Phase I study of amrubicin plus cisplatin and concurrent accelerated hyperfractionated thoracic radiotherapy for limited-disease small cell lung cancer: protocol of ACIST study.

BACKGROUND: Etoposide plus cisplatin (EP) combined with concurrent accelerated hyperfractionated thoracic radiotherapy (AHTRT) is the standard treatment strategy for unresectable limited-disease (LD) small cell lung cancer (SCLC), which has remained unchanged for over two decades. Based on a previous study that confirmed the non-inferiority of amrubicin (AMR) plus cisplatin (AP) when compared with EP for extensive-disease (ED) SCLC, we have previously conducted a phase I study assessing AP with concurrent TRT (2 Gy/time, once daily, 50 Gy in total) for LD-SCLC therapy. Our findings revealed that AP with concurrent TRT could prolong overall survival to 39.5 months with manageable toxicities. Therefore, we plan to conduct a phase I study to investigate and determine the effect of AP combined with AHTRT, recommended dose (RD), maximum tolerated dose (MTD), and dose-limiting toxicity (DLT) of AP in patients with LD-SCLC. METHODS: Treatment-naive patients with LD-SCLC, age between 20 and 75 years, who had a performance status of 0 or 1 and adequate organ functions will be enrolled. For chemotherapy, cisplatin 60 mg/m2 /day (day 1) and AMR (day 1 to 3) will be administered with AHTRT (1.5 Gy/time, twice daily, 45 Gy in total). The initial AMR dose is set to 25 mg/m2 /day. RD and MTD will be determined by evaluating toxicities. DISCUSSION: Based on our previous study, the initial dose of AMR 25 mg/m2 is expected to be tolerated and acceptable. Here, we aim to determine whether treatment with AP and concurrent AHTRT would be an optimal choice with manageable toxicities for LD-SCLC.

SPECT/CT Fusion in the Diagnosis of Hyperparathyroidism.

OBJECTIVES: In this study, we aimed to analyze the relationship between the diagnostic ability of fused single photon emission computed tomography/ computed tomography (SPECT/CT) images in localization of parathyroid lesions and the size of adenomas or hyperplastic glands. METHODS: Five patients with primary hyperparathyroidism (PHPT) and 4 patients with secondary hyperparathyroidism (SHPT) were imaged 15 and 120 minutes after the intravenous injection of technetium99m-methoxyisobutylisonitrile ((99m)Tc-MIBI). All patients underwent surgery and 5 parathyroid adenomas and 10 hyperplastic glands were detected. Pathologic findings were correlated with imaging results. RESULTS: The SPECT/CT fusion images were able to detect all parathyroid adenomas even with the greatest axial diameter of 0.6 cm. Planar scintigraphy and SPECT imaging could not detect parathyroid adenomas with an axial diameter of 1.0 to 1.2 cm. Four out of 10 (40%) hyperplastic parathyroid glands were diagnosed, using planar and SPECT imaging and 5 out of 10 (50%) hyperplastic parathyroid glands were localized, using SPECT/CT fusion images. CONCLUSION: SPECT/CT fusion imaging is a more useful tool for localization of parathyroid lesions, particularly parathyroid adenomas, in comparison with planar and or SPECT imaging.

Re-evaluation of detectability of liver metastases by contrast-enhanced CT: added value of hepatic arterial phase imaging.

PURPOSE: We compared the detectability of liver metastases on 2- and 3-phase images using robust statistical methods. Nine radiologists evaluated unenhanced CT plus portal venous phase (2-phase) images and 2-phase plus hepatic arterial phase (HAP) (3-phase) images. MATERIALS AND METHODS: Our study included 54 patients with primary malignant tumors who underwent 3-phase hepatic dynamic CT more than twice to screen for liver metastases; 24 had 1-6 liver metastases measuring 4-27 mm in diameter (median 13 mm). The other 30 had no metastases. Nine board-certified radiologists participated in our observer performance study. They specified the location of the metastatic lesions and rated the probability of metastatic nodules on 2-phase images acquired with and without HAP imaging. We used jackknife alternative free-response receiver operating characteristic (JAFROC) analysis to compare their performances. RESULTS: For all radiologists the area under the curve without and with HAP imaging was 0.86 and 0.88, respectively; the difference was significant (p = 0.04). For metastases smaller than 10 mm the averaged lesion localization fraction without and with HAP imaging was 0.17 and 0.26 (p < 0.01). CONCLUSION: Adding HAP to 2-phase imaging improved the detectability of liver metastases, especially of lesions smaller than 10 mm.

Kimura's Disease of the Orbit Successfully Treated with Radiotherapy Alone: A Case Report.

We performed radiotherapy in a 28-year-old patient with Kimura's disease of the orbit. Irradiation with 21.6 Gy was administered to the tumor bed with a single dose of 1.8 Gy in 5 weekly fractions delivered via a high-energy linear accelerator (6-MV X-ray). Complete remission of the tumor and improvements in the neurological findings were achieved. Neither tumor regrowth nor late complications were detected up to 84 months after radiotherapy. Radiotherapy is an effective treatment for Kimura's disease of the orbit.

Spontaneous regression of primary malignant lymphoma of the prostate.

We herein report a case of primary lymphoma of the prostate, which arose in an 85-year-old male with dysuria. CT and MRI examinations demonstrated a large mass in the prostate. A transrectal ultrasound-guided biopsy of the prostate was performed. The histological examination showed diffuse large B-cell lymphoma. The large lesion in the prostate showed spontaneous regression. Spontaneous regression of primary lymphoma of the prostate has not been reported previously. The spontaneous regression of primary lymphoma of the prostate observed in this patient suggests that observation may represent a viable treatment option following a biopsy that has provided a histopathological diagnosis.

[Radiation effects on pregnant women, fetuses, and children].

We conducted a review of literature related to radiation effects on pregnant women, fetuses, and children from the perspective of epidemiology, pathology, and radiobiology. During 8-25 weeks post-conception the central nervous system is particularly sensitive to radiation. Fetal doses in excess of 100 mGy can result in some reduction of IQ (intelligence quotient). Fetal doses in the range of 1000 mGy can lead to severe mental retardation and microcephaly, particularly during 8-15 weeks and to a lesser extent 16-25 weeks after conception. Recent studies of cancers and chromosome aberrations indicated less radiosensitivity in prenatally exposed A-bomb survivors compared with postnatally exposed survivors, for which we provide possible hypotheses as an explanation.

An unusual unilocular mesothelial cyst of the pleura: a case report.

A 79-year-old woman was found to have an abnormal shadow on chest radiography. Computed tomography demonstrated a pleural mass. The F-18 fluorodeoxyglucose positron emission tomography (FDG PET) was performed to determine whether the pleural mass was benign or malignant. The histologic examination of the resected mass showed a unilocular mesothelial cyst of the pleura. The FDG PET findings of a mesothelial cyst of the pleura have not yet been previously reported. The FDG PET findings of a mesothelial cyst in the pleura reflected the microscopic findings of the resected mass. The FDG PET findings, therefore, seem to be useful in the diagnosis of mesothelial cysts.

Computed tomography-based three-dimensional dosimetry of intracavitary brachytherapy for cervical cancer.

PURPOSE: The aim of this study was to show the results of computed tomography (CT)-based dosimetry of intracavitary brachytherapy for cervical cancer. MATERIALS AND METHODS: A total of 20 patients with cervical cancer underwent intracavitary brachytherapy with external beam radiation therapy. The prescribed dose of brachytherapy was 6 Gy per fraction to point A. In every fraction a CT scan was performed after applicator insertion and three-dimensional (3D) dosimetry was done. The tumor dose was evaluated using D90 (the minimum dose delivered to 90% of the volume), and the doses of risk organs were evaluated using D2cc (the minimum dose in the most irradiated 2 cm3 of the volume). RESULTS: The mean D90 for the clinical target volume (CTV) was 7.0 Gy (range 4.8-9.8 Gy). There was a negative correlation between the volume and the D90 for the CTV. The mean D2cc doses for the rectum and bladder were 6.0 Gy (range 3.9-9.0 Gy) and 6.5 Gy 5 Gy 2.9-9.0 Gy), respectively. CONCLUSION: CT-based 3D dosimetry of intracavitary brachytherapy for cervical cancer was useful for evaluating the doses of the CTV and the organs at risk. In cases with a large CTV, CTV D90 was often lower than the point A dose, and modulation of the prescribed dose might have to be considered.

Regular surveillance by imaging for early detection and better prognosis of hepatocellular carcinoma in patients infected with hepatitis C virus.

PURPOSE: This study evaluated the usefulness of regular check-ups by ultrasonography and contrast-enhanced imaging for early detection of hepatocellular carcinoma (HCC) in a retrospective analysis. PATIENTS AND METHODS: From April 2001 to March 2007, 240 consecutive patients with HCC who were infected with hepatitis C virus (HCV) were divided into three groups. Patients diagnosed with HCC by repeated imaging constituted Group A (surveillance group). Group B comprised patients in whom HCC was detected during scheduled doctor visits for liver disease or other diseases such as diabetes. Group C comprised non-screened patients. RESULTS: The prevalence of solitary tumors decreased from Group A through Group B to Group C (66, 48 and 24%, respectively, P < 0.001). The proportion of patients in stages I and II decreased from 83% (103/124) in Group A to 53% (42/79) in Group B and 24% (9/37) in Group C (P < 0.001). The proportion of patients who were treated with curative procedures, such as resection or ablation, was highest at 80% (99/124) in Group A, and lower at 53% (42/79) in Group B and 27% (10/37) in Group C (P < 0.001). The cumulative survival rate was better in Group A than B (P < 0.05), and in Group B than C (P < 0.001). Periodical medical check-ups without imaging did not necessarily detect early-stage disease, even when HCC-related markers including des-gamma-carboxy prothrombin were tested. CONCLUSIONS: Regular surveillance with ultrasonography and contrast-enhanced imaging is useful for detecting early-stage HCC and increase chances for curative treatments in patients with HCV-related chronic liver disease.

Results of a preliminary study using hypofractionated involved-field radiation therapy and concurrent carboplatin/paclitaxel in the treatment of locally advanced non-small-cell lung cancer.

BACKGROUND: We aimed to evaluate the feasibility and efficacy of hypofractionated involved-field radiation therapy (IFRT) omitting elective nodal irradiation (ENI) with concurrent chemotherapy for locally advanced non-small-cell lung cancer (NSCLC). METHODS: Between July 2004 and July 2006, ten patients with locally advanced NSCLC were included in this study. One had stage IIIA and 9 had stage IIIB disease. The treatment consisted of IFRT in fractions of 2.5 Gy and weekly carboplatin (CBDCA)/paclitaxel (PTX). Hypofractionated IFRT with a median total dose of 65 Gy with median percent total lung volume exceeding 20 Gy (V20) of 20.2%, and a median of five courses of chemotherapy with weekly CBDCA (area under the curve, 1.5-2.0)/PTX (30-35 mg/m(2)) were given to all patients. RESULTS: The median survival time and the 1-, 2-, and 3-year overall survival rates were 29.5 months and 90.0%, 58.3%, and 43.8%, respectively. No elective nodal failure was encountered during the median follow up of 18.2 months. No acute or late toxicities of grade 3 or worse were observed. No in-field recurrence occurred in the group with a total dose of 67.5 Gy or more, but there was such recurrence in 83.3% of those in the group with less than 67.5 Gy. CONCLUSION: Hypofractionated IFRT with weekly CBDCA/PTX was a feasible treatment regimen. Hypofractionated IFRT with a total dose of 67.5 Gy or more could be a promising modality to improve the treatment results in patients with locally advanced NSCLC.

Radiotherapy for localized orbital mucosa-associated lymphoid tissue lymphoma.

Fourteen patients with localized orbital mucosa-associated lymphoid tissue lymphoma diagnosed between 1998 and 2005 were reviewed. Five patients were males and 9 were females, with a mean age of 58 years. In 8 patients, the disease arose from the conjunctiva, and in 6 patients, it originated from the retrobulbar space. Patients were treated with radiotherapy alone at a dose range from 30 to 54 Gy. All patients with conjunctival lymphoma achieved complete remission (CR). Four patients with retrobulbar lymphoma obtained CR, and unconfirmed CR (CRu) was observed in 2 cases. Orbital extraconal lymphoma disappeared. However, intraconal cord-like tumor and mass involving the medial extraocular muscle remained with the absence of regrowth over the long term. There have been very few reports discussing the histology of residual mass after radiotherapy. Residual mass was suggested to be reactive lymphoid hyperplasia. As a dose of more than 40 Gy induced dry eye syndrome or cataract, the dose must not exceed 40 Gy in order to achieve safe treatment of orbital mucosa-associated lymphoid tissue lymphoma.

[Chemoradiotherapy for neurohypophyseal immature teratoma].

We performed chemoradiotherapy for two patients (aged 6 and 33 years)with neurohypophyseal immature teratoma. The patients received total doses of 40 to 50.6 Gy with concurrent carboplatin and etoposide. In both cases, neurological symptoms improved. Both patients are still alive and remain free from local recurrence and distant metastasis 92 months and 62 months, respectively, after the completion of chemoradiotherapy. No late complications were observed. Chemoradiotherapy is extremely effective in the treatment of neurohypophyseal immature teratoma.

[Second malignancies following radiotherapy: an analysis of 54 cases accumulated by mail survey in Japan].

The increasing incidence of second malignant neoplasms after radiotherapy, while due in part to increasing numbers of survivors, is also thought to be related to new modalities of radiotherapy and/or increasingly more intensive combined modality treatment. From a mail survey conducted in 2000 concerning secondary neoplasms following radiotherapy, 62 patients were collected from 22 hospitals in Japan. The following patients were excluded: benign (4 cases) or unknown (2) first primary diseases, unknown histology of a second malignancy (1), and short latent period (from initial radiotherapy to diagnosis of second neoplasm) (1). Fifty-four patients with second malignancies were analyzed. The most common histology of second malignancies was squamous cell carcinoma (24 cases), followed by sarcoma (16), glioma (5), adenocarcinoma (3), leukemia (3), and others (3). The mean latent period was 17.7 (2-38) years. We investigated the correlation of the latent period with patient's characteristics or initial therapeutic factors. Multivariate analysis revealed that the latent period was significantly shortened in patients with combined chemotherapy and radiotherapy.