Integration methods of making an Image archiving and communication system (PACS) for the radiation therapy and oncology department are described. A large scale PACS for oncology has been running at Aichi Cancer Center Hospital Nagoya city from 1992, and the system is useful for high quality radiation therapy. However, this system can not be applied to future PACS systems for individual radiotherapy facilities except at cancer center hospitals, because the Aichi system requires a large expenditure for system costs, running costs, and manpower. The author proposes PACS economy models for radiotherapy using local area network system, or an Image Save and Carry (IS & C) system which carries the standardized magneto-optical disc recording radiotherapy information including related images.

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From January 1973 to July 1987, a total of 57 patients with cancer of the hypopharynx were treated by radical radiotherapy. Forty cases were treated by radical radiotherapy alone and 17 cases by radical radiotherapy with salvage surgery for recurrences. Clinical examination confirmed that 46% of patients had T_3-4 disease and 58% had metastatic nodes. Fractionated single doses of 2.5 Gy were applied four times per week to 50 patients up to 60 Gy or more (most commonly, 70 Gy in 28 fractions over 7 weeks). Seven patients received relatively shortcourse radiotherapy of 50-55 Gy in 16 fractions over 4 weeks. The 2-, 5-, and 10-year cumulative survival rates of all 57 patients were 37, 19 and 12%, respectively. The 5-year cumulative survival rates were 100, 27, 11 and 13% in stage I, II, III and IV, respectively. Univariate analysis of patients' characteristics revealed that T-stage (T_1-2 versus T_3-4) and stage (stage I versus stage III or IV) were significantly related to 5-year survival (p<0.05). Overall relapse rate was 86%. Relapse rates were 0%(0/3) in stage I, 73%(8/11) in stage II and 95%(41/43) in stages III-IV. Seventy-seven per cent of patients showed loco-regional relapse. Eighty per cent of loco-regional recurrences developed within 2 years after initial irradiation. Distant metastases were detected in 10 patients. Seven patients (12%) were found to have another primary cancer besides hypopharyngeal cancer. The preservation rate of the laryngopharynx at 2-year without primary recurrence was 25%(14/57), in whom T_1-2 disease was found in 71%(10/14). At present, 11%(6/57) of the patients are alive with intact laryngopharyngeal function for more than 4 years (54-167 months). Seven patients are still alive between 54 months and 167 months with no evidence of recurrence, 43% of whom had stage I-II disease. Two of them were salvaged by radical neck dissection or total laryngopharyngectomy after recurrence. It seems that in small tumors, loco-regional control may be achieved by radiotherapy whereas in advanced tumors, disease control is difficult. To enhance tumor control by radiotherapy, systemic adjuvant therapy such as chemotherapy will be reasonable, because not only loco-regional failure but also distant metastasis are common in hypopharyngeal cancer.

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Forty-six patients with T1 and T2 carcinomas of the floor of mouth (FOM), who underwent brachytherapy from February, 1979 to March, 1991, were reviewed retrospectively.
Four of the 46 patients died within 2 years of their initial treatment, without a local recurrence and/or radiation injury. Therefore, they were excluded from the evaluation of two-year local control and radiation injury rate.
The two-year local control rate of the remaining 42 patients was 93%(39/42). The rate was 100%(27/27) in patients treated by brachytherapy (BT) alone, and 80%(12/15) in those treated by BT with external radiation (ERT) and chemotherapy. This rate was not elevated from that achieved at a dose of 70 Gy by BT (88%) when a dose of 80 Gy was given by BT with ERT (90%) in the dose-response relationship.
According to tumor extension, the local control rates for pelvic-gingival (PG), pelvic (P) and pelvic-lingual (PL) tumors were 75%(6/8), 100%(19/19) and 93%(14/15), respectively (N.S.). The two-year radiation injury (mandibular exposure) rate was 10%(4/42). The rate was 7%(2/27) in patients treated by BT alone and 13%(2/15) in those treated by BT with ERT, and was greatly elevated from that occurring with a dose of 70 Gy by BT (5%) when a dose of 80 Gy was given by BT with ERT (13%) in the dose-response relationship.
According to tumor extension, the radiation injury rates for PG, P and PL tumors were 13%(1/8), 5%(1/19) and 13%(2/15), respectively (N.S.).
In conclusion, BT with ERT did not improve the local control rate of T1 and T2 carcinomas of FOM, and elevated the radiation injury rate greatly. Therefore, we believe that T1 and T2 carcinoma, even when extending to the gingiva, should be treated by BT alone.
Multiple cancer incidence in these patients was 28%(13/46), and the incidence of digestive tract cancer was especially high.
Therefore, a complete work-up is necessary before treatment and during the follow-up period.

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Between August 1961 and October 1993, 126 patients (143 lesions) with isolated locoregional recurrence of breast cancer after mastectomy were treated with elective radiotherapy. The most common site of involvement was the chest wall (nodular type; 49 lesions, invasive type; 17 lesions), followed by supraclavicular lymph nodes (47 lesions), axillary lymph nodes (21 lesions) and parasternal lymph nodes (9 lesions).
Complete response (CR) rate for all lesions was 73%. The highest CR rate was obtained in the nodular type of chest wall involvement (84%) and the lowest was in invasive type of chest wall involvement (35%). Six recurrent lesions (6.4%) were detected within and outside of the radiation field, respectively. Failure outside of the field was frequently seen in the invasive type of chest wall involvement.
With respect to the relationship between tumor response and radiation dose, 94% of the lesions were controlled using doses of 50Gy for excised lesions and 67.6% achieved CR for lesions measuring > 3cm and 68.4% for lesions ≥ 3cm at doses of 70Gy.
The five-year survival for the entire group was 37%. The survival rate of patients who achieved CR (48%) was significantly better than those who did not (9%)(p>0.01). The 5-year survival rate was highest for the nodular type of chest wall involvement (76%) and the lowest was for the invasive type of chest wall involvement (24%) and supraclavicular lymph node involvement (25%).
In conclusion, the usefulness of radiotherapy for loco-regional recurrence of breast cancer was confirmed. However, efforts to improve survival in the invasive type of chest wall involvement and supraclavicular lymph node involvement are required. Considering the difficulty in controlling these recurrences with radiotherapy alone, a combined modality to improve local control in the invasive type, as well as, control distant metastasis in supraclavicular lesions could offer the best possibilities.

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Acute reactions induced by proton irradiation were measured using a reflectance spectrophotometer, which is commonly used in the printing and textile industries. In this method, the skin color was expressed by three parameters, lightness (L*), chroma (C*) and hue (h).
At first, in order to evaluate the accuracy of this specrtophotometer, the skin color of a normal volunteer was measured 100 times. The values of the three parameters for normal skin were as follows (mean values and standard deviations), L*: 68.64±0.29, C*: 19.08±0.13, h: 69.41±0.76.
The standard deviations with regard to L* and h, were considered to be sufficiently small when compared with the changes of these parameters (prefix:Δ) in the irradiated sites (ΔL*<-2.41, Δh<-2.00). In measurements of 24 unirradiated sites for 8 patients, there were no statistical differences between the values taken at four different times within a day (p>0.05). These results showed that the accuracy of this equipment was acceptable, even when the measurement was performed at different times.
For irradiated skin, L* and h values significantly decreased with time (p<0.05), and the L*values were highly correlated with elapsed treatment days (/r/>0.6 by linear regression analysis). The h values had a relatively low linear correlation compared with L*. The C* values had no trends as the treatment period was extended.
Among these parameters, the L* values were the most valuable for assessment of protoninduced skin reactions, and it was suggested that the L* values measured with this spectrophotometer were a useful index for showing biological effects induced by proton irradiation.
Further experiments are needed to apply this method to quantify the biological effects induced by other forms of ionizing radiation.

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Fifteen patients with malignant tumor of the ear were treated with radiotherapy between January 1966 and May 1993 at T.W.M.C. The age ranged from 3 to 81 years with a mean age of 52, and male to female ratio was 10 to 5. Tumor sites were the external auditory canal in 12 cases and middle ear in 3 cases. There were 4 cases in T1, 8 in T2, and 3 in T3 by Stell's stage classification, and there were 13 in NO, 1 in N1 and 1 in N2, which were all MO. There were 10 squamous cell carcinomas, 3 adenoid cystic carcinomas, 1 liposarcoma and 1 rhabdomyosarcoma, respectively. Radiotherapy was administered to 12 cases postoperatively, to 3 cases definitively with a total dose of 48Gy to 66Gy in adult cases. The follow-up period ranged from 11 month to 15 years 3 month (mean 8 years). The overall local control rate and the overall cumulative 5-year survival rate and the cause specific 5-year survival rate were 73%, 46.9% and 62.5%, respectively. Four cases died of primary ear malignancy and 2 of intercurrent disease. No severe side effect or complication has been observed. Radiotherapy combined with surgery is a promising modality for treatment of ear malignancy.

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The results of radiation therapy of 48 patients with mesopharyngeal caricinoma were reported. Five-year cumulative survival rate and 5-year cumulative local control probability using Kaplan-Meier's method were 54.5% and 53.6%, respectively. The causes of death in all the patients who passed away were due to tumor progression, especially due to failure of local control. Clinical Tstage, histological type, tumor cell kinetics, overall radiation time, sources of radiotherapy were thought to be important prognostic factors. Clinical usefulness of combined chemotherapy and radiotherapy was not certain. It seemed beneficial to use an interstitial brachytherapy as a boost irradiation and to combine an aggressive surgical resection for advanced mesopharyngeal carcinoma.

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