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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
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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
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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
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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
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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
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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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ABSTRACT: A 45-year-old man complaining of cough, dyspnea, and difficulty in swallowing was referred to our hospital. Chest CT scan showed a mediastinal mass compressing the trachea. He was diagnosed with poorly differentiated lung carcinoma by percutaneous needle biopsy. Bronchoscopy and upper gastrointestinal endoscopy revealed a tracheoesophageal fistula (TEF). Long-lasting febrile neutropenia made it impossible to continue chemotherapy, but a course of radiotherapy (total 61 Gy) was completed. The next endoscopy revealed closure of the TEF. Chemoradiotherapy (CRT) has been reported to close TEF in esophageal cancer, but the risk of a CRT-induced worsening of the fistula has dissuaded physicians from using CRT to treat TEF in lung cancer patients. CRT may serve as a palliative treatment for TEF in lung cancer as well as esophageal cancer.
Case Reports in Oncology 01/2011; 4(2):350-7.
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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
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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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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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ABSTRACT: High-dose irradiation to the pulmonary hilar region is generally considered to be of high risk in causing bronchial injury. The aim of this retrospective study is to investigate the safety and efficacy of stereotactic body radiotherapy (SBRT) for patients with lung tumors in the pulmonary hilum.
21 patients who underwent SBRT for lung tumors within 2 cm from a major bronchus were retrospectively analyzed. The total biologically effective doses ranging from 50.7 to 157.5 Gy (median, 100 Gy) were given to the tumors by SBRT.
The overall survival rates at 1 and 2 years after SBRT were 90.0% and 62.2%, respectively. Nine patients were alive and 15 irradiated tumors were controlled during the follow-up period of 10-54 months (median, 20 months). Nine patients died of tumor progression and one patient each died of hemoptysis, infectious pneumonia, and epidural hemorrhage. Severe late toxicity (>or= grade 3) was seen in three patients of whom two had previously received repeated radiotherapy.
SBRT for lung tumors located in the pulmonary hilar region may be tolerable and acceptable, if multiple treatments to the same major bronchus are avoided, and irradiated volumes are carefully taken into consideration.
Strahlentherapie und Onkologie 05/2010; 186(5):274-9. · 3.56 Impact Factor
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ABSTRACT: The aim of this study was to characterize computed tomography (CT) manifestations of local recurrence after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC).
A total of 27 stage I NSCLC patients who were treated with SBRT, including 5 patients with local recurrence, were retrospectively analyzed for serial CT examinations.
A bulging margin appeared in 4 of the 5 cases (80%) with local recurrence and 1 of 22 cases (5%) without local recurrence. Air bronchograms were seen in 3 of 5 cases with local recurrence and 21 of 22 cases without local recurrence, but they subsequently disappeared in all 3 cases (100%) with local recurrence and in 4 of the 21 cases (19%) without local recurrence. Ipsilateral pleural effusion was observed in all 5 cases (100%) with local recurrence and in 5 of 22 cases (22%) without local recurrence. The opacity increased in size even after 12 months from the completion of SBRT in cases with local recurrence, whereas it decreased or did not change in size in cases without recurrence.
Local recurrence should be suspected on CT when there was (1) a bulging margin, (2) disappearance of air bronchograms, (3) appearance of pleural effusion, or (4) increase in the abnormal opacity after 12 months.
Japanese journal of radiology 05/2010; 28(4):259-65. · 0.65 Impact Factor
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ABSTRACT: Patients with locally advanced breast cancer were treated with intravenously administration of weekly docetaxel (20 mg/m2) and concurrent radiation therapy (66-70 Gy). A complete response was achieved in both cases and toxicities were tolerable. The protocol was effective as a radical or palliative treatment for locally advanced breast cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 06/2005; 32(5):679-82.
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ABSTRACT: We have developed a novel irradiation technique for lung cancer that combines a linear accelerator and CT scanner with patient-controlled breath-hold and radiation beam switching. We applied this technique to stereotactic three-dimensional (3D) conformal radiotherapy for stage I non-small cell lung cancer (NSCLC) and evaluated the primary therapeutic outcomes. A total of 35 patients with stage I (15 IA, 20 IB) primary NSCLC (20 adeno, 13 squamous cell, and 2 others) were treated with this technique. Patients ranged from 65 to 92 years old (median, 78 years). Twenty-three (66%) patients were medically inoperable due to mainly chronic pulmonary disease or high age. Three-dimensional treatment plans were made using 10 different non-coplanar dynamic arcs. The total dose of 60 Gy was delivered in 10 fractions (over 5-8 days) at the minimum dose point in the planning target volume (PTV) using a 6 MV X-ray. After adjusting the isocenter of the PTV to the planned position by a unit comprising CT and linear accelerator, irradiation was performed under patient-controlled breath-hold and radiation beam switching. All patients completed the treatment course without complaint. Complete response (CR) and partial response (PR) rates were 8/35 (23%) and 25/35 (71%), respectively. Pulmonary complications of National Cancer Institute-Common Toxicity Criteria grade >2 were noted in three (9%) patients. During follow-up (range, 6-30 months; median, 13 months), two (6%) patients developed local progression and five (14%) developed distant or regional lymph node metastases. Two-year overall survival rates for total patients and medically operable patients were 58 and 83%, respectively. In conclusion, this new irradiation technique, utilizing patient-controlled radiation beam switching under self-breath-hold after precise alignment of the isocenter, allows safe high-dose stereotactic radiotherapy with sufficient margins around the CTV and reduced treatment times. Based on the initial results, excellent local control with minimal complications is expected for stage I NSCLC.
Lung Cancer 08/2004; 45(1):45-55. · 3.43 Impact Factor
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ABSTRACT: Sarcomatoid carcinomas of the larynx account for less than 1% of all malignant laryngeal tumors and there is currently no consensus regarding the clinical course or appropriate management of this disease. A case of sarcomatoid carcinoma of the larynx displaying rapid systemic progression after radiotherapy and a brief review of the literature are presented.
American Journal of Otolaryngology 26(6):400-2. · 0.87 Impact Factor
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ABSTRACT: We report a case of aorto-bronchial fistula (ABF) caused by a self expanding metallic stent (EMS) 51 days after insertion into the left main bronchus. The patient presented with left main bronchial stenosis caused by post-operative local recurrence of esophageal cancer. Post-operative radio therapy totaling 40 Gy and post-recurrence radiotherapy totaling 34 Gy were administered, with daily fractions of 2 Gy. Stenosis of the left main bronchus improved slightly, and was followed with insertion of EMS to prevent restenosis. The patient experienced massive hemoptysis for 3 days before sudden death. Autopsy revealed the EMS edge perforating the descending aortic lumen. Tumor infiltration and bacterial infection were observed on the wall of the left bronchus, and atherosclerosis was present on the aortic wall around the fistula. It should be noted that the left main bronchus was at considerable risk of ABF after insertion of EMS for malignant stenosis, and prophylactic sent insertion into the left bronchus without imperative need must be avoided.
CardioVascular and Interventional Radiology 27(3):288-90. · 2.09 Impact Factor
