Electron radiotherapy for EMPD of penis and scrotum.

ABSTRACT: Electron beams represent an important treatment modality for providing an accurate dose of therapy to superficial cancers. This case reports important findings of dermal invasion in patients with extramammary Paget's disease (EMPD) using microscopic measurements and electron beam coverage. EMPD is a rare cutaneous adenocarcinoma generally arising in the anogenital region. Surgery is still a curable treatment option for patients with EMPD, whereas radiation therapy (RT) is an alternative for inoperable cases and is necessary in cases where surgery is not performed. This case report describes our experience and reviews the relevant literature on the feasibility of electron RT according to the dermal invasion length. An 80-year-old patient was diagnosed with EMPD and presented for definite radiation treatment. We observed no grade 3 toxicities during electron RT, and at the last follow-up visit, no signs of relapse were observed. There are no reports of electron irradiation as a feasible treatment option for EMPD considering the epidermal invasion length.

Radiation therapy of synchronous bilateral breast carcinoma (SBBC) using multiple techniques.

The purpose of this study was to establish intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for synchronous bilateral breast cancer (SBBC) and to compare those plans with the previous treatment plans using 3D conformal radiation therapy (3DCRT). The differences among the treatments were also statistically compared regarding dosimetry distribution and treatment efficiency. The research was conducted with 10 SBBC patients. The study established IMRT (12 fields with a single isocenter) and VMAT (2 partial arcs with a single isocenter) treatment plans for SBBC patients and then compared those plans with 3DCRT (8 fields with multiple isocenters). The plans were evaluated based on a dose-volume histogram analysis. For planning target volumes (PTVs), the mean doses and the values of V95%, V105%, conformity index, and homogeneity index were reported. For the organs at risk, the analysis included the mean dose, maximum dose, and VXGy, depending on the organs (lungs, heart, and liver). To objectively evaluate the efficiency of the treatment plans, each plan's beam times, treatment times (including set-up time), and monitor units were compared. Tukey test and one-way analysis of variance were used to compare the PTV and organs at risk values of the 3 techniques. Additionally, the independent-samples t-test was used to compare the 2 techniques (IMRT and VMAT) based on the values of Rt. PTV and Lt. PTV (p < 0.05). For PTV dose distribution, IMRT showed increases of approximately 1.2% in Dmean and of approximately 5.7% in V95% dose distribution compared with 3DCRT. In comparison to VMAT, 3DCRT showed about 3.0% higher dose distribution in Dmean and V95%. IMRT was the best in terms of conformity index and homogeneity index (p < 0.05), whereas 3DCRT and VMAT did not significantly differ from each other. In terms of dose distribution on lungs, heart, and liver, the percentage of volume at high doses such as V30Gy and V40Gy was approximately 70% lower for IMRT and approximately 40% lower for VMAT than for 3DCRT. For distribution volumes of low doses such as V5% and V10%, that for 3DCRT was approximately 60% smaller than for IMRT and approximately 70% smaller than for VMAT. Comparison between IMRT and VMAT showed that the IMRT was superior in all distribution factors. VMAT showed better treatment efficiency than 3DCRT or IMRT. Among the SBBC radiotherapy treatment plans, IMRT was superior to 3DCRT and VMAT in terms of PTV dose distribution, whereas VMAT showed the most outstanding treatment efficiency.

Survey of the Patterns of Using Stereotactic Ablative Radiotherapy for Early-Stage Non-small Cell Lung Cancer in Korea.

PURPOSE: Stereotactic ablative radiotherapy (SABR) is an effective emerging technique for early-stage non-small cell lung cancer (NSCLC). We investigated the current practice of SABR for early-stage NSCLC in Korea. MATERIALS AND METHODS: We conducted a nationwide survey of SABR for NSCLC by sending e-mails to all board-certified members of the Korean Society for Radiation Oncology. The survey included 23 questions focusing on the technical aspects of SABR and 18 questions seeking the participants' opinions on specific clinical scenarios in the use of SABR for early-stage NSCLC. Overall, 79 radiation oncologists at 61/85 specialist hospitals in Korea (71.8%) responded to the survey. RESULTS: SABR was used at 33 institutions (54%) to treat NSCLC. Regarding technical aspects, the most common planning methods were the rotational intensity-modulated technique (59%) and the static intensity-modulated technique (49%). Respiratory motion was managed by gating (54%) or abdominal compression (51%), and 86% of the planning scans were obtained using 4-dimensional computed tomography. In the clinical scenarios, the most commonly chosen fractionation schedule for peripherally located T1 NSCLC was 60 Gy in four fractions. For centrally located tumors and T2 NSCLC, the oncologists tended to avoid SABR for radiotherapy, and extended the fractionation schedule. CONCLUSION: The results of our survey indicated that SABR is increasingly being used to treat NSCLC in Korea. However, there were wide variations in the technical protocols and fractionation schedules of SABR for early-stage NSCLC among institutions. Standardization of SABR is necessary before implementing nationwide, multicenter, randomized studies.

Multiple myeloma with biclonal gammopathy accompanied by prostate cancer.

We report a rare case of multiple myeloma with biclonal gammopathy (IgG kappa and IgA lambda type) in a 58-year-old man with prostate cancer who presented with lower back pain. Through computed tomography (CT) imaging, an osteolytic lesion at the L3 vertebra and an enhancing lesion of the prostate gland with multiple lymphadenopathies were found. In the whole body positron emission tomography-computed tomography (PET-CT), an additional osteoblastic bone lesion was found in the left ischial bone. A prostate biopsy was performed, and adenocarcinoma was confirmed. Decompression surgery of the L3 vertebra was conducted, and the pathologic result indicated that the lesion was a plasma cell neoplasm. Immunofixation electrophoresis showed the presence of biclonal gammopathy (IgG kappa and IgA lambda). Bone marrow plasma cells (CD138 positive cells) comprised 7.2% of nucleated cells and showed kappa positivity. We started radiation therapy for the L3 vertebra lesion, with a total dose of 3,940 cGy, and androgen deprivation therapy as treatment for the prostate cancer.

A dosimetric analysis of IMRT and multistatic fields techniques for left breast radiotherapy.

The purpose of this study was to analyze the dosimetric difference between intensity-modulated radiation therapy (IMRT) using 3 or 5 beams and multistatic field technique (MSF) in radiotherapy of the left breast. We made comparative analysis of two kinds of radiotherapy that can achieve improved dose homogeneity. First is a MSF that uses both major and small irradiation fields at the same time. The other is IMRT using 3 or 5 beams with an inverse planning system using multiple static multileaf collimators. We made treatment plans for 16 early left breast cancer patients who were randomly selected and had undergone breast conserving surgery and radiotherapy, and analyzed them in the dosimetric aspect. For the mean values of V(95) and dose homogeneity index, no statistically significant difference was observed among the three therapies. Extreme hot spots receiving >110% of prescribed dose were not found in any of the three methods. Using Tukey's test, IMRT showed a significantly larger increase in exposure dose to the ipsilateral lung and the heart than MSF in the low-dose area, but in the high-dose area, MSF showed a slight increase. To improve dose homogeneity, the application of MSF, which can be easily planned and applied more widely, is considered optimal as an alternative to IMRT for radiotherapy of early left breast cancer.

A case of synchronous double primary cancer of the penis and urinary bladder.

Multiple primary cancers are the occurrence of more than two cancers of different origin in an individual. Penile cancer is a rare disease, and finding it combined with other cancers is even rarer. A 64-year-old man with a painful penile mass was referred to us from a primary urological clinic. We performed a biopsy of the penile mass and the histology revealed a well-differentiated squamous cell carcinoma. Abdominal computed tomography showed a localized bladder tumor with inguinal lymphadenopathy. The patient underwent a partial penectomy, transurethral resection of the bladder tumor and inguinal lymph node dissection. The histology of the bladder tumor was high-grade papillary carcinoma, and that of the lymph node was squamous cell carcinoma. The penile and bladder tumors were in stage II (T1N1M0) and stage I (T1N0M0), respectively. We successfully treated the patient with adjuvant radiotherapy and systemic chemotherapy.

StAR and steroidogenic enzyme transcriptional regulation in the rat brain: effects of acute alcohol administration.

In this study, we showed the presence of steroidogenic acute regulatory protein (StAR) mRNA in the rat brain using Northern blot analysis and revealed its localization using in situ hybridization histochemistry. Although the expression level is less than peripheral steroidogenic organs, the brain has two kinds of StAR transcripts with the same size as peripheral endocrine organs. As expected, StAR mRNA levels were maintained in the brain after gonadectomy and adrenalectomy, which indicates its independent expression. Acute alcohol administration affected the mRNA expression of a variety of steroidogenic enzymes, as well as StAR, in several brain regions, and these changes varied from one region to another. It is suggested that StAR may take part in brain steroidogenesis along with steroidogenic enzymes and that various neurosteroids are synthesized differentially to meet local demands.