Biomedical subjects

Yuzuru Niibe

Publications and source records attributed to Yuzuru Niibe.

14 recordsLinked to original sources

PubMed2007

Phase II study of radiation therapy combined with weekly nedaplatin in locally advanced uterine cervical carcinoma: Kitasato Gynecologic Radiation Oncology Group (KGROG 0501).

In order to evaluate the safety and efficacy of chemoradiotherapy using nedaplatin for locally advanced uterine cervical carcinoma in Japanese patients, we have started a single-institute phase II trial. Eligibility criteria include: (i) pathologically proven squamous cell carcinoma or adenocarcinoma, (ii) clinical FIGO stage Ib, IIa, or IIb with bulky tumor (> 40 mm) or pelvic lymph node swelling, or (iii) clinical FIGO stage IIIa, IIIb and IVa, (iv) no para-aortic lymph node swelling. A combination of external beam radiation and high dose rate intracavitary irradiation is given. Nedaplatin (30 mg/m2) is intravenously infused on a weekly basis for five times. The primary endpoint is 3-year overall survival, and the secondary endpoints are tumor response, 2-year overall survival, 3-year progression-free survival, acute adverse events, protocol treatment compliance, and late adverse events. We plan to recruit 45 patients within 3 years.

Adenocarcinoma↗

PubMed2006

Multi-institutional study of radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma: 84 subjects of a population of more than 5,000.

PURPOSE: Most patients who had any recurrent sites of cancer have been considered to be in their last stage of life. However, recent advances of clinical research reveal some patients achieve long-term survival even in recurrence. Furthermore, for patients who had only one recurrent region, radiation therapy could play an important role. As for uterine cervical carcinoma, the most common recurrent site other than the pelvis is the para-aortic lymph nodes. Thus we conducted the current study. PATIENTS AND METHODS: Between 1994 and 2003, more than 5,000 uterine cervical carcinoma patients were treated with curative intended treatments at 13 Japanese hospitals. Of these patients, 84 developed para-aortic lymph node recurrence as the only site of initial tumor progression. These patients were treated with external beam radiation therapy. Radiation therapy protocol was as follows: 1.7-2.0 Gy per fraction, 5 fractions per week, and the mean total dose was 50.8 Gy (25-60 Gy). RESULTS: Three- and 5-year overall survival rates of all patients were 49.5% and 31.3%, respectively. Stratified by symptom sign, 3-year overall survival rate of symptom positive was 27.6% and those of the negative was 56.1% (p = 0.018). Three-year overall survival rates of the total dose > or =51 Gy and that of < or =50 Gy were 58.0% and 42.8%, respectively (p = 0.07). As for morbidity, no patients received Grade 3 or greater late toxicity. CONCLUSIONS: The current study suggested that radiation therapy for isolated para-aortic lymph node recurrence in uterine cervical carcinoma could have a significant impact on survival.

Adult↗

PubMed2006

Frequency and characteristics of isolated para-aortic lymph node recurrence in patients with uterine cervical carcinoma in Japan: a multi-institutional study.

OBJECTIVE: In most cases of uterine cervical carcinoma recurrence, the first site of distant metastasis or recurrence is reported to be the para-aortic region. Some reports have demonstrated that, in cases of isolated para-aortic lymph node recurrence treated by radiation therapy, patients survived for a long period, which suggests that isolated para-aortic lymph node recurrence in uterine cervical carcinoma is a regional disease rather than systemic disease. Determining the predictive characteristics of isolated para-aortic lymph node recurrence in patients at the time of the initial treatment for primary uterine cervical carcinoma is important, so we conducted the current multi-institutional study. PATIENTS AND METHODS: Patients (n=3137) with uterine cervical carcinoma of stages Ia to IVa were treated in twelve Japanese hospitals between 1994 and 2003. The current study investigated the frequency and characteristics of patients with isolated para-aortic lymph node recurrence as well as the characteristics of clinical stage, histopathology, serum squamous cell carcinoma antigen level, the treatment method at the initial treatment, the duration between the initial treatment and the recurrence, and the serum squamous cell carcinoma antigen level at the recurrence. RESULTS: Of the 3137 patients with uterine cervical carcinoma in stages Ia-IVa, 67 (2.1%) experienced recurrence in isolated para-aortic lymph nodes. Stratified by clinical stage, none of the 613 patients with stage Ia experienced recurrence in isolated para-aortic lymph nodes. However, recurrence was experienced by 14 (1.4%) of the 966 patients with stage Ib, 7 (3.5%) of the 199 patients with stage IIa, 14 (2.3%) of the 613 patients with stage IIb, 1 (2.1%) of the 48 patients with stage IIIa, 26 (4.6%) of the 538 patients with stage IIIb, and 5 (5%) of the 100 patients with stage IVa. The mean duration time between the initial treatment and isolated para-aortic recurrence was 20 months (range, 2-49 months). The correlations between duration time and the clinico-pathological factors (clinical stage, histopathology, serum squamous cell carcinoma antigen level, and treatment method) at the initial treatment were investigated. No statistically significant factors have been revealed in the current study. CONCLUSIONS: The frequency of isolated para-aortic lymph node recurrence was 2.1% and increased with increasing clinical stage at the initial treatment (stage IVa: 5%) in the current study.

Adult↗

PubMed2006

Difference in rectal dosimetry between pre-plan and post-implant analysis in transperineal interstitial brachytherapy for prostate cancer.

BACKGROUND AND PURPOSE: To investigate differences in rectal dosimetry between pre-plan ultrasonography (US) and post-implant computed tomography (CT). PATIENTS AND METHODS: Subjects comprised 49 patients who underwent prostate brachytherapy using (125)I seed implants. Prescribed dose was 145Gy to the periphery of the prostate. Differences in rectal dosimetry between pre-plan US and post-implant CT analysis were evaluated. In addition, patients were divided into two groups according to timing of pre-planning (pre-plan group, n=28; intraoperative pre-plan group, n=21), and differences in rectal dosimetry between groups were assessed. RESULTS: The average of volume differences between pre-plan and post-implant analysis (pre-plan minus post-implant analysis) for all patients were follows: -0.08 cm(3) in V60 (volume of rectal wall receiving 60% of prescribed dose); -0.05 cm(3) in V70; -0.16 cm(3) in V80; -0.38 cm(3) in V90; -0.40 cm(3) in V100; -0.32 cm(3) in V110; -0.22 cm(3) in V120; -0.15 cm(3) in V130; -0.10 cm(3) in V140; -0.07 cm(3) in V150; and -0.05 cm(3) in V160. Apparent differences between pre-plan US and post-implant CT in rectal dosimetry were small. However, considering the steep curve of the relationship between tolerable volume and dose, a large actual difference should be assumed. No advantage was identified for the intraoperative pre-plan group. Safe volume to avoid proctitis tended to be smaller on ultrasonography than on CT at 1 month. CONCLUSIONS: The present work shows that direct comparison of CT analysis and pre-plan US is unfavorable due to large differences in these modalities and overestimation of tolerable volume. However, by comprehending the degree of difference, comparison of data from CT analysis with a US pre-plan may be feasible and useful for providing feedback between these modalities.

Brachytherapy↗

PubMed2005

Simple technique to visualize random set-up displacements using a commercially available radiotherapy planning system.

PURPOSE: To visualize random set-up displacements in isodose distribution images, we introduce a simple technique using a commercially available radiotherapy planning system (RTP). MATERIALS AND METHODS: A distribution of set-up displacement is known to be compatible with that of a Gaussian distribution. Based on that assumption, 41 intentionally misaligned beams with 1-mm intervals were planned in the respective weights according to Gaussian distribution. "Modified" isodose distributions were then visualized using a commercially available RTP. In the next step, only two beams misaligned with one standard deviation (SD) of the Gaussian distribution were used in place of 41 beams, as a large number of beams increases the workload and is unsuitable for clinical use. Differences between the two versions of isodose distribution images were assessed visually. RESULTS: In modified dose distribution images, the edge of distribution was dull compared to normal images. These images show that the larger SD of set-up displacement dulls the edge of dose distribution. Images from two beams were not significantly different to those from 41 beams. CONCLUSION: Using this technique, the impact of random set-up displacements was effectively reflected in isodose distribution images.

Humans↗

PubMed2004

Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study.

BACKGROUND: Stereotactic irradiation (STI) has been actively performed using various methods to achieve better local control of Stage I nonsmall cell lung carcinoma (NSCLC) in Japan. The authors retrospectively evaluated results from a Japanese multiinstitutional study. METHODS: Patients with Stage I NSCLC (n = 245; median age, 76 years; T1N0M0, n = 155; T2N0M0, n = 90) were treated with hypofractionated high-dose STI in 13 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. A total dose of 18-75 gray (Gy) at the isocenter was administered in 1-22 fractions. The median calculated biologic effective dose (BED) was 108 Gy (range, 57-180 Gy). RESULTS: During follow-up (median, 24 months; range, 7-78 months), pulmonary complications of National Cancer Institute-Common Toxicity Criteria Grade > 2 were observed in only 6 patients (2.4%). Local progression occurred in 33 patients (14.5%), and the local recurrence rate was 8.1% for BED > or = 100 Gy compared with 26.4% for < 100 Gy (P < 0.05). The 3-year overall survival rate of medically operable patients was 88.4% for BED > or = 100 Gy compared with 69.4% for < 100 Gy (P < 0.05). CONCLUSIONS: Hypofractionated high-dose STI with BED < 150 Gy was feasible and beneficial for curative treatment of patients with Stage I NSCLC. For all treatment methods and schedules, local control and survival rates were better with BED > or = 100 Gy compared with < 100 Gy. Survival rates in selected patients (medically operable, BED > or = 100 Gy) were excellent, and were potentially comparable to those of surgery.

Adult↗

PubMed2004

Hyperfractionated radiation therapy for oropharyngeal carcinoma in a Japanese population.

BACKGROUND: Hyperfractionated radiation therapy is recognized to be a better treatment method, especially regarding local control, than conventional radiation therapy for oropharyngeal carcinoma. However, the survival benefit of hyperfractionated radiation therapy for oropharyngeal carcinoma has not been reported so far. Moreover, patient populations of previous studies were mostly white or African-American, and rarely included Orientals. Thus, the current study is designed to evaluate not only local control but the survival benefit of hyperfractionated radiation therapy for oropharyngeal carcinoma in a Japanese population. METHODS: The eligibility criteria were as follows. The patients were 20 years or older. Performance status ranged from 0 to 2. No patient with double carcinoma was included except those with superficial esophageal carcinoma or advanced carcinoma controlled for at least 2 years after treatment. In our radiation protocol, hyperfractionated radiation therapy was adopted using 1.2 Gy per fraction, two fractions per day (6 h apart), 5 days a week, for a total dose of 66 Gy or more. RESULTS: Complete response was achieved in all 14 patients with oropharyngeal lesions. In five patients with lymph node metastasis, complete response was achieved in four patients and partial response was achieved in the remaining one. The 3-year loco-regional control rate was 77% and the 3-year overall survival rate was 69%. CONCLUSIONS: Treatment with hyperfractionated radiation therapy is considered superior to conventional radiation therapy with acceptable toxicity for Japanese patients with oropharyngeal carcinoma in terms of loco-regional control rate and overall survival rate.

Aged↗

PubMed2003

Rotational 3D-conformal radiation therapy (conformation therapy) combined with hormone therapy for the treatment of stage B2/C prostate cancer in Japanese men.

BACKGROUND AND PURPOSE: In our institution, rotational 3D-conformal radiation therapy (also called conformation therapy) has been applied since the late 1970s to conform the target volume of high-dose radiation to the cancerous tissue while minimizing radiation to the surrounding normal tissues. This technique has been used most commonly to treat prostate cancers in combination with hormonal therapy. The results of Stage B2/C prostate cancer treated with this method were analyzed. PATIENTS AND METHODS: Between 1987 and 1997, 33 cases of prostate cancer were definitively treated with this method: 9 Stage B2 tumors and 24 Stage C tumors. Of these 33 tumors, 3 were well differentiated, 18 were moderately differentiated, and 12 were poorly differentiated. The average patient age was 75.6 years. The median pretreatment PSA value was 23.8 ng/ml. The total radiation dose ranged from 60 Gy to 70 Gy (average: 63.5 Gy) with conventional fractionation. Hormone therapy was administered permanently; the primary hormonal agent was diethylstilbestrol phosphate. RESULTS: The overall survival rate after 5 years was 58.2% and that after 10 years was 29.6%. The biochemical relapse-free rate after 5 years was 87.0% and that after 10 years was still 87.0%. There were 4 cases of biochemical failure, but no cases of death from prostate cancer. Stage, differentiation, and pretreatment PSA value were not prognostic factors. One of the 2 cases with delayed complications was a case of RTOG Grade 3 gastrointestinal complication. CONCLUSIONS: Rotational 3D-conformal radiation therapy combined with hormone therapy might be promising for the treatment of prostate cancer.

Adenocarcinoma↗

PubMed2003

Hyperfractionated radiation therapy for hypopharyngeal carcinoma compared with conventional radiation therapy: local control, laryngeal preservation and overall survival.

BACKGROUND: Recent randomized trials have revealed the effectiveness of hyperfractionated radiation therapy for treating head and neck carcinomas, especially in their local control. Because the hypopharynx is located near the larynx, increasing local control of hypopharyngeal carcinomas achieves greater laryngeal preservation, which is very important for patients' quality of life. In consideration of this, our facility adopted hyperfractionated radiation therapy for hypopharyngeal carcinoma in 1996. In this study we compared the results of this therapy with those of conventional radiation therapy. METHODS: Forty-two patients with hypopharyngeal carcinoma whose tumors were inoperable or who refused surgery were treated with curative intended radiation therapy between April 1975 and January 2002 at Tokyo Metropolitan Komagome Hospital. Of these patients, 23 were treated with hyperfractionated radiation therapy (the HF group) and 19 were treated with conventional fractionated radiation therapy (the CF group). In the HF group, the numbers of patients at each clinical stage were as follows: stage I, 2; stage II, 5; stage III, 6; stage IV, 10. The fraction size was 1.2 Gy and the mean total dose was 73.4 Gy (range, 66-79.2 Gy). In the CF group, the corresponding numbers were as follows: stage I, 3; stage II, 1; stage III, 5; stage IV, 10. The fraction size was 1.8-2.0 Gy and the mean total dose was 65.4 Gy (range, 60-70 Gy). RESULTS: The 3-year local control rates for the HF group and the CF group were 61.5 and 18.4%, respectively (P = 0.016). The 3-year pharyngolaryngectomy-free survival rates for the HF group and the CF group were 64.7% and 5.3%, respectively (P = 0.0008). The 3-year overall survival rates for the HF group and the CF group were 69.3 and 31.6%, respectively (P = 0.075). CONCLUSION: This study suggests that hyperfractionated radiation therapy for hypopharyngeal carcinoma is promising with a better local control rate, a greater laryngeal preservation rate and a relatively better overall survival rate.

Adult↗

PubMed2003

[Radiation therapy for hypopharyngeal carcinoma: impact of fractionation on treatment outcome].

PURPOSE: The purpose of the current study was to evaluate the impact of fractionation on the treatment outcome of radiation therapy for hypopharyngeal carcinoma. PATIENTS AND METHODS: Thirty-six inoperable or operation-refused hypopharyngeal patients were treated with curative-intended radiation therapy between 1976 and May 2001. Seventeen patients were treated with conventional radiation therapy, 1.8-2.0 Gy per fraction, totaling 64.0 Gy (CF group), and 19 were treated with hyperfractionated radiation therapy, 1.2 Gy per fraction, totaling 74.4 Gy (HF group). RESULTS: The radiation response of the two groups at the end of radiation therapy was almost the same. However, the 2-year local control rates of the HF and CF groups were 59.0% and 26.1% (p = 0.012), respectively, a statistically significant difference. Moreover, multivariate analysis showed that HF was an independent prognostic factor for local control. CONCLUSION: Hyperfractionated radiation therapy was superior to conventional radiation therapy for local control. Local control of hypopharyngeal carcinoma correlated with laryngeal preservation, suggesting that hyperfractionated radiation therapy for hypopharyngeal carcinoma could be beneficial for patient QOL.

Adult↗

PubMedDate not supplied

Difference in prognostic factors between stage IB and II uterine cervical carcinoma patients treated with radical hysterectomy and postoperative radiation therapy.

PURPOSE: The purpose of the current study was to evaluate the difference in prognostic factors between stage IB and II uterine cervical carcinoma patients treated with postoperative radiation therapy. PATIENTS AND METHODS: Between May 1988 and May 1998, a total of 94 patients including 47 patients with stage IB and 47 patients with stage II uterine cervical carcinoma were treated with postoperative radiation therapy at Tokyo Metropolitan Komagome Hospital. All patients were treated with 10 MV X-rays using an anterior-posterior parallel opposed field which covered the whole pelvis. Fractionation was 2 Gy per day, five fractions per week, to a total dose of 50 Gy. RESULTS: The 5-year overall survival rates of stage IB and II were 89.4% and 79.3%, respectively. In multivariate analysis for all patients, lymph node status, histology, and surgical margin status were recognized as prognostic factors. Limited to stage IB patients, lymph node status was the only independent prognostic factor. However, for stage II patients, tumor histology was also an independent prognostic factor. CONCLUSIONS: The prognostic factors of stage IB and II were different. Tumor histology was only associated with stage II patients. These findings suggested that tumor histology might have played a different role as tumor stage progressed. However, further studies with large numbers of patients will be required to confirm these results.

Adult↗

PubMedDate not supplied

Survival benefit of stereotactic radiosurgery for metastatic brain tumors in patients with controlled primary lesions and no other distant metastases.

The prognosis of patients with metastatic brain tumors has been very poor so far because most patients with metastatic brain tumors had other metastatic lesions and/or active primary lesions. Moreover, if no active lesions existed, local control of conventional radiation therapy was not so good, which also led to the poor prognosis. Thus, we conducted the current study concerning whether survival benefit existed in patients with controlled primary lesions and no other distant metastases, who were treated with stereotactic radiosurgery (SRS), a superior method for local control, for metastatic brain tumors. Seventy-seven patients with 90 metastatic brain tumors were treated with SRS between August 1999 and August 2001, at Tokyo Metropolitan Komagome Hospital, Japan. Of these, 10 patients with 17 metastatic brain tumors had primary lesions controlled and no other distant metastases were included in the current study. The median prescribed isocenter dose was 30 Gy (30-45 Gy) and the median prescribed peripheral dose was 25 Gy (12-30 Gy). One-year and 3-year local control rates were 90.0% and 90.0%, respectively. One-year and 3-year overall survival rates were 88.9% and 51.9%, respectively. These results suggest that SRS for metastatic brain tumors does have a survival benefit in patients with controlled primary lesions and no other distant metastases, which means that we should not treat these patients with palliative intent but pursue longer survival.

Adult↗

PubMedDate not supplied

Ten-year disease-free survival of a small cell lung cancer patient with brain metastasis treated with chemoradiotherapy.

We report the first case of 10-year disease-free survival in a patient with small cell lung cancer (SCLC) with brain metastasis. A 63-year-old man was found to have SCLC with brain metastasis and underwent chemoradiotherapy. Radiation therapy was delivered to the brain, lungs, mediastinum and supraclavicular fossa. Chemotherapy regimen mainly consisted of etoposide-plus-cisplatin. The patient has remained alive for more than 10 years after the diagnosis of SCLC with brain metastasis with no relapses.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Successful treatment of concurrent chemoradiotherapy for stage I nasal NK/T cell lymphoma: a report of two cases.

Nasal natural killer/T cell (NK/T cell) lymphoma is a rare subtype of lymphomas, being a subtype of non-Hodgkin's lymphoma with a much worse prognosis than other subtypes. One reason for this worse prognosis is that nasal NK/T cell lymphoma is resistant to standard sequential chemoradiotherapy. Thus, we adopted concurrent chemoradiotherapy using a CHOP-like regimen for treating stage I nasal NK/T cell lymphoma. Case 1 was treated with concurrent chemoradiotherapy using 41-Gy irradiation with 12 cycles of the CHOP-like regimen (THP-CVP). Case 2 was treated with concurrent chemoradiotherapy using 50-Gy irradiation with 10 cycles of THP-CVP. In both Case I and Case 2, the tumors disappeared after chemoradiotherapy. The Case 1 patient is still alive with 45 months free of relapse. The Case 2 patient is also still alive with 39 months free of relapse. These results suggest that concurrent chemoradiotherapy using a CHOP-like regimen for stage I nasal NK/T cell lymphoma provided sufficient dose intensity and may be a useful treatment option.

Adult↗