Purpose: To develop an electronic clinical path for patients with head and neck (H & N) tumor treated with carbon ion radiotherapy (RT) focusing on acute reactions of the oral mucosa and the skin.
Materials and methods: Between January and July, 2002, fifteen patients with H & N tumor had been treated with carbon ion radiotherapy including oral cavity in the RT fields. Acute reactions of the oral mucosa and the skin were analyzed together with face scales (FS) that is an indicator of quality of life obtained daily from patients during RT courses. Medical interventions including prescription for mucositis or dermatitis, nursing care, and changes of meal were also analyzed.
Results: Average period of being in hospital was 42.6±3.6 days and that of radiation was 27.0±1.9 days. Radiation mucositis appeared 5 days (10.8 GyE) after start of carbon ion RT, reached a maximum reaction at 20 days (Grade 1: 7%, Grade 2: 33%, Grade 3: 60%), and recovered less than Grade 1 at 44 days on average. Radiation dermatitis also appeared 8 days (18 GyE), reached a maximum at 33 days (Grade 1: 47%, Grade 2: 40%, Grade 3: 13%), and recovered less than Grade 1 at 51 days on average. Changes of FS showed deterioration 23 days after start of therapy. At the latter half of RT courses, mucositis, FS, and dermatitis reached a maximum in that order. Through analyses of the time-score plots, the change of FS seemed corresponding to that of dermatitis. The required medical interventions were change of meal in 10, analgesics in 8, and gargles in 15 patients. Based on these results, we established a clinical path as a trial piece.
Conclusions: We confirmed that there was a specific pattern in ups and downs of acute reactions of the oral mucosa and the skin during a RT course. We concluded that a clinical path is useful for patients with H & N cancer treated with carbon ion RT.

View full abstract

Carcinoma of the pancreas is one of the most uncontrollable malignancies. Even if curatively resected, its prognosis may be limited by distant metastases (liver metastases, peritoneal seeding, and so on). From 1994 to 2002, 29 patients were treated with prophylactic hepatic irradiation after curative resection with intraoperative radiotherapy. During the hepatic irradiation continuous intravenous infusion of 5-FU (5 mg/kg/day) was performed. Therapy-associated death occurred in 2 patients (6.9%), one had liver failure and the other from infection due to a liver abscess. Grade 3 liver abscess occurred in 2 patients (6.9%). However the prophylactic hepatic irradiation did not increase toxicities compared with the group without hepatic irradiation. The hepatic toxicities occurred in most patients who received 22 Gy/20 fr/12 days as the prophylactic hepatic irradiation. And so, we changed the protocol. Now the prophylactic hepatic irradiation is performed as 20 Gy/20 fr/12 days under continuous intravenous infusion of 5-FU (5 mg/kg/day) during the hepatic irradiation. We recently began to develop the prophylactic hepatic irradiation procedures with multibeam or oblique beam planning for optimized 3-dimensional dose distribution.

View full abstract

Purpose: This study aimed to correlate the predictive values of geometrical sparing factors of rectum and bladder in high-dose-rate intracavitary brachytherapy (HDRICB) after uniform external beam radiotherapy with late sequelae in patients with uterine cervical cancer.
Methods: From September 1992 to December 1998, 154 patients who survived more than 12 months after treatment were studied. Initially, they were treated with 10 MV X-rays (44 to 45 Gy/22 to 25 fractions over 4 to 5 weeks) to the whole pelvis, after which HDRICB was performed using Ir-192 remote after-loading at 1-week intervals for 4 weeks. The standard prescribed dose for each HDRICB was 6.0 Gy to point A. Geometrical sparing factor (GSF) is defined as the ratio between reference doses in HDRICB and point A dose, whereas biological GSF is modified by using a linear-quadratic model. Patient and treatment related factors were evaluated for late rectal complications using Student's t-test and chi-square test.
Result: The probability of rectal complications shows better correlation with increasing biological GSF. If the biological rectal GSF was less than 0.6, the probability of rectal complication did not exceed 20%, while the biological bladder GSF was less than 0.8, the probability of bladder complication did not exceed 10%. The analysis demonstrated a high risk of late rectal sequelae in patients who developed bladder complications (p =0.0001, relative risk, 15.6) and biological rectal GSF>0.6 (p =0.02, relative risk, 2.08). The high risk factors for bladder complications were patients who developed rectal complications (p =0.0001, relative risk, 15.2) and biological bladder GSF>0.8 (p =0.04, relative risk, 2.85).
Conclusion: This study demonstrated the predictive value of rectal and bladder GSF in HDRICB for patients receiving uniform EBRT. Patients who had higher biological GSFs were at risk of late sequelae. Further study is imperative to delineate the close relationship between rectal and bladder complications.

View full abstract

Purpose: To verify operator-based contour delineation on GTV (Gross Tumor Volume) among different facilities using radiotherapy planning systems (RTPS), and to compare their results in terms of volume and spatial distribution.
Method: GTV outlines were delineated for two pulmonary carcinoma (T1N0M0) cases in six radiation therapy facilities using the Radiotherapy Treatment Planning System (RTPS) capability of each facility. Image sizes and resolutions were different among each facility. Therefore, helped by anatomical landmarks, the tumor and surrounding regions were excised using sequential CT images in order to standardize all of the images to equal size (500×500 pixels) and position. Image magnifications (pixels/mm) was calculated from the image scale shown on the RTPS. A summation of the GTV areas for each section were calculated and multiplied by the slice thickness to obtain the calculated value of GTV (GTVc). GTV images were analyzed to study differences in GTV among the various facilities. The mean and variance of the GTV images for all the facilities were obtained.
Result: The GTVc values were 7.0±0.7 ml (case 1) and 12.3±1.8 ml (case 2). The values obtained directly from RTPS (GTVr) were 7.0±0.7 ml and 12.1±1.7 ml, respectively. Differences were seen among the volumes and spatial distributions of GTV. Variation of the image in case 2 indicated that GTV differences were large where the bronchus and the vessels were close to the tumor.
Conclusion: Image areas that overlap vascular structures tend to indicate relatively large variations in GTV.

View full abstract

A case of hypoglossal palsy after neck dissection and radiation therapy for the nasopharyngeal cancer is presented. A 50-year-old man with a diagnosis of the nasopharyngeal cancer in T1N1M0 underwent a modified radical neck dissection and curative radiation therapy with 67.5 Gy to the primary site. Five years and seven months after the therapy, hypoglossal palsy occurred. The literature on radiation-induced cranial nerve palsy was critically reviewed.

View full abstract

A 74-year-old woman was in hospital because of a metastatic lung tumor from breast cancer. On April 3, 2001, the platelet count decreased to 4.1×10⁴/μl, on April 18, to 1.6×10⁴/μl. The number of megakaryocytes in bone marrow was rather small, but the concentration of platelet-associated IgG (PAIgG) increased and other diseases which were capable of inducing thrombocytopenia were excluded, and a diagnosis of idiopathic thrombocytopenic purpura was made. A 3-week course of corticosteroid therapy was ineffective. Splenic irradiation (1 Gy/fr, 3 fr/week, total 6 Gy) was performed instead of splenectomy because of her age, bad prognosis due to breast cancer stage IV and her general state was poor. Thereafter, although corticosteroid therapy was tapered, the platelet count increased to 7.8×10⁴/μl one month after the end of irradiation.

View full abstract

Early squamous cell carcinoma of the hypopharynx is a rare clinical entity, and the appropriate treatment strategy is not well known. Therefore, a national survey on the current status of treatment of early hypopharyngeal cancer was performed in 2003. We sent questionnaires to 118 main radiotherapy facilities in Japan and 59 (50%) responses were analyzed. Radical radiotherapy with or without chemotherapy was chosen as an initial treatment for stage I disease in 80% of institutions, and for stage II disease in 50% of institutions. Radiotherapy techniques varied widely depending on institutions. The role of radiotherapy in the management of early hypopharyngeal cancer should be established.

View full abstract