Radiation hepatitis is clearly demonstrated by noncontrast and contrast enhanced CT following radiotherapy for liver diseases. Radiation hepatitis is dependent on dose distribution and is usually demonstrated as a non-segmental bandlike lesion after photon therapy. We report a case of focused, oval-shaped radiation hepatitis that was induced by photon therapy. The attenuation difference was localized in a high-dose area caused by Bragg-peak proton therapy.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

MRI of mucosal malignant melanoma of the head and neck.

PURPOSE: The objective of this study was to determine the characteristic MR findings for mucosal malignant melanomas of the head and neck. METHOD: We retrospectively analyzed the MR images for six patients with this entity. T1-weighted SE images with and without gadolinium and T2-weighted fast SE images were obtained. MR images were analyzed qualitatively and quantitatively by comparing the signal intensity of the melanoma with that of muscle. RESULTS: On T1-weighted images, five melanomas were hyperintense and one was isointense. On T2-weighted images, five were of mixed intensity and one showed isointensity. The mean signal intensity ratio of the primary melanoma to muscle was 1.51 and 1.39 on T1-weighted images with and without gadolinium, respectively. These values were not statistically significant. CONCLUSION: Hyperintensity on T1-weighted images is characteristic of this entity, but not universal.

Adipose Tissue↗

PubMedDate not supplied

Prognostic significance of c-erbB-2/HER2 expression in advanced uterine cervical carcinoma with para-aortic lymph node metastasis treated with radiation therapy.

This paper looks at whether c-erbB-2/HER2 expression in uterine cervical carcinoma before treatment is a predictive parameter of prognosis in patients with para-aortic lymph node metastasis (PALN) in advanced disease after treatment with radiation therapy (RT). Twenty-one patients with PALN at the first visit and/or during follow-up and treated with RT for PALN lesions were studied. Their clinical stages were IIIB or greater and they were referred to the National Institute of Radiological Sciences Hospital for RT between 1987 and 1995. They consisted of 12 patients with PALN detected at the first visit and nine with PALN detected during the follow-up period. All patients had no distant metastasis except PALN. They were treated with a combination of external whole pelvis and intracavitary irradiation to the primary pelvic lesions. The PALN was treated with external irradiation alone with anterior-posterior parallel opposed fields and anterior oblique fields or anterior-posterior parallel opposed oblique fields. The average total dose to PALN was 53.3 Gy (40-61Gy). Tissue samples were obtained from cervical tumors (primary lesions) before RT. Immunohistochemical staining was performed using anti-c-erbB-2/HER2 monoclonal antibody for conventional paraffin sections. c-erbB-2/HER2 positive staining was observed in cancer membrane and cytoplasm. Nine specimens were positive for c-erb-B2/HER2 and the total positive rate was 43%. The 5-year survival rate was 38% for all patients. The 5-year survival rate of the c-erbB-2/HER2 positive patients was 28%, representing a trend toward poorer prognosis than the 52% of negative patients (P = 0.10). Multivariate analysis using Cox proportional hazards model showed that c-erbB-2/HER2 was an independent prognostic factor (P = 0.024). The present study suggests that c-erbB-2/HER2 expression of cervical tumors might be a predictive parameter of prognosis after radiation therapy for PALN of very advanced uterine cervical carcinoma patients.

Adult↗

PubMedDate not supplied

Oxygenated and reoxygenated tumors show better local control in radiation therapy for cervical cancer.

The presence of hypoxic cells is one of the major factors affecting resistance against radiation therapy. In the clinical setting, little information exists as to the relationship between intratumoral oxygen partial pressure (pO(2)) and outcome. This study involved 30 consecutive patients with cervical cancer, who were treated with a combination of external and high-dose rate intracavitary irradiation. The pO(2) was measured before radiation therapy and at 9 Gy, using a needle-type polarographic oxygen electrode. The mean intratumoral pO(2) before radiation therapy was 17.3 +/- 10.8 mm Hg. The 3-year local control rates of patients with pO(2)< or = 20 mm Hg and pO(2) > 20 mm Hg before radiation therapy were 52% and 100%, respectively, representing a significant difference (P= 0.035). At 9 Gy, mean intratumoral pO(2) was 23.6 +/- 9.1 mm Hg, a significant increase compared to the value before radiation therapy (P= 0.006). The 3-year local control rates of tumors with pO(2)< or = 20 mm Hg and pO(2) > 20 mm Hg at 9 Gy were 35% and 93%, respectively, representing a significant difference (P= 0.001). The significantly better local control for oxygenated tumors at 9 Gy as well as before radiation therapy indicated that the oxygen effect and reoxygenation by radiation played an important role in local control in radiation therapy for cervical cancer.

Adenocarcinoma↗

PubMedDate not supplied

The phase I/II clinical study of carbon ion therapy for cancer of the uterine cervix.

PURPOSE: The phase I/II clinical study of carbon beam therapy was undertaken for 31 cases of advanced cervical cancer of stages IIIB and IVA from June 1995 to November 1997. The main purpose was to determine clinically useful fraction doses without severe acute reaction of normal tissues and to assess tumor control dose levels achievable without significant normal tissue toxicity. PATIENTS AND METHODS: The treatment was given with four fixed fractions per week (24 fractions over 6 weeks) and was initiated with a fraction dose of 2.2 Gray equivalent (GyE), and the dose was increased as 2.4 GyE, 2.6 GyE, 2.8 GyE, and 3.0 GyE. Consequently, the total dose initiated was 52.8 GyE, to increase up to 72.0 GyE in 4.8-GyE increments in the dose-escalation fashion. Thirty patients with eligible advanced cervical cancers consisting of 27 squamous cell carcinomas and three adenocarcinomas were analyzed. RESULTS: Acute response of normal tissues was less than with photon treatment until fraction doses of 2.8 GyE were administered, and patients finished treatment with comfortable conditions. Severe late complications occurred in the two patients who received more than 67.2 GyE. The 2-year cumulative survival rate and the local control rate of 27 patients with squamous cell carcinoma were 61.5% and 59.3%, respectively. According to stages, the 2-year survival rates of stage IIIB and IVA patients were 54.4% and 75.0%, respectively. The 2-year local control rates of stage IIIB and IVA patients were 52.6% and 75.0%, respectively. DISCUSSION: These results indicated that the disease control seems to be relatively better for very advanced disease and with dose escalation treatment. Local control was not significantly correlated with total dose and tumor volume. The results of the present study, despite small numbers and short observation, suggest that an adequate fraction dose for pelvis fields is 2.8 to 3.0 GyE and that the carbon beam therapy might be advantageous for advanced cervical cancer.

Adult↗

PubMedDate not supplied

Definitive proton beam radiation therapy for inoperable gastric cancer: a report of two cases.

Proton beam radiation therapy using 250 MeV protons was carried out on two patients with early gastric cancer (T1, N0, M0). One patient was an 85-year-old man with early gastric cancer of type IIa + IIc. The other one was a 70 year old man with early gastric cancer of type IIc. In both cases histological examination of biopsy specimens showed differentiated adenocarcinoma; distant metastasis was not found by other examinations. Both patients were considered inoperable due to their poor cardiac and/or respiratory functions. Therefore, it was decided to treat them by definitive proton irradiation, delivering total doses of 86 Gy and 83 Gy, respectively. In both patients, skin erythema that did not require any special treatment was found in the irradiation field. Hematobiological examinations did not show any abnormality. Although endoscopic examination at two years after irradiation in the former case and at seven months in the latter case showed persistent gastric ulcer at the site of the cancerous lesions, cancer cells were not found histologically. Therefore, we concluded that proton irradiation therapy was useful for inoperable early gastric cancers.

Adenocarcinoma↗

PubMedDate not supplied

Results of prophylactic adjuvant chemotherapy for early stage non-Hodgkin's lymphoma of the head and neck.

Results were reviewed in 46 patients who had stage I and II head and neck non-Hodgkin's lymphoma, and received five to six cycles of CVP chemotherapy after regional irradiation. Disease-free survival, pattern of relapse, and time of relapse were compared with those of 64 patients, who received regional irradiation alone. Adjuvant, post irradiation CVP significantly improved five-year survival in stage I (and IE) disease, 49.6% to 81.9% (p less than 0.05), but was less successful in patients with heavier tumor burden, such as stage II disease or advanced loco regional disease in Waldeyer's ring (48.3% to 63.7%; p greater than 0.10 in stage II patients). In addition, in those who relapsed, the time and pattern of relapse were not altered by adjuvant CVP chemotherapy. This easily tolerated, mild adjuvant chemotherapy, we conclude, failed to prove significant in preventing relapse, especially in patients with heavier tumor burden.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Long-term results of treatment with mild toxicities in small cell lung carcinoma.

Results of treating small cell lung carcinoma with mild toxicities were investigated retrospectively. From 1974 to 1981, 38 patients were treated according to three institutional protocols: radiation alone (RAD), radiation with ifosfamide (IFOS), and radiation with adriamycin, vincristine, and cyclophosphamide (AOC). Of the three five-year survivors, two were treated with IFOS and one with RAD. The time period between admission and the beginning of radiotherapy was longer and the treatment field smaller in AOC than in the other two protocols. IFOS and RAD showed less toxicity. Our study indicated that IFOS and RAD should be regarded as curative treatments for limited disease and are suitable for patients who do not have sufficient bone marrow reserve.

Adult↗

PubMedDate not supplied

An experience with slit beam rotation therapy (SBRT).

A new rotation therapy technique using slit beams of 10 Mev X-rays (3.3 mm X 50 mm at isocenter FCD 100 cm) was developed. The dose distribution of a 360-degree rotation of the slit beam described above is similar to that of a 137-Cs needle. The axes of a 360-degree rotation of the slit beam were arranged to cover the target volume to produce a dose distribution similar to interstitial irradiation. This technique was named as the slit beam rotation therapy. Twenty patients who had radioresistant tumors or were difficult to control by conventional therapy have been treated with this technique, combined with or without conventional external beam irradiation, since 1982. Eight out of ten extracranial lesions showed good regression and a palliative effect was obtained without severe morbidity. A one year survival rate of 67% in six patients with glioblastoma multiforme was achieved by this method. Although the feasibility study is still in progress, this new treatment technique looks highly promising.

Brachytherapy↗

PubMedDate not supplied

Ultrasonographic measurement of tumor regression in radiation therapy.

Ultrasonography was evaluated as a measurement procedure for investigating the tumor regression of cervical lymph nodes. Preliminary results suggested that interobserver compatibility in the measurement of nodes deteriorates when the diameter of the node is less than 15 mm. There was no systematic disparity between ultrasonographic and manual measurements. The tumor regression line fit the exponential line with a correlation coefficient of more than 0.95 in seven of 16 nodes. During the sequential examination, a central low-echo area suddenly appeared in one node at 15 Gy/6 Fr.

Carcinoma, Squamous Cell↗