Development of a Japanese Benefit Finding scale (JBFS) for patients with cancer.

The primary aim of this study was to develop a scale to evaluate benefits for patients with cancer under treatment in Japan (the Japan Benefit Finding scale [JBFS]). The participants were 98 patients with cancer who completed the JBFS, which has 26 items, the General Health Questionnaire short version (GHQ 12). Factor analysis, structural equation modeling (SEM), and correlation analysis were performed. Three key domains were identified: ''Recognition of one's role in the family and priorities,'' ''Appreciation for life,'' and ''Faith.'' Validity was confirmed by SEM. There was a significant correlation between the JBFS and GHQ 12. The reliability and validity are adequate, and the JBFS shows that Japanese patients who found benefits in cancer were able to adjust to their disease.

Carbon ion radiotherapy: clinical experiences at National Institute of Radiological Science (NIRS).

In June 1994, the world's first clinical center offering carbon ion radiotherapy opened at the National Institute of Radiological Science (NIRS), Japan. Among several types of ion species, carbon ions were chosen for cancer therapy because they were judged to have the most optimal properties in terms of superior physical and biological characteristics. As of March 2010, 5,196 patients have been registered for carbon ion radiotherapy. Clinical results have shown that carbon ion radiotherapy has the potential to provide a sufficient radiation dose to the tumor, while having acceptable morbidity in the surrounding normal tissues. Tumors that appear to respond favorably to carbon ions include locally advanced tumors as well as histologically non-squamous cell tumor types such as adenocarcinoma, adenoid cystic carcinoma, malignant melanoma, hepatoma, and bone/soft tissue sarcoma. By taking advantage of the unique properties of carbon ions, treatment with small fractions within a short treatment period has been successfully carried out for a variety of tumors. This means that carbon ion radiotherapy can offer treatment for larger numbers of patients than is possible with other modalities over the same time period.

Variation of clinical target volume definition among Japanese radiation oncologists in external beam radiotherapy for prostate cancer.

BACKGROUND: We investigated the interobserver variation in the prostate target volume and the trend toward the use of diagnostic computed tomography (CT) or magnetic resonance (MR) images for treatment planning. METHODS: Twenty-five radiation oncologists were asked to draw the external contour of the prostate on CT images (0.3 cm spacing) of a patient with localized prostate cancer. They also answered a questionnaire regarding the use of diagnostic CT or MR images for the contouring. RESULTS: Of the 25 physicians, 28% rarely or never referred to the diagnostic CT images. In contrast, the physicians tended to refer to the MR images more frequently. Approximately 50% of the physicians believed in the usefulness of contrast-enhanced images for the delineation of the prostate. As for the variation of the prostate contouring, the median craniocaudal prostate length was 36 mm (range, 21-54 mm), and the median prostate volume was 43.5 cm(3) (range, 23.8-98.3 cm(3)). The interobserver variability was not significant in the duration as a radiation oncologist, the board certification status as radiation oncologists, and the number of treatment plans developed for prostate cancer during the last 1 year. CONCLUSION: A wide variety of the definitions of the prostate was found among Japanese radiation oncologists.

Treatment of early tongue carcinoma with brachytherapy: results over a 25-year period.

BACKGROUND: Brachytherapy for patients with early tongue cancer is an accepted method of treatment. PATIENTS AND METHODS: The records of 409 patients with T1/2N0M0 tongue cancer treated with brachytherapy between 1978 and 2004 were reviewed. RESULTS: The overall and disease-free 5-year survival rates were 82.3% and 64.6% for patients with T1 disease, and 72.2% and 56.0% for patients with T2 disease, respectively. The 5-year nodal metastasis-free survival rates for patients treated between 1978 and 1986, 1987 and 1996, and 1997 and 2004 were 64.8%, 74.8% and 81.3% for patients with T1 disease (p=0.22), and 47.4%, 70.4% and 76.4% for patients with T2 disease (p=0.0011), respectively. The 5-year local recurrence-free survival rates for patients treated between 1978 and 1986, 1987 and 1996, and 1997 and 2004 were 91.0%, 84.0% and 96.9% for patients with T1 disease (p=0.31), and 87.6%, 83.3% and 85.8% for patients with T2 disease (p=0.90), respectively. CONCLUSION: The incidence rate of nodal metastasis in patients with early tongue cancer improved over the 25-year period studied, while the local recurrence-free survival rates remained stable.

Is glossectomy necessary for late nodal metastases without clinical local recurrence after initial brachytherapy for N0 tongue cancer? A retrospective experience in 111 patients who received salvage therapy for cervical failure.

PURPOSE: To assess the efficacy of neck dissection (ND) without glossectomy (GL) for late nodal metastases without local recurrence after brachytherapy for N0 tongue cancer. MATERIALS AND METHODS: Among 396 patients with N0 tongue cancer treated with brachytherapy, a retrospective analysis was performed in 111 patients who were clinically diagnosed as having nodal metastases without local recurrence and whose neck lymph nodes turned out to be pathologically positive after salvage surgery. One hundred and five patients had undergone only ND (the ND group), six patients had undergone ND with GL (the ND+GL group). RESULTS: The 5 year disease-free and cause-specific survival rates after salvage therapy for the 111 patients included in this study were 58.1 and 61.9%, respectively. In the ND group, there were only nine patients who had local recurrence after ND. In addition, only six patients (5.7%) had a local recurrence within 2 years in the ND group. Sixty-three patients were free of disease after ND, 31 patients had regional or distant metastases without local recurrence and two patients had progressive disease at ND. In the ND+GL group, four patients were alive without disease and two died from regional or distant metastases. None of the patients in the ND+GL group were found to have malignant tissue in the pathological findings from the excised tongue. CONCLUSION: GL should be avoided or suspended when the clinical evaluation had revealed cervical failure without apparent local recurrence in the mobile tongue cancer patients after initial brachytherapy.

Salvage radiation therapy for residual superficial esophageal cancer after endoscopic mucosal resection.

PURPOSE: To analyze the outcomes of radiation therapy for patients with residual superficial esophageal cancer (rSEC) after endoscopic mucosal resection (EMR). METHODS AND MATERIALS: From May 1996 to October 2002, a total of 30 rSEC patients without lymph node metastasis received radiation therapy at Tohoku University Hospital and associated hospitals. The time interval from EMR to start of radiation therapy ranged from 9 to 73 days (median interval, 40 days). Radiation doses ranged from 60 Gy to 70 Gy (mean dose, 66 Gy). Chemotherapy was used in 9 of 30 patients (30%). RESULTS: The 2-year, 3-year, and 5-year overall survival rates and cause-specific survival rates were 91%, 82%, and 51%, respectively, and 95%, 85%, and 73%, respectively. The 2-year, 3-year, and 5-year local control rates for mucosal cancer were 91%, 91%, and 91%, respectively, and those for submucosal cancer were 89%, 89%, and 47%, respectively. These differences in survival rates for patients with two types of cancer were not statistically significant. Local recurrence and lymph node recurrence were more frequent in patients with submucosal cancer than in patients with mucosal cancer (p = 0.38 and p = 0.08, respectively). Esophageal stenosis that required balloon dilatation developed in 3 of the 30 patients, and radiation pneumonitis that required steroid therapy developed in 1 patient. CONCLUSIONS: Radiation therapy is useful for preventing local recurrence after incomplete EMR.

[High-dose-rate brachytherapy with local injection of bleomycin for N0 oral tongue cancer--possibilities of the control of tumor implant by inserting applicators and the decrease in tumor dose].

Twenty-eight patients with N0 oral tongue cancer were treated with high-dose-rate (HDR) interstitial brachytherapy combined with local injection of bleomycin between December 1997 and June 2001 at the Department of Radiology, National Kyushu Medical Center Hospital. A median dose of 5 mg of bleomycin was injected locally, and 16-20 Gy was delivered to the area surrounding applicators for control of the tumor implant during the initial two days. The two-year local recurrence-free survival rate was 96% [T1, 2: 100% (8/8, 15/15), T3: 80% (4/5)]. The two-year secondary neck node metastasis rate was 7.1% [T1: 12.5% (1/8), T2: 6.7% (1/15), T3:0% (0/5)]. There were no tumor implants in any patients. We tried to decrease the minimal tumor dose step by step. The groups with median minimal tumor doses of 60 Gy, 50 Gy, and 40 Gy had local recurrence rates of 12.5% (1/8), 0% (0/14), and 0% (0/6), respectively. Local recurrence rates were not increased by decreasing the minimal tumor dose. Two patients (7%) had secondary neck node metastasis. Late adverse effects were tongue ulcer: 11% (3/28), oral floor ulcer: 4% (1/28), and osteonecrosis: 4% (1/28). These results suggest that control of the tumor implant and the decrease in minimal tumor dose below 60 Gy may be possible with the local injection of bleomycin and delivery of doses to the area surrounding the applicators when NO tongue cancer is treated using 192Ir-HDR brachytherapy.