Advances in the era of bone marrow transplantation and high-dose chemotherapy have resulted in high response rates and cures in a selected subgroup of patients with non-Hodgkin's lymphoma (NHL). Therefore, much concern is being directed to the development of chemotherapy with bone marrow transplantation. However, radiotherapy still plays an important role in the treatment of NHL. In this article, we describe treatment, follow-up, and outcome of patients with NHL treated at the Department of Clinical Radiology, Kyushu University Hospital, during about 15-year period. From a radiological point of view, we present our findings and discuss them in relation to previous literature.

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We constructed an electronic medical record system in the Department of Radiology and described medical records of patients who entered hospital to receive radiotherapy. Using this system, we studied the usefulness of the electronic medical record system from the readers' point of view. We measured time taken to read the medical records while checking important items of radiotherapy, and tried to investigate the usefulness of the electronic medical record system compared with a conventional medical record system. In selecting important items of radiotherapy, we referred to the database of radiotherapy medical records made by JASTRO. The average time for reading electronic medical records and conventional medical records were 130.0 seconds and 249.9 seconds respectively (p=0.0001). The frequency of descriptions of important items were not statistically different. As to primary site and external radiotherapy field, they were not statistically different, and regarding the method of therapy, this was the same.

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In order to examine the usefulness of radiotherapy for verrucous carcinoma, eight cases of oral verrucous carcinoma treated with radiation therapy were reviewed. Definitive radiotherapy was performed in six patients and preoperative radiotherapy was performed in two patients. Definitive radiotherapy doses ranged from 20 to 60 Gy (median: 47.5 Gy) and preoperative radiotherapy doses were 25 Gy, delivered with a daily fraction size of 2.5 Gy in principle. All cases that received definitive irradiation became CR, but two of these patients underwent local recurrence; one was a patient irradiated with only 20 Gy and the other case underwent local recurrence of squamous cell carcinoma. In the cases irradiated with 45 Gy or more, 4 of 5 cases were locally controlled. No patient underwent regional lymph node metastases. One of two patients that received preoperative radiotherapy had local recurrence in spite of a negative surgical margin. Because the radiosensitivity of verrucous carcinoma was often good and anaplastic transformation was not common, radiotherapy can become a radical treatment for verrucous carcinoma.

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Purpose: The aim of the study is to develop high dose-rate (HDR) conformal interstitial brachytherapy by means of combined real-time computed tomography (CT) fluoroscopy guidance with CT-based treatment planning for locally recurrent rectal carcinoma.
Materials and methods: The procedures of brachytherapy needle insertion were guided with a helical CT scanner providing real-time fluoroscopy reconstruction. A video monitor placed adjacent to the CT gantry simultaneously allowed the operator to see the process of needle insertion. CT images were transferred by an on-line system to the treatment-planning computer which reconstructed the implant needles and organ contours. The doses in planning target volume were normalized and geometrically optimized. The patients received a dose of 5 Gy per fraction on a daily hyperfractionation schedule at a total dose of 30-50 Gy with or without external radiation therapy. Nine patients were treated for this procedure.
Results: Thirteen to 36 needles (average 19.1) were successfully placed at the planning target volume in each patient. The average time for CT fluoroscopy was 370.1 seconds in each procedure. No accident was occurred during needle insertion, but one patient developed fibular nerve palsy after needle removal but gradually recovered. The CT-based treatment planning was faster and more accurate than projection reconstruction with conventional radiograms. Analysis of a dose volume histogram demonstrated conformal dose distribution of the target, while avoiding dose to normal structures with this method.
Conclusion: Real-time CT fluoroscopy ensures safety and increases the accuracy of needle placement. Conformal high dose-rate (HDR) interstitial brachytherapy with CT-based treatment planning is an attractive method for locally recurrent rectal cancer.

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Purpose: This study was undertaken to assess the biochemical and pathological results of combined external beam radiotherapy and high dose rate Ir-192 brachytherapy (HDR-Ir 192) for clinically localized prostate cancer.
Method and materials: Between October 1997 and August 1999, 39 evaluable patients with adenocarcinoma of prostate diagnosed by biopsy were treated with interstitial and external beam irradiation. Patients ranged in age from 58-82 years, with a mean of 69.7 years. T lc, T2 and T3 tumors, according to the UICC classification system (1997), were found in 7, 21 and 11 cases respectively. The mean initial pre-treatment PSA was 35.9 ng/ml (median 13.2), with 77% of the patients having had a pre-treatment PSA greater than 10 ng/ml. Of all patients, 17 had received pretreatment hormonal therapy. Hormonal pretreatment was stopped at the beginning of radiotherapy in all cases. External beam four-field box irradiation was given to the small pelvis to a dose of 45 Gy/25 fractions. Three HDR-Ir192 treatments were given over a 30-h period, with 5.5 Gy per fraction at the circumference of the prostate gland over the course of this study. Biochemical failure was defined as a PSA level>1.5 ng/ml and rising on three consecutive values. If serial post-treatment PSA levels showed a continuous downward trend, failure was not scored. The patient with clinical evidence of progression was classified as a clinical failure. The median follow-up at the time of evaluation was 19.6 months.
Results: A post-treatment PSA level 1.0 ng/ml was seen in 26 (67%) patients, and values from>1.0 to≤2.0 ng/ml were seen in 10 (26%) patients. Biochemical failure was not seen in 38 patients except for one patient who developed a distant bone metastasis with negative prostatic biopsy 15 months after treatment. Biochemical control rate was 100%(38/38) except for the patient with bone metastasis classified as clinical failure. Negative biopsies 18 months after treatment were found in 93%(14/15) of patients. Only one patient had evidence of residual tumor without clinical and biochemical failure. The bladder or rectal complications have been minimal.
Conclusion: The rate of negative prostate biopsies of 93% after 18 months represents an encouraging result. These results support the use of combined external beam radiotherapy and high dose rate interstitial brachytherapy for localized prostate cancer. Further long-term follow-up is warranted to assess this treatment.

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We analyze the clinical data of the head and neck cancer in the Radiation Oncology Greater Area Database (ROGAD) in Japan. From the 2nd to 7th study of the ROGAD, a total of 8, 950 patients were registered. In ICD-O, coding numbers of from C00.0 to C14.8 and from 30.0 to 32.9 were considered as head and neck cancer. Clinical data of 1, 311 patients with head and neck cancer were evaluated in this study. Among the patients registered in the ROGAD, 17-18% of all items of TNM classification and stage were emptied. Fifteen percent of the patients with squamous cell cancer were treated without the information of the stage. The most important problem of this national-wide database is the quality of the data.

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Data on lung cancer from the Radiation Oncology Greater Area Database (ROGAD) was evaluated in this paper. Between the 2nd survey in 1992 and the 8th survey in 1998, 2, 082 cases were accumulated. There were 1, 584 (76%) men, and 498 (24%) women. The most frequent ages were between 60 and 69 (36%), followed by 70 and 79 (27%). The clinical stage 1 was 6%, stage 2, 5%, stage 3, 34%, and stage 4, 54%. The histology was adenocarcinoma in 35.1%, squamous cell carcinoma in 26.4%, small cell carcinoma in 14.3% and large cell carcinoma in 3.3%. The treatment methods were radiation only in 52%, chemoradiotherapy in 31% and post-or pre-operative radiation in 10%. The treatment targets were primary only in 16%, lymh node only in 9%, metastases only in 37%, primary with metastases in 28% and others in 10%. The curative purposes were 24%, semi-curative purposes were 11%, palliative purposes were 37% and symptomatic purpose were 27%. The cumulative survival rate was not accurate because of the difficulty of following-up cases. The one-year, twoyear, three-year and five-year cumulative survival of the cases without metastases would be 86.7-36.8%, 73.6-18.2%, 59.6-11.2% and 40.1-7.0%, respectively. The data deficit rate was 88% in the grade of histology, 17% in T cathegory, 18% in N-category, 12% in M-category, 14% in stage, 11% in primary response, 16% in complications. Considering our data analysis, a new datebase for JASTRO should be created, and methods for building up a more useful database should be discussed.

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We developed the Radiation Oncology Greater Area Database (ROGAD) that contained the patient records concerning the radiation therapy. We selected the patients with breast cancer from the ROGAD from November 1992 to November 1998. From the analysis of the database, the increase of the operation and radiation treatment is not clear. The blank rate or error rate of each field of database are decreasing, but acute response and follow up fields contain 16-20% blank data. We had to decrease the blank ratio of these fields in future. The merit of such as ROGAD, one is the educational effect to inexperienced radiation oncologist, and the other is political effect to the academic society (JASTRO).

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Clinical data of 230 patients with prostate cancer that had been registered in Radiation Oncology Greater Area Database (ROGAD) from November 1992 to December 1998 was evaluated. The data of the patients with poorly differentiated histology (G3: 52%) in advanced stage (IV: 73%) were most commonly observed. External dose range to pelvis lymph node area or prostate gland for these patients was still immature in Japan, compared with those of the data of Patterns of Care Study in the United States. Estimated number of prostate cancer patients increased 2.4 times during the last 7 years.

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Purpose: To measure simulation to treatment error (STE) in radiation therapy and to evaluate factors which influence STE in computed tomography (CT) simulation.
Materials & Methods: Off-line treatment verification using conventional portal films and CT-simulated digitally reconstructed radiographs (DRRs) was performed to measure the treatment accuracy in radiation therapy. Isocenter displacement of the portal films in relation to the DRRs was measured as a simulation to treatment error (STE). Correlation between STE and several treatment factors were examined statistically for 77 patients.
Results: Factors that significantly affected STE were treatment site and use of immobilization devices. The mean STE of the patients with head and neck cancer was 3.9±2.7 mm whereas that of patients with thoracic or abdominal tumor was 6.4±6.1 mm (p=0.028). The mean STE in patients with and without immobilization device was 3.7±2.6 mm and 5.7±4.7 mm, respectively (p=0.027). Distance between isocenter and reference point at the time of planning CT scan did not correlate with STE. None of other factors influenced the accuracy of isocenter position.
Conclusion: Although the position of isocenter was not marked at the time of CT-simulation, STE was within an acceptable range. Distance between the isocenter and reference point at the time of planning CT scan had no impact on STE.

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