Improvement of the robustness to set up error by a virtual bolus in total scalp irradiation with Helical TomoTherapy.

Intensity-modulated radiation therapy has recently been used for total scalp irradiation. In inverse planning, the treatment planning system increases the fluence of tangential beam near the skin surface to counter the build-up region. Consequently, the dose to the skin surface increases even with small setup errors. Replacing the electron density of the surrounding air of some thickness with a virtual bolus during optimization could suppress the extremely high fluence near the skin. We confirmed the usefulness of a virtual bolus in total scalp irradiation. For each patient, two beams were planned, one with and the other without a virtual bolus. The dose distribution was calculated using computed tomography images that were shifted to simulate setup errors. The hot spot dose was suppressed in the plans using a virtual bolus. In conclusion, using a virtual bolus improved the robustness to setup errors.

Details of recurrence sites after definitive radiation therapy for cervical cancer / 부인종양

OBJECTIVE: This is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT). METHODS: Data were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB-IVA cervical cancer. RESULTS: One hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse. CONCLUSION: Local disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.

Semi-radical chemoradiotherapy for 53 esophageal squamous cell carcinomas with supraclavicular lymph node metastasis in a single institutional retrospective study.

OBJECTIVE: Outcomes were examined for the cases that received radiotherapy (RT) for esophageal cancer with metastasis to supraclavicular lymph nodes (ScLN) in a single institutional retrospective study. MATERIALS AND METHODS: Cases examined were 53 consecutive patients with pathologically confirmed esophageal cancer enrolled from our institution who received semi-radical RT from 2001 to 2013. Radiotherapy consisted of a total dose of from 50-50.4 Gy given in 25-28 fractions of 1.8-2.0 Gy with five fractions per week. The chemotherapy regimen included nedaplatin and 5-fluorouracil. All had ScLN metastasis, and all diseases were included in the RT field. RESULTS: The median follow up time was 42 months for survival patients. Overall survival (OS) and progression free survival (PFS) for 1-, 2-, and 3 years were 39%, 19%, and 12% and 14%, 9%, and 6%, respectively. Acute grade 3-5 esophagitis and neutropenia was seen in 11% and 81%, respectively. Late grade 3-5 toxicity in esophagus, lung, and heart was seen in 4%, 0%, and 0%. Five patients (9%) survived more than 4 year. CONCLUSION: Although the 2-year PFS was less than 10% and very poor, long term survival for over 4 year was seen in 9% cases. In other words, despite the poor results, the fact remains that some patients were cured with CRT.