SCC antigen and ApoC-II as serum biomarkers of cervical cancer

There are currently no reliable, established serum biomarkers to predict the prognosis of radiotherapy for advanced cervical cancer. We aimed to identify serum biomarkers for survival after radiotherapy for cervical cancer. In this multicenter prospective cohort study, the usefulness of pre- and posttreatment serum protein levels of potential biomarkers, including squamous cell carcinoma antigen (SCC-Ag), apolipoprotein C-II (ApoC-II), matrix metalloproteinase (MMP)1, and MMP2, were evaluated together with clinical factors in 145 cervical cancer patients in order to determine their suitability to predict survival. Progression-free survival (PFS) was the primary endpoint, and overall survival (OS), pelvic PFS (PPFS), and distant metastasis-free survival (DMFS) were the secondary endpoints. Blood samples were collected before and 1 month after radiotherapy to measure serum biomarker levels. ApoC-II was measured using a monoclonal antibody-based enzyme-linked immunosorbent assay, which was developed for this purpose. Kaplan-Meier method, log-rank test, and univariate and multivariate Cox proportional hazards models were used for statistical analyses. In multivariate analysis, larger tumor size was independently associated with shorter PFS, OS, PPFS, and DMFS, while longer overall treatment time was independently associated with shorter PPFS. Higher pretreatment SCC-Ag (P 25.8 μg/ml (P = 0.023, log-rank test). Pre- and posttreatment serum SCC-Ag and pretreatment serum ApoC-II levels may be important biomarkers to predict survival outcomes of patients with cervical cancer after radiotherapy. Pre- and posttreatment SCC-Ag and pretreatment ApoC-II might be useful in clinical settings for screening patients to improve treatment strategies in cervical cancer

CT-based CTVHR for cervical brachytherapy

Our purpose was to develop recommendations for contouring the computed tomography (CT)-based high-risk clinical target volume (CTVHR) for 3D image-guided brachytherapy (3D-IGBT) for cervical cancer. A 15-member Japanese Radiation Oncology Study Group (JROSG) committee with expertise in gynecological radiation oncology initiated guideline development for CT-based CTVHR (based on a comprehensive literature review as well as clinical experience) in July 2014. Extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. The CT-based CTVHR boundaries were defined by each anatomical plane (cranial–caudal, lateral, or anterior–posterior) with or without tumor progression beyond the uterine cervix at diagnosis. Since the availability of magnetic resonance imaging (MRI) with applicator insertion for 3D planning is currently limited, T2-weighted MRI obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. Furthermore, utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. In conclusion, these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of MRI for 3D treatment planning

QOL after RT or OP for uterine cervix cancer

This study aimed to research the post-treatment quality of life (QOL) between radiotherapy (RT)- and operation (OP)-treated early cervical cancer survivors, using separate questionnaires for physicians and patients. We administered an observational questionnaire to patients aged 20–70 years old with Stages IB1–IIB cervical cancer who had undergone RT or OP and without recurrence as outpatients for ≥6 months after treatment. We divided 100 registered patients equally into two treatment groups (n = 50 each). The average age was 53 and 44 years in the RT and OP groups, respectively. The RT group included 34 and 66% Stage I and II patients, respectively, whereas the OP group included 66 and 34% Stage I and II patients, respectively. The OP group included 58% of patients with postoperative RT. Combination chemotherapy was performed in 84 and 48% of patients in the RT and OP groups, respectively. On the physicians’ questionnaire, we observed significant differences in bone marrow suppression (RT) and leg edema (OP). On the patients’ questionnaire, significantly more patients had dysuria and leg edema in the OP group than in the RT group, and severe (Score 4–5) leg edema was significantly higher in the post-operative RT group than in the OP only group. The frequency of sexual intercourse decreased after treatment in both groups. On the patients’ questionnaire, there were no significant differences between the two groups regarding sexual activity. These findings are useful to patients and physicians for shared decision-making in treatment choices. The guidance of everyday life and health information including sexual life after treatment is important

Clinical Results of Proton Beam Therapy for Esophageal Cancer: Multicenter Retrospective Study in Japan

There are few reports about the clinical results of proton beam therapy for esophageal cancer in a large population. The purpose of this study was to evaluate the clinical results of proton beam therapy for esophageal cancer in a large population using a multicentered database. Between January 2009 and December 2013, patients newly diagnosed with esophageal cancer and who had received proton beam therapy were retrospectively recruited from a database of four proton beam therapy centers in Japan. Two hundred and two patients (including 90 inoperable patients) fulfilled the inclusion criteria, and 100 patients (49.5%) had stage III/IV cancer (Union for International Cancer Control 8th). The 3-year and 5-year overall survival rate was 66.7% and 56.3%, respectively. The five-year local control rate was 64.4%. There were two patients with grade three pericardial effusion (1%) and a patient with grade three pneumonia (0.5%). No grade 4 or higher cardiopulmonary toxicities were observed (Common Terminology Criteria for Adverse Events version 4.0). This study suggests that proton beam therapy for esophageal cancer was not inferior in efficacy and had lower rates of toxicities in comparison to photon radiotherapy. Therefore, proton beam therapy can serve as an alternate treatment for patients with esophageal cancer

Clinical Results of Proton Beam Therapy for Esophageal Cancer: Multicenter Retrospective Study in Japan.

There are few reports about the clinical results of proton beam therapy for esophageal cancer in a large population. The purpose of this study was to evaluate the clinical results of proton beam therapy for esophageal cancer in a large population using a multicentered database. Between January 2009 and December 2013, patients newly diagnosed with esophageal cancer and who had received proton beam therapy were retrospectively recruited from a database of four proton beam therapy centers in Japan. Two hundred and two patients (including 90 inoperable patients) fulfilled the inclusion criteria, and 100 patients (49.5%) had stage III/IV cancer (Union for International Cancer Control 8th). The 3-year and 5-year overall survival rate was 66.7% and 56.3%, respectively. The five-year local control rate was 64.4%. There were two patients with grade three pericardial effusion (1%) and a patient with grade three pneumonia (0.5%). No grade 4 or higher cardiopulmonary toxicities were observed (Common Terminology Criteria for Adverse Events version 4.0). This study suggests that proton beam therapy for esophageal cancer was not inferior in efficacy and had lower rates of toxicities in comparison to photon radiotherapy. Therefore, proton beam therapy can serve as an alternate treatment for patients with esophageal cancer

Proton beam therapy is a safe and effective treatment in elderly patients with esophageal squamous cell carcinoma

Background: There are many elderly patients with esophageal squamous cellcarcinoma (ESCC). However, there are currently few articles regarding the clinical outcome following proton beam therapy in these patients. The purpose of this study was to evaluate the clinical results of proton beam therapy in elderlypatients with ESCC.Methods: Between January 2009 and December 2013, patients aged ≥75 yearswho underwent proton beam therapy were examined using multi-institutionaldata from Japan.Results: There were 38 inoperable patients (70.4%) and 16 operable patients(29.6%). More than 40% of patients had stage III/IV ESCC. The five-year overalland cancer-specific survival rates were 56.2% and 71.7%, respectively. Performance status was the only factor that significantly influenced overall survival during the multivariate analysis. The five-year local control rate was 61.8%, and local recurrence occurred within 13 months in 82.4% of patients,. There was no grade 3 or higher toxicity, excluding three patients with grade 3 esophageal ulcers.Conclusions: In conclusion, proton beam therapy may become an alternativetreatment with lower toxicity in elderly patients with ESCC, compared to surgeryor conventional X-ray radiotherapy. This includes inoperable patients

Long-term results of carbon ion radiation therapy for locally advanced or unfavorably located choroidal melanoma: usefulness of CT-based 2-port orthogonal therapy for reducing the incidence of neovascular glaucoma.

To determine the long-term results of carbon ion radiation therapy (C-ion RT) in patients with choroidal melanoma, and to assess the usefulness of CT-based 2-port irradiation in reducing the risk of neovascular glaucoma (NVG)

Insufficiency Fractures after Pelvic Radiotherapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

Purpose/Objective(s): To investigate the pelvic insufficiency fractures (IF) post definitive pelvic radiotherapy for early stage uterine cervicalcancer, we analyzed the subject in a prospective multi-institutional study (JAROG0401/ JROSG04-2).\nMaterials/Methods: Between September 2004 and July 2007, 59 eligible patients, all Japanese, were enrolled. Median age was 73 years (range:37-84 years). The eligible patients had squamous cell carcinoma of the uterine cervix, and FIGO stages were Ib1: 35, IIa: 12, IIb: 12, and no pelvic/paraaortic lymphadenopathy. Protocol treatment consisted of whole pelvic external beam radiotherapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions (at point A) without chemotherapy. After radiotherapy, the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of the IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as the signal intensity changes in the bones, both on T1 and T2 weighted images. The patients also evaluated by CTCAE (Common Terminology Criteria for Adverse Events)-v.3.0 every 3months from 3 until 30 months.\nResults: Median follow-up was 24 months (range: 3-30 months). The 2-year pelvic IF cumulative occurrence rate was 36% (21pts). On CTCAE-v3.0, G1, G2 and G3 were seen in 12 pts (20%), 6 pts (10%), and 3 pts (5%), respectively. Sixteen patients had multiple fractures, so the IF were identified at 44 sites. The pelvic IF were frequently seen at the ileo-cecal joints (32 sites: 72%),and at the pubes (9 sites: 20%). Nine patients complained of pelvic or back pains. All patients\u27 pains were palliated by non-narcotic analgesic drugs.No patients needed surgical intervention. The higher age (>70y) was thought to be a risk factor of pelvic IF (p=0.03, log-rank test).\nConclusions: Older cervical cancer patients received pelvic radiotherapy may have some risks to develop pelvic IF. However, less than a half of the patients with IF complained of pains, and the pains caused by IF were treated effectively by non-narcotic analgesic drugs.52nd ASTRO Annual meetin

Primary central nervous system lymphoma in Japan: Changes in clinical features, treatment, and prognosis during 1985–2004

We have conducted nationwide surveys of primary central nervous system lymphoma (PCNSL) treated since 1985. In the present study, we newly collected data between 2000 and 2004 and investigated changes in clinical features and outcome over time. A total of 739 patients with histologically proven PCNSL undergoing radiotherapy were analyzed. Seventeen institutions were surveyed, and data on 131 patients were collected. These data were compared with updated data that were previously obtained for 466 patients treated during 1985–1994 and 142 patients treated during 1995–1999. Recent trends toward decrease in male/female ratio, increase in aged patients, and increase in patients with multiple lesions were seen. Regarding treatment, decrease in attempts at surgical tumor removal and increases in use of systemic chemotherapy and methotrexate (MTX)–containing regimens were observed. The median survival time was 18, 29, and 24 months for patients seen during 1985–1994, 1995–1999, and 2000–2004, respectively, and the respective 5-year survival rates were 15%, 30%, and 30%. In groups seen during 1995–1999 and during 2000–2004, patients who received systemic or MTX-containing chemotherapy had better prognosis than those who did not. Multivariate analysis of all patients seen during 1985–2004 suggested the usefulness of MTX-containing chemotherapy as well as the importance of age, lactate dehydrogenase level, and tumor multiplicity as prognostic factors. Thus, this study revealed several notable changes in clinical features of PCNSL patients. The prognosis improved during the last 10 years. Advantage of radiation plus chemotherapy, especially MTX-containing chemotherapy, over radiation alone was suggested