Biomedical subjects
Publications and source records attributed to M Chatani.
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From August 1978 through December 1982, a total of 200 patients with previously untreated carcinoma of the uterine cervix were treated using remote afterloading high-dose rate intracavitary therapy (RALS) at our department. According to the staging of UICC (1978), 8 patients were classified into Stage Ia, 22 Ib, 22 IIa, 53 IIb, 85 III, and 10 IV. Actuarial 5-year survival rates by Stage were 100% in Stage Ia, 86% Ib, 67% IIa, 72% IIb, 41% III, and 20% IV (p = 0.0001). Significant prognostic factors in Stage II were the value of hemoglobin (p = 0.0115) and age (p = 0.0431) by logrank test. Corresponding factors in Stage III were the value of hemoglobin (p = 0.0005) and total protein (p = 0.0036). Late complications after RALS developed in 22 patients (11%), that is, rectum 14 (7%), bladder 6 (3%), small intestine 4 (2%) and sigmoid colon 1 (1%). Severe complications requiring surgery were noted in 7 patients (4%). There was no fatal case attributable to complication. It is concluded that RALS is one of the most effective and safe means for the treatment of carcinoma of the uterine cervix based on our results.
Serological follow-up studies for up to 4 years on the levels of IgG antibody to EBV-determined nuclear antigen (EBNA) were carried out on 36 patients with nasopharyngeal carcinoma (NPC). The serum levels of IgA antibody specific to EBV capsid antigen (VCA) were also measured in some of the patients. The titers of EBNA antibody were measured by enzyme-linked immunosorbent assay (ELISA) and those of IgA antibody to VCA were measured by the indirect immunofluorescence method. The EBNA antibody titers in most sera from the patients before radiation therapy were found to be at least 4 times the mean values in the sera of healthy control adults. Within 2 to 8 months after completion of therapy by 4-MV liniac X-ray irradiation with total doses of 60 to 80 Gy, the titers of EBNA antibody in the sera of 6 patients had returned to normal levels, and low levels of EBNA antibody were maintained for a long time after therapy. These serological data were associated with a good clinical prognosis without recurrence or metastases. But in 6 patients, the patterns of change in the EBNA antibody levels were different: the levels remained high after therapy or first decreased to the normal level and then rose to at least 4 times this level. These 6 patients showed recurrence or metastases. The patterns of change in the EBNA antibody levels were well correlated with those of change in the levels of IgA antibody specific to VCA.(ABSTRACT TRUNCATED AT 250 WORDS)
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From January, 1978 to December, 1984 fifty four cases of cancer of the mesopharynx were registered at our clinic. There were 47 males and 7 females. Age distribution was from 18 to 80 years old with a mean age of 59. Site distributions were 32 in the lateral wall, 11 in the superior wall, 3 in the anterior wall and 2 in the posterior wall. The Brinkman index for smoking habits and to alcohol index for drinking habits were 488.3 and 20.8 respectively, which were significantly higher than for the control group (p less than 0.05). Pathohistological diagnosis was squamous cell carcinoma in 46 cases, adenocarcinoma in 3 cases, anaplastic carcinoma in 3 cases, and 4 others. Secondary malignancies were highly developed in 15 cases (27.8%), including cancer of the larynx (5), esophagus (3), stomach (2) and others (5). Stage classification was stage I in 3 cases, stage II in 13 cases, stage III in 16 cases and stage IV in 22 cases. Of 47 cases, 39 cases were treated by radiation, 5 cases by operation and 2 cases by pre-radiation chemotherapy. The local control and absolute survival rates for T1-T2, N0-N1 lesions were quite good. Advanced local and nodal disease proved difficult to control with radiation alone. Three and five-year survival rates were both 37.0%. It is suggested that heavy drinking is one of the probable etiologic factors in cancer of the mesopharynx. Intensive follow-up is necessary to detect second primary cancers. For better results, multi-disciplinary treatment should be explored.
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From September 1977 to June 1985, 63 patients received radical radiotherapy for squamous cell carcinoma of the thoracic esophagus at the Center for Adult Diseases, Osaka. Fourty-six of them received radiation therapy alone (RT) and 17 received surgical treatment after irradiation (RT-OP) due to local recurrence or residual tumor. In these groups, 38 of 46 in RT only group and twelve of 17 in RT-OP group were selected for radiotherapy because of high risk for surgery or T3 lesion. For RT only group, tumor response after irradiation was the most important prognostic factor and a statistically significant difference of survival rates was detected between complete response (CR) group and non-CR group. Among RT-OP group, there were three five-year survivors in CR group (n = 8) after irradiation while no five-year survivor in non-CR group (n = 9). Tumor response after radical radiation therapy seems to show the indication for the salvage surgery in high risk or T3 patient.
A method of computerized optimization system of radiotherapy treatment planning is presented. For the optimization of treatment planning, it is highly desirable to evaluate treatment planning quantitatively corresponding to a set of three-dimensional criteria. For this purpose, we introduce a set of criteria using some parameters defined as three-dimensional extension of those of ICRU report 29. The development of computer software has become feasible for clinical use of our criteria. This paper described some preliminary results of our criteria which was applied to some clinical cases. Our method was proved applicable to any type of treatment plannings, and the optimization of treatment plannings will surely be realized through our criteria.
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One hundred five patients with nasopharyngeal carcinoma were treated with radiation therapy combined with or without chemotherapy at 16 of the participating institutes in Kansai Cancer Therapist Group, Japan, from January 1978 to December 1980. The study comprised 77 males and 28 females; their ages ranged from 15 to 80 years (mean, 53 years). Five-year survival rates according to stage were as follows: Stage I, 100%; Stage II, 67%; Stage III, 44%; and Stage IV, 34%. As far as Stage IV disease was concerned, the radiation therapy only group showed significantly poorer prognosis than the combined radiation and chemotherapy group (P less than 0.05). Concerning the N stage and treatment method, the radiation therapy only group showed a higher metastatic rate than the chemotherapy combined group (35% versus 14%, P less than 0.05).
One hundred forty previously untreated cases of T1N0M0 glottic carcinoma underwent therapy at our department from November 1977 through May 1984. Ninety-six of them were treated with the open-field technique of 4 MVX-ray using parallel opposed fields in bandage up to April 1982 (group I). The remaining 44 cases were treated with the wedge-filtered technique in a plastic shell in order to improve the dose distribution and immobilization during radiotherapy starting in May 1982 (group II). The two-year disease-free survival rates were 85% and 91%, respectively. Thus, better results were achieved by improved treatment techniques.
Between September 1980 to December 1983, 70 consecutive patients were entered into two randomly allocated trials in order to investigate the effectiveness of different time-dose radiotherapy schemes (i.e., 30 Gy/ten fractions/two weeks versus 50 Gy/20 fractions/four weeks) and the prognostic factors on the palliation for patients with brain metastases from lung carcinoma. The most important factors for predicting poor prognosis in this series, which were shown by stepwise proportional hazard (Cox) model, were lactate dehydrogenase (LDH) and general performance status. In normal LDH group, the most important factors for predicting poor prognosis were multiplicity of brain metastases (p less than 0.001), treatment methods (p less than 0.0005) and age (p less than 0.0053). In high LDH group any items were not shown for meeting of the 0.05 significant level.
Between July 1977 and October 1983, 40 patients with nasopharyngeal carcinoma were treated by radiation therapy. From the investigation of this series, prophylactic treatment for distant metastases was recommended for good prognosis. Between November 1983 and May 1985, 10 patients with nasopharyngeal carcinoma were treated using a combination of cis-diamminedichloroplatinum (CDDP) and radiation therapy. Treatment results showed complete response in all 10 patients. One patient failed in the out field of boost therapy after whole-neck irradiation. This patient has shown no distant metastases. The remaining 9 patients have been controlled well. Major side effects were renal toxicity, and nausea and vomiting, which were mostly transient. However, severe mucositis of the oral cavity was observed in 4 patients (40%) of the CDDP-radiation group in contrast with 3 patients (8%) of the radiation-therapy-only group (p less than 0.01).
A dual stainless steel applicator (CADO-E I type) was developed for intracavitary radiotherapy of endometrial carcinoma using remotely controlled afterloader (RALS). An inverted pear-shaped isodose curve was obtained by means of this metallic applicator and Co-60 source with a stepwise movement. Reference point X was defined as 2 cm below the fundus and 2 cm lateral to the center line of the uterus to specify the dose absorbed to the uterine corpus with our endometrial applicator. Since cancer residua resulting from cold spots in dose distribution were recognized at the uterine fundus by histopathological investigation of serial sections in the hysterectomy specimens, we intend to develop an applicator with three metallic tubes (CADO-E II type).
From September 1977 through January 1983, 34 previously untreated cases with primary non-Hodgkin's lymphoma of the head and neck in stage I-II were treated at our department. 16 cases were classified into stage I and 18 into stage II. Patients were treated with 4 MV X-ray (40 to 45 Gy) which encompassed Waldyer's ring and supraclavicular region with or without chemotherapy. The survival rates at three years were 93% and 50% in stage I and II, respectively. Stage, surface markers (T- and B-cell analysis) and initial primary site and the level of lymph node involvement were important prognostic factors. Chemotherapy in pre- or post-irradiation was essential, especially for cases in stage II. It was also indicated that the adequacy of radiation portal with special reference to anatomical consideration was necessary.
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