PubMed Health⌕ Search

Biomedical subjects

Toshinori Soejima

Publications and source records attributed to Toshinori Soejima.

16 recordsLinked to original sources
PubMed2006

Efficacy and feasibility of cisplatin-based concurrent chemoradiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: To investigate the efficacy and feasibility of a cisplatin-based concurrent chemoradiotherapy (CRT) protocol based on Intergroup Study 0099 for nasopharyngeal carcinoma (NPC). METHODS: Sixteen patients with stage II-IVB NPC were treated with a protocol of cisplatin-based concurrent CRT and adjuvant chemotherapy from 1998 to 2002. Three courses of cisplatin (80 mg/m2) were scheduled during 70 Gy of radiotherapy (RT), and two agents of adjuvant chemotherapy (FP regimen: cisplatin 80 mg/m2 and 5-fluorouracil 800 mg/m2/day by 4-day continuous infusion) were challenged. Overall survival (OS) and relapse-free survival (RFS) rates were calculated by the Kaplan-Meier method. RESULTS: Median follow-up duration was 45 months. Both 3-year OS and RFS rates were 81%. Proportions of patients who tolerated each scheduled treatment were 94% for RT, 63% for concurrent chemotherapy and 38% for adjuvant chemotherapy. CONCLUSIONS: Our protocol of the cisplatin-based concurrent CRT followed by adjuvant chemotherapy consisting of FP regimen was effective for Japanese patients with NPC. However, the doses and numbers of cycle of chemotherapy need to be modified because of the low compliance rate. Larger numbers of data accumulation and/or multi-institutional trials may be warranted to confirm the efficacy of this protocol.

Adolescent↗
PubMed2006

White matter changes on magnetic resonance imaging following whole-brain radiotherapy for brain metastases.

PURPOSE: The purpose of this study was to evaluate white matter (WM) abnormalities induced by WBRT. MATERIALS AND METHODS: Twenty-four patients (11 men and 13 women; age range 38-74 years, median 60 years) who survived for more than 1 year after completion of WBRT (radiation dose range 30-40 Gy, median 35 Gy) at our institution between January 2000 and June 2003 were followed up with magnetic resonance (MR) scans for 11-51 months (median 19 months). We evaluated WM changes attributable to WBRT as grade 0-6 and assessed possible contributing factors by statistical analysis. RESULTS: WM changes were found in 20 patients: Eight were assessed as grade 2, three as grade 3, and nine as grade 5. In total, 12 patients developed grade 3 or higher WM changes. Age (<60 vs > or =60 years), sex, radiation dose (< or =35 vs >35 Gy), chemotherapy (with CDDP vs without CDDP), biologically effective dose (< or =120 vs >120 Gy1), and head width (<16.3 vs > or =16.3 cm) were found not to be relevant to the incidence or severity of the WM changes. CONCLUSION: Long-term survivors who have under-gone WBRT may have a higher incidence of WM abnormalities.

Adult↗
PubMed2005

Radiation pneumonitis following concurrent accelerated hyperfractionated radiotherapy and chemotherapy for limited-stage small-cell lung cancer: Dose-volume histogram analysis and comparison with conventional chemoradiation.

PURPOSE: The aim of this study was twofold: to determine whether the dose-volume metrics are valuable in predicting radiation pneumonitis (RP) in small-cell lung cancer (SCLC) patients treated with accelerated hyperfractionated radiotherapy and chemotherapy (AHFRT + CT); and to clarify how AHFRT influences the risk of RP in comparison to conventional once-daily radiotherapy and chemotherapy (QDRT + CT). METHODS AND MATERIALS: Study subjects were 43 patients with SCLC treated with AHFRT + CT. Radiotherapy was delivered at 1.5 Gy/fraction (fr) twice daily to 45 Gy/30 fr/3 weeks. We analyzed the relation between RP incidence and several dosimetric factors. We also compared this series data with our previously published data from lung cancer patients treated with QDRT + CT. RESULTS: Radiation pneumonitis Grades 1, 2, and 3 were observed in 28 patients, 7 patients, and 1 patient, respectively. Univariate analysis revealed that the percentage of lung volume receiving more than 15 Gy, 20 Gy, and 30 Gy (V15, V20, V30) and normal tissue complication probability were of predictive value for the development of RP. The 12-month cumulative incidences of RP greater than Grade 2 were 0%, 7.1%, 25%, and 42.9% in patients with a V20 of < or =20%, 21-25%, 26-30%, and > or =31%, respectively. These incidences were lower than that of our patients treated with QDRT + CT. CONCLUSIONS: Dosimetric factors are valuable in predicting RP in SCLC patients treated with AHFRT + CT. Regarding the incidence of RP, AHFRT appears to have some advantage over QDRT.

Adult↗
PubMed2005

Ocular adnexal mucosa-associated lymphoid tissue lymphoma treated with radiotherapy.

Forty-two patients with stage IE ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma were retrospectively analyzed. Five-year local control and progression-free survival rates were 100 and 77%, respectively. The most common relapsed site was the contralateral orbit. Thirty Gy of local irradiation seemed to be quite effective and safe.

Adult↗
PubMed2005

[Survey of patients' impressions of radiotherapy and their need for additional medical information: Japanese domestic survey of 1,529 patients in 2002].

PURPOSE: We clarified the images, impressions, and information about radiotherapy in standard Japanese patients and, at the same time, investigated their need for information about radiotherapy, in order to identify what we, as radiation oncologists, should do to decrease patient anxiety and create good physician-patient relationships. MATERIALS AND METHODS: We handed out 10 questionnaires to 1529 patients from April 2002 through July 2002 in 22 Japanese institutions that were equipped with radiotherapy machines. Questionnaires contained 10 items asking about patients' background, their impression of radiotherapy, frequency of exposure to information about radiotherapy, need to obtain information about radiotherapy, and ideal additional medical informational resources or their content. RESULTS: About 60% of patients had had the opportunity to obtain information about radiotherapy "sometimes" or "often," but 80% of them were not satisfied with the availability of information and answered that it was inadequate. Ten percent responded that they had no idea about radiotherapy. Thirty percent felt unspecified anxiety concerning radiotherapy, and those who had less chance to be exposed to information about radiotherapy felt more anxiety than the others (33.2% vs. 25.2%, p=0.0008). The need for "explanation and information about adverse effects" was the top priority, followed by "explanation of outcome." Although they generally obtained information from their physician (radiation oncologist), they also wanted additional information via written media (662 patients, 43%). However, patients who were over 60 years old most wanted to obtain additional medical information directly from their own radiation oncologist (37.7%). CONCLUSION: Information about radiotherapy given to patients and the general public is still insufficient in Japan. To fully utilize radiotherapy, which is a very effective treatment option against cancer, and to reduce anxiety about radiotherapy among cancer patients, more information is necessary.

Adult↗
PubMed2004

Successful treatment for squamous cell carcinoma of the female urethra with combined radio- and chemotherapy.

We report on two cases of women with locally advanced squamous cell carcinoma of the urethra. Patient 1 also displayed regional lymph node metastasis. Treatment comprised combined radiotherapy to 60 Gy and chemotherapy with 5-fluorouracil and cisplatin. Complete response was obtained in both patients, including the inguinal lymph nodes of Patient 1. Patient 1 experienced recurrent inguinal lymph node metastasis on the contralateral side at 42 months after initial treatment, and the same treatment was performed followed by surgical excision. Both patients remain alive with no evidence of disease, at 12 months after recurrence in Patient 1, and at 27 months after treatment in Patient 2.

Aged↗
PubMed2004

[Hypothyroidism after radiotherapy to the neck].

PURPOSE: The purpose of this study was to investigate the incidence and possible predictors of hypothyroidism after radiotherapy to the neck, focusing on radiation dose-volume factors. METHODS AND MATERIALS: Thyroid function was measured in 169 patients treated with radiation ports including the thyroid, between 1989 and 2000. Hypothyroidism was determined with an endpoint of elevated serum thyroid stimulating hormone(TSH) levels > 10.0 microU/ml. In 60 patients, radiation dose-volume factors were calculated; e.g., total volume of the thyroid, mean radiation dose to the thyroid, and %-volume of the thyroid which received radiation doses of no less than 10-70 Gy(V10-V70). The evaluated risk factors for hypothyroidism included these dose-volume factors, sex, age, primary disease, combined chemotherapy, and follow-up period. RESULTS: Hypothyroidism was detected in 33 (19.5%) of the 169 patients. None of them had clinical symptoms of hypothyroidism. V10, V20, and V30 seemed to be possible predictors of hypothyroidism and had a significant impact on the peak level of serum TSH. CONCLUSION: Radiation dose-volume factors of the thyroid seemed to correlate with the incidence of hypothyroidism, and V10, V20, and V30 had a significant impact on the peak level of serum TSH.

Adolescent↗
PubMed2004

Combination of genistein with ionizing radiation on androgen-independent prostate cancer cells.

AIM: To study the effect of the combined use of genistein and ionizing radiation (IR) on prostate DU145 cancer cells. METHODS: DU145, an androgen-independent human prostate cancer cell line, was used in the experiment. Clonogenic assay was used to compare the survival of DU145 cells after treatments with genistein alone and in combination with graded IR. Apoptosis was assayed by DNA ladder and TUNEL stain. Cell cycle alterations were observed by flow cytometry and related protein expressions by immunoblotting. RESULTS: Clonogenic assay demonstrated that genistein, even at low to medium concentrations, enhanced the radiosensitivity of DU145 cells. Twenty-four hours after treatment with IR and/or genistein, apoptosis was mainly seen with genistein at high concentrations and was minimally related to IR. At 72 h, apoptosis also occurred in treatment with lower concentration of genistein, especially when combined with IR. While both IR and genistein led to G2/M cell cycle arrest, combination of them further increased the DU145 cells at G2/M phase. This G2/M arrest was largely maintained at 72 h, accompanied by increasing apoptosis and hyperdiploid cell population. Cell-cycle related protein analysis disclosed biphasic changes in cyclin B1 and less dramatically cdc-2, but stably elevated p21 cip1 levels with increasing genistein concentrations. CONCLUSION: Genistein enhanced the radiosensitivity of DU145 prostate cancer cells. The mechanisms might be involved in the increased apoptosis, prolonged cell cycle arrest and impaired damage repair.

Androgens↗
PubMed2003

Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma.

PURPOSE: We conducted a prospective trial of combined transarterial chemoembolization (TACE) and three-dimensional conformal radiotherapy (3D-CRT) for portal vein tumor thrombus (PVTT) in unresectable hepatocellular carcinoma (HCC). The aim of the present study was to investigate the efficacy and toxicity of this trial regime. METHODS AND MATERIALS: Patients with unresectable HCC complicated with tumor thrombus in the first branch of portal vein were selected as eligible for this study. TACE was performed using Lipiodol, epirubicin hydrochloride, and mitomycin, followed by gelatin sponge cubes. The 3D-CRT was performed targeting the clinical target volume (CTV) defined as PVTT only to a total dose of 60 Gy using 10-MV accelerator. RESULTS: A total of 19 patients were enrolled in this study. Survival rates at 1 and 2 years were 40.6% and 10.2%, respectively. The median survival time was 7.0 months. An objective response was observed in 11 of 19 cases (57.9%). Recanalization of the first portal branches was not observed; however, the protrusion of PVTT into the main portal trunk decreased in all cases. Growth of intrahepatic metastasis outside the 3D-CRT field was observed in 12 cases (63%). Deterioration of the Child-Pugh Score was observed in 5 of 6 cases with the percent volume of the total liver receiving a dose exceeding 30 Gy (V(30)) > or =40%, vs. 2 of 13 cases with a V(30) <40% (p < 0.01). CONCLUSION: This combined therapy was feasible. Our results indicate that V(30) was a predictive test for deterioration of liver function. Further investigation of treatment modalities is needed to prevent the growth of intrahepatic metastasis.

Aged↗
PubMed2003

Severe complications in advanced esophageal cancer treated with radiotherapy after intubation of esophageal stents: a questionnaire survey of the Japanese Society for Esophageal Diseases.

PURPOSE: A questionnaire survey was performed to evaluate the complications and prognosis of esophageal cancer treated with esophageal intubation before or during radiotherapy. METHODS AND MATERIALS: Clinical data were accumulated on a total of 47 patients treated at 17 institutions in Japan. Five patients had Stage II, 30 Stage III, and 11 Stage IV, and the stage was unknown in 1 patient. Covered expandable metallic stents were inserted in 30 patients, uncovered expandable metallic stents in 13, plastic or silicon prosthesis in 3, and an unknown type in 1 patient. Esophageal stenting was performed before the start of RT for 23 patients and during the course of RT for 24 patients. The reasons for the stenting were severe stricture in 32 patients (Group 1) and esophageal fistula in 15 patients (Group 2). RESULTS: The most frequent toxicity was formation or worsening of esophageal fistulas in 13 patients (28%), followed by massive hematemesis or GI bleeding in 10 patients (21%). In total, 24 patients (51%), including 10 patients with possible treatment-related deaths (Grade 5), had nonhematologic toxicities of Grade 3-5. The interval from the start of RT to the nonhematologic toxicity ranged from 16 to 312 days (median 78). The incidence of toxicities was higher for Group 1 (59%) than for Group 2 (33%), although the difference was not statistically significant. The median survival time for those with Stage II-III and Stage IV was 5 and 3.5 months, respectively. CONCLUSIONS: Patients with esophageal intubation before or during RT have a high risk of life-threatening complications, especially for those with severe esophageal stricture. Because long survival is expected for a substantial proportion of patients with locally advanced esophageal cancer after chemoradiotherapy, palliative intubation should be delayed until radiotherapy or chemoradiotherapy appears to have failed.

Aged↗
PubMed2003

Three-dimensional treatment planning using electrocardiographically gated multi-detector row CT.

PURPOSE: Information concerning the amount and nature of target motion is essential for the determination of internal margin size. However, there are few published reports outlining the motion with heart and aortic pulsation. We introduce a method for three-dimensional radiation treatment planning (3D-RTP) by using electrocardiographically (ECG) gated spiral scanning with a four-section CT system. We describe a new approach to visualize internal organ motion resulting from cardiac motion with ECG gated multidetector row CT. MATERIALS AND METHODS: Five patients with lung or liver tumors were studied with a multidetector row CT system under shallow inspiration breath-holding. With retrospective ECG gating, only data acquired within a predefined interval of the cardiac cycle are used for image reconstruction. All reconstructed image data at diastolic and systolic phases of the cardiac cycle were transferred to the 3D-RTP system. The shift of the internal organs between the cardiac cycles was evaluated. RESULTS: Cardiac contraction influences anterior thorax, pulmonary peripheral vessels, and liver position, in addition to locations near the heart. Apparent movements more than 5 mm between diastolic and systolic phases were observed in the left ventricle, right atrium, and superior vena cava. Two-phase imaging was useful for showing the movement of internal organs during cardiac contraction under breath-holding. CONCLUSIONS: Spatial information using ECG-gated CT has the potential to determine the planning target volume of moving lung and liver tumors more precisely than conventional CT planning.

Computer Systems↗
PubMed2002

Improvement of three-dimensional treatment planning models of small lung targets using high-speed multi-slice computed tomographic imaging.

PURPOSE: To improve the reliability of the patient model and reduce treatment volume by acquiring multi-slice computed tomographic (CT) data with the patients' single holding of breath at normal inhalation and exhalation. METHODS AND MATERIALS: Seven patients with nine small peripheral lung cancer tumors underwent CT scanning under three respiration conditions using multi-slice CT: free breathing (FB), shallow inspiration (SI), and shallow expiration (SE). To compare the treatment plan created using the two-respiratory-phase images (SI + SE) with the plans created using only SE images or using only FB images, we attempted to calculate the true dosimetric characteristics for three-dimensional treatment planning taking respiratory movement into consideration. Minimum dose to the gross tumor volume (GTV) and ipsilateral lung dose-volume histogram (DVH) were calculated for the inhalation and exhalation positions of shallow breathing. RESULTS: There was no significant difference between minimum doses of the GTV in the three treatment plans when using anteroposterior/posteroanterior parallel-opposed fields. However, there was a significant difference between the minimum doses of the GTV in the two-phase treatment plan and the minimum dose in the other treatment plans when using the four-field technique, consisting of shaped anterior, posterior, right and left lateral fields (p = 0.03, 0.04). Comparison of the percent volume of ipsilateral lung receiving a dose exceeding 20 Gy (V(20)) based on inhalation and exhalation CT data revealed that the V(20) of the two-phase plan was the smallest of the three treatment planning fields (p < 0.001). CONCLUSION: Two-phase planning using multi-slice CT provides an immediate reduction in the amount of normal tissue treated and improved reliability of patient data for DVH modeling.

Humans↗
PubMed2002

Angiosarcoma treated with radiotherapy: impact of tumor type and size on outcome.

PURPOSE: Angiosarcoma is a rare and highly malignant vascular neoplasm. The purpose of this study was to elucidate the tumor characteristics and evaluate the efficacy of radiotherapy (RT) for angiosarcoma. MATERIALS AND METHODS: Thirty patients with angiosarcoma (20 males and 10 females, age range 4-89 years, median 66) who received RT from 1986 to 1999 were enrolled in the study. Twenty-four patients had angiosarcoma of the face and scalp (AFS), and 6 patients had angiosarcomas at other sites. AFS was classified into two categories (according to the macroscopic features): nodular AFS (14 patients) and endophytic AFS (10 patients). The median prescribed irradiation dose was 68 Gy. Surgery had been previously performed in 9 patients, and adjuvant immunotherapy using recombinant interleukin-2 (rIL-2) was combined during and after RT in 20 patients. Univariate analyses and calculation of survival by Kaplan-Meier methods were performed. RESULTS: Local tumor control was obtained in 17 patients (57%). However, 7 (47%) of them developed distant metastases. The median survival time for all patients was 8 months (7 months for AFS), and the 13-year overall survival rate was 25% (20% for AFS). Twenty-one patients died of angiosarcoma, with the cause of death local failure in 7 patients, distant failure in 7, and both in 7. Tumor type and size were found to be significant prognostic factors (p = 0.004 and p = 0.007, respectively), and age, total amount of rIL-2, gender, radiation dose, and surgery were not. Six patients (4 with nodular AFS and 2 with angiosarcoma in other parts) survived >2 years. No patient with endophytic AFS survived >2 years. Ten patients (33%) died of respiratory failure secondary to pulmonary metastases. High-dose rIL-2 administration suppressed the occurrence of distant metastases (p = 0.006). Two patients developed radiation dermatitis (Radiation Therapy Oncology Group Grade 4). CONCLUSION: RT, combined with complete resection or adjuvant rIL-2 immunotherapy, could be a promising treatment strategy, leading to prolonged survival in patients with angiosarcoma.

Adolescent↗
PubMed2002

Neoadjuvant androgen withdrawal prior to external radiotherapy for locally advanced adenocarcinoma of the prostate.

BACKGROUND: It is unclear whether positive interactions between radiation and androgen withdrawal for patients with locally advanced prostate cancer is synergistic or additive. The present study aimed to clarify the significance of neoadjuvant androgen ablation prior to external radiotherapy in a human prostate LNCaP tumor model and in patients with locally advanced prostate cancer. METHODS: Comparisons were made between the effect of castration prior to radiation on the growth of subcutaneous LNCaP tumors implanted into male nude mice and their serum prostate-specific antigen (PSA) levels, and the results of castration or radiation alone. Twenty-nine patients with histologically proven and locally advanced adenocarcinoma of the prostate were treated with luteinizing hormone-releasing hormone analog at least 3 months before, during, and after external radiation therapy with a total dose of 70 Gy. The toxicity and response to this therapy were evaluated. RESULTS: Treatment combining castration and radiation resulted in synergistic inhibition of LNCaP tumor growth and a significant delay in the emergence of androgen-independent recurrence as opposed to either treatment alone. The external radiotherapy was completed in 28 patients (96.6%), resulting in a reduction of serum PSA levels in all 28 patients to below 1.0 ng/mL. All patients were alive after a mean follow-up period of 34 months (range 11-53) with a 3-year PSA relapse-free survival rate of 83.7%. Among several factors examined, only the Gleason score was significantly associated with PSA relapse-free survival in univariate analysis, but not in multivariate analysis. Thirteen of 28 patients (46%) and 7 of 28 (25%) also showed at least one form of gastrointestinal or genitourinary toxicity, respectively. Of these patients, 8 with gastrointestinal toxicities, and 1 with genitourinary toxicity, experienced acute complications higher than grade 3. CONCLUSION: The experimental findings objectively suggested the use of neoadjuvant androgen withdrawal prior to radiation therapy. Although our clinical experience is preliminary, combined androgen ablation and radiation therapy may also be effective in controlling locally advanced prostate cancer, with tolerable side-effects.

Adenocarcinoma↗
PubMedDate not supplied

Radiotherapy for medically inoperable non-small cell lung cancer at clinical stage I and II.

We reviewed the records of 36 patients with medically inoperable stage I-II non-small cell lung carcinoma who were treated with radiotherapy. The median dose to the target was 60 Gy with conventional fractionation. Fifteen patients were treated without elective irradiation fields, while the remaining 21 were treated with extended fields including elective mediastinal regional lymph nodes. The overall survival rates at three and five years were 32.3% and 18.8%, the cause-specific survival rates were 40.9% and 27.3%, and the local control rates were 31.7% and 23.8%, respectively. In multivariate analysis the radiation dose had a marginally significant influence on the cause-specific survival, while tumor size had a significant influence on the local control rate. Only one patient had relapse in the regional mediastinal lymph nodes as the only site of metastasis. We conclude that the dose used in the present study is inadequate and recommend that further efforts be made to improve local control by dose escalation within a small target volume.

Aged↗