Accuracy of Intracavitary Applicator Reconstruction for Cervix Cancer Brachytherapy

The accuracy of intracavitary applicator reconstruction for cervical cancer was assessed. A homemade phantom that mimics clinical applicator placement and reference points was used. Three stainless steel (15°, 30°, and 45°) tandems, x-ray markers, and three reference points were used to compare radiography- and CT-based systems. For CT reconstructions, two Fletcher CT compatible (15° and 30°) tandems, two ovoids, and two reference points, with and without inserted x-ray markers, were used. A 2.5-mm CT slice thickness was used. To check for inter- and intra-operator variations in CT, only a 30° tandem without x-ray markers and 1.25-mm CT slice thickness were used. Applicators were reconstructed three times for each image set to verify the operator reproducibility. A 6 Gy dose was prescribed and normalized at AL-point. Source dwell times were compared to check for dose variation at A-point. Maximum standard deviations SD (σ) for radiography and CT reconstructions were 0.35 and 0.83mm, respectively. Analysis of variance for the means of 15° and 30° tandems showed no significant difference. Levene’s test proved insignificant difference for 15° tandem (p value = 0.131), whereas it showed a significant difference for 30° tandem (p value = 0.011). This phantom study showed that the variance of dwell times between the two methods for 30° tandem was statistically significant due to increased applicator curvature. CT proves superiority to radiography. X-ray marker method was more accurate but has less image quality. Inter- and intra-oncologist variations showed good agreement

Significant impact of biochemical recurrence on overall mortality in patients with high-risk prostate cancer after carbon-ion radiotherapy combined with androgen deprivation therapy

BACKGROUNDWhether biochemical recurrence (BR) is a significant predictive factor of mortality after definitive radiation therapy for prostate cancer remains unknown. The aim of the current study was to investigate the relation between BR and overall mortality (OAM) in high-risk prostate cancer patients who were treated with carbon-ion radiotherapy (CIRT) and had long-term follow-up in 2 prospective trials.METHODSIn the 2 phase 2 clinical trials, which involved 466 prostate cancer patients who received 63.0 to 66.0 Gy of CIRT (relative biological effect) in 20 fractions between 2000 and 2007, 324 patients who were deemed to be at high risk on the basis of the modified D\u27Amico classification criteria and received CIRT along with androgen-deprivation therapy (ADT) were examined. The OAM rate was adjusted for the ADT duration, and multivariate analyses using a Cox proportional hazards model were performed for OAM with BR as a time-dependent covariate.RESULTSThe median follow-up period was 107.4 months, and the 5- and 10-year OAM rates after adjustments for the ADT duration were 7.0% (95% confidence interval [CI], 4.0%-9.4%) and 23.9% (95% CI, 16.4%-26.2%), respectively. A multivariate analysis revealed that the presence of BR (hazard ratio, 2.82; 95% Cl, 1.57-5.08; P = .001) was one of the predictive factors for OAM. On the other hand, the duration of ADT had no impact on OAM.CONCLUSIONSBR after CIRT combined with ADT is an independent predictive factor for OAM in high-risk prostate cancer patients. The results of this study could be applied to other high-dose radiation therapies

Prognostic Factors in High-Risk Prostate Cancer after Carbon-Ion Radiotherapy Combined with Long-Term Androgen Deprivation Therapy

Purpose: To determine the prognostic factors for biochemical recurrence (BR) and mortality in patients with high-risk localized prostate cancer after carbon-ion radiotherapy (CIRT) combined with long-term androgen deprivation therapy (LTADT).Methods and Materials: A total of 1247 patients were enrolled in three phase II clinical trials of fixed-dose CIRT between 2000 and 2013. Excluding T4 disease, 614 patients received CIRT combined with LTADT for high- or very-high-risk disease, according to the National Comprehensive Cancer Network (NCCN) classification system. Results: Median follow-up time was 78.7 months, and 5-year rates of BR-free, prostate cancer-specific survival, and overall survival were 90.4% (95% confidence interval [CI]: 87.6 - 92.7), 98.5% (95% CI: 97.2 - 99.2), and 94.7% (95% CI: 92.8 - 96.5), respectively. T3a/b disease, Gleason score (GS) 9-10, percentage of positive biopsy cores (PPCs) > 75%, and age > 75 years had a significant impact on BR. Moreover, patients with T3b disease, GS 9-10, and PPCs > 75% had significantly higher prostate cancer-specific mortality (p = 0.007, p = 0.009, and p = 0.015, respectively) and overall mortality (p = 0.035, p = 0.025, and p 75% should be considered to have very-high-risk disease requiring a new treatment strategy.the 56th Annual Conference of the Particle Therapy Co-operative Group (PTCOG56

Tc-99m MAG3 Renogram is a Useful Non-Invasive Diagnostic Tool to Evaluate Renal Function After Carbon-Ion Radiotherapy (CIRT) in Patients with Renal Cell Carcinoma

TEACHING POINTS1) 99mTc-MAG3 renogram is a useful non-invasive diagnostic tool to evaluate renal function after CIRT in patients with renal cell carcinoma, especially for the assessment of split renal function. 2) With 99mTc-MAG3 renogram, it is possible to detect renal function deterioration of non-irradiated renal parenchyma. 3) Serial assessment of renal function by measuring tubular extraction with 99mTc-MAG3 might permit earlier and more sensitive detection of renal damage after CIRT. TABLE OF CONTENTS/OUTLINE# Background # Contents - Renogram before and after CIRT for RCC. - Renogram; Pre-, 3-6 months and 12-18 months after CIRT with comparison National Cancer Institute\u27s Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 as adverse event evaluation. - Relationship between total cERPF and eGFR # Case presentation, - Case: T1aN0M0, 66Gy/12Fr., Comorbidity: none - Case: T1bN0M0, 66Gy/12Fr., Comorbidity: none - Case: T1bN0M0, 66Gy/12Fr., Cerebrovascular disease - Case: T1aN0M0, 72Gy/12Fr., Cerebrovascular disease - Case: T1aN0M0, 72Gy/12Fr., Diabetic nephropathy - Case: T3aN0M0, 72Gy/12Fr., Diabetic nephropathy # SummaryRSNA201

Correlation of liver reserve capacity before and after carbon-ion radiotherapy using 99mTc-GSA SPECT in patients with liver tumor

[Objective] 99mTc-GSA SPECT is performed for patients before and after carbon-ion radiotherapy (CIRT) for liver tumors in our hospital. It is essential to assess reduced liver reserve capacity and prediction of post-CIRT value before treatment. In this study, we evaluated the usefulness of the liver reserve capacity estimation using GSA SPECT and CT/MRI fusion images in patients before and after CIRT for liver tumors.[Materials and Methods]Eight patients who received 99mTc-GSA SPECT imaging before and 3 months after CIRT were enrolled in this investigation. After intravenous injection of 99mTc-GSA, dynamic and SPECT imaging was performed using a gamma camera. All acquired SPECT images were fused with CT or MRI images using fusion viewer software, followed by evaluation of liver reserve capacity by the maximal GSA removal rate (GSA-Rmax) and GSA-Rmax of the predicted residual liver after CIRT (GSA-RL) using multicompartment analysis. Then we assessed correlation between GSA-RL before CIRT and GSA-Rmax after CIRT to evaluate the usefulness of residual liver function estimation with 99mTc-GSA SPECT.[Results]GSA-Rmax before and after CIRT were 0.302±0.189 and 0.264±0.172, respectively. GSA-RL before CIRT was 0.266±0.174, which was estimated using GSA SPECT-CT/MRI fusion images before CIRT. There was a high correlation between GSA-RL before CIRT and GSA-Rmax after CIRT (r=0.93, p<0.001). [Conclusion]GSA SPECT is useful for evaluating liver reserve capacity and the prediction of post-CIRT value in patients with liver tumors.第79回日本医学放射線学会総

Correlation of liver reserve capacity before and after carbon-ion radiotherapy using 99mTc-GSA SPECT in patients with liver tumor

[Objective] 99mTc-GSA SPECT is performed for patients before and after carbon-ion radiotherapy (CIRT) for liver tumors in our hospital. It is essential to assess reduced liver reserve capacity and prediction of post-CIRT value before treatment. In this study, we evaluated the usefulness of the liver reserve capacity estimation using GSA SPECT and CT/MRI fusion images in patients before and after CIRT for liver tumors.[Materials and Methods]Eight patients who received 99mTc-GSA SPECT imaging before and 3 months after CIRT were enrolled in this investigation. After intravenous injection of 99mTc-GSA, dynamic and SPECT imaging was performed using a gamma camera. All acquired SPECT images were fused with CT or MRI images using fusion viewer software, followed by evaluation of liver reserve capacity by the maximal GSA removal rate (GSA-Rmax) and GSA-Rmax of the predicted residual liver after CIRT (GSA-RL) using multicompartment analysis. Then we assessed correlation between GSA-RL before CIRT and GSA-Rmax after CIRT to evaluate the usefulness of residual liver function estimation with 99mTc-GSA SPECT.[Results]GSA-Rmax before and after CIRT were 0.302±0.189 and 0.264±0.172, respectively. GSA-RL before CIRT was 0.266±0.174, which was estimated using GSA SPECT-CT/MRI fusion images before CIRT. There was a high correlation between GSA-RL before CIRT and GSA-Rmax after CIRT (r=0.93, p<0.001). [Conclusion]GSA SPECT is useful for evaluating liver reserve capacity and the prediction of post-CIRT value in patients with liver tumors.第79回日本医学放射線学会総

Heavy charged particles for gastrointestinal cancers

Carbon ion beams constitute the primary delivery method of heavy ion radiotherapy. It offers improved dose distribution, and enables concentration of dose within target volumes with minimal extraneous exposure of normal tissue, while delivering superior biological effect in comparison with photon and proton technologies. Here, we review the application of this technology to various gastrointestinal cancers