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1.
Clin Transl Radiat Oncol ; 27: 85-88, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33532635

ABSTRACT

The abscopal effect describes the ability of locally administered radiotherapy to induce systemic antitumor effects. Although mentioned for the first time in the 1950s, records of abscopal effects, considered to be immune-mediated, are scarce with radiotherapy alone. However, with the continued development and use of immunotherapy, reports on the abscopal effect have become increasingly frequent during the last decade. Here, we report a patient with advanced malignant pleural mesothelioma who had progressive disease while on the anti-PDL1 inhibitor pembrolizumab and showed an abscopal response after palliative radiotherapy.

3.
J Radiat Res ; 58(2): 217-224, 2017 Mar 01.
Article in English | MEDLINE | ID: mdl-28399575

ABSTRACT

This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and <0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.


Subject(s)
Burnout, Professional/epidemiology , Burnout, Professional/psychology , Oncologists/psychology , Oncologists/statistics & numerical data , Radiation Oncology/statistics & numerical data , Adult , Aged , Demography , Female , Humans , Japan/epidemiology , Male , Middle Aged , Morbidity , Prevalence , Young Adult
4.
Med Dosim ; 41(4): 305-309, 2016.
Article in English | MEDLINE | ID: mdl-27623737

ABSTRACT

The purpose of this article is to quantitatively evaluate differences in dose distributions calculated using various computed tomography (CT) datasets, dose-calculation algorithms, and prescription methods in stereotactic body radiotherapy (SBRT) for patients with early-stage lung cancer. Data on 29 patients with early-stage lung cancer treated with SBRT were retrospectively analyzed. Averaged CT (Ave-CT) and expiratory CT (Ex-CT) images were reconstructed for each patient using 4-dimensional CT data. Dose distributions were initially calculated using the Ave-CT images and recalculated (in the same monitor units [MUs]) by employing Ex-CT images with the same beam arrangements. The dose-volume parameters, including D95, D90, D50, and D2 of the planning target volume (PTV), were compared between the 2 image sets. To explore the influence of dose-calculation algorithms and prescription methods on the differences in dose distributions evident between Ave-CT and Ex-CT images, we calculated dose distributions using the following 3 different algorithms: x-ray Voxel Monte Carlo (XVMC), Acuros XB (AXB), and the anisotropic analytical algorithm (AAA). We also used 2 different dose-prescription methods; the isocenter prescription and the PTV periphery prescription methods. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data were within 3 percentage points (%pts) employing the isocenter prescription method, and within 1.5%pts using the PTV periphery prescription method, irrespective of which of the 3 algorithms (XVMC, AXB, and AAA) was employed. The frequencies of dose-volume parameters differing by >1%pt when the XVMC and AXB were used were greater than those associated with the use of the AAA, regardless of the dose-prescription method employed. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data on patients who underwent lung SBRT were within 3%pts, regardless of the dose-calculation algorithm or the dose-prescription method employed.


Subject(s)
Four-Dimensional Computed Tomography/methods , Lung Neoplasms/radiotherapy , Radiosurgery/methods , Radiotherapy Planning, Computer-Assisted/methods , Algorithms , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Monte Carlo Method , Prescriptions , Radiotherapy Dosage , Tumor Burden
5.
J Radiat Res ; 55(5): 934-9, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24801474

ABSTRACT

The aim of this study was to evaluate the impact of abdominal compression (AC) on outcome in patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer. We retrospectively reviewed data for 47 patients with histologically proven non-small cell lung cancer and lung tumour motion ≥ 8 mm treated with SBRT. Setup error was corrected based on bony structure. The differences in overall survival (OS), local control (LC) and disease-free survival (DFS) were evaluated to compare patients treated with AC (n = 22) and without AC (n = 25). The median follow-up was 42.6 months (range, 1.4-94.6 months). The differences in the 3-year OS, LC and DFS rate between the two groups were not statistically significant (P = 0.909, 0.209 and 0.639, respectively). However, the largest difference was observed in the LC rate, which was 82.5% (95% CI, 54.9-94.0%) for patients treated without AC and 65.4% (95% CI, 40.2-82.0%) for those treated with AC. After stratifying the patients into prognostic groups based on sex and T-stage, the LC difference increased in the group with an unfavourable prognosis. The present study suggests that AC might be associated with a worse LC rate after SBRT using a bony-structure-based set-up.


Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/radiotherapy , Immobilization/methods , Lung Neoplasms/diagnosis , Lung Neoplasms/radiotherapy , Radiosurgery/methods , Radiotherapy Setup Errors/prevention & control , Abdomen , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patient Positioning/methods , Prognosis , Retrospective Studies , Survival Rate , Treatment Outcome
6.
Med Phys ; 40(9): 091718, 2013 Sep.
Article in English | MEDLINE | ID: mdl-24007151

ABSTRACT

PURPOSE: To assess the effect of abdominal compression on the interfraction variation in tumor position in lung stereotactic body radiotherapy (SBRT) using cone-beam computed tomography (CBCT) in a larger series of patients with large tumor motion amplitude. METHODS: Thirty patients with lung tumor motion exceeding 8 mm who underwent SBRT were included in this study. After translational and rotational initial setup error was corrected based on bone anatomy, CBCT images were acquired for each fraction. The residual interfraction variation was defined as the difference between the centroid position of the visualized target in three dimensions derived from CBCT scans and those derived from averaged intensity projection images. The authors compared the magnitude of the interfraction variation in tumor position between patients treated with [n = 16 (76 fractions)] and without [n = 14 (76 fractions)] abdominal compression. RESULTS: The mean ± standard deviation (SD) of the motion amplitude in the longitudinal direction before abdominal compression was 19.9 ± 7.3 (range, 10-40) mm and was significantly (p < 0.01) reduced to 12.4 ± 5.8 (range, 5-30) mm with compression. The greatest variance of the interfraction variation with abdominal compression was observed in the longitudinal direction, with a mean ± SD of 0.79 ± 3.05 mm, compared to -0.60 ± 2.10 mm without abdominal compression. The absolute values of the 95th percentile of the interfraction variation for one side in each direction were 3.97∕6.21 mm (posterior∕anterior), 4.16∕3.76 mm (caudal∕cranial), and 2.90∕2.32 mm (right∕left) without abdominal compression, and 2.14∕5.03 mm (posterior∕anterior), 3.93∕9.23 mm (caudal∕cranial), and 2.37∕5.45 mm (right∕left) with abdominal compression. An absolute interfraction variation greater than 5 mm was observed in six (9.2%) fractions without and 13 (17.1%) fractions with abdominal compression. CONCLUSIONS: Abdominal compression was effective for reducing the amplitude of tumor motion. However, in most of the authors' patients, the use of abdominal compression seemed to increase the interfraction variation in tumor position, despite reducing lung tumor motion. The daily tumor position deviated more systematically from the tumor position in the planning CT scan in the lateral and longitudinal directions in patients treated with abdominal compression compared to those treated without compression. Therefore, target matching is required to correct or minimize the interfraction variation.


Subject(s)
Abdomen , Dose Fractionation, Radiation , Lung Neoplasms/surgery , Mechanical Phenomena , Radiosurgery/methods , Aged , Aged, 80 and over , Cone-Beam Computed Tomography , Female , Four-Dimensional Computed Tomography , Humans , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Radiosurgery/instrumentation
7.
Med Dosim ; 38(1): 95-9, 2013.
Article in English | MEDLINE | ID: mdl-23246194

ABSTRACT

The objective of this study was to evaluate the differences in dose-volumetric data obtained using the analytical anisotropic algorithm (AAA) vs the x-ray voxel Monte Carlo (XVMC) algorithm for stereotactic body radiation therapy (SBRT) for lung cancer. Dose-volumetric data from 20 patients treated with SBRT for solitary lung cancer generated using the iPlan XVMC for the Novalis system consisting of a 6-MV linear accelerator and micro-multileaf collimators were recalculated with the AAA in Eclipse using the same monitor units and identical beam setup. The mean isocenter dose was 100.2% and 98.7% of the prescribed dose according to XVMC and AAA, respectively. Mean values of the maximal dose (D(max)), the minimal dose (D(min)), and dose received by 95% volume (D95) for the planning target volume (PTV) with XVMC were 104.3%, 75.1%, and 86.2%, respectively. When recalculated with the AAA, those values were 100.8%, 77.1%, and 85.4%, respectively. Mean dose parameter values considered for the normal lung, namely the mean lung dose, V5, and V20, were 3.7Gy, 19.4%, and 5.0% for XVMC and 3.6Gy, 18.3%, and 4.7% for the AAA, respectively. All of these dose-volumetric differences between the 2 algorithms were within 5% of the prescribed dose. The effect of PTV size and tumor location, respectively, on the differences in dose parameters for the PTV between the AAA and XVMC was evaluated. A significant effect of the PTV on the difference in D95 between the AAA and XVMC was observed (p = 0.03). Differences in the marginal doses, namely D(min) and D95, were statistically significant between peripherally and centrally located tumors (p = 0.04 and p = 0.02, respectively). Tumor location and volume might have an effect on the differences in dose-volumetric parameters. The differences between AAA and XVMC were considered to be within an acceptable range (<5 percentage points).


Subject(s)
Algorithms , Imaging, Three-Dimensional/methods , Lung Neoplasms/radiotherapy , Lung Neoplasms/surgery , Radiosurgery/methods , Radiotherapy Planning, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Monte Carlo Method , Radiotherapy Dosage , Reproducibility of Results , Sensitivity and Specificity , Surgery, Computer-Assisted/methods
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