Biomedical subjects

A Akanuma

Publications and source records attributed to A Akanuma.

At least 19 recordsLinked to original sources

PubMed2001

[Troubles inherent to long-term home parenteral nutrition (HPN) and the use of technologies to improve communication between medical institutions and patients].

The continuous advance of technology has contributed to the improvement of the quality of life of patients under long-term home parenteral nutrition (HPN). But the longer the patient stays home, the higher the risk of many kinds of troubles. We designed an HPN system in June 1999, which uses E-mail for patients and to contact with each other (including the patient's family) and to prevent troubles from worsening. We describe the case of a patient which shows the efficacy and usefulness of our system, which makes use of the Internet, video mail, voice mail and electric medical records.

Aged↗

PubMed2000

[A case of terminal cancer patient whom the home staying terminal cares were provided with ease supported by the regional core hospital].

A physician who practices generally at his private clinic will be sometimes referred to a cancer patient staying at home. This referral is hardly acceptable without helps from other medical and paramedical specialities. He needs a support organization in which a supporting hospital is the most important. A case of home staying terminal cancer patient is reported here whom a private practician provided terminal cares with great difficulties at the beginning and afterwards with no significant difficulties organizing a care team for the home staying patient and assisted by a supporting hospital.

Aged↗

PubMed2000

[Home infusion therapy system from a resident's point of view].

We started a new home infusion therapy system in July 1999. The home infusion therapy system is made up of doctors, nursing stations, and pharmacies in the community. We coordinate these parties before patient discharge from our hospital and support them when the patient needs hospitalization (for example, he or she develops pneumonia). This report discusses past experiences and future issue.

Home Care Services, Hospital-Based↗

PubMed1998

High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme.

BACKGROUND AND PURPOSE: Although glioblastoma multiforme is clearly radiation-resistant, there is evidence of a dose-dependent response relationship. The purpose of the study was to evaluate the impact of higher dose by rotational multileaf collimator (MLC) conformal radiation therapy. MATERIALS AND METHODS: From 1984 to 1995, 38 consecutive cases with intracranial glioblastoma multiforme were treated using the rotational MLC conformal therapy. There were 25 men and 13 women with a median age of 47 years (12-73 years, mean 46.5 years). Median Karnofsky performance score was 80 (30-100, mean 78.2). Median tumor volume was 64 cc (8-800 cc, mean 110.3 cc). All underwent surgical intervention (only biopsy in 1, partial resection in 13, subtotal resection in 21, and gross total resection in 3). Radiation dose to was 60 to 80 Gy (median 68.5 Gy, mean 68.3 Gy) in 21 patients treated before 1990 and 90 Gy in the 17 patients thereafter. Biweekly i.v. chemotherapy was also administered for both arms. RESULTS: The 1-year, 2-year, 5-year, and 10-year overall survival rates were 75%, 42%, 20%, and 15%, respectively. Univariate analysis showed the initial tumor volume, residual tumor volume, and Karnofsky performance score were statistically significant factors for survival. Only the residual tumor volume was statistically significant by multivariate analysis. The 5-year survival rate of patients with residual tumors of 5 cc or less in volume was as good as 37%. Survival of the 90-Gy Group appeared inferior to that of the Low-Dose Group, though no statistical difference was seen (the 3-year survival was 40% vs. 22%). Local failure was observed in 16 of the 19 recurrences in the Low-Dose Group, whereas it was observed in only 4 of the 13 recurrences in the 90-Gy Group. The difference in pattern of failure was statistically significant. Two patients of the High-Dose Group developed radiation necrosis and one died of it. CONCLUSIONS: The high-dose conformal radiotherapy did not improve survival in the disease, but did change the pattern of failure.

Adolescent↗

PubMed1998

[C-MOS flat-panel sensor for real time X-ray imaging].

Flat-panel, self-scanning, solid state diagnostic x-ray imaging devices using complementary metal-oxide-semiconductor (C-MOS) arrays are under investigation. A unit device with a 5 cm by 5 cm sensor area was developed and tested. The device consists of a CsI scintillator and C-MOS detector arrays. The detector arrays are composed of a regular arrangement of pixels (256 x 256), each of which is made of a C-MOS photodiode sensor coupled to a C-MOS FET (field effect transistor). A common FET gate line is connected to all the FET gates along each column. A common date line is connected to all the FET drains of each row. The source contact of each FET is connected to that of its corresponding photodiode. A positive gate pulse applied to a gate turns on all FETs connected to the date lines. The readout continues column by column. Correlated double sampling circuits and an offset variance compensation circuit were installed to reduce noise. A sampling speed of 15 frames per second and spatial resolution of 2.5 line per mm were achieved. Noise level and maximum signal were 1.5 mV rms and 1.8 V, respectively. Image quality was considered acceptable for clinical use. It is also discussed how to fabricate a large area sensor with the unit device.

Humans↗

PubMed1996

[Method of calculating TDF biological equivalent for optimal treatment dose in fractionated intracavitary irradiation of carcinoma of the uterine cervix].

Intracavitary irradiation therapy for carcinoma of the uterine cervix used with high or low dose rate irradiation is fractionated in Japan. The optimal treatment dose is determined according to the biological effect on both diseased and healthy tissues. The equations of modified NSD and TDF biological equivalents were recalculated from Arai's clinical data, which were used to examine the optimal time-dose-fractionation relationship for high and low dose rate intracavitary irradiation on squamous cell carcinoma of the cervix uteri. The optimal time-dose-fractionation relationship at point A is expressed as follows: D = NSD N0.26 T0.06 where NSD is 17.75 get for high dose rate and 31.78 get for low dose rate. TDF = K n d1.47 x-0.09 where K is 1.46 for high dose rate and 0.62 for low dose rate. The range of the optimal total dose to point A given by one fraction per week was 30.7 Gy for 4 fractions and 38.3 Gy for 8 fractions in high dose rate irradiation. In the case of low dose rate irradiation, the optimal total dose given by one fraction per week and the dose rate of 75.0 cGy/h was 55.0 Gy for 4 fractions. The maximum dose difference between our result and Arai's was about +/- 10%. The dose modification ratio for high dose rate and low dose rate is 1.79.

Brachytherapy↗

PubMed1995

A pilot study of combination therapy of radiation and local administration of OK-432 for esophageal cancer. Five-year survival and local control rate.

BACKGROUND: Combination therapy consisting of radiation and local administration of OK-432 was administered to 73 patients with esophageal cancer without distant metastases. Seventy patients were examined. The average age was 71 years. There were 60 males and 10 females. The mean tumor length was 7.0 cm. METHODS: One mg of OK-432 was administered endoscopically to and around the cancerous lesion at the beginning of radiotherapy and a second dose of 0.5 mg of OK-432 was given in the same manner 2 weeks later. X-ray irradiation was given at a daily dose of 1.6-1.8 Gy, five fractions a week. The average total dose was 61.1 Gy. RESULTS: Complete responses were obtained in 49 of the 70 patients (70.0%), and partial responses (PR) in the remaining 21. The 5-year cause-specific survival rate of the 70 patients was 33.1%. The 5-year survival rate of the 49 patients with CR was 44.9%, and there were no patients with PR who survived more than 2 years. The 5-year survival rate of the 13 patients with T1 (UICC, 1987) was 79.6%, of the 24 patients with T2/3 41.1%, and of the 33 patients with T4 11.6%. The 5-year survival rates of the 18 patients with tumors less than 5 cm in length and the 40 patients with tumors 5 to 10 cm were 59.9 and 37.9%, respectively. In the patients with tumors more than 10 cm in length, the 4-year survival rate was 14.6%. Sixty-nine of the 70 patients were discharged in good condition and were able to take food orally. CONCLUSIONS: This combination therapy may contribute not only to the survival rate, but also to patients' quality of life.

Aged↗

PubMed1995

[Verification of rotational conformation radiotherapy using megavoltage CT scanning].

Although portal imaging is a promising method of verification during static multi-port irradiation, it cannot be applied directly to dynamic irradiation such as rotational conformation with multi-leaf collimator movement. A real-time beam monitoring system based on megavoltage computed tomography scanning has been developed to establish a verification method for the rotational conformation technique. The exit beam through the patient is extracted by the same detector unit as that used for megavoltage scanning during the actual treatment. The beam edge is defined as the 50% level of the maximum dose of the detector array. Megavoltage computed tomography is done after patient setup and just prior to the actual irradiation. Detected beam pathways are overlaid on this image approximately every 1 sec. Therapists can monitor the correlation between the target and actual beam pathways on a real-time computer display. The accuracy of field edge detection has been proven to be less than 2 mm from various measurements. Field errors were identified in two of 54 sessions using this method. Although several limitations remain to be solved, the method presented is an useful tool for treatment verification of high accuracy radiation therapy, particularly rotational conformation irradiation.

Brachytherapy↗

PubMed1994

Radiation therapy in early glottic carcinoma: uni- and multivariate analysis of prognostic factors affecting local control.

PURPOSE: The purpose of this report is to clarify prognostic factors affecting local control of T1 and T2 glottic tumors and to define an optimal regimen for radiation therapy. METHODS AND MATERIALS: Two hundred and ten patients (199 males, 11 females, age range 30 to 86 years with an average of 62 years) with previously untreated invasive squamous cell carcinoma of the glottis were treated with radiation therapy at the University of Tokyo between January 1972 and December 1989. Endoscopic microsurgery was introduced as an integral part of treatment in 1974. From 1974 to 1979 the radiation dose was gradually reduced, reaching a mean of 20 Gy in 2 weeks in 1979. From 1980 to 1983, the total dose increased to 50.4 Gy, with a fraction size of 1.8 Gy, over a mean of 5.6 weeks. From 1984 onward, the mean total radiation dose increased to 60 Gy with a fraction of 2 Gy. RESULTS: Recurrence-free 5 year survival rates for T1a, T1b, and T2 were 79%, 73%, and 67%, respectively. When the relationship between radiation dose and local control rates was analyzed for each year from 1974 to 1989, total doses were strongly associated with local control for patients with T1a disease. Age, sex, daily dose, total dose, radiation machine (Co-60 or 10 MV Lineac), treatment technique (anterior wedged pair or parallel opposed fields), treatment volume, use of endoscopic microsurgery, and involvement of the anterior commissure were examined for effects upon relapse-free survival in T1a disease by uni- and multivariate analysis. Total dose was the only significant factor for T1a disease (p < 0.02). The effect of these variables upon relapse-free survival in T2 disease as well as the effect of cord mobility, and number of involved sites was examined by multivariate analysis. Total dose (p < 0.03), cord mobility (p < 0.05), and number of involved sites (p < 0.04) significantly affected relapse-free survival in T2 disease. CONCLUSION: At least 50 Gy is required for treatment of T1 disease when 2 Gy is used as a daily dose, even if endoscopic microsurgery is performed. Better local control of T2 disease in patients with impaired cord mobility or more than three involved sites leads to an improved prognosis; we recommend doses of at least 70 Gy or use of hyperfractionation in such patients with these factors. Although the daily dose did not significantly affect prognosis in multivariate analyses, 1.8 Gy is not recommended for treatment of T2 tumors instead of 2 Gy.

Adult↗

PubMed1994

Thermoradiotherapy in the treatment of locally advanced nonsmall cell lung cancer.

PURPOSE: To improve the treatment results of locally advanced non-small cell lung cancer (NSCLC), we have been conducting a clinical trial using regional hyperthermia combined with radiotherapy. METHODS AND MATERIALS: Between 1985 and 1990, 19 patients were treated. All cases except one were regarded as initially unresectable. There were 10 Stage IIIA cases and nine Stage IIIB cases. In 10 cases thermoradiotherapy was used definitively, and in the other nine cases preoperatively. Radiotherapy was administered with conventional fractionation. Total dose ranged from 42 to 80 Gy (mean 62.9 Gy) for definitive treatment cases, and 38 to 47 Gy (mean 40.6 Gy) for preoperative cases. Radiofrequency (RF) capacitive hyperthermia was administered twice weekly, immediately after radiotherapy. Total sessions of hyperthermia ranged from 5 to 16 times (mean 9.0) for definitive treatment cases and 3 to 8 times (mean 6.7) for preoperative cases. RESULTS: The results of thermoradiotherapy group (HTRT group) were compared with our historical control group (RT group); initially unresectable Stage III NSCLC irradiated definitively with 50 Gy or more (26 cases), or became resectable after radiotherapy and operated (4 cases). As for initial response, there were 5 complete responses (CRs), 13 partial responses (PRs), and 1 no change (NC) (CR rate 26%, response rate 95%) in the HTRT group, whereas there were no CR, 21 PRs, and 9 NCs in the RT group (CR rate 0%, p < 0.005, response rate 70%, p < 0.05). Overall 3-year local relapse-free survival and survival rate for the HTRT group was 73% and 37%, respectively, and 20% and 6.7%, respectively, for the RT group (p < 0.01, p < 0.01). The rate of death from uncontrolled primary disease for the HTRT group was significantly lower than for the RT group (21% vs. 53%, p < 0.03). CONCLUSION: Although the number of cases is rather small, thermoradiotherapy in the treatment of locally advanced NSCLC is promising in raising resectability, local control, and, thus, long-term survival.

Adolescent↗

PubMed1994

Real-time beam monitoring in dynamic conformation therapy.

PURPOSE: Although portal imaging is a promising method of verification during static multiport irradiation, it cannot be applied directly to dynamic irradiation such as rotational conformation with multileaf collimator movement. A real-time beam monitoring system based on megavoltage computed tomography scanning has been developed to establish a verification method for the rotational conformation technique. METHODS AND MATERIALS: Exit beam through the patient is extracted by the same detector unit as used for megavoltage scanning during the actual treatment. Beam edge is defined as the 50% level of the maximum dose of the detector array. Megavoltage computed tomography is done after patient setup and just prior to the actual irradiation. Detected beam pathways are overlaid on this image approximately every 1 s. Therapists can monitor correlation between the target and actual beam pathways on a real-time computer display. RESULTS: The accuracy of field edge detection has been proven to be less than 2 mm from various measurements. Real-time monitoring is more useful in rotational conformation than in static multiport irradiation due to dynamic movement of the collimator. Field errors were identified in two of 54 sessions using this method. CONCLUSIONS: Although several limitations remain to be solved, the method presented is a useful tool for treatment verification of high accuracy radiation therapy, particularly rotational conformation irradiation.

Brain Neoplasms↗

PubMed1994

In vitro effects of OK-432 on irradiated mouse bone marrow cells.

PURPOSE: In vitro effects of OK-432 on irradiated mouse bone marrow cells are examined. METHODS AND MATERIALS: Bone marrow cells of BDF1 mouse (1 x 10(6) cells/ml) were incubated with alpha medium, 2% fetal calf serum and OK-432 in a CO2 incubator at 37 degrees C for 24, 48 and 72 h, respectively. After centrifugation, each supernatant was collected and used for conditioned medium in CFU-GM assay: Changes in CFU-GM as a function of incubation time and OK-432 dose was examined; changes of CFU-GM according to various doses of OK-432 were examined in two mouse strains, BDF1 and BALB/c mouse; changes in protective effect of OK-432 in terms of CFU-GM as a function of administration timing of OK-432 in relation to irradiation. As a radiation source, 137Cs at a dose rate of 500 cGy/min was used. RESULTS: The CFU-GM decreased with the incubation time when OK-432 was not administered, while it significantly increased with incubation time when OK-432 was added at 0.5 and 1.0 KE/ml at 48-72 h of incubation. The former showed marked increase at 48-72 h of incubation. CFU-GM of BDF1 mouse was always higher than that of BALB/c mouse for any dose of OK-432. CFU-GM per femur according to the timing of administration of OK-432 from 24 h before to 24 h after irradiation showed 10299 +/- 2300 (24 h before), 10783 +/- 2463 (3 h before), 10045 +/- 1501 (immediately after), 8504 +/- 1188 (3 h after), 4898 +/- 1212 (6 h after), 1214 +/- 736 (12 h after) and 181 +/- 113 (24 h after irradiation), respectively. CONCLUSION: OK-432 stimulates cultured mouse bone marrow cells to produce GM-CSF in vitro by direct contact action. This direct stimulating action of OK-432 on GM-CSF production of bone marrow cells can be kept from 24 h before to at least 3 h after irradiation.

Animals↗

PubMed1994

Radiation therapy for patients of malignant salivary gland tumors with positive surgical margins.

PURPOSE: Surgery is an essential part of treatment for tumors of the salivary gland, yet there is increasing evidence in the literature supporting the necessity of adjuvant radiation therapy. The patients described in this report were selected to receive postoperative radiation therapy because they were found to have positive margins. We have reviewed their records to identify factors influencing the control of local disease, the development of distant metastases and overall survival, and to define the role of postoperative radiation therapy in patients with positive surgical margins. PATIENTS AND METHODS: A total of 17 patients with malignant tumors originating from the major salivary glands seen between 1970 and 1988 who were treated with surgery and postoperative radiation therapy were reviewed. All patients had positive surgical margins. RESULTS: Overall local control at five years was 65%. Classified by T-stage, local control was obtained in all two patients for T1 disease, in five of six for T2, in four of six for T3, and in none of three for T4. At five years, the ratio of patients free of distant metastases was two of two for T1 lesion, four of six for T2, three of six for T3, and none of three for T4. Five-year survival was obtained in all eight patients with T1 and T2 lesions, four of six for T3, and one of three for T4. Patients with neck nodal metastases present in the neck at admission did worse than those with negative nodes, with 0% (none of three patients) free of locoregional recurrence vs. 71% (eleven of 14), 0% (none of three) free of distant metastases vs. 63% (nine of 14), and 0% (none of three) survival at five years vs. 93% (13 of 14). CONCLUSIONS: Postoperative radiation therapy for patients with positive surgical margins was effective for T1 and T2 disease. However, patients with T3 and T4 disease require more aggressive therapy. Patients with nodal metastases in the neck at admission tended to have distant metastases and had poor prognoses. Further therapeutic measures using adjuvant chemotherapy might be explored for these patients. Patients with adenoid cystic carcinoma with positive surgical margins tended to have perineural invasion and distant metastases. However, the utility of chemotherapy for patients of adenoid cystic carcinoma with distant metastases remains uncertain, because effective drugs for adenoid cystic carcinoma do not exist and patients live for several years without chemotherapy.

Adolescent↗

PubMed1994

Wide variation of probability of local failure and distant metastasis among various stages of patients with nasopharyngeal carcinoma.

PURPOSE: Although radiation therapy is the mainstay of therapy in nasopharyngeal carcinoma (NPC), the optimal dosage schemes for treating the primary tumor or cervical lymph node metastases have not been generally agreed upon. NPC is thought to be a tumor well suited to treatment with adjuvant chemotherapy because distant metastases are more common than with other head and neck sites. However, there are several reports that fail to demonstrate improved survival in chemotherapy treated patients. Careful selection of patients for chemotherapy may be required in order to show a benefit. PATIENTS AND METHODS: A total of 61 patients with nasopharyngeal carcinoma seen between January, 1972 and December, 1985 who were treated with radiation therapy alone were reviewed. We analyzed the factors influencing distant metastasis and primary control. RESULTS: The five-year survival rate for observed and relapse-free survival were 44% and 31%, respectively. The survival rates for N3 in TNM classification and for N3 in Ho's classification were significantly worse and distant metastasis rates were significantly higher as compared with N0, N1, N2. 16 of 25 patients who had distant metastases developed them following locoregional failure. No patient with N0, N1, N2a, N2b developed distant metastases without a locoregional recurrence. There were several recurrent cases in which radiation was terminated when tumor disappeared at inspection or palpation. The five-year survival rates for T4 was 0%. CONCLUSION: The patients with N3 in TNM. Ho's classification or locoregional failure may be candidates for chemotherapy, because they have a high probability of distant metastasis. CT should be used in T staging routinely to exclude tumor involvement of the base of the skull. 70 Gy may be appropriate for T3 disease, even if tumor disappeared at lower doses. More than 70 Gy may be required to treat T4 tumors. 50 Gy may be appropriate for N0, N1 and N2b and 70 Gy for N2c and N3, even if tumor was not palpable at lower doses.

Carcinoma, Squamous Cell↗

PubMed1994

Radiosensitivity of CD45RO+ memory and CD45RO- naive T cells in culture.

Radiosensitivities of various human T-cell subsets were investigated by a proliferation assay and by a single-cell gel electrophoresis assay. Each T-cell subset was purified using a cell sorter and was induced to proliferate by ionomycin and interleukin 2. Unsorted T cells showed biphasic dose-survival curves, indicating the heterogeneity of T cells in terms of radiosensitivity. Purified CD4+ helper and CD8+ killer T cells showed similar biphasic dose-survival curves. Hence both T-cell subsets were composed of cells of different radiosensitivity. The T-cell subsets belonging to different activation stages such as CD45RO+ memory and CD45RO- naive T cells had different dose-survival curves. The former was more radiosensitive than the latter. The high radiosensitivity of CD45RO+ cells was also demonstrated by single-cell gel electrophoresis after irradiation. This is the first demonstration that a particular cell surface marker on T cells is correlated with greater radiosensitivity.

Antigens, CD↗

PubMed1993

Effect of human recombinant granulocyte colony-stimulating factor on induction of myeloid leukemias by X-irradiation in mice.

Hematopoietic suppression is one of the serious problems induced by whole body irradiation. Granulocyte colony-stimulating factor (G-CSF) stimulates the progenitors of granulocytes and accelerates their recovery from bone marrow suppression induced by cytotoxic chemotherapy or radiation. On the other hand, G-CSF stimulates proliferation of myeloid leukemia cells as well as normal granulocytes in vitro. We designed a method to determine if G-CSF affects the incidence of myeloid leukemias induced by irradiation and the types of leukemias induced according to the French-American-British (FAB) classification in RFM/MsNrs mice. Administration of G-CSF (2 micrograms/d for 7 days) after a single 3-Gy irradiation significantly increased the number of peripheral blood neutrophils as compared with those in control mice. Even after discontinuation of G-CSF, both the total leukocyte and neutrophil counts increased to day 10, and their levels remained elevated until day 14. The incidence of myeloid leukemia in mice exposed to a single 3-Gy irradiation was 18.6% (38 of 204), and treatment with G-CSF did not increase the incidence (15.7% [32 of 204]). In the mice with radiation-induced leukemia, those receiving G-CSF had a mean survival time of 357 days, whereas those not receiving the factor survived for 349 days. There was no significant difference of survivals between the two groups. Most of the radiation-induced leukemias in the two groups were M1 or M2, according to the FAB classification; no characteristic difference was observed among the types of leukemias. Although G-CSF stimulated the leukemia cells in vitro, G-CSF administration after irradiation did not increase the occurrence of radiation-induced myeloid leukemias. Our results show that administration of G-CSF effectively accelerates neutrophil recovery from irradiation-induced hematopoietic injury and does not enhance the induction of myeloid leukemia in RFM/MsNrs mice by irradiation.

Animals↗

PubMed1993

Radiation therapy of well-differentiated neuroblastoma and central neurocytoma.

BACKGROUND: Central neurocytoma is a rare intraventricular tumor with prominent neuronal differentiation. Although reported cases of this disease are increasing, the clinical benefit of radiation therapy remains unclear. METHODS: From 1979 to 1990, two patients with central neurocytoma and five with well-differentiated neuroblastomas received radiation therapy. Five were men and two were women; the age at onset ranged from 20 to 37 years (mean age, 25.6 years). The follow-up period ranged from 14 to 134 months (median, 68 months). The initial histologic diagnosis was oligodendroglioma in five, ependymoma in one, and suspected central neurocytoma in one. Electron microscopic examination showed numerous neuronal processes containing microtubules and membrane-bound neurosecretory granules. Well-formed synaptic junctions were observed in the two cases of central neurocytoma. All patients underwent partial or subtotal tumor resection before radiation therapy (partial resection in three and subtotal resection in four). Three patients received radiation therapy locally, up to 50-60 Gy. Four cases were treated with a combination of whole brain irradiation (32-40 Gy) and local irradiation (20-32 Gy). RESULTS: Treatment results were quite favorable, and all patients are alive and well without evidence of recurrence. Computed tomography studies showed that bulky residual tumors disappeared from several months to 1 year after the completion of radiation therapy. In a patient who had surgery again, significant vacuolar degeneration was observed by light microscopic examination. CONCLUSIONS: A high level of radiosensitivity was confirmed, but additional data are required to clarify the clinical benefit of radiation therapy.

Adult↗

PubMed1993

Analysis of the results of combined therapy for maxillary carcinoma.

BACKGROUND: Maxillary sinus carcinomas usually are locally advanced. A wide variety of modalities, including surgery, radiation therapy, and intraarterial chemotherapy, alone or in combination, have been used. However, there is still much controversy with regard to the optimum treatment. METHODS: From 1972 to 1986, 108 patients with squamous cell carcinoma of the maxillary sinus were treated at the Department of Radiology, University of Tokyo Hospital. From 1972 to 1974 (the first period), the treatment consisted of operation for reduction of tumor volume, daily cleaning of the maxillary antrum, 20 Gy of postoperative radiation therapy, and intraarterial infusion of 1500 mg of 5-fluorouracil (5-FU) and 3000 mg of 5-bromodeoxyuridine (BUdR). From 1975 to 1979 (the second period), the radiation dose was reduced to 10 Gy, and intraarterial infusion of 5-FU and BUdR was not performed. Surgery for reduction of tumor volume and daily cleaning of the antrum played a major role in this period. From 1980 to 1982 (the third period), daily cleaning of the antrum was not performed. Instead, the dose of radiation was increased to 50-60 Gy. From 1983 to 1986 (the fourth period), more extensive surgery to resect the tumor en bloc was introduced. The radiation dose was increased to 70 Gy. Intraarterial infusion of 3750 mg of 5-FU and 120 mg of cisplatin also was administered. RESULTS: The 5-year survival rate was 46% in the first period, 24% in the second period, 7.2% in the third period, and 53% in the fourth period. In the third period, there were more cases in which death resulted from a cause other than local failure, such as distant metastasis, pneumonia, or secondary primary cancer. Since 1984, we planned treatment with computed tomography (CT) and used the linear accelerator with a multileaf collimator to treat patients with an irregular field of irradiation. These have made it possible to administer radiation therapy in doses as high as 70 Gy without severe complications and improve the survival rate, especially for T4 disease. CONCLUSIONS: Radiation plays an important role in sterilizing malignant cells that cannot be removed by operation. The dose of radiation should be determined according to the volume of residual tumor. Careful treatment planning is required to irradiate the tumor adequately and reduce complications.

Antineoplastic Combined Chemotherapy Protocols↗