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Masao Tanooka,
Hiroshi Doi,
Hideharu Miura,
Hiroyuki Inoue,
Yasue Niwa,
Yasuhiro Takada,
Masayuki Fujiwara,
Toshiyuki Sakai,
Kiyoshi Sakamoto, Norihiko Kamikonya,
Shozo Hirota
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ABSTRACT: We validated 3D radiochromic film dosimetry for volumetric modulated arc therapy (VMAT) using a newly developed spiral water phantom. The phantom consists of a main body and an insert box, each of which has an acrylic wall thickness of 3 mm and is filled with water. The insert box includes a spiral film box used for dose-distribution measurement, and a film holder for positioning a radiochromic film. The film holder has two parallel walls whose facing inner surfaces are equipped with spiral grooves in a mirrored configuration. The film is inserted into the spiral grooves by its side edges and runs along them to be positioned on a spiral plane. Dose calculation was performed by applying clinical VMAT plans to the spiral water phantom using a commercial Monte Carlo-based treatment-planning system, Monaco, whereas dose was measured by delivering the VMAT beams to the phantom. The calculated dose distributions were resampled on the spiral plane, and the dose distributions recorded on the film were scanned. Comparisons between the calculated and measured dose distributions yielded an average gamma-index pass rate of 87.0% (range, 91.2-84.6%) in nine prostate VMAT plans under 3 mm/3% criteria with a dose-calculation grid size of 2 mm. The pass rates were increased beyond 90% (average, 91.1%; range, 90.1-92.0%) when the dose-calculation grid size was decreased to 1 mm. We have confirmed that 3D radiochromic film dosimetry using the spiral water phantom is a simple and cost-effective approach to VMAT dose verification.
Journal of Radiation Research 05/2013; · 1.68 Impact Factor
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Hiroshi Doi,
Naohito Beppu,
Soichi Odawara,
Masao Tanooka,
Yasuhiro Takada,
Yasue Niwa,
Masayuki Fujiwara,
Fumihiko Kimura,
Hidenori Yanagi,
Naoki Yamanaka, Norihiko Kamikonya,
Shozo Hirota
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ABSTRACT: The purpose of this study was to examine the safety and feasibility of a novel protocol of neoadjuvant short-course hyperfractionated accelerated radiotherapy (SC-HART) combined with S-1 for locally advanced rectal cancer. A total of 56 patients with lower rectal cancer of cT3N1M0 (Stage III b) was treated with SC-HART followed by radical surgery, and were analyzed in the present study. SC-HART was performed with a dose of 2.5 Gy twice daily, with an interval of at least 6 hours between fractions, up to a total dose of 25 Gy (25 Gy in 10 fractions for 5 days) combined with S-1 for 10 days. Radical surgery was performed within three weeks following the end of the SC-HART. The median age was 64.6 (range, 39-85) years. The median follow-up term was 16.3 (range, 2-53) months. Of the 56 patients, 53 (94.4%) had no apparent adverse events before surgery; 55 (98.2%) completed the full course of neoadjuvant therapy, while one patient stopped chemotherapy because of Grade 3 gastrointestinal toxicity (CTCAE v.3). The sphincter preservation rate was 94.6%. Downstaging was observed in 45 patients (80.4%). Adjuvant chemotherapy was administered to 43 patients (76.8%). The local control rate, disease-free survival rate and disease-specific survival rate were 100%, 91.1% and 100%, respectively. To conclude, SC-HART combined with S-1 for locally advanced rectal cancer was well tolerated and produced good short-term outcomes. SC-HART therefore appeared to have a good feasibility for use in further clinical trials.
Journal of Radiation Research 05/2013; · 1.68 Impact Factor
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ABSTRACT: BACKGROUND: The polycomb group (PcG) family BMI1, acting downstream of the hedgehog (Hh) pathway, plays an essential role in the self-renewal of haematopoietic, neural, and intestinal stem cells, and is dysregulated in many types of cancer. Our recent report has demonstrated that Hh signalling activation can predict very earlier relapse of oesophageal cancers. As data were not available on the clinical role of BMI1 expression in oesophageal cancers after chemoradiotherapy (CRT), we analysed whether it could be also used to predict disease progression and prognosis in oesophageal cancer patients undergoing trimodality therapy of preoperative CRT and oesophagectomy. METHODS: Expressions of BMI1 and p16INK4A, a downstream target of PcG, were analysed in 78 patients with histologically confirmed oesophageal squamous cell carcinoma (ESCC) after preoperative CRT by immunohistochemical staining. The association of BMI1 and p16INK4A expression with clinicopathologic characteristics was analysed by chi2-test. Survival analysis was carried out by the log-rank test using Kaplan-Meier method. RESULTS: Among 78 ESCC patients, 24 patients (30.8%) showed BMI1 positivity, mainly localised in the nuclei of tumour cells. Patients harbouring BMI1-positive tumour cells showed significantly poorer prognoses than those without such cells or residual tumours (mean disease-free survival (DFS) time 16.8 vs 71.2 months; 3-yr DFS 13.3% vs 49.9%, P=0.002; mean OS time 21.8 vs 76.6 months; 3-yr OS 16.2% vs 54.9%, P=0.0005). There was no significant correlation between p16INK4A expression and BMI1 expression. CONCLUSIONS: Our study shows that BMI1 expression is a predictor of early relapse and poor prognosis in ESCC after CRT. These findings suggest that BMI1 signal activation might be involved in promoting cancer regrowth and progression after CRT, and might be indicative of emergence of 'more aggressive' cancer progenitor cells.
BMC Cancer 10/2012; 12(1):461. · 3.01 Impact Factor
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Hiroshi Doi, Norihiko Kamikonya,
Yasuhiro Takada,
Yasue Niwa,
Masayuki Fujiwara,
Keita Tsuboi,
Hideharu Miura,
Hiroyuki Inoue,
Masao Tanooka,
Takeshi Nakamura,
Toshiyuki Shikata,
Takeshi Kimura,
Tohru Tsujimura,
Shozo Hirota
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ABSTRACT: Background:Although anticoagulation therapy is commonly used
in the prostate cancer population, there are only a few studies about
the correlation between radiation proctitis and anticoagulation ther-apy. The purpose of the present study was to determine whether
low-dose aspirin increases the severity of acute radiation proctitis
in an experimental animal model.
Methods:Wistar rats were used in the present study. The rats were
administered either aspirin at doses of 5, 10, and 20 mg/kg, or sa-line, daily before and after irradiation. The rats were irradiated to
the rectum as a single fraction of 25 Gy. The rectal mucosal changes
of each rat were evaluated macroscopically and pathologically on
the tenth day following irradiation. The findings of proctitis were
graded from 0 to 4, and then were compared with regard to the
status.
Results:No apparent correlations were observed between the ad-ministration of aspirin and the severity of radiation proctitis in the
macroscopic findings and in the morphological mucosal damage
in the pathological examination. The proportion of rats with a se-vere degree of mucosal inflammation was 90.0%, 100.0%, 16.7%
and 100.0% at 5 mg/kg, 10 mg/kg, and 20 mg/kg of aspirin, or
saline, respectively. The rats receiving aspirin at the dose of 20 mg/
kg showed significantly milder inflammation than the other groups
(P < 0.05).
Conclusions:In the present study, low-dose aspirin did not in-crease the severity of acute radiation proctitis. In addition, aspirin
might decrease the severity of radiation-induced mucosal inflam-mation in the rectum.
World Journal of Surgical Oncology 08/2012; 3:173-181. · 1.12 Impact Factor
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ABSTRACT: We compared the efficiency and accuracy of full-arc and half-arc volumetric-modulated arc therapy (VMAT) delivery for maxillary cancer. Plans for gantry rotation angles of 360° and 180° (full-arc and half-arc VMAT) were created for six maxillary cancer cases with the Monaco treatment planning system, and delivered using an Elekta Synergy linear accelerator. Full-arc and half-arc VMAT were compared with regard to homogeneity index (HI), conformity index (CI), mean dose to normal brain, total monitor units (MU), delivery times, root mean square (r.m.s.) gantry accelerations (°/s(2)), and r.m.s. gantry angle errors (°). The half-arc VMAT plans achieved comparable HI and CI to the full-arc plans. Mean doses to the normal brain and brainstem with the half-arc VMAT plans were on average 16% and 17% lower than those with the full-arc VMAT plans. For other organs at risk (OARs), no significant DVH differences were observed between plans. Half-arc VMAT resulted in 11% less total MU and 20% shorter delivery time than the full-arc VMAT, while r.m.s. gantry acceleration and r.m.s. gantry angle error during half-arc VMAT delivery were 30% and 23% less than those during full-arc VMAT delivery, respectively. Furthermore, the half-arc VMAT plans were comparable with the full-arc plans regarding dose homogeneity and conformity in maxillary cancer, and provided a statistical decrease in mean dose to OAR, total MU, delivery time and gantry angle error. Half-arc VMAT plans may be a suitable treatment option in radiotherapy for maxillary cancer.
Journal of Radiation Research 07/2012; 53(5):785-90. · 1.68 Impact Factor
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ABSTRACT: The prognosis of advanced esophageal cancer patients is poor. Trimodality therapy of surgical resection plus neoadjuvant chemoradiotherapy (CRT) has been developed to improve survival through locoregional control, leading to prevention of micrometastasis. We investigated whether or not neoadjuvant CRT led to survival benefits in TNM stage II/III esophageal cancer patients. We retrospectively reviewed 62 patients with stage II or III esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant CRT. All patients received esophagectomy 4-7 weeks after CRT consisting of 40 Gy irradiation and chemotherapy (5-FU, 500 mg/m2/day, days 1-5 and cisplatin, 10-20 mg/body, days 1-5). Clinical response and survival rates were analyzed using Kaplan-Meier methods, with p<0.05 considered as significant. The clinical effect rate of CRT for both primary tumors and metastatic nodes was 82.3%. Operative and hospital mortality rates were 1.65 and 6.5%, respectively. The 3-year overall survival (OS) and disease-free survival (DFS) rates were 52.6 and 49.2%, respectively. A significant difference was noted between stages II and III for both OS and DFS. The 5-year OS rates were 64.2% for stage II, 33.1% for stage III (T4 and non-T4) and 46.9% for stage III (non-T4 only) patients. The depth of tumor invasion (T3 vs. T4), resectability (R0 vs. R1, R2), lymph node metastasis (positive vs. negative), and the effect of CRT were proven to be independent prognostic factors for univariate analysis, with resectability and the effect of CRT for multivariate analysis. These data suggest that CRT in stage II/III (non-T4) ESCC patient contributed to tumor shrinkage, leading to higher resectability and longer survival. Neoadjuvant CRT appears to be a promising option for these patients.
Oncology Reports 06/2012; 28(2):446-52. · 1.84 Impact Factor
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Hiroshi Doi, Norihiko Kamikonya,
Yasuhiro Takada,
Masayuki Fujiwara,
Keita Tsuboi,
Hideharu Miura,
Hiroyuki Inoue,
Masao Tanooka,
Takeshi Nakamura,
Toshiyuki Shikata,
Takeshi Kimura,
Tohru Tsujimura,
Shozo Hirota
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ABSTRACT: The purpose of the present study was to establish an experimental rat model for late radiation proctitis, and to examine the assessment strategy for late radiation proctitis. A total of 57 Wistar rats were used. Fourty-five of the rats were exposed to selective rectal irradiation with a single fraction of 25 Gy. These rats were sacrificed at the 4(th), 12(th), 24(th), and 37(th) week following irradiation. The remaining 12 rats comprised the control group without irradiation. The rectal mucosa of each rat was evaluated macroscopically and pathologically. The number of vessels in the rectal mucosa was counted microscopically. In addition, the vascular stenosis was evaluated. In the results, the degree of clinical and macroscopic findings decreased following acute proctitis and developed later. In the pathological examination, mucosal changes and microangiopathy were followed up, as well. The absolute number of vessels in the rectum was the greatest at the 12(th) week following irradiation and was the lowest in the control group. The severity of the microangiopathy was also well evaluated. To conclude, we established an animal experimental model of late radiation proctitis, and also established an assessment strategy to evaluate objectively the severity of late radiation proctitis with focusing on microangiopathy using an animal experimental model. This model can be used as an animal experimental model of radiation-induced microangiopathy.
Journal of Radiation Research 01/2012; 53(2):217-24. · 1.68 Impact Factor
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ABSTRACT: Introduction
Primary undifferentiated carcinomas of the lacrimal sac are extremely rare with only a few documented cases and with no cases of Japanese patients to best of our knowledge.
Case report
A 49-year-old female with lacrimation and an orbital mass was referred to our hospital. FDG-PET did not reveal any evidence of metastatic diseases. The patient was treated with a wide resection of right orbital tumor. The pathological examination led to a diagnosis of undifferentiated carcinoma. The postoperative site received 60 Gy in 30 fractions as adjuvant radiotherapy. Neck dissection was performed later. Two cycles of systemic chemotherapy, consisting of docetaxel, cisplatin, and 5-fluorouracil, were delivered sequentially. However, multiple metastatic lesions occurred in the lung, skin and lymph nodes. The patient died 7 months after the initial operation.
Conclusion
The undifferentiated carcinoma of the lacrimal sac exhibited an aggressive behavior with a poor prognosis. Therefore, a careful follow-up is required, because recurrence and metastasis may occur within a very short period of time after the initial treatment.
World Journal of Surgical, Medical and Radiation Oncology. 01/2012; 1(18):91-96.
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ABSTRACT: The feasibility and efficacy of trimodality therapy for malignant pleural mesothelioma (MPM) are still controversial mainly due to the lack of clinical evidence. Although three major clinical trials on this therapy have been recently reported from North America and Europe, it remains unclear whether results in Caucasian populations may be directly applicable to Asian populations. In this context, as a project of the "Comprehensive approach on asbestos-related diseases" supported by the "Special Coordination Fund for Promoting Science and Technology of MEXT, Japan", a prospective multi-institutional study has been planned to evaluate the feasibility of induction chemotherapy using pemetrexed plus cisplatin, followed by extrapleural pneumonectomy (EPP) and postoperative hemithoracic radiation in patients with resectable MPM. Primary endpoints are macroscopic complete resection rate by EPP and treatment-related mortality for trimodality therapy. The study was initiated in May 2008 and patient enrollment was finished in November 2010.
Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene) 05/2011; 66(3):558-61.
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Hiroshi Doi, Norihiko Kamikonya,
Yasuhiro Takada,
Masayuki Fujiwara,
Keita Tsuboi,
Hiroyuki Inoue,
Masao Tanooka,
Takeshi Nakamura,
Toshiyuki Shikata,
Tohru Tsujimura,
Shozo Hirota
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ABSTRACT: The purpose of the present study was to standardize the experimental rat model of radiation proctitis and to examine the efficacy of polaprezinc on radiation proctitis.
A total of 54 female Wistar rats (5 weeks old) were used. The rats were divided into three groups: those treated with polaprezinc (PZ+), those treated with base alone, exclusive of polaprezinc (PZ-), and those treated without any medication (control). All the rats were irradiated to the rectum. Polaprezinc was prepared as an ointment. The ointment was administered rectally each day after irradiation. All rats were killed on the 10th day after irradiation. The mucosal changes were evaluated endoscopically and pathologically. The results were graded from 0 to 4 and compared according to milder or more severe status, as applicable.
According to the endoscopic findings, the proportion of mild changes in the PZ+, PZ-, and control group was 71.4%, 25.0%, and 14.3% respectively. On pathologic examination, the proportion of low-grade findings in the PZ+, PZ-, and control group was 80.0%, 58.3%, and 42.9% for mucosal damage, 85.0%, 41.7%, and 42.9% for a mild degree of inflammation, and 50.0%, 33.3%, and 4.8% for a shallow depth of inflammation, respectively. The PZ+ group tended to have milder mucosal damage than the other groups, according to all criteria used. In addition, significant differences were observed between the PZ+ and control groups regarding the endoscopic findings, degree of inflammation, and depth of inflammation.
This model was confirmed to be a useful experimental rat model for radiation proctitis. The results of the present study have demonstrated the efficacy of polaprezinc against acute radiation-induced rectal disorders using the rat model.
International journal of radiation oncology, biology, physics 03/2011; 80(3):877-84. · 4.59 Impact Factor
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ABSTRACT: A prospective multi-institutional study has been commenced in Japan to evaluate the feasibility of induction chemotherapy using pemetrexed plus cisplatin, followed by extrapleural pneumonectomy (EPP) and postoperative hemithoracic radiation in patients with resectable malignant pleural mesothelioma. The study was initiated on May 2008 and 40 patients will be recruited over 3 years. Primary endpoints are macroscopic complete resection rate by EPP and treatment-related mortality for trimodality therapy. Secondary endpoints include treatment completion rate, adverse events, response rate by chemotherapy and 2-year overall and relapse-free survival.
Japanese Journal of Clinical Oncology 02/2009; 39(3):186-8. · 1.78 Impact Factor
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ABSTRACT: Disseminated necrotizing leukoencephalopathy (DNL) is a potentially fatal complication of treatment involving intrathecal administration of chemotherapeutic agents such as methotrexate (MTX) alone or in combination with cranial radiotherapy (RT). We describe a case of acute lymphoblastic leukemia (ALL) treated with high-dose intravenous and intrathecal methotrexate combined with craniospinal RT resulting in DNL. Typical MR imaging features of progressive deep white matter lesions showing a characteristic pattern of enhancement after contrast was seen in this case. Deep white matter lesions with ring-like enhancement and calcifications were seen on CT; it showed a mass effect at one stage, which is not typical for DNL. Long-term clinical and imaging follow-up were helpful for the diagnosis in this case.
Radiation Medicine 09/2006; 24(7):515-9.
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Yoshinori Fujiwara, Norihiko Kamikonya,
Takashi Inoue,
Kenji Koishi,
Reigetsu Yoshikawa,
Koji Nakao,
Ryuuichirou Yagyu,
Manabu Nishiwaki,
Masayuki Fujiwara,
Shoudou Kojima,
Kazuhiko Nakagawa,
Takehira Yamamura
[show abstract]
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ABSTRACT: We conducted this study to evaluate the clinical significance of preoperative concurrent chemoradiotherapy (CRT) followed by esophagectomy in the management of T3 and T4 esophageal cancer. Thirty patients with squamous cell carcinoma of the esophagus received CRT followed by surgery. Preoperative CRT consisted of 5-fluorouracil (500 mg/m(2) by 24 h infusion for 5 days), cisplatin (15 mg/m(2) on days 1-5), and concurrent radiotherapy (a total dose of 40 Gy delivered in daily fractions of 2 Gy, 5 times per week). Esophagectomy was planned for 4-6 weeks after treatment and restaging. All 30 patients completed preoperative CRT. A clinical response (PR+CR) of the primary tumor was obtained in 82.8%, and a response of metastatic nodes was seen in 23.1%. Radical resection was possible in 17 of 29 operated patients (58.6%). The postoperative mortality rate was 6.9%, and the hospital mortality rate was 10.3%. Ten out of 29 operated patients (34.5%) had no residual cancer in the resected esophagus, corresponding to pathological CR. The 1-year survival rate was 80.6%, the 2-year survival rate was 62.7%, and the 3-year survival rate was 53.8%. The clinical response group and the R0 or R1 group showed better survival than other patients. Preoperative CRT should be given to patients with squamous cell carcinoma, while esophagectomy remains the standard therapy for responders and has a tolerable mortality.
Oncology Reports 12/2005; 14(5):1177-82. · 1.84 Impact Factor
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ABSTRACT: Because of the low incidence of nasopharyngeal carcinoma (NPC) in Japan, few studies have reported on the use of concurrent chemo-radiotherapy (CCRT) for treatment of this disease. The present study investigated the efficacy and toxicity of CCRT with Carboplatin (CBDCA) and UFT for NPC.
CCRT with injection of CBDCA and oral administration of UFT was given to 21 patients in our institution during 1996-2000. We compared the patients treated with CCRT with those treated with RT alone from 1976 to 1995 or those treated with RT after chemotherapy (Pre-RT chemotherapy) from 1985 to 1995. Overall survival rate (OS), progression free survival rate (PFS) and cause specific survival (CSS) rate were analyzed.
The actual 2-year OS, PFS, and CSS of CCRT were 85.7, 66.7 and 90%, respectively. The rates were improved compared to RT alone (37.9, 31.0, and 56.6%) and Pre-RT chemotherapy (58.8, 41.2, and 64.7%). The most frequent and severe acute toxicities were leukopenia (42.9%) and mucositis with grade 3-4 (28.6%), both of which eventually resolved.
CCRT with CBDCA and UFT is considered to be an effective, convenient, and tolerable treatment, which improves survival rates for NPC patients. Therefore, we recommend this CCRT method for the treatment of NPC.
Auris Nasus Larynx 04/2004; 31(1):43-7. · 0.76 Impact Factor
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ABSTRACT: To shorten the TBI process, we developed a new device for making the three-dimensional (3D) compensating filter that improves dose distribution. The dose distributions in the phantom and manufacturing time were compared between the new device and the previous one. Clinical evaluations included dose distribution in patients and the clinical rate of interstitial pneumonitis (IP). Our 3D compensating filter is made of polystyrene resin and gypsum. The filter was made after performing two procedures as follows. Patient data were measured by CT, and the 3D dose-distribution data and 3D compensating-filter data were obtained from the CT data by the 3D radiation planning system. We were able to produce the new 3D compensating filter within about 4 hours, including all procedures. The average dose distribution to each site when the 3D compensating filter was used was 92.7% to the head, 102.1% to the thorax, 106.4% to the pelvis, 90.2% to the knee, and 93.8% to the ankle joint, when the scheduled dose was taken as 100%. Dose distribution was improved. IP occurred in 6 of 32 patients (18.8%). There was no significant difference between the TBI and non-TBI groups in the frequency of IP (p = 0.27).
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica 10/2003; 63(8):399-404.
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Ryohei Sasaki,
Toshinori Soejima,
Kazushi Kishi,
Yoshinari Imajo,
Saeko Hirota, Norihiko Kamikonya,
Masao Murakami,
Tetsuya Kawabe,
Yasuo Ejima,
Akira Matsumoto,
Kazuo Sugimura
[show abstract]
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ABSTRACT: Angiosarcoma is a rare and highly malignant vascular neoplasm. The purpose of this study was to elucidate the tumor characteristics and evaluate the efficacy of radiotherapy (RT) for angiosarcoma.
Thirty patients with angiosarcoma (20 males and 10 females, age range 4-89 years, median 66) who received RT from 1986 to 1999 were enrolled in the study. Twenty-four patients had angiosarcoma of the face and scalp (AFS), and 6 patients had angiosarcomas at other sites. AFS was classified into two categories (according to the macroscopic features): nodular AFS (14 patients) and endophytic AFS (10 patients). The median prescribed irradiation dose was 68 Gy. Surgery had been previously performed in 9 patients, and adjuvant immunotherapy using recombinant interleukin-2 (rIL-2) was combined during and after RT in 20 patients. Univariate analyses and calculation of survival by Kaplan-Meier methods were performed.
Local tumor control was obtained in 17 patients (57%). However, 7 (47%) of them developed distant metastases. The median survival time for all patients was 8 months (7 months for AFS), and the 13-year overall survival rate was 25% (20% for AFS). Twenty-one patients died of angiosarcoma, with the cause of death local failure in 7 patients, distant failure in 7, and both in 7. Tumor type and size were found to be significant prognostic factors (p = 0.004 and p = 0.007, respectively), and age, total amount of rIL-2, gender, radiation dose, and surgery were not. Six patients (4 with nodular AFS and 2 with angiosarcoma in other parts) survived >2 years. No patient with endophytic AFS survived >2 years. Ten patients (33%) died of respiratory failure secondary to pulmonary metastases. High-dose rIL-2 administration suppressed the occurrence of distant metastases (p = 0.006). Two patients developed radiation dermatitis (Radiation Therapy Oncology Group Grade 4).
RT, combined with complete resection or adjuvant rIL-2 immunotherapy, could be a promising treatment strategy, leading to prolonged survival in patients with angiosarcoma.
International Journal of Radiation OncologyBiologyPhysics 03/2002; 52(4):1032-40. · 4.11 Impact Factor
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ABSTRACT: The aim of this study was to analyze the complications that may develop after preoperative intraluminal brachytherapy (IBT)
and radical surgery for rectal carcinoma. A total of 106 rectal carcinoma patients who were given moderate (16–40 Gy) or high
(40–80 Gy) doses of IBT between 1986 and 1995 were followed up and recorded in our outpatient clinic. Postoperative complications
developed in 34 of 87 patients in the moderate-dose group and 13 of 19 patients in the high-dose group, 7 of whom in the former
groups and 5 in the latter group required surgical intervention for their complication. The other patients were treated conservatively.
Statistical analysis identified the factors related to the incidence of complications to be: the IBT dose, the field length,
the timedose factor (TDF), and the distance from above the anal verge to the distal border of the tumor. The incidence and
severity of complications suggested that moderate-dose IBT was better than high-dose IBT preoperatively, especially when restorative
operations were scheduled.
Surgery Today 01/1997; 27(12):1103-1108. · 1.22 Impact Factor
