Application of modified shrinking field radiation in RT-DeVIC chemoradiotherapy for treating localized extranodal natural killer/T-cell lymphoma

　Concurrent chemoradiotherapy (CRT) is the recommended treatment for localized extranodal natural killer/T-cell lymphoma, nasal type (ENKL). In 2009, the Japan Clinical Oncology Group first documented the safety and efficacy of a regimen involving radiotherapy (RT) plus dexamethasone, etoposide, ifosfamide, and carboplatin (DeVIC) in their phase I/II trials (JCOG0211 study). The application of this regimen has drastically improved outcomes of patients with localized ENKL. In 2013, the current guidelines were made to the cost in JCOG0211 study.　We retrospectively investigated the outcomes of three patients who received CRT for stage localized ENKL at the Kawasaki Medical School Hospital between August 2007 and March 2011. Our CRT protocol differed from that used in the JCOG0211 study as we used a different shrinking field RT method. A recent report on shrinking or extended-field RT raised questions regarding which fields are appropriate. Thus, we compared our clinical results with those of the JCOG0211 study and analyzed the effect of the differences in field size on clinical results. The median follow-up of the three patients in the present study was 9 months (range, 5-106 months), two and one of whom achieved complete and partial responses, respectively. Regarding adverse events, no severe acute side effects (e.g., mucositis) higher than Grade 4 were observed.　We reviewed cases and the JCOG0211 study which we experienced in the past about fields of the RT. The present study described our experiences with three patients receiving shrinking field RT

強度変調放射線治療を施行した胃MALT リンパ腫の1例

症例は60歳代男性で,下肢浮腫を主訴に受診.ネフローゼ症候群を認め,精査の結果,胃MALTリンパ腫および膜性腎症と診断された.Helicobacter pylori陰性であり,除菌は行なわず放射線療法の方針となり,強度変調放射線治療を用いた30.6Gy/17回の全胃照射を施行した.従来の三次元原体照射と比較し,強度変調放射線治療を用いることで,両腎の照射線量を低減できた.照射後24カ月の時点で,腫瘍は寛解を維持しており,放射線治療の副作用による腎機能の低下も認めていない.強度変調放射線治療を用いた全胃照射は,安全かつ有用な照射方法と考えられた.We present a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma in a 60s year-old male Helicobacter pylori negative patient. The patient presented with lower extremity oedema and nephrotic syndrome. Thorough examination revealed the presence of gastric MALT lymphoma and nephrotic syndrome. We chose a treatment strategy involving radiation therapy, and carried out whole stomach irradiation using intensity modulated radiation therapy (IMRT) at a total dose of 30.6 Gy delivered in 17 fractions. Using IMRT the maximum and V20 dose to the bilateral kidney was lower than using conventional 3D conformal radiation therapy. The patient has been in complete remission for 24 months after IMRT, and no further renal impairment has been detected. In conclusion, we consider that IMRT is a reliable and valuable modality for whole stomach irradiation

前立腺癌に対する高線量率組織内照射におけるアプリケーター刺入本数に関する検討

　前立腺癌に対する高線量率組織内照射において，アプリケーター針の刺入本数や刺入位置は線量分布に大きく影響する．刺入方法は各施設の経験やポリシー，使用装置に依存する部分があり，最適な刺入法として確立された普遍的な方法はない．今回我々はアプリケーター針の刺入本数と線量体積因子の関連を解析し，最適な刺入本数を検討した．対象は2010年６月１日から2012年10月31日の間に同治療を受けた初発前立腺癌135例．治療計画にはOncentra® を用いた．治療前エコーによる前立腺体積，治療計画CT により算出された線量体積因子（PTV のDmin%，D90%，dosenon-uniformity ratio：DNR，homogeneity index：HI，conformity index：CI，尿道最大線量，直腸最大線量），治療時期（一次解析として前期：～2011年１月，中期：2011年２月～９月，後期：2011年10月～2012年５月，さらに追加解析として直近：2012年６月〜），アプリケーター針刺入本数について，相互の関連をJMP 14，Student のｔ検定を用いて検討した．一次解析の結果，刺入本数は前立腺体積と相関せず，刺入本数が多い群は少ない群に比べ尿道最大線量が有意に低かった．他の線量体積因子では有意差はないものの，刺入本数が多い群でPTV のDmin% は高値，D90% は高値，DNR は低値，HI は高値，CI は高値と，本数が多いほど良好な線量分布であることを示していた．なお，治療時期が後期の症例で刺入本数が有意に増加していた．これらの結果が判明した後に治療された直近16例においては，さらに刺入本数が増加し，線量体積因子の改善が認められていた．今回の検討から，アプリケーター針の刺入本数が多いほど線量分布が改善し，とくに16-17本の刺入により良好な線量分布が得られることが示された．　In high-dose-rate brachytherapy (HDR-BT) for prostate cancer, the number and arrangement of applicator needles have a decisive impact on radiation dose distribution. Brachytherapy techniques largely depend on the operator’s experience, policy and devices. Furthermore, the procedures of needle insertion, dose prescription and plan optimization vary according to institutions. The aim of this study was to determine the optimal needle number for achieving the best quality of HDR-BT for prostate cancer by analyzing the relationship between needle number and dose-volume parameters. We included 135 patients with newly diagnosed prostate cancer who received HDR-BT between June 2010 and October 2012. Treatment planning was performed on Oncentra® using volume optimization, followed by manual graphical optimization. Dose-volume parameters, such as Dmin% and D90% of the planning target volume (PTV), dose non-uniformity ratio (DNR), homogeneity index (HI), conformity index (CI), and maximum dose to the urethra and rectum, were calculated on the treatment planning system. Student’s t-test was performed to determine the correlation of these parameters and prostate volume with needle number using the JMP® 14 software. We divided the treatment period into three phases: early, middle, and late; needle number and dose-volume parameters were analyzed according to these periods. Needle number was not correlated with prostate volume but showed correlations with several dose-volume parameters. Higher needle number was significantly correlated with lower maximum dose to the urethra; furthermore, higher needle number had a tendency to show correlations with higher Dmin% of PTV, higher D90%, lower DNR, higher HI, and higher CI. These results indicated that a higher needle number could achieve better radiation dose distribution. Concerning the treatment period, the number of needles used in patients was higher in the late period than in the earlier period. Based on these results, we started using the highest number of needles that could be inserted safely; this led to the achievement of better radiation dose distribution. In conclusion, our results show that a high needle number can achieve better quality of brachytherapy for prostate cancer. We think that using 16 or 17 needles is the most appropriate

The Physics of the B Factories

This work is on the Physics of the B Factories. Part A of this book contains a brief description of the SLAC and KEK B Factories as well as their detectors, BaBar and Belle, and data taking related issues. Part B discusses tools and methods used by the experiments in order to obtain results. The results themselves can be found in Part C

Decline in the Functional Status and Mortality in Patients on Hemodialysis: Results from the Japan Dialysis Outcome and Practice Patterns Study

ObjectivesPatients with end-stage renal disease (ESRD) treated with hemodialysis suffer a high burden of poor functional status. Poor functional status is known as a strong, consistent predictor of mortality. However, little is known about the trajectory of functional status and its association with clinical outcomes in the ESRD population. We examined the association between a change in the functional status over time and all-cause mortality among patients on hemodialysis.Design and methodsThis was a prospective cohort study of 817 patients with ESRD on hemodialysis with repeat measures of functional status, who enrolled in the Japan Dialysis Outcomes and Practice Patterns Study phase V. The functional status was assessed based on the Katz Index and Lawton-Brody instrumental activities of daily living scale, and the assessments were conducted twice over a median of 361 (range: 339-378) days between 2012 and 2013. We classified patients into 2 groups based on having or not having at least a 1-point decline in the functional status score. To evaluate the association between the decline in the functional status and all-cause mortality with adjustment for potential confounders, a Cox regression analysis was conducted.ResultsOver the study period, 19.9% of the patients showed a decline in the functional status score. During the follow-up period, 44 (5.4%) patients died. Using the Cox regression analysis and adjusting for potential confounders, it was determined that the decline in functional status score was significantly associated with higher mortality (incidence rate: 2.2 vs. 7.0 per 100 person-years; adjusted hazard ratio: 2.68; 95% confidence interval: 1.31-5.50).ConclusionsThe present study provides evidence that ESRD patients on hemodialysis demonstrating a decline in the functional status are at elevated risk of mortality. Our findings strengthen the evidence underpinning the importance of interventions to maintain the functional status in this vulnerable population

Boron neutron capture therapy for vulvar melanoma and genital extramammary Paget’s disease with curative responses

Abstract Background Although the most commonly recommended treatment for melanoma and extramammary Paget’s disease (EMPD) of the genital region is wide surgical excision of the lesion, the procedure is highly invasive and can lead to functional and sexual problems. Alternative treatments have been used for local control when wide local excision was not feasible. Here, we describe four patients with genital malignancies who were treated with boron neutron capture therapy (BNCT). Methods The four patients included one patient with vulvar melanoma (VM) and three with genital EMPD. They underwent BNCT at the Kyoto University Research Reactor between 2005 and 2014 using para-boronophenylalanine as the boron delivery agent. They were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin/mucosal doses. Results All patients showed similar tumor and normal tissue responses following BNCT and achieved complete responses within 6 months. The most severe normal tissue response was moderate skin erosion during the first 2 months, which diminished gradually thereafter. Dysuria or contact pain persisted for 2 months and resolved completely by 4 months. Conclusions Treating VM and EMPD with BNCT resulted in complete local tumor control. Based on our clinical experience, we conclude that BNCT is a promising treatment for primary VM and EMPD of the genital region. Trial registration numbers UMIN00000512