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Teruki Teshima,
Hodaka Numasaki,
Masamichi Nishio, Hiroshi Ikeda,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yutaka Ando,
Nobuhito Tsukamoto,
Atsuro Terahara,
Katsumasa Nakamura,
Masao Murakami,
Mitsuhiro Takahashi,
Tetsuo Nishimura
[show abstract]
[hide abstract]
ABSTRACT: The ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution was evaluated in order to radiation identify and improve any deficiencies. A questionnaire-based national structure survey was conducted from March 2010 to January 2011 by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study (PCS). The total numbers of new cancer patients and total of cancer patients (new and repeat) treated with radiation in 2009 were estimated at 201,000 and 240,000, respectively. The type and numbers of systems in actual use consisted of Linac (816), telecobalt (9), Gamma Knife (46), (60)Co remote afterloading system (RALS) (29) and (192)Ir RALS systems (130). The Linac systems used dual energy function for 586 (71.8%), 3DCRT for 663 (81.3%) and IMRT for 337 units (41.3%). There were 529 JASTRO-certified radiation oncologists (ROs), 939.4 full-time equivalent (FTE) ROs, 113.1 FTE medical physicists and 1836 FTE radiation therapists. The frequency of interstitial radiation therapy use for prostate and of intensity-modulated radiotherapy increased significantly. PCS stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more radiation therapy tended to be used for cancer patients. In conclusion, the Japanese structure has clearly improved during the past 19 years in terms of equipment and its use, although a shortage of manpower and variations in maturity disclosed by PCS stratification remained problematic in 2009.
Journal of Radiation Research 07/2012; 53(5):710-21. · 1.68 Impact Factor
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Hodaka Numasaki,
Hitoshi Shibuya,
Masamichi Nishio, Hiroshi Ikeda,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yutaka Ando,
Nobuhiro Tsukamoto,
Atsuro Terahara,
Katsumasa Nakamura,
Michihide Mitsumori,
Tetsuo Nishimura,
Masato Hareyama,
Teruki Teshima,
Japanese Society Therapeutic Radiology Oncology Database Committee and of Committee
[show abstract]
[hide abstract]
ABSTRACT: Background and Purpose:
The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel,
patient load, and geographic distribution. The effect of changes in the health care policy in Japan on radiotherapy structure
was also examined.
Material and Methods:
The Japanese Society of Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2007.
The structures of 349 designated cancer care hospitals and 372 other radiotherapy facilities were compared.
Results:
Respective findings for equipment and personnel at designated cancer care hospitals and other facilities included the following:
linear accelerators/facility: 1.3 and 1.0; annual patients/linear accelerator: 296.5 and 175.0; and annual patient load/full-time
equivalent radiation oncologist was 237.0 and 273.3, respectively. Geographically, the number of designated cancer care hospitals
was associated with population size.
Conclusion:
The structure of radiation oncology in Japan in terms of equipment, especially for designated cancer care hospitals, was as
mature as that in European countries and the United States, even though the medical costs in relation to GDP in Japan are
lower. There is still a shortage of manpower. The survey data proved to be important to fully understand the radiation oncology
medical care system in Japan.
Hintergrund und Ziel:
Es wurde die Struktur der Radioonkologie in auf Krebsbehandlung spezialisierten Krankenhäusern in Japan untersucht, und zwar
im Hinblick auf Ausrüstung, Personal, Patientenaufkommen und geografische Verteilung. Ebenso wurden die Auswirkungen von Veränderungen
in der japanischen Gesundheitsfürsorge-Politik auf die Strahlungstherapie-Struktur untersucht.
Material und Methodik:
Die Japanische Gesellschaft für radiologische Therapie und Onkologie hat eine Erhebung zur nationalen Struktur der Strahlungsonkologie
im Jahr 2007 durchgeführt. Dabei wurden die Strukturen von 349 auf Krebsbehandlung spezialisierten Krankenhäusern und 372
anderen Strahlentherapie-Einrichtungen verglichen.
Ergebnisse:
Die jeweiligen Ergebnisse in Bezug auf die Ausrüstung und das Personal in den auf Krebsbehandlung spezialisierten Krankenhäusern
und anderen Einrichtungen waren: Linearbeschleuniger pro Einrichtung: 1,3 bzw. 1,0; jährliche Patientenzahl pro Linearbeschleuniger:
296,5 bzw. 175,0. Das jährliche Patientenaufkommen pro Vollzeitäquivalent-Radioonkologe betrug 237,0 bzw. 273,3. In geografischer
Hinsicht stand die Anzahl der auf Krebsbehandlung spezialisierten Krankenhäuser in Relation zur Bevölkerungszahl.
Schlussfolgerung:
Die Struktur der Radioonkologie in Japan war, was die Ausrüstung und insbesondere die auf Krebsbehandlung spezialisierten
Krankenhäuser betrifft, ebenso ausgereift wie oder ausgereifter als in europäischen Ländern und in den Vereinigten Staaten,
obwohl die medizinischen Kosten im Verhältnis zum BIP in Japan geringer sind. Es besteht weiterhin ein Mangel an Arbeitskräften.
Die Erhebungsdaten haben sich als bedeutsam für ein umfassendes Verständnis des Radioonkologie-Krankenpflegesystems in Japan
erwiesen.
Key WordsStructure survey–Radiotherapy facility–Radiotherapy personnel–RaCaseloaddiotherapy equipment–Medical care system
SchlüsselwörterStrukturerhebung–Strahlentherapie-Einrichtung–Strahlentherapie-Personal–Strahlentherapie-Ausrüstung–Patientenaufkommen–Medizinisches Versorgungssystem
Strahlentherapie und Onkologie 04/2012; 187(3):167-174. · 3.56 Impact Factor
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Hodaka Numasaki,
Hitoshi Shibuya,
Masamichi Nishio, Hiroshi Ikeda,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yutaka Ando,
Nobuhiro Tsukamoto,
Atsuro Terahara,
Katsumasa Nakamura,
Michihide Mitsumori,
Tetsuo Nishimura,
Masato Hareyama,
Teruki Teshima
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care.
In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO).
The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001).
ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.
International journal of radiation oncology, biology, physics 04/2011; 82(1):e111-7. · 4.59 Impact Factor
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Hodaka Numasaki,
Hitoshi Shibuya,
Masamichi Nishio, Hiroshi Ikeda,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yutaka Ando,
Nobuhiro Tsukamoto,
Atsuro Terahara,
Katsumasa Nakamura,
Michihide Mitsumori,
Tetsuo Nishimura,
Masato Hareyama,
Teruki Teshima
[show abstract]
[hide abstract]
ABSTRACT: The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution. The effect of changes in the health care policy in Japan on radiotherapy structure was also examined.
The Japanese Society of Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2007. The structures of 349 designated cancer care hospitals and 372 other radiotherapy facilities were compared.
Respective findings for equipment and personnel at designated cancer care hospitals and other facilities included the following: linear accelerators/facility: 1.3 and 1.0; annual patients/linear accelerator: 296.5 and 175.0; and annual patient load/full-time equivalent radiation oncologist was 237.0 and 273.3, respectively. Geographically, the number of designated cancer care hospitals was associated with population size.
The structure of radiation oncology in Japan in terms of equipment, especially for designated cancer care hospitals, was as mature as that in European countries and the United States, even though the medical costs in relation to GDP in Japan are lower. There is still a shortage of manpower. The survey data proved to be important to fully understand the radiation oncology medical care system in Japan.
Strahlentherapie und Onkologie 02/2011; 187(3):167-74. · 3.56 Impact Factor
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Teruki Teshima,
Hodaka Numasaki,
Hitoshi Shibuya,
Masamichi Nishio, Hiroshi Ikeda,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yutaka Ando,
Nobuhito Tsukamoto,
Atsuro Terahara,
Katsumasa Nakamura,
Michihide Mitsumori,
Tetsuo Nishimura,
Masato Hareyama
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load, and geographic distribution to identify and improve any deficiencies.
A questionnaire-based national structure survey was conducted from March to December 2008 by the Japanese Society of Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study.
The total numbers of new cancer patients and total cancer patients (new and repeat) treated with radiation in 2007 were estimated at 181,000 and 218,000, respectively. There were 807 linear accelerator, 15 telecobalt, 46 Gamma Knife, 45 (60)Co remote-controlled after-loading, and 123 (192)Ir remote-controlled after-loading systems in actual use. The linear accelerator systems used dual-energy function in 539 units (66.8%), three-dimensional conformal radiation therapy in 555 (68.8%), and intensity-modulated radiation therapy in 235 (29.1%). There were 477 JASTRO-certified radiation oncologists, 826.3 full-time equivalent (FTE) radiation oncologists, 68.4 FTE medical physicists, and 1,634 FTE radiation therapists. The number of interstitial radiotherapy (RT) administrations for prostate, stereotactic body radiotherapy, and intensity-modulated radiation therapy increased significantly. Patterns of Care Study stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more RT tended to be used for cancer patients.
The Japanese structure has clearly improved during the past 17 years in terms of equipment and its use, although a shortage of personnel and variations in maturity disclosed by Patterns of Care Study stratification were still problematic in 2007.
International journal of radiation oncology, biology, physics 04/2010; 78(5):1483-93. · 4.59 Impact Factor
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Hodaka Numasaki,
Teruki Teshima,
Hitoshi Shibuya,
Masamichi Nishio, Hiroshi Ikeda,
Hisao Ito,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yasushi Nagata,
Hidekazu Masaki,
Tetsuo Nishimura,
Shogo Yamada
[show abstract]
[hide abstract]
ABSTRACT: The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities.
The Japanese Society of Therapeutic Radiology and Oncology (JASTRO) conducted a questionnaire survey about the national structure of radiation oncology in 2005. In the current study, the structures of 326 designated cancer care hospitals and the other 386 radiotherapy facilities in Japan were compared.
Designated cancer care hospitals accounted for 45.3% of all radiotherapy facilities. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were as follows: linear accelerators/facility, 1.2 and 1.0; dual-energy function, 73.1% and 56.3%; three-dimensional conformal radiotherapy function, 67.5% and 52.7%; intensity-modulated radiotherapy function, 30.0% and 13.9%; annual number of patients/linear accelerator, 289.7 and 175.1; (192)Ir remote-controlled afterloading systems, 27.6% and 8.6%; and average number of full-time equivalent radiation oncologists/facility, 1.4 and 0.9 (P < 0.0001). There were significant differences in equipment and personnel between the two types of facilities. Annual patient loads/full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 252 and 240. Geographically, the number of designated cancer care hospitals was associated with the population, and the number of JASTRO-certified physicians was associated with the number of patients undergoing radiotherapy.
The Japanese structure of radiation oncology in designated cancer care hospitals was more mature than that in the other radiotherapy facilities in terms of equipment, although a shortage of personnel still exists. The serious understaffing problem in radiation oncology should be corrected in the future.
International Journal of Clinical Oncology 06/2009; 14(3):237-44. · 1.41 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The role of elective nodal irradiation of non-small-cell lung cancer (NSCLC) patients treated with radiotherapy remains unclear. We investigated the significance of treating clinically uninvolved lymph nodes by retrospectively analyzing the relationship between loco-regional failure and the irradiated volume.
Between 1998 and 2003, patients with IA-IIIB NSCLC were treated with radiotherapy. The eligibility criteria for this study were an irradiation dose of 60Gy or more and a clinical response better than stable disease. Typical radiotherapy consisted of 40 Gy/20 fr to the tumor volumes (clinical target volume of the primary tumor [CTVp], of the metastatic lymph nodes [CTVn], and of the subclinical nodal region [CTVs]), followed by off-cord boost to CTVp+n to a total dose 60-68 Gy/30-34 fr. The relationship between the sites of recurrence and irradiated volumes was analyzed.
A total of 127 patients fulfilled the eligibility criteria. Their median overall and progression-free survival times were 23.5 (range, 4.2-109.7) and 9.0 months (2.2-109.7), respectively. At a median follow-up time of 50.5 months (range, 14.2-83.0) for the surviving patients, the first treatment failure was observed in 95 patients (loco-regional; 41, distant; 42, both; 12). Among the patients with loco-regional failure, in-field recurrence occurred in 38 patients, and four CTVs recurrences associated with CTVp+n failure were observed. No isolated recurrence in CTVs was observed.
In-field loco-regional failure, as well as distant metastasis, was a major type of failure, and there was no isolated elective nodal failure. Radiation volume adequacy did not seem to affect elective nodal failure.
Radiotherapy and Oncology 02/2009; 91(3):433-7. · 5.58 Impact Factor
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Teruki Teshima,
Hodaka Numasaki,
Hitoshi Shibuya,
Masamichi Nishio, Hiroshi Ikeda,
Hisao Ito,
Kenji Sekiguchi,
Norihiko Kamikonya,
Masahiko Koizumi,
Masao Tago,
Yasushi Nagata,
Hidekazu Masaki,
Tetsuo Nishimura,
Shogo Yamada
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the structure of radiation oncology in Japan in terms of equipment, personnel, patient load, and geographic distribution to identify and improve any deficiencies.
A questionnaire-based national structure survey was conducted between March 2006 and February 2007 by the Japanese Society of Therapeutic Radiology and Oncology. These data were analyzed in terms of the institutional stratification of the Patterns of Care Study.
The total numbers of new cancer patients and total cancer patients (new and repeat) treated with radiotherapy in 2005 were estimated at approximately 162,000 and 198,000, respectively. In actual use were 765 linear accelerators, 11 telecobalt machines, 48 GammaKnife machines, 64 60Co remote-controlled after-loading systems, and 119 192Ir remote-controlled after-loading systems. The linear accelerator systems used dual-energy function in 498 systems (65%), three-dimensional conformal radiotherapy in 462 (60%), and intensity-modulated radiotherapy in 170 (22%). There were 426 Japanese Society of Therapeutic Radiology and Oncology-certified radiation oncologists, 774 full-time equivalent radiation oncologists, 117 medical physicists, and 1,635 radiation therapists. Geographically, a significant variation was found in the use of radiotherapy, from 0.9 to 2.1 patients/1,000 population. The annual patient load/FTE radiation oncologist was 247, exceeding the Blue Book guidelines level. Patterns of Care Study stratification can clearly discriminate the maturity of structures according to their academic nature and caseload.
The Japanese structure has clearly improved during the past 15 years in terms of equipment and its use, although the shortage of manpower and variations in maturity disclosed by this Patterns of Care Study stratification remain problematic. These constitute the targets for nationwide improvement in quality assurance and quality control.
International Journal of Radiation OncologyBiologyPhysics 04/2008; 72(1):144-52. · 4.11 Impact Factor
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Hideyuki Mizuno,
Tatsuaki Kanai,
Yohsuke Kusano,
Susumu Ko,
Mari Ono,
Akifumi Fukumura,
Kyoko Abe,
Kanae Nishizawa,
Munefumi Shimbo,
Suoh Sakata,
Satoshi Ishikura, Hiroshi Ikeda
[show abstract]
[hide abstract]
ABSTRACT: The characteristics of a glass dosimeter were investigated for its potential use as a tool for postal dose audits. Reproducibility, energy dependence, field size and depth dependence were compared to those of a thermoluminescence dosimeter (TLD), which has been the major tool for postal dose audits worldwide.
A glass dosimeter, GD-302M (Asahi Techno Glass Co.) and a TLD, TLD-100 chip (Harshaw Co.) were irradiated with gamma-rays from a (60)Co unit and X-rays from a medical linear accelerator (4, 6, 10 and 20 MV).
The dosimetric characteristics of the glass dosimeter were almost equivalent to those of the TLD, in terms of utility for dosimetry under the reference condition, which is a 10 x 10 cm(2) field and 10 cm depth. Because of its reduced fading, compared to the TLD, and easy quality control with the ID number, the glass dosimeter proved to be a suitable tool for postal dose audits. Then, we conducted postal dose surveys of over 100 facilities and got good agreement, with a standard deviation of about 1.3%.
Based on this study, postal dose audits throughout Japan will be carried out using a glass dosimeter.
Radiotherapy and Oncology 03/2008; 86(2):258-63. · 5.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: To investigate the practice process of postoperative radiation therapy for non-small-cell lung cancer (NSCLC) in Japan. Between April 2002 and March 2004, the Patterns of Care Study conducted an extramural audit survey for 76 of 556 institutions using a stratified two-stage cluster sampling. Data on treatment process of 627 patients with NSCLC who received radiation therapy were collected. Ninety-nine (16%) patients received postoperative radiation therapy between 1999 and 2001 (median age, 65 years). Pathological stage was stage I in 8%, II in 17%, IIIA in 44%, and IIIB in 20%. The median field size was 9 cmx11 cm, and median total dose was 50 Gy. Photon energies of 6 MV or higher were used for 64 patients, whereas a cobalt-60 unit was used for five patients. Three-dimensional conformal treatment was used infrequently. Institutional stratification influenced several radiotherapy parameters such as photon energy and planning target volume. Smaller non-academic institutions provided worse quality of care. The study confirmed continuing variation in the practice of radiotherapy according to stratified institutions. Outdated equipment such as Cobalt-60 units was used, especially in non-academic institutions treating only a small number of patients per year.
Lung Cancer 07/2007; 56(3):357-62. · 3.43 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 02/2007; 65 Suppl 1:540-4.
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Yoshihiro Enokido,
Hiroyuki Okamoto,
Yukio Kiyomiya,
Tomihisa Furuya,
Kengo Fujimori,
Yousuke Kusano,
Naoki Touyama,
Tomonori Goka,
Masaya Ooyama,
Toshiyuki Minemura,
Yuzuru Kutsutani-Nakamura,
Munefumi Shimbo,
Katsuyoshi Tabushi,
Satoshi Ishikura,
Masahiro Endou, Hiroshi Ikeda
[show abstract]
[hide abstract]
ABSTRACT: Field survey on output for X-ray therapeutic accelerators took place three times in Saitama Prefecture. The result of the field survey in 1997 showed the different rate from the designated dose at peak depth of 35 beams in 18 institutions. As different rate within +/-5% stood 91.4% in all beams, so different rate within +/-3% stood 85.7% in the same beams. The average different rate from the designated dose at peak depth was 11.06%. The standard deviation of the same condition was 3.72.The result of the field survey in 2005 showed the different rate from the designated dose at correction depth of 36 beams in 18 institutions. As different rate within +/-5% stood 100% in all beams, so different rate within +/-3% stood 91.6% in the same beams. The average different rate from the designated dose at correction depth was +0.80%. The standard deviation of the same condition was 1.46.We understood that the different rate from the designated dose at radiotherapeutic institutions decreased and even the value of the standard deviation was decreasing, by receiving 3 times of field surveys that was held in Saitama Pref. Also we understood that the beam numbers of different rate within +/-5% and the beam numbers of different rate within +/-3% were going up. We recognized that the good result of accurate dose is obtained more, by doing a continual field survey. The field survey was carried out in 2006 in Tochigi Prefecture and was the insufficient result in 10% of institutions.
Igaku butsuri: Nihon Igaku Butsuri Gakkai kikanshi = Japanese journal of medical physics: an official journal of Japan Society of Medical Physics 02/2007; 27(2):71-7.
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Mitsuhiko Kawashima,
Yoshikazu Kagami,
Takafumi Toita,
Takashi Uno,
Masato Sugiyama,
Yoichirio Tamura,
Saeko Hirota,
Nobukazu Fuwa,
Mitsumasa Hashimoto,
Hiroshi Yoshida,
Naoto Shikama,
Masaaki Kataoka,
Keizo Akuta,
Kinro Sasaki,
Tetsuro Tamamoto,
Kenji Nemoto,
Hisao Ito,
Hoichi Kato,
Shogo Yamada, Hiroshi Ikeda
[show abstract]
[hide abstract]
ABSTRACT: To assess the safety and efficacy of external beam radiotherapy for elderly patients with esophageal cancer.
A trial testing external beam radiotherapy (66 Gy within 6.5 weeks) as a single-modality treatment was performed for biopsy-proven squamous cell carcinoma of the thoracic esophagus clinically staged as Stage I and IIA (T1-T3N0M0, International Union Against Cancer, 1987) in patients aged > or =80 years.
From January 1999 through December 2002, 51 evaluable patients (35 men and 16 women) with a median age of 83 years (range, 80-91 years) were enrolled from 22 institutions. Of the 51 patients, 18 (35%) had Stage T1 and 33 (65%) had Stage T2-T3 disease. Radiotherapy could be completed in 47 patients (92%) within 43-58 days (median, 49). The actuarial incidence of Grade 3 or worse cardiopulmonary complications at 3 years was 26%, with 3 early deaths, and correlated significantly with the size of the anteroposterior radiotherapy portals. The median survival time and overall survival rate at 3 years was 30 months and 39% (95% confidence interval, 25-52%), respectively.
The results of high-dose radiotherapy in octogenarians are comparable to those in younger patients, but meticulous treatment planning and quality control is required.
International Journal of Radiation OncologyBiologyPhysics 04/2006; 64(4):1112-21. · 4.11 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Prophylactic cranial irradiation (PCI) reduces the incidence of brain metastasis with an effect on overall survival in patients with small cell lung carcinoma (SCLC). In spite of multidisciplinary intensive treatment approaches, many patients still experience brain metastasis. The authors retrospectively analyzed the characteristics of the first failure event due to brain metastasis (FBM) in patients treated with PCI.
Between January 1990 and April 2004, 71 patients with limited disease SCLC were treated with PCI after completing systemic treatment at the National Cancer Center Hospital (Tokyo, Japan). Univariate and multivariate analyses were used to identify factors related to FBM and survival.
The FBM and overall incidence of brain metastasis (OBM) were 16.9 % (12 of 71) and 26.8% (19 of 71), respectively. Median time to progressive disease and median survival were 8.4 months and 21.6 months, respectively. Elevation of pro-gastrin-releasing peptide (Pro GRP) level before PCI was found to be a significant predictive and prognostic factor for FBM, OBM, and survival on multivariate analysis (P = 0.007, P = 0.025, and P = 0.009, respectively).
An elevated Pro GRP level before PCI was found to be significantly related to FBM and survival, and should be considered before PCI is performed.
Cancer 09/2005; 104(4):811-6. · 4.77 Impact Factor
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Shinji Atagi,
Masaaki Kawahara,
Tomohide Tamura,
Kazumasa Noda,
Koshiro Watanabe,
Akira Yokoyama,
Takahiko Sugiura,
Hiroshi Senba,
Satoshi Ishikura, Hiroshi Ikeda,
Naoki Ishizuka,
Nagahiro Saijo
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate whether radiotherapy with carboplatin would result in longer survival than radiotherapy alone in elderly patients with unresectable stage III non-small cell lung cancer (NSCLC).
Eligible patients were 71 years of age or older with unresectable stage III NSCLC. Patients were randomly assigned to the radiotherapy alone (RT) arm, irradiation with 60 Gy; or the chemoradiotherapy (CRT) arm, the same radiotherapy and additional concurrent use of carboplatin 30 mg/m(2) per fraction up to the first 20 fractions.
This study was terminated early when 46 patients were registered from November 1999 to February 2001. Four patients (one in the RT arm, three in the CRT arm) were considered to have died due to treatment-related causes. The JCOG Radiotherapy Committee assessed these treatment-related deaths (TRDs) and the compliance with radiotherapy in this trial. They found that 60% of the cases corresponded to protocol deviation and 7% were protocol violation in dose constraint to the normal lung, two of whom died due to radiation pneumonitis. As to the effectiveness for the 46 patients enrolled, the median survival time was 428 days [95% confidence interval (CI) = 212-680 days] in the RT arm versus 554 days (95% CI = 331 to not estimable) in the CRT arm.
Due to the early termination of this study, the effectiveness of concurrent use of carboplatin remains unclear. We re-planned and started a study with an active quality control program which was developed by the JCOG Radiotherapy Committee.
Japanese Journal of Clinical Oncology 05/2005; 35(4):195-201. · 1.78 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Chemoradiotherapy, which is one of the standard treatments for locally advanced pancreatic carcinoma, is considered a high-risk procedure in elderly patients. This study investigated the outcome and tolerability of this treatment in elderly patients.
We reviewed our database from November 1993 to March 2003 and retrospectively examined the clinical data of patients with histologically confirmed exocrine pancreatic carcinomas that were nonresectable but confined to the pancreatic region, who were treated with protracted 5-fluorouracil infusion (200 mg/m2/day) and concurrent radiotherapy (50.4 Gy in 28 fractions over 5.5 weeks). We evaluated the outcome of patients > or =70 years and those <70 years.
There were 19 patients > or =70 and 39 patients <70. On pretreatment evaluation, the elderly patients showed lower serum albumin levels, lower transaminase levels, better ECOG performance status, more frequent body weight loss and less frequent abdominal and/or back pain with the administration of morphine than the younger patients. There were no significant differences in the frequency of severe toxicity. Neither the response rate nor the incidence of treatment discontinuation differed significantly between the two groups. The median survival time was longer in the elderly patients than in the younger patients (11.3 vs. 9.5 months, p = 0.04).
With careful patient selection, chemoradiotherapy can be one of the treatment options for locally advanced pancreatic carcinoma in elderly patients.
Oncology 01/2005; 68(4-6):432-7. · 2.27 Impact Factor
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Hiroshi Ikeda
[show abstract]
[hide abstract]
ABSTRACT: This report summarizes lectures by Professor William U. Shipley on the non-invasive management of invasive bladder cancer with chemoradiotherapy and transurethral resection, presented at the 60th Meeting of the International Lectureship, in the international lectureship program of the FPCR.
Japanese Journal of Clinical Oncology 12/2003; 33(11):592-4. · 1.78 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: We examined whether the data registered in the Japanese Patterns of Care Study (PCS) for patients with non-small-cell lung cancer (NSCLC) represent the actual situation of radiotherapy in Japan. The Osaka Cancer Registry (OCR) data, forming the largest database of a regional cancer registry in Japan, were adopted for use as a benchmark against the national condition.
We examined 906 patients of the PCS treated between 1995 and 1997 and 845 patients of the OCR registered between 1988 and 1992. The investigation was made by descriptive statistical methods to measure age, stage, combined treatments, type of treated hospitals, and prognosis. Furthermore, the national averages (NAs) of the PCS process (PCS NA) were also calculated to compensate for the imbalance in the PCS data sampling.
The mean age was 67.3 +/- 10.1 in PCS and 64.4 +/- 11.0 in OCR (p < 0.001), 67.2 in PCS NA. The male ratio was 84.2% in PCS and 84.0% in OCR (p = 0.411), 84.1% in PCS NA. The ratio of the patients at the localized stage was 24.2% in PCS and 15.6% in OCR (p = 0.001), 21.1% in PCS NA. The ratio of surgery combined was 24.2% in PCS and 28.9% in OCR (p = 0.026), 25.3% in PCS NA. The ratio of chemotherapy combined was 50.1% in PCS and 67.5% in OCR (p = 0.001), 47.4% in PCS NA. Because the definitions of institution classification and period of prognostic inquiry were different between the two databases, the 3-year survival rates were calculated for reference. In the nonsurgery group, it was 20.3% in PCS and 11.3% in OCR (p = 0.001), and in the surgery group it was 52.5% in PCS and 42.2% in OCR (p = 0.057).
Ages in the two databases were inconsistent. Sex distributions were consistent. Surgery and chemotherapy were more frequently performed for the OCR patients, and more patients at more advanced stages were also observed in OCR. The PCS NAs of sex, stage, and ratio of surgery combined were at the midpoints between those of PCS and OCR. The survival rate of NSCLC patients in the OCR was significantly inferior to that in the PCS. The follow-up rate of the PCS was lower than that of the OCR. The general features of PCS data showed similarity to OCR data, and the results of the PCS NAs suggested the effectiveness of this method to adjust the sampling imbalance in PCS.
International Journal of Radiation OncologyBiologyPhysics 08/2003; 56(4):1005-12. · 4.11 Impact Factor
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ABSTRACT: To evaluate the effectiveness of small-field radiotherapy in combination with concomitant 5-fluorouracil (5FU) or cisplatin for locally advanced pancreatic carcinoma.
From November 1993 to January 1999, 53 patients underwent continuous 5FU infusion at 200mg/m2 (27 patients) or a 30-min cisplatin infusion at 5mg/m2/day (26 patients) just prior to each irradiation. The radiation field was limited to cover the primary and the paraaortic regions at celiac and supramesenteric axis levels. A total dose of 50.4Gy in 28 sessions was given in 5.6 weeks.
Median and 1-year survival rates were 10.2 months and 35.2%, respectively. Local failure occurred in 19 patients (36%) and liver metastases in 16 patients (30%). All local recurrences occurred only within the radiation field.
Median survival rates were comparable to other studies. Because local failure occurred only within the radiation field, the use of relatively small-field radiotherapy may be justified in the treatment of locally advanced pancreatic carcinoma in addition to concurrent administration of either 5FU or cisplatin.
Radiotherapy and Oncology 07/2003; 67(3):327-30. · 5.58 Impact Factor
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ABSTRACT: To assess the efficacy of chemoradiotherapy on pain relief in patients with intrapelvic recurrence of rectal cancer.
The records of 30 patients treated with radiotherapy with or without chemotherapy for intrapelvic recurrence of rectal cancer between September 1993 and February 1999 were retrospectively reviewed. There were 17 patients in the chemoradiotherapy (CRT) group and 13 patients in the radiotherapy alone (RTA) group. Simultaneous extrapelvic distant metastases were found in 11 patients in the CRT group and in seven patients in the RTA group. Radiotherapy was administered with a median total dose of 50 Gy in both groups. In the CRT group, 15 patients received 5-fluorouracil by continuous infusion and two patients received irinotecan in a biweekly infusion schedule during the course of radiotherapy. The response rate and duration of pain relief were evaluated and were compared between the two groups.
The response rate of pain relief in the CRT and RTA was 100 and 77%, respectively. The median duration of pain relief in the CRT and RTA groups was 7.8 and 4.0 months, respectively and there was a significant difference between the two groups (P = 0.019). The median survival time from the start of radiotherapy was 15.1 and 9.3 months in the CRT and RTA groups, respectively, and there was a significant difference between the two groups (P = 0.046).
The results suggest that chemoradiotherapy for intrapelvic recurrence of rectal cancer for the purpose of pain relief appears to be more effective than radiotherapy alone.
Japanese Journal of Clinical Oncology 05/2003; 33(4):180-5. · 1.78 Impact Factor
