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Kinji Nishiyama

Publications and source records attributed to Kinji Nishiyama.

17 recordsLinked to original sources
PubMed2006

Factors affecting the prognosis of patients with esophageal cancer undergoing salvage surgery after definitive chemoradiotherapy.

BACKGROUND AND OBJECTIVES: Although salvage surgery after definitive chemoradiotherapy (CRT) is common, the safety and indication has not yet been established. METHODS: We retrospectively compared the mortality and morbidity of 24 patients who underwent salvage surgery with those of historical controls treated with neoadjuvant CRT followed by planned esophagectomy during the same period, and analyzed the prognostic factor of salvage surgery. RESULTS: Preoperative serum albumin (3.7 vs. 4.1 g/dl, P = 0.0157) and lymphocyte count (763 vs. 964/mm(3), P = 0.0111) in the salvage group were significantly lower than those in the neoadjuvant group. A significant difference was also observed in operation time (567 vs. 474 min, P = 0.0381), C-reactive protein (CRP) on postoperative day 1 (11.2 vs. 8.7 mg/dl, P = 0.0021), and postoperative systemic inflammatory response syndrome (SIRS) duration (3.5 vs. 2.9 days, P = 0.0486). There were three hospital deaths in the salvage group, whereas no patient died in the neoadjuvant group. Multivariate analysis showed curability (R0 vs. R1 + R2) to be the strongest prognostic factor of salvage surgery (P = 0.0064). R1 + R2 operation was more frequently performed in the salvage group (33% vs. 13%), and the reason for all cases was unresectable T4, which had been underestimated preoperatively. CONCLUSIONS: Salvage surgery is a highly invasive and morbid operation, which is performed on immunocompromised hosts. The indication must be carefully considered, with care taken to avoid non-curative surgery.

Aged↗
PubMed2006

High-dose-rate brachytherapy for small-sized peripherally located lung cancer.

BACKGROUND: The demand for minimally invasive therapies is increasing in the treatment of small peripheral non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Twelve patients with T1-2 N0 M0 peripheral NSCLC were treated by high-dose-rate brachytherapy with (192)Ir radioactive source. RESULTS: A (192)Ir source was introduced into the tumors percutaneously in five patients (percutaneous brachytherapy) or transbronchially in seven patients (transbronchial brachytherapy). Whereas irradiation was performed with a single fraction of 20 Gy in percutaneous brachytherapy, it was hypofractionated from 5 x 5 Gy to 2 x 12.5 Gy in transbronchial brachytherapy. Complications were generally mild in all patients, although focal radiation pneumonitis was observed in most patients. Primary recurrence occurred in three patients, including one with a T2 tumor and one treated by brachytherapy as a salvage treatment for recurrence after conformal radiotherapy. When brachytherapy is evaluated as a primary treatment for T1 N0 M0 NSCLC, local control rate is 88.9% and estimated 5-year survival rate is between 60% and 70%. CONCLUSION: Brachytherapy has a potential to be a method to treat peripheral T1 N0 M0 NSCLC.

Aged↗
PubMed2006

Function-preserving surgery for breast cancer.

Breast-conserving treatment is well established as a safe method of treatment for the majority of breast cancers. Issues to be addressed concerning breast-conserving treatment include the omission of radiation therapy in low-risk patients, optimal local and systemic treatment for ipsilateral breast tumor recurrence, classification of ipsilateral breast tumor recurrence into true recurrences and new primary cancers, and the selection of patients who are eligible for breast conservation after neoadjuvant chemotherapy. There is much evidence that sentinel node biopsy is an accurate method of screening for axillary nodal status in patients with early breast cancer. Clearly, the avoidance of axillary dissection improves quality of life. The feasibility, accuracy, and timing of sentinel node biopsy in patients undergoing neoadjuvant chemotherapy are not yet clear. Also, the clinical significance of micrometastasis should be evaluated to determine the optimal application of sentinel node biopsy. There is interest in replacing breast-conserving treatment by nonsurgical ablation, although additional findings are needed to show that this technique is a true advance in breast cancer treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

A pilot study of wider use of accelerated partial breast irradiation: intraoperative margin-directed re-excision combined with sole high-dose-rate interstitial brachytherapy.

BACKGROUND: Accelerated partial breast irradiation (APBI) is generally limited to patients at extremely low risk of local recurrence. The significance of the risk factors, however, depends on the extent of surgery, radiation, and systemic therapy. In Japan, wide excision is generally supplemented by intraoperative margin-directed re-excision if the frozen section examination yields positive results. This approach combined with conventional radiotherapy achieved an excellent 10-year local control rate of 93%, and young age and ductal carcinoma in situ were not risk factors for local recurrence. To reduce the treatment duration, high-dose-rate interstitial brachytherapy (HDRIB) was employed. The first APBI phase I / II trial in Japan was conducted to determine if wider indications for early breast cancer patients were appropriate. METHODS: The subjects comprised 20 patients including those with extensive intraductal component (n=7), ductal carcinoma in situ (n=2), positive final margins (n=3), and of younger age (< or = 45 years; n=5). Breast-conserving surgery using an intraoperative re-excision approach was followed by intraoperative implantation of applicators. Sole HDRIB of a 36-42 Gy in 6-7 fractions was delivered postoperatively over 3-4 days. Tumors were staged as follows: cT1 (n=12), cT2 (n=8), cN0 (n=20). Systemic therapy was used in 16 patients (80%). The median follow-up period was 52 months (range, 26-86 months). RESULTS: Te five-year crude local, distant control, and Kaplan-Meier cause-specific survival rates were 95%, 95%, and 89%, respectively. Fat necrosis developed in 1 patient. CONCLUSIONS: Sole HDRIB with intraoperative margin-directed re-excision was feasible under wider indications compared to other contemporary APBI series, and achieved acceptable and similar results to these series in terms of the local control rate and complications.

Adult↗
PubMed2006

[Pre- and post-operative chemoradiation therapies for pancreatic cancers].

Due to a high incidence of local recurrence, the long-term outcome after resection of locally advanced pancreatic cancer is still pessimistic. Many previous reports showed that locoregional control was partly improved by intraoperative radiation or postoperative chemoradiation, while others suggested its insufficient effects for patients with R1- or R2-resections. Therefore some recent authors have recommended preoperative chemoradiation for more promising results in advanced pancreatic cancer. Since patient survival is influenced not only by local control but also by distant (the liver is the most common) metastases, we should develop other strategies that can prevent liver metastases, in addition to the combination of chemoradiation with sur-

Carcinoma, Ductal↗
PubMed2005

Radiotherapy for early glottic carcinoma (T1N0M0): results of prospective randomized study of radiation fraction size and overall treatment time.

PURPOSE: To investigate in a prospective randomized study the effect of radiation fraction size and overall treatment time on the local control of early glottic carcinoma. METHODS AND MATERIALS: Between December 1993 and December 2001, 180 patients with early glottic carcinoma (T1N0M0) were treated at our department. The patients were randomly allocated to either treatment arm A (radiation fraction size 2 Gy, n = 89) or B (2.25 Gy, n = 91). The total radiation dose administered was 60 Gy in 30 fraction within 6 weeks for minimal tumors (two-thirds of the vocal cord or less) or 66 Gy in 33 fractions in 6.6 weeks for larger than minimal tumors (more than two-thirds of the vocal cord) in Arm A and 56.25 Gy in 25 fractions within 5 weeks for minimal tumor or 63 Gy in 28 fractions within 5.6 weeks for larger than minimal tumors in Arm B. RESULTS: The 5-year local control rate was 77% for Arm A and 92% for Arm B (p = 0.004). The corresponding 5-year cause-specific survival rates were 97% and 100% (no significant difference). No significant differences were found between these two arms in terms of rates of acute mucosal reaction, skin reactions, or chronic adverse reactions. CONCLUSION: Use of 2.25-Gy fractions with a shorter overall treatment time for Arm B showed superior local control compared with conventional use of 2-Gy fractions for Arm A without adverse reactions from the greater fraction.

Aged↗
PubMed2005

Feasibility and efficacy of combination therapy with preoperative and postoperative chemoradiation, extended pancreatectomy, and postoperative liver perfusion chemotherapy for locally advanced cancers of the pancreatic head.

BACKGROUND: The outcome after resection of advanced pancreatic cancers is extremely poor because of the high incidence of the postoperative development of liver metastasis and local recurrence. We performed a combination of chemoradiation and liver perfusion chemotherapy and extended pancreatectomy. METHODS: Nineteen patients with T3 pancreatic head cancers were enrolled. A total of 24 Gy in 12 fractions of 10-MV x-rays with a concurrent intravenous infusion of 5-fluorouracil (5-FU; 3 g/12 days) was administered to the pancreatic head area. An extended pancreaticoduodenectomy was performed, and catheters were placed into the gastroduodenal artery and the superior mesenteric vein. During the first 28 postoperative days, 5-FU was continuously infused via the hepatic artery and portal vein (3.5 g/28 days x 2). Finally, 36 Gy in 18 fractions with 5-FU (3 g/6 days) was applied to the pancreatic bed. RESULTS: After preoperative chemoradiation, four patients did not undergo surgical resection because of distant metastases. Fifteen patients underwent pancreaticoduodenectomy, liver perfusion chemotherapy, and postoperative chemoradiation. No patient developed grade 3 toxicity as a result of preoperative chemoradiation, but one patient (7%) developed grade 3 leukopenia during the postoperative treatments. The morbidity rate was 20% (3 of 15 patients), and the mortality rate was 0%. The overall 3-year survival rate was 53%. The 3-year disease-free survival rate was 66% in patients who pathologically responded well (>50%), versus 0% in patients with poor responses (P = .04). CONCLUSIONS: A combination of preoperative and postoperative chemoradiation plus postoperative liver perfusion chemotherapy with an extended pancreatectomy is feasible, and the long-term outcomes are also promising.

Adult↗
PubMed2005

In vivo dosimetry of high-dose-rate brachytherapy: study on 61 head-and-neck cancer patients using radiophotoluminescence glass dosimeter.

PURPOSE: The largest in vivo dosimetry study for interstitial brachytherapy yet examined was performed using new radiophotoluminescence glass dosimeters (RPLGDs). Based on the results, a dose prescription technique achieving high reproducibility and eliminating large hyperdose sleeves was studied. METHODS AND MATERIALS: For 61 head-and-neck cancer patients who underwent high-dose-rate interstitial brachytherapy, new RPLGDs were used for an in vivo study. The Paris System was used for implant. An arbitrary isodose surface was selected for dose prescription. Locations of 83 dosimeters were categorized as on target (n = 52) or on nontarget organ (n = 31) and were also scaled according to % basal dose isodose surface (% BDIS). Compatibility (measured dose/calculated dose) was analyzed according to location. The hyperdose sleeve was assessed in terms of prescription surface expressed in % BDIS. RESULTS: The spread of compatibilities was larger for on nontarget organ (1.06 +/- 0.32) than for on target (0.87 +/- 0.17, p = 0.01). Within on target RPLGDs, compatibility on <95% BDIS (0.95 +/- 0.10) was better than on > or =95% BDIS (0.84 +/- 0.18, p = 0.02). The number of patients with diameter of hyperdose sleeve > or =10 mm was increased with a dose prescription to <77% BDIS (p = 0.046). For nontarget organs, the maximal positive deviation was 84% of the calculated dose. CONCLUSIONS: Dose prescription is recommended to >77% and <95% BDIS for reproducibility and elimination of excessive hyperdose sleeve. For organs at risk, radioprotection should be considered even when calculated dose seems sufficiently low. Further development of planning software is necessary to prevent overestimation.

Adult↗
PubMed2005

Bone metastasis of intracranial meningeal hemangiopericytoma.

The authors investigated the clinical and radiological features and the treatment strategy for bone metastasis from a rare tumor, intracranial meningeal hemangiopericytoma. The clinical presentations and characteristic imagings were retrospectively reviewed in 15 bony metastatic lesions of four patients with this tumor. All four cases were initially diagnosed as atypical meningioma, and all of the bone metastases developed more than 10 years after the initial intracranial surgery. The common symptom induced by the metastatic lesions was pain. On plain roentgen films and computed tomography (CT), the involved bones showed thinning and expansion. On bone scintigraphy, a "cold-in-hot" appearance was typically observed. The clinical and radiological findings were diagnosed as bone metastasis from intracranial meningeal hemangiopericytoma. The prognosis after bone metastasis was relatively short compared to the long duration before bone metastases, because of the coexistence of other, visceral, metastasis. Combined with effective radiation therapy, surgical intervention for bone metastasis of this tumor should be carefully considered.

Aged↗
PubMed2005

Reduced tumor vessel density and high expression of glucose transporter 1 suggest tumor hypoxia of squamous cell carcinoma of the esophagus surviving after radiotherapy.

BACKGROUND: Squamous cell carcinoma of the esophagus (ESCC) is radiosensitive; however, surgeons frequently encounter ESCC that survives radiotherapy to grow more rapidly and invasively. This alteration of tumor behavior may result from tumor hypoxia induced by radiotherapy. METHODS: Forty-four patients with advanced (T3 and T4) ESCC, who underwent radiotherapy before operation, either with 40 Gy for preoperative treatment or 60 Gy or more for radical treatment, and 44 patients without preoperative therapy were subjected to retrospective immunohistochemical study. CD34 for tumor vessels, glucose transporter 1 (GLUT1) which was induced by hypoxia, MIB-1 for proliferating activity, and p53 were stained for surgical samples from ESCC patients. Tumor tissue at the invading front was the focus of evaluation. Macroscopic morphologic differences of ESCC were also evaluated. RESULTS: Loss of esophageal wall thickness and deep ulceration were morphologic characteristics of ESCC after radiotherapy. Tumor vessel density was reduced and GLUT1 expression was greater in the ESCC after radiotherapy than in those without treatment. Tumor vessel density was similar for both preoperative and radical radiotherapy samples, while GLUT1 expression tended to be greater in the latter than in the former. The expression of MIB-1 and p53 did not show any significant difference between ESCC with or without radiotherapy. CONCLUSIONS: Reduced vessel density and increased GLUT1 expression suggested tumor hypoxia for ESCC occurred after radiotherapy. Tumor hypoxia would induce ulcerative and invasive growth, which is a great obstacle to clinical treatment of residual or relapse ESCC after radiotherapy.

Aged↗
PubMed2004

High-dose-rate interstitial brachytherapy for oropharyngeal carcinoma: results of 83 lesions in 82 patients.

PURPOSE: Low-dose-rate interstitial brachytherapy (LDRIB) represents an effective modality for treatment of oropharyngeal carcinoma. The drawback is radioexposure of medical personnel. To eliminate this concern, we initiated high-dose-rate interstitial brachytherapy (HDRIB) in 1993. The present study evaluated the efficacy and complications associated with this approach. METHODS AND MATERIALS: Between 1993 and 2003, HDRIB +/- external radiotherapy was used to treat 83 oropharyngeal squamous cell carcinomas. Median duration of follow-up was 26 months (range, 1-108 months). Of the 82 patients, 76 were previously untreated and 6 displayed previous history of head and neck cancer. T distribution comprised T1 (n = 7), T2 (n = 47), T3 (n = 24), and T4a (n = 5). External radiotherapy of 46 Gy was combined with 21 Gy/3.5 fractions/2 days HDRIB for 68 lesions, and 48 Gy/8 fractions/5 days HDRIB alone was used for 15 lesions. Involved nodes were either boosted by external radiotherapy or resected. RESULTS: Five-year local control, regional control, cause-specific and overall survival rates were 82%, 84%, 88%, and 64%, respectively. Local control rates for early (T1/T2) and advanced (T3/T4) tumors were 89% and 66%, respectively (p = 0.02). Transient soft tissue necrosis was experienced in 29% of patients. No bone sequelae were observed in previously untreated patients. CONCLUSIONS: High-dose-rate interstitial brachytherapy could achieve excellent local control and acceptable rates of complication, equivalent to reported results for LDRIB series. Given the advantage of radioprotection, HDRIB may replace LDRIB in the treatment of oropharyngeal carcinoma.

Adult↗
PubMed2004

Late effects of post-high-dose-rate brachytherapy for oropharyngeal carcinoma: are they severer than post-low-dose-rate?

BACKGROUND: . Late effects by high-dose-rate (HDR) brachytherapy have been believed severer than low-dose-rate (LDR) provided tumor control was constant. Local control of oropharyngeal carcinoma with HDR at Osaka Medical Center was comparable to LDR series from Centre Alexis Vautrin (82%, 79.5%, respectively). To assess the feasibility of HDR brachytherapy, the late effects were compared. PATIENTS AND METHODS: . The data of 29 HDR and 24 LDR patients (median follow-up of 27 and 29.5 months, respectively; p = 0.89) were collected. The HDR schedule was 21 Gy/3.5 fractions/2 days following 46 Gy/23 fractions external beam, while 25 Gy/3 days following 50 Gy/25 fractions external beam was for LDR. Late changes were evaluated using RTOG/EORTC late morbidity scoring scheme. For subclinical late changes, mucosa chapter of Dische score was modified for brachytherapy. Scores were discussed through photos and were agreed on by authors. Late sequelae were estimated, by reviewing charts, concerning frequency, severity, and duration of mucosal damages (erosion and ulcer). RESULTS: . Late changes were of no difference (p = 0.12 for EORTC/RTOG, and p = 0.45, 0.47, 1.00, 0.12, 0.16, 0.95, 0.27, 0.21 for erythema, ulceration, edema, thinning, pallor, telangiectasia, mobility impairment of tongue/faucial pillars, respectively, of the modified Dische score). Late sequelae showed no differences (p = 0.90, 0.12, 0.40 for frequency, severity, duration, respectively, of mucosal damages). CONCLUSION: . The late effects by HDR were not severer than by LDR. HDR oropharyngeal brachytherapy is as safe as LDR.

Adult↗
PubMed2004

[Concurrent chemoradiotherapy using full-dose gemcitabine for patients with unresectable pancreatic cancer].

To examine the feasibility of radiotherapy with a full dose of gemcitabine (1000 mg/m2 once a week) for unresectable pancreatic carcinoma, we treated 15 patients with 50 Gy/25 fractions/5 weeks concurrent chemoradiotherapy using a limited irradiation field. Eleven patients completed treatment. No lethal side effects were seen during and after these therapies. Two patients quit therapy because of tumor progression; one patient quit radiotherapy owing to general fatigue and nausea; and the other patient stopped gemcitabine administration owing to a grade 4 hematological adverse event. As only two patients stopped this protocol as a result of untoward effects of treatment, limited-field radiotherapy enabled us to treat pancreatic cancer with full-dose gemcitabine.

Adult↗
PubMed2002

Postoperative modified stereotactic radiotherapy using a micro-multileaf collimator in patients with malignant glioma.

To achieve local control of malignant glioma, we designed a postoperative stereotactic radiotherapy using a micro-multileaf collimator (micro-MLC). The purpose of this study was to clarify the feasibility of this treatment. The treatment was performed in six patients who met the following eligibility criteria: (1) supratentorial tumor, (2) residual tumor volume < or = 40 cm3, and (3) Karnofsky performance status > or = 70. The three planning target volumes (PTVs), which consisted of restricted PTV (RPTV), intermediate PTV (IPTV), and extended PTV (EPTV), defined as the residual tumor plus a 1 cm, 2 cm, and 3 cm margins, respectively, and total dose delivery of 60-68 Gy, 52-60 Gy, and 44-52 Gy to the isocenters of RPTV, IPTV, and EPTV, respectively, in 4 Gy per fraction at five fractions per week, were established. The beam arrangement and the conformal blockade with a micro-MLC for the optimal treatment plan were designed. The treatment plans showed the high dose conformation to EPTV, the appropriate dose gradients in the three PTVs with the high dose homogeneity to RPTV, and the tolerated dose to critical structures. Following the plans, treatment was performed. The clinical findings more than 12 months after the treatment supported its possible use. We conclude that this treatment is feasible at least in selected patients.

Adult↗
PubMedDate not supplied

Successful preoperative treatment for hepatocellular carcinoma with tumor thrombus in the major portal branch by three-dimensional conformal radiation therapy--two case reports.

The prognosis of hepatocellular carcinoma (HCC) patients with tumor thrombus in the main portal branch (PVTT) is very poor and a standard treatment regimen for HCC with PVTT has not yet been established. Therefore, a new strategy is necessary to control the patients of HCC with PVTT. Conventional radiation therapy for HCC was not effective because of low liver tolerance. On the other hand, because three-dimensional conformal radiation therapy (3D-CRT) can focus high-dose irradiation on a small area, we tried it for patients with PVTT as the preoperative adjuvant treatment. 3D-CRT which targeted the PVTT was performed for two HCC patients with PVTT before radical hepatectomy. Treatment schedules of 3D-CRT were as follows: in Case 1, the daily fraction size was 3 Gy, given five times per week, and the total dose was 39 Gy. In Case 2, the daily size was 6 Gy and the total dose was 60 Gy. Three or four weeks after 3D-CRT, the main tumor and PVTT were completely removed. On histological examination, the PVTT showed complete necrosis in Case 1, and 60% necrosis in Case 2. No serious complications occurred, and there have been no recurrences for more than one year after surgery in both cases. 3D-CRT targeting the PVTT may be promising as a preoperative adjuvant therapy for HCC with PVTT.

Aged↗