoma and Squamous Cell Carcinoma after Stereotactic Body Radiotherapy for Early-Stage Lung Cancer. Cancers (Basel) 2023; 15:cancers15030887. [PMID: 36765844 PMCID: PMC9913504 DOI: 10.3390/cancers15030887] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
We compared recurrence patterns between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) after stereotactic body radiotherapy (SBRT) for early-stage lung cancer. Patients with ADC and SCC histology, who were treated with SBRT for clinical stage IA1-IIA lung cancer at our institution, were included in the analysis. The rates of disease-free survival (DFS), overall survival (OS), local recurrence (LR), lymph node metastasis (LNM), and distant metastasis (DM) were calculated using the Kaplan-Meier method or the cumulative incidence function. Among the 204 patients analyzed, 138 and 66 were in the ADC and SCC groups, respectively. The median follow-up period was 60 months. The five-year DFS and OS rates were 57% vs. 41% and 69% vs. 48% in the ADC and SCC groups, respectively (p = 0.015 and 0.019, respectively). In the multivariate analysis, the histological type was not associated with DFS or OS. Five-year LR, LNM, and DM rates were 10% vs. 24%, 12% vs. 20%, and 25% vs. 27% in the ADC and SCC groups, respectively (p = 0.0067, 0.074, and 0.67, respectively). The multivariate analysis identified the histological type of SCC as an independent factor for LR (hazard ratio, 2.41; 95% confidence interval, 1.21-4.77; p = 0.012). The present results suggest that the risk of LR after SBRT is higher for SCC than for ADC.
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Affiliation(s)
- Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
- Correspondence: ; Tel.: +81-52-853-8276
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Shuou Sudo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Yusuke Tsuzuki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Aichi, Japan
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14
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Tomita N, Ishiyama H, Makita C, Ohshima Y, Nagai A, Baba F, Kuno M, Otsuka S, Kondo T, Sugie C, Kawai T, Takaoka T, Okazaki D, Torii A, Niwa M, Kita N, Takano S, Kawakami S, Matsuo M, Kumano T, Ito M, Adachi S, Abe S, Murao T, Hiwatashi A. Daily irradiation versus irradiation at two- to three-day intervals in stereotactic radiotherapy for patients with 1-5 brain metastases: study protocol for a multicenter open-label randomized phase II trial. BMC Cancer 2022; 22:1259. [PMID: 36471274 PMCID: PMC9720969 DOI: 10.1186/s12885-022-10371-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radiobiological daily changes within tumors are considered to be quite different between stereotactic radiotherapy (SRT) (e.g., 50 Gy in 4 fractions) and conventional radiotherapy (e.g., 60 Gy in 30 fractions). We aim to assess the optimal interval of irradiation in SRT and compare outcomes of daily irradiation with irradiation at two- to three-day intervals in SRT for patients with one to five brain metastases (BM). METHODS This study is conducted as a multicenter open-label randomized phase II trial. Patients aged 20 or older with one to five BM, less than 3.0 cm diameter, and Karnofsky Performance Status ≥70 are eligible. A total of 70 eligible patients will be enrolled. After stratifying by the number of BMs (1, 2 vs. 3-5) and diameter of the largest tumor (< 2 cm vs. ≥ 2 cm), we randomly assigned patients (1:1) to receive daily irradiation (Arm 1), or irradiation at two- to three-day intervals (Arm 2). Both arms are performed with total dose of 27-30 Gy in 3 fractions. The primary endpoint is an intracranial local control rate, defined as intracranial local control at initially treated sites. We use a randomized phase II screening design with a two-sided α of 0∙20. The phase II trial is positive with p < 0.20. All analyses are intention to treat. This study is registered with the UMIN-clinical trials registry, number UMIN000048728. DISCUSSION This study will provide an assessment of the impact of SRT interval on local control, survival, and toxicity for patients with 1-5 BM. The trial is ongoing and is recruiting now. TRIAL REGISTRATION UMIN000048728. Date of registration: August 23, 2022. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000055515 .
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Affiliation(s)
- Natsuo Tomita
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Hiromichi Ishiyama
- grid.410786.c0000 0000 9206 2938Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0329 Japan
| | - Chiyoko Makita
- grid.411704.7Department of Radiation Oncology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yukihiko Ohshima
- grid.411234.10000 0001 0727 1557Department of Radiology, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195 Japan
| | - Aiko Nagai
- grid.260433.00000 0001 0728 1069Department of Radiation Oncology, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya, Aichi 464-8547 Japan
| | - Fumiya Baba
- grid.260433.00000 0001 0728 1069Department of Radiation Oncology, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya, Aichi 462-8508 Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Shinya Otsuka
- grid.413724.70000 0004 0378 6598Department of Radiation Oncology, Okazaki City Hospital, 3-1 Goshoai, Koryuji-cho, Okazaki, Aichi 444-8553 Japan
| | - Takuhito Kondo
- grid.416417.10000 0004 0569 6780Department of Radiation Oncology, Nagoya Ekisaikai Hospital, 4-66 Syonen-cho, Nakagawa-ku, Nagoya, Aichi 454-8502 Japan
| | - Chikao Sugie
- Department of Radiation Oncology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi 466-8650 Japan
| | - Tatsuya Kawai
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Taiki Takaoka
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Dai Okazaki
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Akira Torii
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Masanari Niwa
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Nozomi Kita
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Seiya Takano
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Shogo Kawakami
- grid.410786.c0000 0000 9206 2938Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0329 Japan
| | - Masayuki Matsuo
- grid.411704.7Department of Radiation Oncology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Tomoyasu Kumano
- grid.411704.7Department of Radiation Oncology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Makoto Ito
- grid.411234.10000 0001 0727 1557Department of Radiology, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195 Japan
| | - Sou Adachi
- grid.411234.10000 0001 0727 1557Department of Radiology, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195 Japan
| | - Souichiro Abe
- grid.411234.10000 0001 0727 1557Department of Radiology, Aichi Medical University, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195 Japan
| | - Takayuki Murao
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558 Japan
| | - Akio Hiwatashi
- grid.411885.10000 0004 0469 6607Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
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15
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Kawamura M, Koide Y, Murai T, Ishihara S, Takase Y, Murao T, Okazaki D, Yamaguchi T, Uchiyama K, Itoh Y, Kodaira T, Shibamoto Y, Mizuno M, Kikkawa F, Naganawa S. The importance of choosing the right strategy to treat small cell carcinoma of the cervix: a comparative analysis of treatments. BMC Cancer 2021; 21:1046. [PMID: 34556082 PMCID: PMC8461987 DOI: 10.1186/s12885-021-08772-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/30/2020] [Accepted: 09/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Standard treatments for small cell carcinoma of the cervix (SCCC) have not been established. In this study, we aimed to estimate the optimal treatment strategy for SCCC. Methods This was a multicenter retrospective study. Medical records of patients with pathologically proven SCCC treated between 2003 and 2016 were retrospectively analyzed. Overall survival (OS) was plotted using the Kaplan-Meier method. Log-rank tests and Cox regression analysis were used to assess the differences in survival according to stage, treatment strategy, and chemotherapy regimen. Results Data of 78 patients were collected, and after excluding patients without immunohistopathological staining, 65 patients were evaluated. The median age of the included patients was 47 (range: 24–83) years. The numbers of patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stages I-IIA, IIB-IVA, IVB were 23 (35%), 34 (52%), and 8 (12%), respectively. Of 53 patients who had undergone chemotherapy, 35 and 18 received SCCC and non-SCCC regimens as their first-line chemotherapy regimen, respectively. The 5-year OS for all patients was 49%, while for patients with FIGO stages I-IIA, IIB-IVA, IVB, it was 60, 50, and 0%, respectively. The 5-year OS rates for patients who underwent treatment with SCCC versus non-SCCC regimens were 59 and 13% (p < 0.01), respectively. This trend was pronounced in locally advanced stages. Multivariate analysis showed that FIGO IVB at initial diagnosis was a significant prognostic factor in all patients. Among the 53 patients who received chemotherapy, the SCCC regimen was associated with significantly better 5-year OS in both the uni- and multivariate analyses. Conclusion Our results suggest that the application of an SCCC regimen such as EP or IP as first-line chemotherapy for patients with locally advanced SCCC may play a key role in OS. These findings need to be validated in future nationwide, prospective clinical studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08772-x.
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Affiliation(s)
- Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shunichi Ishihara
- Department of Radiology, Toyohashi Municipal hospital, Toyohashi, Japan
| | - Yuuki Takase
- Department of Radiology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takayuki Murao
- Department of Radiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Dai Okazaki
- Department of Radiology, Okazaki City Hospital, Okazaki, Japan
| | | | - Kaoru Uchiyama
- Department of Radiology, Kariya-Toyota General Hospital, Kariya, Japan
| | - Yoshiyuki Itoh
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mika Mizuno
- Department of Obstetrics and Gynecology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan
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16
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Okazaki D, Shibamoto Y, Yanagi T, Ishikura S, Kondo T, Yamada Y, Niwa M. Local radiotherapy for pleural dissemination of thymic tumors after initial treatment. J Radiat Res 2021; 62:676-681. [PMID: 34036359 PMCID: PMC8273798 DOI: 10.1093/jrr/rrab046] [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] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/13/2021] [Accepted: 04/28/2021] [Indexed: 05/28/2023]
Abstract
Pleural dissemination is a common pattern of failure after initial treatment of thymoma and thymic carcinoma, but there is no standardized treatment. As these tumors are relatively radiosensitive, we investigated the effectiveness of radiotherapy. Twenty patients underwent 33 series of local radiotherapy for 96 pleural dissemination lesions after initial treatment. Conventional radiotherapy (CRT), tomotherapy, and combination of the two were employed in 19, 13, and 1 series, respectively. The median follow-up period after the first irradiation for pleural dissemination was 46 months (range, 14-161). For all 20 patients, overall survival (OS) rates from initial radiotherapy for pleural dissemination were 100% at three years and 86% at five years. Progression-free survival (PFS) rates after 33 series of radiotherapy were 30% at three years and 16% at five years. Local control (LC) rates for 96 lesions were 98% at three years and 96% at five years. In-field recurrence was observed in only two among the 96 lesions. One patient (5%) developed grade 3 radiation pneumonitis and another (5%) developed grade 3 pericardial effusion. No other serious adverse events were observed. When disseminated nodules can be covered within localized fields, local radiotherapy may be a treatment option. Using tomotherapy, multiple lesions can be treated safely.
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Affiliation(s)
- Dai Okazaki
- Corresponding author: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan E-mail: ; FAX: +81-52-852-5244 Phone: +81-52-853-8274
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Takeshi Yanagi
- Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi, Aichi 441-8021, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Takuhito Kondo
- Department of Radiology, Nagoya Ekisaikai Hospital, 4-66 Syonen-cyo, Nakagawa-ku, Nagoya, Aichi 454-8502, Japan
| | - Yuki Yamada
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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17
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Manabe Y, Shibamoto Y, Murai T, Torii A, Niwa M, Kondo T, Okazaki D, Sugie C. Intensity-modulated radiation therapy for multiple targets with tomotherapy using multiple sets of static ports from different angles. J Appl Clin Med Phys 2020; 21:132-138. [PMID: 32250015 PMCID: PMC7324698 DOI: 10.1002/acm2.12874] [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: 11/05/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To treat multiple targets separated in the craniocaudal direction within a short time, we invented a new technique using multiple static-port tomotherapy with the dynamic-jaw mode and named it the pseudo-DJDC (pDJDC) technique. We compared the pDJDC plans and helical tomotherapy plans using the dynamic-jaw mode (HDJ) for multiple targets. In the pDJDC plans, we used a beam set with 2-7 ports to the targets at the same level in the craniocaudal direction, and employed another beam set for other targets using different port angles (9-12 angles in total). METHODS In seven patients, two plans using the pDJDC and HDJ techniques were compared. For multiple targets (n = 2-6), 20-60 Gy in 2- to 7.5-Gy fractions were prescribed for the planning target volumes at D50%. The conformity index, uniformity index (D5%/D95%), dose distribution in the lung, and treatment time were evaluated. RESULTS The median conformity index of all seven patients was 3.0 for the pDJDC plans and 2.4 for the HDJ plans (P = 0.031). The median uniformity indices of the planning target volume (n = 25) for the two plans were 1.048 and 1.057, respectively (P = 0.10). For five patients with thoracic targets, the median mean lung doses were 2.6 Gy and 2.4 Gy, respectively (P = 0.63). The median V5Gy and V20Gy of the lungs in the five patients were 11.8% and 8.5% (P = 0.63), and 1.6% and 2.1% (P = 0.31), respectively. The pDJDC plans reduced the treatment time by 48% compared to the HDJ plans (median: 462 and 884 sec, respectively, P = 0.031). CONCLUSION The pDJDC technique allows treatment of multiple targets in almost half the time of the HDJ technique. The pDJDC plans were comparable to the HDJ plans in dose distribution, although the conformity index deteriorated.
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Affiliation(s)
- Yoshihiko Manabe
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuhito Kondo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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18
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Takaoka T, Shibamoto Y, Murai T, Kobayashi M, Sugie C, Manabe Y, Kondo T, Okazaki D, Yamada Y, Torii A. Helical tomotherapy for chemo-refractory multiple liver metastases. Cancer Med 2019; 8:7594-7602. [PMID: 31663296 PMCID: PMC6912035 DOI: 10.1002/cam4.2651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/26/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background Despite advances in chemotherapy, curing multiple liver metastases is quite rare. Even when response is obtained, regrowth of the tumors is almost inevitable. We aimed to evaluate the efficacy and adverse events of helical tomotherapy for chemo‐refractory multiple liver metastases. Methods Forty‐five patients with chemo‐refractory multiple (3‐10) liver metastases after standard systemic chemotherapy entered the single‐institutional prospective study. Liver metastases were the major disease; however, 31 also had uncontrolled primary lesions and/or other metastases. The prescribed dose was 55 Gy in 25 fractions. The median planning target volume (PTV) and normal liver volume (NLV) of first treatment were 128 cm3 and 1175 cm3, respectively. The median of V15Gy, V30Gy, and mean dose to NLV were 45%, 23%, and 19.4 Gy, respectively. Results Forty‐two patients (93%) completed the planned treatment. Median survival time (MST) for all patients was 8 months, and the 1‐year survival rate was 29%. The median local control (LC) period was 5 months and the 6‐month control rate of irradiated tumors was 33%. A ≥30% decrease in tumor markers was observed in 31%. The most common grade 3 toxicity was lymphocytopenia (40%), followed by fatigue (6%). Radiation‐induced liver disease (RILD) was not observed. Pancreatic cancer as the primary tumor, distant metastases outside the liver, low pretreatment neutrophil‐to‐lymphocyte ratio (NLR), and low pretreatment monocyte‐to‐lymphocyte ratio (MLR) were associated with poorer prognoses. Conclusions Helical tomotherapy for chemo‐refractory multiple liver metastases is a feasible and potentially effective treatment. Incorporating tomotherapy into the first‐line treatment in combination with systemic chemotherapy should be considered. Trial registration number CROG 12005.
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Affiliation(s)
- Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiko Manabe
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuhito Kondo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuki Yamada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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19
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Kawamura M, Koide Y, Murai T, Ishihara S, Takase Y, Murao T, Okazaki D, Yamaguchi T, Uchiyama K, Itoh Y, Kodaira T, Shibamoto Y, Mizuno M, Kikkawa F, Naganawa S. Should Small Cell Carcinoma of the Cervix be Treated As Localized Small Cell Cancer or Advanced Cervical Cancer: A Retrospective Multi-Institutional Cohort Study. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1809] [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: 10/26/2022]
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20
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Manabe Y, Shibamoto Y, Torii A, Niwa M, Kondo T, Okazaki D, Murai T, Sugie C. Intensity-Modulated Radiation Therapy for Multiple Targets with Tomotherapy Using Multiple Sets of Static Ports From Different Angles - Pseudo Dynamic-Jaw and Dynamic-Couch Technique. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1290] [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: 10/28/2022]
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21
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Takaoka T, Shibamoto Y, Matsuo M, Sugie C, Murai T, Ogawa Y, Miyakawa A, Manabe Y, Kondo T, Nakajima K, Okazaki D, Tsuchiya T. Biological effects of hydrogen peroxide administered intratumorally with or without irradiation in murine tumors. Cancer Sci 2017. [PMID: 28627761 PMCID: PMC5581514 DOI: 10.1111/cas.13302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 11/29/2022] Open
Abstract
Despite insufficient laboratory data, radiotherapy after intratumoral injection of hydrogen peroxide (H2O2) is increasingly being used clinically for radioresistant tumors. Especially, this treatment might become an alternative definitive treatment for early and advanced breast cancer in patients who refuse any type of surgery. The purpose of this study was to investigate the biological effects and appropriate combination methods of irradiation and H2O2in vivo. SCCVII tumor cells transplanted into the legs of C3H/HeN mice were used. Chronological changes of intratumoral distribution of oxygen bubbles after injection of H2O2 were investigated using computed tomography. The effects of H2O2 alone and in combination with single or five‐fraction irradiation were investigated using a growth delay assay. The optimal timing of H2O2 injection was investigated. Immunostaining of tumors was performed using the hypoxia marker pimonidazole. Oxygen bubbles decreased gradually and almost disappeared after 24 h. Administration of H2O2 produced 2–3 days’ tumor growth delay. Tumor regrowth was slowed further when H2O2 was injected before irradiation. The group irradiated immediately after H2O2 injection showed the longest tumor growth delay. Dose‐modifying factors were 1.7–2.0 when combined with single irradiation and 1.3–1.5 with fractionated irradiation. Pimonidazole staining was weaker in tumors injected with H2O2. H2O2 injection alone had modest antitumor effects. Greater tumor growth delays were demonstrated by combining irradiation and H2O2 injection. The results of the present study could serve as a basis for evaluating results of various clinical studies on this treatment.
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Affiliation(s)
- Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasutaka Ogawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akifumi Miyakawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiko Manabe
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuhito Kondo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Koichiro Nakajima
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Tsuchiya
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
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Okazaki D, Tatekawa K, Uchiyama K, Hashizume C, Manabe Y, Ogawa Y, Sugie C, Yanagi T, Shibamoto Y. Focal Radiation Therapy for Pleural Dissemination of Thymic Tumors. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1709] [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: 10/20/2022]
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Murai T, Hattori Y, Manabe Y, Okazaki D, Ogawa Y, Nakajima K, Iwata H, Shibamoto Y. Indication of the Multileaf Collimator Technology in a Commercially Available Robotic Radiosurgery System: Which Cases Are Suitable? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2205] [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: 11/30/2022]
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Raju NR, Koestner A, Marushige K, Lovell KL, Okazaki D. Effect of nerve growth factor on the transplacental induction of neurinomas by ethylnitrosourea in Sprague-Dawley rats. Cancer Res 1989; 49:7120-3. [PMID: 2555060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Administration of nerve growth factor (NGF) to the offspring of Sprague-Dawley rats transplacentally exposed to 50 mg/kg ethylnitrosourea on the 20th day of gestation resulted in a significant reduction of trigeminal and peripheral nerve neurinomas. Forty, 60, and 80 micrograms of NGF was administered in five s.c. doses, one dose on each of days 12-16, 90-94, and 210-214 postnatally. Of the 34 rats in the NGF-treated group, 11 animals were affected with trigeminal nerve neurinomas as compared to 18/34 in the NGF-untreated group (P less than 0.05). In the peripheral nerves (spinal cord nerve roots) there were five and 11 neurinomas, respectively, in each group of 34 rats. When the total numbers of neurinomas (trigeminal and peripheral nerves) between these groups were compared (16/34 versus 29/34), the significance of neurinoma reduction was P less than 0.01. Five trigeminal and two peripheral neurinomas in the NGF-untreated group were shown by immunohistochemical staining to contain nerve growth factor receptor protein, whereas none of the neurinomas in the NGF-treated group were positive for the receptor protein. The results obtained from this experiment lend support to the hypothesis that NGF has the capability to reduce the oncogenic consequences of ethylnitrosourea exposure perhaps by the process of maturation and/or differentiation of the transformed cells, and that this effect may depend upon the presence of receptor binding sites.
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Affiliation(s)
- N R Raju
- Department of Pathology, Michigan State University, East Lansing, 44824
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