Interventional radiology (IVR) and endoscopic therapy have already been noted as two main subspecialities of minimally invasive therapy (MIT). Furthermore, radiotherapy (RT) has been added to the field of MIT with advances and spread of high energy targeting machines and brachytherapy using small radio-sources and has been playing a very important role in MIT.
A collaboration between diagnostic radiology including IVR and RT including brachytherapy which uses the same procedures as IVR such as insertion of small radio-sources using punctures and/or drainage has not been undertaken for a long period in Europe and USA. Therefore, each therapy of RT and IVR has been advanced independently without a close relation and official communication between the two fields has been rare in congresses; although in practice has been seam in the clinical setting.
Recently, brachytherapy using ¹⁹²Ir micro-source has become feasible making use of remote afterloading systems. Owing to these advances in brachytherapy machines, application of brachytherapy will expand to not only interstitial but also to various intraluminal fields such as biliary, bronchial, esophageal and vascular organs. This expansion of applications of brachytherapy is going to contribute to make closer the relation between RT and IVR.
In our institute, multidisciplinary therapy including mainly the combined therapy of IVR and RT has been applied for various kinds of malignant disease and favorable therapeutic results and QOL have been obtained by our efforts of step by step as compared with past experiences.
Here, we would like to expect that the close relationship and good collaboration between IVRist and RTist will contribute to the establishment of both of diagnostic radiology and therapeutic radiology with high quality and strong power characterized by making the best use of the special ability of each.

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In order to coincide the high dose region to the target volume, the ‘Conformation Radiotherapy Technique’ using the multileaf collimator and the device for ‘hollow-out technique’ was developed by Prof. S. Takahashi in 1960. This technique can be classified a type of 2D-dynamic conformal RT techniques. By the clinical application of this technique, the late complications of the lens, the intestine and the urinary bladder after radiotherapy for the maxillary cancer and the cervical cancer decreased. Since 1980's the exact position and shape of the tumor and the surrounding normal tissues can be easily obtained by the tremendous development of the CT/MRI imaging technique. As a result, various kinds of new conformal techniques such as the 3D-CRT, the dose intensity modulation, the tomotherapy have been developed since the beginning of 1990'. Several ‘dose escalation study with 2D-/3D conformal RT’ is now under way to improve the treatment results.

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Fifty two patients with advanced or recurrent cervical cancer were treared by intraarterial infusion chemotherapy (IAIC) with or without radiotherapy. IAIC regimen was separated into two groups: group I consisted of 5-FU+MMC±ADR (30 patients) and group II consisted of CDDP+MMC±5-FU (22 patients). The tip of the catheter was placed in the bifurcation of abdominal aorta or the bilateral internal iliac arteries (7 patients). Overall response rate (CR+PR) was 71% for all patients, 87% in patients who received radiotherapy, 50% in those not receiving radiotherapy, and 100% in primary patients. Five-year survival rate was 20% in primary patients, 14% in recurrent patients, 3% in group I and 38% in group II (p=0.00182) by chemotherapy regimen, 30% in CR patients, and 13% in non-CR patients (p=0.00436), respectively. Acute hematological side effects of grade III-IV was 48% for all patients, but recovered from by interruption of drugs. Among the 7 patients which the tip of the catheter was placed in internal iliac arteries, there were severe skin ulcers in 2 cases, and severe leg or gluteal region pain, for which narcotics were needed in 2 patients. These data suggest that IAIC mainly with cisplatin with or without radiotherapy was not particulary effective treatment for advanced cervical cancer, but it might be one of the effective treatment for residual cervical cancer after surgery and recurrent cervical cancer once the patient has obtained CR. One should check the blood flow distribution periodically, and control the concentration of drugs. In order to improve prognosis of these patients, one should furthermore consider a combination of IAIC and systemic chemotherapy.

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OBJECTIVE: To report the therapeutic results of preoperative irradiation using acombination of external irradiation and high dose rate intraluminal irradiation using ⁶⁰Co aimed at enhancing postoperative local control of advanced rectal cancer.
MATERIALS AND METHODS: The subjects comprised 38 patients (RT group: 31 men and 7 women ranging in age from 26-77 years; mean 61.2 years; tumor site RaRb 10, Rb 22, RbP 6) in whom≥A_l'lower rectal cancer was suspected and who under went preoperative irradiation at this hospital. A control group (N-RT group) consisted of 16 patients (11 men and 5 women, age 31-76 years; mean 59.9 years; tumor site RaRb 4, Rb 10, RbP 2) subjected to operation alone in whom clinical≥A₁' and postoperative histological study revealed≥a₁. The pre-irradiation biopsy diagnosis in all cases was adenocarcinoma except 2 cases with negative cancer cells. Intraluminal irradiation was performed using a balloon applicator developed to maximize the radiation dose to the tumor portion and minimize it to the extent possible to the unaffected portions, delivering 30-40 Gy/3-4 Fr (dose evaluation point set at 1.0, 1.5 or 2.0 cm from the source). The external irradiation was performed with a 10 MVX delivering 30-40 Gy/15-20 Fr to the entire pelvic cavity (upper margin being the upper edge of L5 and lower margin the lower edge of the ischium). After a mean waiting period of 13.9 days after irradiation, abdominoperineal resection (APR) was performed in 34 cases and low anterior resection (LAR) in four. In the N-RT group the surgical procedure was APR in 10 cases and LAR in six.
RESULTS: Using the criteria of Ohboshi and Shimozato to judge the histopathological effect, no cases showed Grade I, while of Grade II, 15 cases showed IIA and 19 cases IIB, Grade III in 4 cases. Grade IIB or above was noted in 23 of 38 (61%).
Five and 8-year survival rates were 82.5 and 82.5% in the RT group, and were 79.5 and 79. 5% in the N-RT group. Although these differences were not significant, a trend to better survival was found in the RT group. The local recurrence rate was 8%(3/38 cases) in the RT group in contrast to 25%(4/16 cases) in the N-RT group. The following complications developed during radiation therapy: diarrhea 19 (50%), anal pain 18 (47%), pollakisuria 3 (8%), anal erosion 2 (5%), and herpes zoster 2 (5%), but did not require premature termination of the therapy in any case. Postoperative complications consisted of perineal fluid collection 4 (10%), bowel obstruction 3 cases (8%), an anastomotic insufficiency 3 (8%), fistula formation of bladder 2 (5%), ureteral narrowing 1 (3%), and thrombosis of vein 1 cases (3%) of the RT group, while perineal fluid collection 1 (6%), bowel obstruction 1 (6%), an anastomotic insufficiency 4 (25%) of the N-RT group, only one case of RT group (3%) required surgical treatment for the fistula formation of bladder.
CONCLUSION: Although a significant enhancement of the survival rate was not achieved by preoperative radiotherapy with external plus intraluminal irradiation for advanced lower rectal cancer, this treatment contributed to excellent local control and a decrease and distant metastasis rate.

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A clinical trial of a heavy-ion cancer therapy was started in June, 1994, at HIMAC (Heavy Ion Medical Accelerator in Chiba). With heavy-ion therapy, one can expect good treatment results in comparison with the usual X-ray treatment, because of its application of a uniform and maximum dose to deep positions in the human body. Moreover, multi-port irradiation with heavy-ions can be used to improve the dose-concentration inside of the target, through proper adjustment of by adjusting the irradiation coefficients (number of ports, beam angle, beam weight), and simultaneously decreasing any unnecessary dose to normal tissue. Before improving the irradiation system, we estimated the clinical effectiveness of the irradiation method and the realizable potential of irradiation without a bolus, using 50 % tolerance dose (TD₅₀) or effective volume (V_eff) in the normal tissue. In this paper, we proceed with an estimation based on the assumption in which uses biological dose distribution for the dose distribution of heavy-ions. We investigated the relationship between the target radius and TD₅₀ of the normal tissue. When the number of ports is increased, TD₅₀ shows a tendency of to increase. Therefore, we concluded that multi-port irradiation with heavy-ions is advantageous in that the irradiated dose of normal tissue is completely eliminated.

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Purpose: Hepatocellular carcinoma (HCC) usually produces a bulky, highlyvascularized mass on the metastatic site of the bone. The purpose of this retrospective study is to analyze the effectiveness of radiation therapy (RT) for the patients with bone metastasis from HCC with regard to tumor regression and pain relief.
Materials and methods: Twenty-five patients (17 males and 8 females, 42-78 years old) with 32 bone metastases (7 ribs, 13 vertebras, 6 iliums, 3 humeruses, 2 femurs and 1 scapula) from HCC received RT (10-60 Gy, mean 35.9 Gy). RT was performed using 5-10 MV x-rays or 12-18 MeV electron beams from a linear accelerator. Additional transcatheter arterial injection of anticancer drugs (TAI) and/or arterial embolization (TAE) were carried out for five lesions.
Results: Pain relief was obtained in 22 patients with 26 lesions (81%). Pain relief appeared at a dose of 12-30 Gy with a mean of 18.5 Gy. In 9 patients (82%) with 12 lesions out of 11 patients with 15 lesions who could be evaluated for duration of pain relief, recurrence of pain was not noted up to the last follow-up day or to the death of the patients (1-36 months). In 13 lesions, tumor regression was evaluated by CT and/or MRI; Complete regression (CR: completetumor regression) was noted in 1 lesion, partial regression (PR: more than 50% but less than 100% tumor regression) in 6 lesions, no change (NC: less than 50% tumor regression) in 2 lesions, and progressive disease (PD; interval enlargement) in 4 lesions. The tumor regression (CR+PR) rate was 53.8%. In 8 lesions treated with RT alone, there was PR in 2 lesions, NC in 2 lesions, PD in 4 lesions, and CR was not seen. In 5 lesions treated with a combination of RT and TAI and/or TAE, CR was noted in 1 lesion, PR in 4 lesions and no NC or PD. There was a correlation between the initial tumor volume and the degree of pain before RT, but there was no correlation between tumor regression and pain relief after RT. The one-year survival rate was 17%, and the two-year rate was 8%.
Conclusions: RT for bone metastasis from HCC is effective for pain relief. A combination of RT and TAI and/or TAE may be a more effective treatment method than RT alone when dealing with tumor regression.

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Purpose: Using imaging, we analyzed progressive cases of brain tumors by imagings within 2 months after linac radiosurgery, and considered indications and optimal radiosurgery dose. Materials and method: We performed radiosurgery for 53 cases of brain tumor. Thirty-one cases were metastatic brain tumors, 9 cases were malignant gliomas and 13 cases were other tumors. CT or MRI were performed on these cases within two months after radiosurgery. We reviewed the progressive cases in these images.
Results: Local response rate of brain metastasis was 55 %(17/31). Twenty five Gy as peripheral dose was suitable for brain metastasis. Five cases of brain metastasis and 5 cases of malignant gliomas were progressive in size. In the brain metastasis cases, 3 were slowly growing tumor; 1 was mucoepidermoid ca., 2 were renal ca. There were no progressive cases of the metastatic brain tumors from pulmonary cancer.
For malignant glioma, 5/9 (55.6 %) were progressive cases. Four of 5 progressive cases had large target volume that was over 16 ml. In the autopsy cases of glioblastoma, tumor necrosis were recognized in the irradiated area of 90 Gy (fractionated irradiation and boost SRS) and 75 Gy (SRS).

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Radiotherapy clinical records of 7, 057 cases were collected from 208 hospitals in the period from 1992 to 1997 as recorded in the Radiation Oncology Greater Area Database (ROGAD) under the Japanese Society for Therapecutic Radiology and Oncology JASTRO, and their statistical analysis was carried out. A portion of these are presented in this paper.
Case distribution in terms of ICD-O code for primary tumor region expressed by 286 tables and 286 figures were worked out, but only 26 figures were selected for presentation here. Chronological variation of cases distribution during those six years were found and stated as follow as examples.
Primary response in “head and neck” and “ungs and bronchus” showed improvement both in terms of complete response (CR) and partial response (PR) in those 6 years. As for female genital organs, both CR and “alive with cancer” showed improvement. The averaged figures for all topographical regions for these 7, 057 cases reveal that CR, CR+PR, “alive with cancer” and “alive without cancer” increased relatively, and we can state that total contribution of radiotherapy itself is increasing.
The rate of chemotherapy combined with radiotherapy had increased and that of surgery combined with radiotherapy had decreased in the primary tumor region of both esophagus and female genital organs. Cases of radiotherapy alone without any other treatment have a tendency to incerase in lungs and bronchus. Ratios of primary regions of lungs and bronchus, liver, biliary tract and pancreas, bones and hematopoietic systems, breast and stomach and colon compared with that of total topographic regions involving other regions are found to have increased. In contrast, female genital organs and head and neck regions decreaced on a relative basis.
Change of performance status between at radiotherapy start and at radiotherapy termination for primary regions of lungs and bronchus and breast searched in 1996 tells that radiotherapy contributed to improve PS as far as the primary response is concerned. But change of PS from the time of radiotherapy termination of treatment in the two topographical regions mentioned above in February of 1996 to the time of follow up survey in June of 1997, which was 16 months after radiotherapy termination, does not indicate any improvement.
One record for irradiated topographical region in radiotherapy treatment is composed of 13 items with 48 fields, and one record for follow up investigation is composed of 5 items with 7 fields. Consequently, various combinations of logical and clinical interest in data retrieval and statistics can be worked out. Further findings and interpretations of statistics extracted from this database ROGAD can be sent to ROGAD subscribers. We plan to deliver user friendly software packages that are capable of conducting statistics and database subsets to any subscriber.
However, the most important thing is that intensive effort is paid to maintain confidence level for clinical data registration at sites of database subscribers in every radiotherapy facility anywhere in Japan.

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