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Meguru Watanabe,
Hiroshi Onishi,
Kengo Kuriyama,
Takafumi Komiyama,
Kan Marino, Masayuki Araya,
Ryo Saito,
Shinichi Aoki,
Yoshiyasu Maehata,
Rihito Tominaga,
Jitsuhiko Oguri,
Naoki Sano,
Tsutomu Araki
[show abstract]
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ABSTRACT: Intrafractional setup errors during hypofractionated stereotactic radiotherapy (SRT) were investigated on the patient under voluntary breath-holding conditions with non-invasive immobilization on the CT-linac treatment table. A total of 30 patients with primary and metastatic lung tumors were treated with the hypofractionated SRT with a total dose of 48-60 Gy with four treatment fractions. The patient was placed supine and stabilized on the table with non-invasive patient fixation. Intrafractional setup errors in Right/Left (R.L.), Posterior/Anterior (P.A.), and Inferior/Superior (I.S.) dimensions were analyzed with pre- and post-irradiation CT images. The means and one standard deviation of the intrafractional errors were 0.9 ± 0.7mm (R.L.), 0.9 ± 0.7mm (P.A.) and 0.5 ± 1.0 mm (I.S.). Setup errors in each session of the treatment demonstrated no statistically significant difference in the mean value between any two sessions. The frequency within 3mm displacement was 98% in R.L., 98% in P.A. and 97% in I.S. directions. SRT under the non-invasive patient fixation immobilization system with a comparatively loose vacuum pillow demonstrated satisfactory reproducibility of minimal setup errors with voluntary breath-holding conditions that required a small internal margin.
Journal of Radiation Research 02/2013; · 1.68 Impact Factor
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Atsushi Nambu,
Hiroshi Onishi,
Shinichi Aoki,
Licht Tominaga,
Kengo Kuriyama, Masayuki Araya,
Ryoh Saito,
Yoshiyasu Maehata,
Takafumi Komiyama,
Kan Marino,
Tsuyota Koshiishi,
Eiichi Sawada,
Tsutomu Araki
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate alpha/beta ratios for discriminating between fracture and non-fracture groups were also investigated. METHODS: Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of alpha/beta ratios (1--10 Gy). Receiver operating characteristics analysis was used to define the most appropriate alpha/beta ratio. RESULTS: Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an alpha/beta ratio of 8 Gy. CONCLUSIONS: Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an alpha/beta ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.
BMC Cancer 02/2013; 13(1):68. · 3.01 Impact Factor
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Hiroshi Onishi,
Kengo Kuriyama,
Takafumi Komiyama,
Kan Marino, Masayuki Araya,
Ryo Saito,
Shinichi Aoki,
Yoshiyasu Maehata,
Licht Tominaga,
Naoki Sano,
Mitsuhiko Oguri,
Kojiro Onohara,
Iori Watanabe,
Tsuyota Koshiishi,
Kazuhiko Ogawa,
Tsutomu Araki
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to define the effects of voluntary anal contraction on prostate motion in an experimental setting.
Thirty-eight patients (median age, 76years) with prostate cancer underwent thin-slice computed tomography (CT) in the vicinity of the prostate before and after active anal contraction. Three-dimensional displacement of the pelvis and prostate was measured.
Mean (±standard deviation, SD) overall displacement of the prostate due to anal contraction was 0.3±1.4mm to the right, 9.3±7.8mm to the anterior, and 5±4mm to the cranial direction. Mean displacement of the pelvis was 0.5±1.8mm to the right, 4.1±7.1mm to the anterior, and 1±3mm to the cranial direction. Mean displacement of the prostate relative to the pelvis was 0.1±1.1mm to the left, 5.2±3.3mm to the anterior, and 4±4mm to the cranial direction.
Voluntary anal contraction within an experimental setting induces large prostate and bone motion, mainly in the anterior and cranial directions. The frequency and magnitude of actual anal contractions during radiotherapy for prostate cancer need to be determined.
Radiotherapy and Oncology 06/2012; 104(3):390-4. · 5.58 Impact Factor
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Hiroshi Onishi,
Masatoki Ozaki,
Kengo Kuriyama,
Takafumi Komiyama,
Kan Marino, Masayuki Araya,
Ryo Saito,
Shinichi Aoki,
Yoshiyasu Maehata,
Lichit Tomiaga,
Mitsuhiko Oguri,
Iori Watanabe,
Koshiro Onohara,
Naoki Sano,
Tsutomu Araki
Acta oncologica (Stockholm, Sweden) 05/2012; 51(5):624-8. · 2.27 Impact Factor
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Hiroshi Onishi,
Masatoki Ozaki,
Kengo Kuriyama,
Takafumi Komiyama,
Kan Marino, Masayuki Araya,
Ryo Saito,
Shinichi Aoki,
Yoshiyasu Maehata,
Licht Tominaga,
Mitsuhiko Oguri,
Iori Watanabe,
Kojiro Onohara,
Meguru Watanabe,
Naoki Sano,
Tsutomu Araki
[show abstract]
[hide abstract]
ABSTRACT: Stereotactic body radiotherapy (SBRT) for oligometastases represents a recent trend in radiation oncology. While abundant data are available regarding the use of SBRT for the treatment of lung or liver oligometastases from various retrospective series and prospective trials, relatively little information has been accumulated for the treatment of oligometastases at sites other than the lungs and liver, particularly for sequential oligometastases in multiple organs. Oligometastases with primary lesions controlled is called "oligo-recurrence." We describe herein the case of a lung cancer patient who developed repeated oligo-recurrence at multiple sites that were each controlled by radical radiotherapy and achieved long-term survival and discuss the merits of locally aggressive radiotherapy for this type of disease condition with reviewing the literature. Although further investigation should be undertaken to clarify the benefits, objectives, and methods of SBRT for the treatment of oligometastases, we believe utilization of SBRT may be worthwhile for patients with remote metastases who hope for treatment to acquire better local control and possible longer survival.
Pulmonary medicine. 01/2012; 2012:713073.
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Yoko Satoh,
Atsushi Nambu,
Hiroshi Onishi,
Eiichi Sawada,
Licht Tominaga,
Kengo Kuriyama,
Takafumi Komiyama,
Kan Marino,
Shinichi Aoki, Masayuki Araya,
Ryo Saito,
Yoshiyasu Maehata,
Mitsuhiko Oguri,
Tsutomu Araki
[show abstract]
[hide abstract]
ABSTRACT: To investigate prognostic and risk factors for recurrence after stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung carcinoma (NSCLC), focusing on dual time point [18]F-fluorodeoxyglucose positron emission tomography (FDG PET).
We prospectively evaluated 57 patients with stage I NSCLC (45 T1N0M0 and 12 T2N0M0) who had undergone pretreatment FDG-PET/CT and were subsequently treated with SBRT. All patients received a whole-body PET/CT scan at 60min and a whole-lung at 120min after the injection. The maximum standardized uptake value (SUV) and retention index (RI) of the lesions were calculated. Local recurrence, regional lymph node metastasis, distant metastasis, and the recurrence pattern were evaluated. Cox proportional hazard regression analyses were performed to evaluate prognostic factors or risk factors of recurrence.
During the median follow-up period of 27months, local recurrence, regional lymph node metastasis, and distant metastasis were seen in 17 (30%), 12 (21%), and 17 (30%) of the 57 patients, respectively. The 3-year overall survival rate was 63.4%. SUV(max) did not affect any recurrence, DFS, OS, or CSS. RI significantly predicted higher distant metastasis (HR 47.546, p=0.026). In contrast, RI tended to predict lower local recurrence (HR 0.175, p=0.246) and regional lymph node metastasis (HR 0.109, p=0.115).
SUV(max) at staging FDG-PET does not predict any recurrence, DFS, OS or CSS. In contrast, higher RI predicts higher distant metastasis and tended to predict lower local or regional lymph node metastasis.
European journal of radiology 12/2011; 81(11):3530-4. · 2.65 Impact Factor
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Atsushi Nambu,
Hiroshi Onishi,
Shinichi Aoki,
Tsuyota Koshiishi,
Kengo Kuriyama,
Takafumi Komiyama,
Kan Marino, Masayuki Araya,
Ryo Saito,
Lichto Tominaga,
Yoshiyasu Maehata,
Eiichi Sawada,
Tsutomu Araki
[show abstract]
[hide abstract]
ABSTRACT: Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer
A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated.
Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4-58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms.
Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present.
Radiation Oncology 01/2011; 6:137. · 2.32 Impact Factor
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[show abstract]
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ABSTRACT: To delineate changing trends in radical external beam radiotherapy (EBRT) for prostate cancer in Japan.
Data from 841 patients with clinically localized prostate cancer treated with EBRT in the Japanese Patterns of Care Study (PCS) from 1996 to 2005 were analyzed.
Significant increases in the proportions of patients with stage T1 to T2 disease and decrease in prostate-specific antigen values were observed. Also, there were significant increases in the percentages of patients treated with radiotherapy by their own choice. Median radiation doses were 65.0 Gy and 68.4 Gy from 1996 to 1998 and from 1999 to 2001, respectively, increasing to 70 Gy from 2003 to 2005. Moreover, conformal therapy was more frequently used from 2003 to 2005 (84.9%) than from 1996 to 1998 (49.1%) and from 1999 to 2001 (50.2%). On the other hand, the percentage of patients receiving hormone therapy from 2003 to 2005 (81.1%) was almost the same as that from 1996 to 1998 (86.3%) and from 1999 to 2001 (89.7%). Compared with the PCS in the United States, patient characteristics and patterns of treatments from 2003 to 2005 have become more similar to those in the United States than those from 1996 to 1998 and those from 1999 to 2001.
This study indicates a trend toward increasing numbers of patients with early-stage disease and increasing proportions of patients treated with higher radiation doses with advanced equipment among Japanese prostate cancer patients treated with EBRT during 1996 to 2005 survey periods. Patterns of care for prostate cancer in Japan are becoming more similar to those in the United States.
International journal of radiation oncology, biology, physics 10/2010; 81(5):1310-8. · 4.59 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: To evaluate the use, structural principles, operation, and acquired reproducibility of a respiratory monitoring device to be used for voluntary patient breath holding.
Evaluation was performed of a respiratory monitoring device that enables determination of the respiratory level in a patient by measuring the movement of two contacts on the abdomen and chest wall. Neither metallic nor electronic materials are used in the mechanics for this device. The initial study group comprised 21 consecutive patients (15 men, six women; mean age, 75 years; range, 56-92 years) with lung or abdominal tumors who underwent examination with the device and computed tomography (CT) for three-dimensional reproducibility of lung base position during voluntary breath holding with or without use of the device.
One patient with mild dementia was excluded; in most of the remaining 20 patients, high reproducibility of the breath-holding position was achieved in a short time with the device. In these 20 patients who were able to adapt to use of the device, three-dimensional mean maximum differences in lung base position during three random voluntary breath holds were 2.0 mm along the cranial-caudal axis, 1.5 mm along the anterior-posterior axis, and 1.2 mm along the right-left axis. The differences in all axes were significantly smaller with use of the respiratory monitoring device than without the device.
The device demonstrates satisfactory reproducibility of voluntary patient breath holding easily and inexpensively and may offer a convenient device for easy use during irradiation with voluntary breath-holding conditions that require a small internal margin.
Radiology 06/2010; 255(3):917-23. · 5.73 Impact Factor
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[show abstract]
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ABSTRACT: To analyze retrospectively the results of postoperative radiotherapy for localized prostate cancer and to investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcome after radiotherapy.
Seventy-six patients with localized prostate cancer treated with postoperative radiotherapy were retrospectively reviewed. Total radiation doses ranged from 50 to 70 Gy (median: 60 Gy), and the median follow-up period for all 76 patients was 47.9 months (range, 12.4-101.3 months).
The 5-year actuarial overall survival, progression-free survival, biochemical relapse-free survival (BRFS) and local control rates in all 76 patients after radiotherapy were 86.1%, 77.8%, 80.0% and 92.2%, respectively. Distant metastases and/or regional lymph node metastases developed in 11 patients (14%) after radiotherapy, while local progression was observed in only 5 patients (7%). Of all 76 patients, the median nPSA12 in patients with biochemical failure and that in patients without biochemical failure were 1.16 ng/ml and 0.05 ng/ml, respectively. The 5-year BRFS rates in patients with low nPSA12 (<0.5 ng/ml) and those with high nPSA12 (> or =0.5 ng/ml) were 92.7% and 42.2%, respectively (p<0.0001). In univariate analysis, nPSA12, pre-radiotherapy PSA, Karnofsky performance status and the use of chemotherapy had a significant impact on BRFS, and in multivariate analysis, nPSA12 alone was an independent prognostic factor for BRFS.
Postoperative radiotherapy results in an excellent local control rate for localized prostate cancer and nPSA12 is predictive of biochemical failure after postoperative radiotherapy.
Anticancer research 11/2009; 29(11):4605-13. · 1.73 Impact Factor
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[show abstract]
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ABSTRACT: The purpose of this study is to identify the treatment planning process for Japanese patients with localized prostate cancer.
The Patterns of Care Study conducted a random survey of 61 institutions nationwide. Detailed information was collected on prostate cancer patients without distant metastases who were irradiated during the periods 2003-05. Radiation treatment planning and delivery were evaluated in 397 patients who were treated radically with external photon beam radiotherapy.
Computed tomography data were used for planning in approximately 90% of the patients. Contrast was rarely used for treatment planning. Simulations and treatments were performed in the supine position in almost all patients. Immobilization devices were used in only 15% of the patients. Verification of the treatment fields using portal films or electric portal imaging devices was performed in most of the patients. However, regular or multiple verifications in addition to initial treatment and/or portal volume changes were performed in only 30% of the patients. Typical beam arrangements for treatment of the prostate consisted of a four-field box. Three-dimensional conformal techniques were applied less frequently in non-academic hospitals than in academic ones. Modernized multileaf collimators with leaf widths < or =10 mm were used in about two-thirds of the patients. Although the total doses given to the prostate were affected by the leaf widths, there were no significant differences between leaf widths of 5 and 10 mm.
The results of the survey identified certain patterns in the current treatment planning and delivery processes for localized prostate cancer in Japan.
Japanese Journal of Clinical Oncology 10/2009; 39(12):820-4. · 1.78 Impact Factor
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[show abstract]
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ABSTRACT: To analyze retrospectively the results of external beam radiotherapy for clinically localized hormone-refractory prostate cancer and investigate the clinical significance of nadir prostate-specific antigen (PSA) value within 12 months (nPSA12) as an early estimate of clinical outcomes after radiotherapy.
Eighty-four patients with localized hormone-refractory prostate cancer treated with external beam radiotherapy were retrospectively reviewed. The total radiation doses ranged from 30 to 76 Gy (median, 66 Gy), and the median follow-up period for all 84 patients was 26.9 months (range, 2.7-77.3 months).
The 3-year actuarial overall survival, progression-free survival (PFS), and local control rates in all 84 patients after radiotherapy were 67%, 61%, and 93%, respectively. Although distant metastases and/or regional lymph node metastases developed in 34 patients (40%) after radiotherapy, local progression was observed in only 5 patients (6%). Of all 84 patients, the median nPSA12 in patients with clinical failure and in patients without clinical failure was 3.1 ng/mL and 0.5 ng/mL, respectively. When dividing patients according to low (<0.5 ng/mL) and high (>or=0.5 ng/mL) nPSA12 levels, the 3-year PFS rate in patients with low nPSA12 and in those with high nPSA12 was 96% and 44%, respectively (p < 0.0001). In univariate analysis, nPSA12 and pretreatment PSA value had a significant impact on PFS, and in multivariate analysis nPSA12 alone was an independent prognostic factor for PFS after radiotherapy.
External beam radiotherapy had an excellent local control rate for clinically localized hormone-refractory prostate cancer, and nPSA12 was predictive of clinical outcomes after radiotherapy.
International journal of radiation oncology, biology, physics 04/2009; 74(3):759-65. · 4.59 Impact Factor
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ABSTRACT: Optimal management of radiotherapy for prostate cancer patients has become a major concern for physicians in Japan. We reviewed published reports identifying the differences in the patterns of care for prostate cancer patients treated with radical external beam radiotherapy in Japan, Germany, and the United States. The reports indicate that Japanese patients have more advanced primary disease than patients in Germany or the United States. These patient characteristics for Japan and the United States have been almost unchanged for several years. Regarding radiotherapy, conformal radiotherapy was less frequently administered to patients in Japan than patients in Germany or the United States, and the total radiation dose was higher in Germany and the United States than in Japan. Concerning changes in trends in the patterns of radiotherapy, the percentage of patients treated with higher dose levels in the United States has rapidly increased, whereas the percentage of patients receiving these dose levels in Japan has remained extremely low. On the other hand, hormonal therapy has been used more frequently in Japan than in Germany or the United States. These findings indicate that patient characteristics and patterns of care for prostate cancer in Japan are considerably different from those in Germany or the United States.
Radiation Medicine 03/2008; 26(2):57-62.
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Kazuhiko Ogawa,
Katsumasa Nakamura,
Tomonari Sasaki,
Hiroshi Onishi,
Masahiko Koizumi, Masayuki Araya,
Yoshiyuki Shioyama,
Atsushi Okamoto,
Michihide Mitsumori,
Teruki Teshima,
Japanese Patterns of Care Study,
Working Subgroup of Prostate Cancer
[show abstract]
[hide abstract]
ABSTRACT: Optimal management of radiotherapy for prostate cancer patients has become a major concern for physicians in Japan. We reviewed
published reports identifying the differences in the patterns of care for prostate cancer patients treated with radical external
beam radiotherapy in Japan, Germany, and the United States. The reports indicate that Japanese patients have more advanced
primary disease than patients in Germany or the United States. These patient characteristics for Japan and the United States
have been almost unchanged for several years. Regarding radiotherapy, conformal radiotherapy was less frequently administered
to patients in Japan than patients in Germany or the United States, and the total radiation dose was higher in Germany and
the United States than in Japan. Concerning changes in trends in the patterns of radiotherapy, the percentage of patients
treated with higher dose levels in the United States has rapidly increased, whereas the percentage of patients receiving these
dose levels in Japan has remained extremely low. On the other hand, hormonal therapy has been used more frequently in Japan
than in Germany or the United States. These findings indicate that patient characteristics and patterns of care for prostate
cancer in Japan are considerably different from those in Germany or the United States.
Radiation Medicine 01/2008; 26(2):57-62.
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[show abstract]
[hide abstract]
ABSTRACT: The influence of age on the patterns and outcomes of external beam radiotherapy for clinically localized prostate cancer patients was examined.
The Japanese Patterns of Care Study surveys were used to compare the processes and outcomes of radical external beam radiotherapy in 140 elderly patients (>75 years old) and 304 younger patients (<75 years old).
Although the Karnofsky performance status was significantly different between elderly and younger patients, there were no significant differences in disease characteristics such as pretreatment PSA level, differentiation, Gleason combined score and clinical T stage. There were also no significant differences in the treatment characteristics such as CT-based treatment planning, conformal therapy, total radiation doses (both a median of 66.0 Gy) and hormonal therapy usage. Moreover, no significant differences in overall survival, biochemical relapse-free survival and late toxicity rates were observed between elderly and younger patients.
Age did not influence the disease characteristics, patterns of external beam radiotherapy, survival and late toxicities for clinically localized prostate cancer patients. Therefore, radiotherapy could represent an important treatment modality for elderly patients as well as for younger ones.
Anticancer research 26(2B):1319-25. · 1.73 Impact Factor
