Efficacy and feasibility of ambulatory treatment-based monthly nedaplatin plus S-1 in definitive or salvage concurrent chemoradiotherapy for early, advanced, and relapsed esophageal cancer

Background: Standard chemoradiotherapy (CRT) using cisplatin (CDDP) and 5-fluorouracil (5-FU) is an optional treatment for patients with stage II-III esophageal cancer. However, there are some demerits in this regimen because CDDP administration requires a large transfusion volume and 5-FU must be continuously infused over 24 h. Therefore, hospitalization is unavoidable. We collected retrospectively the data of definitive CRT with nedaplatin and S-1 as carried out in our institution. Methods: Patients with early and advanced esophageal cancer and relapsed esophageal cancer after radical surgery were included. Nedaplatin 80 mg/m2 was given on days 1 and 29, and S-1 80 mg/m2 on days 1-14 and 29-42. No prophylactic treatment with granulocyte colony stimulating factor was administered. Patients received two courses of concurrent radiotherapy of more than 50 Gy with or without two additional courses as adjuvant therapy every 4 weeks. Results: Between August 2011 and June 2015, 89 patients (age range, 44–86 years; K-PS 90–100, 81 %; squamous cell carcinoma histology, 97 %; definitive/salvage CRT, 75/25 %) were collected. Twenty-one (24 %) patients completed four cycles, and 94 % received two or more cycles. Grade 4 leukopenia, thrombocytopenia, and anemia occurred in 12, 7, and 10 % of the patients, respectively. Five patients developed febrile neutropenia. Grade 3 non-hematological toxicity included infection in 12 %, mucositis/esophagitis in 3 %, kidney in 3 %, and fatigue in 3 %. Sixty-four patients (72 %) received the prescribed full dose and full cycles of chemotherapy. A complete response was achieved in 76 patients (85 %). The 3-year overall survival rate was 54.4 % in definitive CRT and 39.8 % in salvage CRT, respectively. Sixty-two subjects (70 %) received treatment as outpatients. Conclusions: Nedaplatin and S-1 in combination with radiotherapy is feasible, and toxicity is tolerable. This treatment method has the potential to shorten hospitalization without impairing the efficacy of CRT

Volumetric and dosimetric comparison of organs at risk between the prone and supine positions in postoperative radiotherapy for prostate cancer

Abstract Background The aim of this study was to evaluate the effects of patient positioning on the volume of organs at risk (OARs) in or near the planning target volume (PTV) and the dose distribution in adjuvant or salvage radiotherapy for prostate cancer after prostatectomy. Methods Seventeen patients who received intensity-modulated radiation therapy (66 Gy in 33 fractions) as adjuvant or salvage therapy after prostatectomy were evaluated. All patients underwent CT scans in both the prone (on a belly board) and supine positions. The target volumes and OARs were delineated on each CT series. The planning target volume (PTV) was extended in every direction to generate the PTV + 0.5 cm, PTV + 1 cm, PTV + 2 cm, PTV + 3 cm, and PTV + 4 cm values. The volumes of the OARs overlapping with the PTV and the extended target volumes in the prone and supine position were compared using the Wilcoxon signed-rank test. Dose-volume histogram (DVH) parameters in the prone and supine position were compared using the paired t-test. Results The mean overlapping volumes of the small intestine for each of the PTV values were as follows (prone position vs. supine position [mean ± SD]): PTV, 1.5 ± 5.5 cm3 vs. 7.9 ± 15.7 cm3 (P = 0.028); PTV + 0.5 cm, 2.6 ± 8.9 cm3 vs. 12.1 ± 22.6 cm3 (P = 0.028); PTV + 1 cm, 3.5 ± 11.4 cm3 vs. 17.1 ± 29.8 cm3 (P = 0.028); PTV + 2 cm, 5.6 ± 14.5 cm3 vs. 26.8 ± 46.9 cm3 (P = 0.028); and PTV + 3 cm, 9.0 ± 17.4 cm3 vs. 36.5 ± 63.2 cm3 (P = 0.019), respectively. Some of the overlapping volumes of the rectum and bladder were significantly smaller in the prone position. On the other hand, when the target volume was extended by ≥2 cm, the overlapping volumes of the femurs were significantly larger in the prone position. V15 of the rectum and mean dose and V65 of the bladder were significantly lower in the prone position. Conclusions This study indicated that the volumes of the small intestine, rectum, and bladder in or near the PTV decreased when the patient was placed in the prone position on a belly board in postoperative radiotherapy for prostate cancer. The dose distribution seemed superior in the prone position to the supine position

The incidence of double hypoglossal canal in Japanese: evaluation with multislice computed tomography.

Double hypoglossal canal, namely a hypoglossal canal bridging, is a normal variation of the hypoglossal canal. Racial differences in the prevalence of double hypoglossal canal have been reported. We evaluated the prevalence of double hypoglossal canal in a Japanese population with multidetector computed tomography (MDCT).We reviewed five hundred and ninety consecutive patients (mean age, 61 years: range, 15-94 years: 254 men, 336 women) who underwent computed tomographic angiography (CTA) of the brain for a variety of CNS abnormalities. Two radiologists achieved consensus on the canal being single or double, and measured the sizes of single canals on CT images. Kappa statistics was used to test the reliability between the 2 investigators. A logistic regression was used to evaluate the prevalence of double hypoglossal canal and the following factors: sex, age, and laterality. Student's t-test was used to evaluate the asymmetry of single hypoglossal canal diameters. Statistical significance was accepted at P < 0.05.Double hypoglossal canal was identified in 16.9% of the patients, and was bilateral in 2.2%. Double hypoglossal canal was significantly more frequent on the left side than right (P = 0.004, odds ratio = 1.79) and in males than females (P = 0.011, odds ratio = 1.67). A larger left or right-sided canal was found in 31.6% and 12.2% of the patients, respectively, following the same side preference as that of double hypoglossal canal. Almost perfect agreement was achieved between the two readers (k = 0.975).In this Japanese population, the prevalence of a double hypoglossal canal was 16.9%, of which 2.2% were bilateral. Double hypoglossal canal was more frequent in males than females, and on the left side than right

Prevalence of double hypoglossal canal.

<p>Prevalence of double hypoglossal canal.</p

Sizes of single hypoglossal canals.

<p>* The left hypoglossal canal in males and females was significantly larger than the right (P < 0.001).</p><p>** The hypoglossal canals in males were significantly larger than those in females (P < 0.001).</p><p>Sizes of single hypoglossal canals.</p

46-year-old female with meningioma had left Double hypoglossal canal.

<p>(a) 3D CT image (b) Oblique sagittal reconstructed CT image showed the right hypoglossal canal. (c) Oblique sagittal reconstructed CT image showed left double hypoglossal canal. (d) Low signal intensity of the right hypoglossal nerve within an enhancing venous plexus was seen on oblique sagittal reconstructed image of contrast enhanced and fat saturation T1WI. (e) Low signal intensity of left hypoglossal nerve within a duplicated enhancing venous plexus was seen on oblique sagittal reconstructed image of contrast enhanced and fat saturation T1WI.</p

Indications for CT angiography of 590 patients.

<p>Indications for CT angiography of 590 patients.</p