The advantage of iron-containing fiducial markers placed with a thin needle for radiotherapy of liver cancer in terms of visualization on MRI: an initial experience of Gold Anchor.

Radiotherapy for liver malignancy is increasing due to advances in radiotherapy technique. Visualization of the tumor as well as fiducial markers is essential. To see if improved visibility exists on computed tomography (CT) and magnetic resonance imaging (MRI), we evaluated an iron-containing fiducial marker. A patient with hepatocellular carcinoma and a patient with cholangiocarcinoma were enrolled. Pain caused by placement of marker and the best MRI sequence for visualization of both the fiducial marker as well as the liver tumor on MRI was evaluated. CT was obtained in 2.5-mm thickness, and MRIs were obtained in eight sequences (ie, T2-weighted image). 22G preloaded needles were used for marker placement in both patients; this caused little pain during placement under local anesthesia with xylocaine. No complication occurred in either patient. Both markers and tumors were well visualized by the same MRI sequence. The iron-containing fiducial marker is safe and useful for detecting fiducial markers in the liver and for registration using CT and MRI.

Fiducial marker for prostate radiotherapy: comparison of 0.35- and 0.5-mm-diameter computed tomography and magnetic resonance images.

PURPOSE: When performing intensity-modulated radiotherapy for prostate cancer, a marker is inserted into the prostate to enable the recognition of its position using cone-beam computed tomography (CT). However, it is difficult to recognize the prostatic outline using CT alone. Magnetic resonance imaging (MRI) can depict the prostatic outline better than CT. In treatment plans using CT and MRI registration, various markers are used in institutions; however, the selection of an optimal marker size is difficult. Comparison of a different fiducial marker study was conducted using phantom, but no study in vivo was found. Therefore, we prospectively investigated the effects of different marker diameter sizes using CT and MR images. METHODS: Thirty-one consecutive patients were enrolled in this study. CT and MRI were performed 3 weeks after marker placement. The 0.35-mm-diameter marker was placed on the left side of the prostate, and the 0.5-mm-diameter marker was placed on the right side. The length of each marker was 10 mm. The better MRI image was selected between those obtained using T2*-two-dimensional weighted image (T2*2D) and T2*-three-dimensional weighted image (T2*3D). Two observers evaluated and scored the prostatic outline image quality as well as visualized the prostatic markers using CT and MRI. RESULTS: MRI was significantly superior to CT in depicting the prostatic outline. The CT artifacts were significantly lesser for the 0.35-mm-diameter marker than for the 0.5-mm-diameter marker. The degree of marker recognition using MRI was significantly better with the 0.5-mm-diameter marker. CONCLUSION: The 0.5-mm-diameter fiducial marker had significantly better visualization than the 0.35-mm-diameter marker. While CT artifacts were significantly worse with the 0.5-mm-diameter marker, the artifact level was tolerable for clinical practice. Therefore, we recommend the 0.5-mm-diameter diameter marker in terms of prostatic outline and marker visualization using MRI.

Low dose palliative radiotherapy for refractory aggressive lymphoma.

AIM: To determine the efficacy of low-dose palliative radiotherapy in patients with refractory aggressive lymphoma. BACKGROUND: There are few reports on the administration of palliative radiotherapy to patients with aggressive lymphoma. MATERIALS AND METHODS: The present study included 11 patients with 30 sites of aggressive lymphoma (diffuse large cell lymphoma, n = 7; mantle cell lymphoma, n = 2; follicular large cell lymphoma, n = 1; and peripheral T cell lymphoma, n = 1). The patients received local palliative radiotherapy after receiving a median of 4 chemotherapy regimens. The radiotherapy doses administered to the 30 sites were as follows: 8 Gy, single fraction (n = 27); 6 Gy, single fraction (n = 1); 4 Gy, single fraction (n = 1); and 4 Gy, 2 fractions (n = 1). RESULTS: The complete response rate was 45% (5/11); the partial response rate was 36% (4/11). Toxicity occurred at one irradiated site (the mandibular), which showed temporal acute gingivitis; however, medication was not required. Retreatment was required for 3 sites on the head (parotid, face and mandible) due to persistent discomfort. None of the other sites (27/30) required retreatment. A patient with refractory DLBCL underwent radiotherapy (4 Gy, single fraction) for hepatic hilar lymph node involvement but did not recover from jaundice and died of DLBCL. CONCLUSIONS: Eight Gray single fraction radiotherapy was one of meaningful options for the treatment of refractory aggressive lymphoma in terms of its efficacy and the incidence of adverse events. The use of 8 Gy single fraction radiotherapy is therefore recommended for achieving local control in patients with refractory aggressive lymphoma.

A phase II study of nab-paclitaxel plus carboplatin in combination with thoracic radiation in patients with locally advanced non-small-cell lung cancer.

We investigated the efficacy and safety of albumin-bound paclitaxel (nab-PTX) and carboplatin (CBDCA) with concurrent radiotherapy for unresectable locally advanced non-small-cell lung cancer (NSCLC). Patients with Stage III NSCLC and an Eastern Cooperative Oncology Group performance status of 0 or 1 were eligible. Concurrent chemoradiotherapy consisted of weekly administration of nab-PTX (40 mg/m(2)) plus CBDCA (area under the plasma concentration time curve (AUC) 2) and thoracic radiotherapy (60 Gy/30 fractions) for a total of 6 weeks. After concurrent chemoradiotherapy, patients received an additional two cycles of consolidation phase chemotherapy that consisted of 4-week cycles of nab-PTX (100 mg/m(2) on Days 1, 8 and 15)/CBDCA (AUC 5 mg/ml/min on Day 1). Response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors. Progression-free survival and overall survival were estimated using the Kaplan-Meier method. Toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events. A total of 10 patients were enrolled in this trial between September 2013 and January 2014 from three institutes. The overall response rate was 40.0% and the median progression-free survival was 6.7 months. Treatment-related death occurred in two patients. Grade 2 or worse severe radiation pneumonitis was observed in all three patients that had the volume of lung receiving at least 20 Gy (V20) >30%. The results of this study indicate that no further investigation is warranted into nab-PTX and CBDCA with concurrent thoracic radiation for Stage III NSCLC with V20 > 30% due to severe toxicity.

[Late adverse events after concurrent chemoradiation therapy in long-term survivors with non-small cell lung cancer].

Long-term survival in patients with non-small cell lung cancer( NSCLC) can be achieved more frequently with combined modality therapy. However, an increased risk of late treatment-related toxicities has been reported for this treatment strategy. We retrospectively evaluated NSCLC patients treated with chemoradiation therapy from January 1988 to January 2007. Patients who had survived for more than 5 years after treatment were included in an analysis of late adverse events (excluding radiation pneumonitis and pulmonary fibrosis). A total of 188 NSCLC patients treated with chemoradiation therapy were evaluated, with 25 patients having survived for more than 5 years. Of these patients, 4 had stage I disease, 4 had stage IIB disease, 1 had stage IIIA disease, 14 had stage IIIB disease, 1 had stage IV disease, and 1 had disease of unknown stage. The following grade 3 late adverse events were noted: skin ulceration( n=1), skin induration( n=1), brachial plexopathy( n=1), malignant neoplasm( n=1). Adequate management of late adverse events due to chemoradiation therapy is needed for long-term NSCLC survivors.

[Review of chemoradiotherapy followed by surgical resection in locally advanced non-small-cell lung cancer].

Chemoradiotherapy is recommended for locally advanced non-small-cell lung cancer(NSCLC). However, the overall median survival time remains poor(<20 months). We evaluated the outcome and complications of chemoradiotherapy, followed by surgical resection, in locally advanced NSCLC. Eight patients(7 men and 1 woman; median age, 59.5 years (range, 47-68 years) who underwent chemoradiotherapy followed by surgical resection for locally advanced NSCLC from 2002 to 2011 were retrospectively analyzed. In all cases, chemotherapy consisted of platinum-based combination therapy. Postoperatively, bronchopleural fistula occurred in 1 patient and Horner syndrome was observed in 1 patient. No treatment -related deaths were observed. The median of progression-free survival was 34.2 months. In conclusion, chemoradiotherapy should be the standard of care for locally advanced NSCLC. Trimodality therapy is still experimental but seems to be promising for certain subgroups of patients with locally advanced NSCLC.

[Stereotactic radiotherapy following chemo-radiotherapy for lymph node metastasis of stage III non-small-cell lung cancer].

It has been expected that stereotactic radiotherapy (SRT) is one of the useful treatments for non-resectable early lung cancer. In the case radiotherapy was thought to be difficult due to the wideness of irradiation area, it is probable to undergo chemo-radiotherapy safely using SRT for a primary lesion. We report two cases of Stage III non-small-cell lung cancer, which underwent SRT for primary tumors following chemo-radiotherapy for the lymph node metastasis. In both two cases, a reduction of V20 (the normal pulmonary volume to receive radiation exposure: more than 20 Gy) was a possibility, and symptomatic radiation pneumonitis was not observed.

Usefulness of CT-MRI fusion in radiotherapy planning for localized prostate cancer.

We compared the prostate volumes and rectal doses calculated by CT and CT-MRI fusion, and verified the usefulness of CT-MRI fusion in three-dimensional (3D) radiotherapy planning for localized prostate cancer. Three observers contoured the prostate and rectum of 13 patients with CT and CT-MRI fusion. Prostate delineations were classified into three sub-parts, and the volumes and distances to the rectum (PR distance) were calculated. 3D radiotherapy plans were generated. A dose-volume histogram (DVH) was constructed for the rectum. The intermodality and interobserver variations were assessed. CT-MRI fusion yielded a significantly lower prostate volume by 31%. In the sub-part analysis, the greatest difference was seen for the apical side. The PR distance was significantly extended by 3.5-mm, and the greatest difference was seen for the basal side. The irradiated rectal volume was reduced in the CT-MRI fusion-based plan. The reduction rates were greater in the relatively high-dose regions. The decrease of the prostate volume and length alteration of the distance between the prostate and rectum were correlated with the decrease of the irradiated rectal volume. The prostate volume delineated by CT-MRI fusion was negatively correlated with the decrease of the irradiated rectal volume. CT showed a tendency towards overestimation of the prostate volume and underestimation of the PR distance as compared to CT-MRI fusion. The rectal dose was significantly reduced in CT-MRI fusion-based plan. Using CT-MRI fusion, especially in cases with a small prostate, the irradiated rectal volume can be reduced, with consequent reduction in rectal complications.

[The efficacy and safety of stereotactic radiotherapy for non-resectable non-small cell lung cancer].

Stereotactic radiotherapy (SRT) has recently been used for the treatment of small lung tumors. We retrospectively evaluated the efficacy and safety of SRT for non-small cell lung cancer (NSCLC) treated in our hospital. Between October 2007 and December 2009, 31 tumors of 29 patients were treated by SRT (mean age, 75 years: stage IA, n=13; stage IB, n=5; stage IIIA, n=1; stage IIIB, n=1; recurrence, n=11). All of the patients completed the treatment. In one patient who had radiation pneumonitis before SRT, a progression of pulmonary fibrosis was observed, and treated with steroid therapy. In evaluable 29 tumors of 27 patients, the recurrence rates are 11/29 (37.9%). Median progression free survival time was 8 months. The recurrence rate and median progression free survival time of stage IA and IB subgroups were 4/17 (23.5%) and 12 months, respectively. SRT is thought to be a safe and effective treatment for stage I NSCLC. For patients with stage I NSCLC, SRT can be a complemental therapy for surgical resection.

Reirradiation with local-field radiotherapy for painful bone metastases.

PURPOSE: The purpose of this study was to evaluate retrospectively the effectiveness, prognostic factors, and sequelae of the first course of local-field reirradiation for painful bone metastases. PATIENTS AND METHODS: From 1994 to 2000, a total of 30 patients were reirradiated for painful bone metastases. The most commonly used initial treatment regimen was 30 Gy/10 Fr/2 wk. An additional dose in the range from 10 Gy/5 Fr to 26 Gy/13 Fr was reirradiated. RESULTS: Fifteen patients (50%) showed some type of pain relief after reirradiation. Patients with initial CR were more likely to respond than those with previous PR (100% vs. 41%). The median duration of pain relief was five months. The duration of response was longer in initial CR than initial PR. The median survival time of responders after retreatment was 11 months. No patient developed radiation myelopathy. Prognostic factors for pain relief were duration from initial treatment, performance status (PS), and status of bone metastases. CONCLUSION: Reirradiation for patients with a long duration from initial treatment (> or = 4 months), good PS (ECOG: 1-2), or solitary bone metastases was effective for pain relief. The appropriate indications, optimal dose, fractions, and technique for reirradiation to painful bone metastases should be further explored in randomized study.