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Purpose We developed a system for calculating patient positional displacement between digital radiography images (DRs) and digitally reconstructed radiography images (DRRs) to reduce patient radiation exposure, minimize individual differences between radiological technologists in patient positioning, and decrease positioning time. The accuracy of this system at five sites was evaluated with clinical data from cancer patients. The dependence of calculation accuracy on the size of the region of interest (ROI) and initial position was evaluated for clinical use. Methods For a preliminary verification, treatment planning and positioning data from eight setup patterns using a head and neck phantom were evaluated. Following this, data from 50 patients with prostate, lung, head and neck, liver, or pancreatic cancer (n = 10 each) were evaluated. Root mean square errors (RMSEs) between the results calculated by our system and the reference positions were assessed. The reference positions were manually determined by two radiological technologists to best‐matching positions with orthogonal DRs and DRRs in six axial directions. The ROI size dependence was evaluated by comparing RMSEs for three different ROI sizes. Additionally, dependence on initial position parameters was evaluated by comparing RMSEs for four position patterns. Results For the phantom study, the average (± standard deviation) translation error was 0.17 ± 0.05, rotation error was 0.17 ± 0.07, and ΔD was 0.14 ± 0.05. Using the optimal ROI size for each patient site, all cases of prostate, lung, and head and neck cancer with initial position parameters of 10 mm or under were acceptable in our tolerance. However, only four liver cancer cases and three pancreatic cancer cases were acceptable, because of low‐reproducibility regions in the ROIs. Conclusion Our system has clinical practicality for prostate, lung, and head and neck cancer cases. Additionally, our findings suggest ROI size dependence in some cases.

Background/aim To analyze the accuracy of patient positioning and dose distribution quality using a fiducial marker-matching technique in carbon-ion radiotherapy (C-ion RT) for stage I lung cancer. Patients and methods Thirteen patients with 26 fiducial markers and 104 radiation fields were examined. Change in the fiducial marker position coordinates from the gross tumor volume center (Δm), and change in the water-equivalent path length of the chest wall (ΔWEL) were measured in each radiation field. Criterion for an acceptable change in dose distribution was defined as the percentage of D95 (%D95) at gross tumor volume greater than 90% of the prescribed dose. Results Thirteen radiation fields (12.5%) were classified as unacceptable. Δm and ΔWEL had significant negative correlations with %D95 and thus were significant factors related to unacceptable irradiation fields. Conclusion Patient positioning using a fiducial marker-matching technique resulted in 12.5% of radiation fields demonstrating unacceptable degradation due to Δm and ΔWEL.

Background and purpose Patient positioning was compared by tumor matching (TM) and conventional bony structure matching (BM) in carbon ion radiotherapy for stage I non-small cell lung cancer to evaluate the robustness of TM and BM in determining interfractional error. Material and methods Sixty irradiation fields were analyzed. Computed tomography (CT) images acquired before treatment initiation for confirmation (Conf-CT) were obtained under the same settings as the treatment planning CT images and used to evaluate both positioning methods. The dose distributions were recalculated for Conf-CT using both BM and TM, and the dose–volume histogram parameters [V 95% of clinical target volume, V 5Gy(RBE) of normal lung, and acceptance ratio (ratio of cases with V 95% > 95%)] were evaluated. The required margin, which in 90% of cases achieved the acceptable condition, was also examined. Results Using BM and TM, the median V 95% was 98.93% and 100% ( p 5Gy(RBE) was 135.9 and 125.8 ( p = 0.694), respectively. The estimated required margins were 7.9 and 3.3 mm and increased by 53.9% and 2.5% of V 5Gy(RBE) , respectively, compared with planning. Conclusions TM ensured a better dose distribution than did BM. To enable TM, volumetric imaging is crucial and should replace 2D radiographs for carbon therapy of stage I lung cancer.

症例は42歳の男性で, 胸部中部進行食道癌に対し術前化学放射線療法を施行後, 右開胸開腹食道亜全摘, 3領域リンパ節郭清 (胸管温存) を行った. 第3病日より胸腔ドレーンの排液が急増し, 翌日経腸栄養を開始したところ排液が白濁したため乳糜胸と診断した. 同日総排液量は1,800mlに達し循環動態に影響が出たため手術を施行した. 下縦隔で胸管をクリッピングしたが上縦隔からの乳糜漏出は停止せず, 上縦隔左側を展開し胸管の乳糜漏出部を確認し, その足側をクリッピングして漏出を停止できた. しかし, 翌日にはドレーンから再度多量の乳糜流出が認められたため, オクトレオチド50μg×3回/日の間歇皮下投与を試みた. 2日目から排液は著明に減少し, 計8日間漸減投与し中止としたが乳糜漏の停止が確認され退院できた. 食道癌術後の乳糜胸には難渋することがあるが, オクトレオチド間歇皮下投与は, 副作用も認められず試みる価値があるものと思われた.

腫瘍はさまざまなサイトカインを産生し,その進展を促すとともに随伴症状を呈する.今回,胃癌術後類白血病反応を呈したG-CSF, IL-6を産生する再発例を経験した.症例は55歳,男性.平成13年12月胃全摘術が施行され,翌年11月より39°C台の発熱, WBC, CRP, CEA, CA19-9などの著明な上昇を認めた.骨髄検査では,反応性の骨髄過形成以外異常所見はみられず血液疾患は否定された.左腎上極外側に6×4cmの腫瘤を認め,組織学的に胃癌の再発腫瘍と診断された.また,腫瘍の細胞質にG-CSF, IL-6の陽性所見を認め各血清値 (242.0pg/ml, 60.3pg/ml) への反映が示唆された.病状はしだいに進行し類白血病反応を呈するとともに,癌性悪液質のため平成15年1月永眠された.死亡前の白血球数114,960/μl, CRP 16.18mg/dl, CEA 229.79ng/ml, CA19-9 491.57U/mlまで上昇した.術後の急速な進展と生体反応は, G-CSFおよびIL-6の強い影響が示唆された.

Objective: We compared the efficacy of plastic prostheses and self-expandable metallic stents in the treatment of malignant esophageal stenosis and/or fistula.Subjects and Methods: Subjects were 31 patients with esophageal cancer, 4 with esophagotracheal fistula, and 1 with esophageal stenosis. A plastic prosthesis was inserted in 15 patients (group A) and a self-expandable metallic stent in 21 patients (group B). We evaluated food ingestion improvement, effectiveness, complications, mean survival, food ingestion duration, the percentage of food ingestion capability in total survival time, and inhospital mortality.Results: No differences were seen in food intake improvement or in the effectiveness between groups, whereas fatal complications were higher in Group A. No significant differences were seen in mean survival, food ingestion duration, percentage of food ingestion capability, or inhospital mortality between groups.Conclusion: We concluded that a self-expandable metallic stent was safer than a plastic prosthesis because of fewer serious complications such as bleeding, and recommended the use of metallic stents in the treatment of malignant esophageal stenosis and/or fistula.

A method for hand-assisted laparoscopic construction of gastric conduit for thoracic esophageal cancer was developed. Since this endoscopic surgical procedure is less invasive than open surgery, it contributes to improvement of post-operative respiratory functions and reduces respiratory complications. What distinguishes our surgical procedure is that unlike methods described in previous reports, it begins with treatment of the left gastroepiploic vessels at the height of the inferior edge of the spleen, followed by dissection from the esophageal hiatus to the lesser curvature and then dissection and excision of left gastric arteries and veins. Finally, the exposed esophagus and stomach are drawn outside the body and the right gastroepiploic blood vessels are preserved, followed by dissection of the greater omentum. This approach to gastric conduit construction was undertaken in 6 patients and the mean operating time was 123 minutes. Although in the first 3 of these patients the operating time was 150 minutes or more, the time required shortened to around 90 minutes for each of the last 3 cases, as the procedure was mastered. In each case, the volume of intraoperative hemorrhage did not exceed 50 ml.

We encountered 588 patients with esophageal carcinoma between 1986 and 1998. For 96 (16.4%) of the patients 75-year-old or older, we examined the features and issues of esophageal carcinoma in elderly people based on preoperative conditions and treatment results. 1) Cardiac dysfunction was observed in 39 patients (40.6%). Concerning respiratory function, there was a significant difference in forced expiratory volume in 1 second (FEV1.0%) and % vital capacity (%VC) compared to patients under 75 years of ages (t-test). Furthermore, disorders of several organs were observed in 31 patients (32.2%). 2) Eleven patients underwent right thoracotomy and laparotomy. Three (25%) of these patients died in hospital postoperatively. The 3-year survival rate was 27.3%. 3) Fourteen patients underwent esophagectomy. Four (28.6%) of these patients died in hospital. The 3-year survival rate was 7.7%. 4) In 66 patients who did not undergo resection, the 3-year survival rate was 11.7%. 5) With respect to postoperative complications, the incidences of pulmonary complications and postoperative delirium were high. Some patients died during surgery or during hospitalization. Careful perioperative management is important. 6) There was no significant difference in long-term results between treatment methods. However, none of the patients who underwent C0 surgery survived more than 2 years. Therefore, this procedure should be avoided if possible.

Background. It is becoming clear that various cytokines are associated with the spread of cancer cells. The purpose of this study was to compare interleukin (IL)-6 levels in patients with gastric cancer to elucidate the role of IL-6 in predicting the spread of tumors. Methods. In 60 patients, we assessed the correlation of serum IL-6 (pg/ml) with stage, histological findings, hepatic metastasis, and related factors (hepatocyte growth factor [HGF], IL1� , tumor necrosis factor [TNF]-α, and transforming growth factor [TGF]-� 1). We also investigated the diagnostic significance of the IL-6 level for advanced gastric cancer and lymph node metastasis, as well as the association between IL-6 elevation and outcome. Finally, we examined the expression of IL-6 in tumor tissue. Results. Significant relationships were seen between serum IL-6 and stage, depth of tumor invasion (pT), lymphatic invasion (ly), venons invasion (v)*, lymph node metastasis (pN), hepatic metastasis (cH), and HGF (P 0.01; *P 0.05). With regard to the diagnostic significance of the IL-6 level for advanced gastric cancer and lymph node metastasis, when the cutoff value of IL-6 was set at 1.97 pg/ml, the sensitivity was 81.8% and 87.5%; specificity was 66.7% and 58.3%; and accuracy was 77.1% and 72.9%, respectively. The 1- and 3-year cumulative survival rates for patients with an IL-6 value of more than 1.97 pg/ml (69.0% and 43.4%, respectively) were significantly lower than those for patients with an IL-6 value of 1.97 pg/ml or less (94.4% and 87.2%, respectively; P 0.05). Immunohistochemical staining was positive for IL-6 in the cytoplasm of cancer cells. Conclusion. We suspect that IL-6 is involved in cancer invasion and lymph node and/or hepatic metastasis. Our results indicate that IL-6 could be used as a prognostic factor for survival.