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Stereotactic body radiotherapy (SBRT) uses hypofractionated and more precise irradiation methods, and has the advantages of shorter duration, better outcomes, and fewer side effects than conventional radiotherapy. However, the optimal dosage remains unclear. The purpose of the study was to analyze our preliminary treatment results and safety. We retrospectively analyzed 32 patients (primary cancer, 22 ; metastatic cancer, 10) who underwent SBRT for pulmonary tumors at our hospital from April 2015 to June 2020. SBRT was performed with escalated dose prescriptions (up to 55Gy in 4 fractions/64Gy in 8 fractions for peripheral/central lesions, respectively). We evaluated the local control rate (LC rate), overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), and adverse events. The target lesions comprised 22 primary lung cancers and 13 metastatic lung cancers. The 2-year LC, OS, PFS, and DSS rates were 82.5%, 68.3%, 50.5%, and 88.0% for primary lung cancer patients and 83.1%, 29.9%, 23.1%, and 48.6% for metastatic lung cancer patients, respectively. Five cases of radiation pneumonitis of grade 2 or higher, one of grade 1 dermatitis and 1 of esophagitis were observed as adverse events. We showed that the treatment outcomes of SBRT for primary and metastatic lung cancers were mostly acceptable.

To address the major issue of regional disparity in the treatment for elderly cancer patients in an aging society, we compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. Using the national database of hospital‐based cancer registries in 2008‐2011, patients aged 75 years or older who had been diagnosed with thoracic esophageal cancer were enrolled. We divided the patients into two groups: those treated in metropolitan areas (Tokyo, Kanagawa, Osaka, Aichi, Saitama, and Chiba prefectures) with populations of 6 million or more and those treated in other areas (the other 41 prefectures). Compared were patient backgrounds, treatment strategies, and survival curves at each cancer stage. In total, 1236 (24%) patients from metropolitan areas and 3830 (76%) patients from nonmetropolitan areas were enrolled. Patients in metropolitan areas were treated at more advanced stages. There was also a difference in treatment strategy. The 3‐year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. For cStage II‐IV patients, there were no differences. Multivariable Cox proportional hazard analysis including interaction terms between treatment areas, cStage, and the first‐line treatments revealed that treatments in the metropolitan areas were significantly associated with better survival among patients treated with radiotherapy alone for cStage I cancer. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions., We compared the treatment strategies used for elderly patients with thoracic esophageal cancer and their survival outcomes in metropolitan areas and other regions. The 3‐year survival rate among cStage I patients was better in metropolitan areas (71.6% vs. 63.7%), and this finding mainly reflected the survival difference between patients treated with radiotherapy alone. Treatment strategies for elderly patients with thoracic esophageal cancer and its survival outcomes differed between metropolitan areas and other regions.

We evaluated treatment outcomes of external beam radiation therapy (EBRT) for unresectable locally advanced thyroid cancer (LATC) with or without metastasis. We enrolled 11 LATC patients who underwent EBRT (median age: 76 (45–83) years, six males and five females). Eastern Cooperative Oncology Group performance statuses of 0 (n = 3), 1 (n = 1), 2 (n = 6), and 3 (n = 1) were observed. Histologic types included papillary carcinoma (n = 5), anaplastic carcinoma (n = 3), and squamous cell carcinoma (n = 3). The organs invaded by the tumor that caused it to be deemed unresectable were common carotid artery (n = 5), trachea (n = 4), aorta (n = 1) and larynx (n = 1). The median follow-up time was 6 months. One, seven, two, and one patient showed complete response (CR), partial response (PR), stable disease, and progressive disease, respectively. The rate of local CR+PR was 73%, moreover, 75% of patients achieved a &gt, 30% tumor size reduction within 6 months. The median local progression-free survival of patients with local CR+PR was 11.5 (4–68) months. The median overall survival was 6 (1–68) months. Grade 3 acute complications occurred in five (45%) patients. No patients had Grade 4 or 5 complications. In conclusion, EBRT reduced the tumor volume in 75% of LATC patients without inducing severe toxicity. This therapy should be considered as a treatment option for LATC.

Background Determining the appropriate gross tumor volume is important for irradiation planning in addition to palliative radiation for bone metastases. While irradiation planning is commonly performed using simulation computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, and 18fluorodeoxyglucose-positron emission tomography-CT (18FDG-PET-CT) are more sensitive for detecting bone metastasis and invasion areas. Therefore, this study evaluated whether pretreatment imaging modalities influenced the response to palliative radiation therapy (i.e., the irradiation effect) for painful bone metastases from solid malignant carcinomas. Methods Consecutive patients with painful bone metastases treated with palliative radiation between January 2013 and December 2017 at our institution were included. We retrospectively investigated the pretreatment images from the different imaging modalities (CT, MRI, bone scintigraphy, and 18FDG-PET-CT) obtained between 1 month before and the initiation of palliative radiation and determined the primary site of carcinoma, histological type, metastatic lesion type (osteolytic, osteoblastic, or mixed), pathological fracture, and metastatic site (vertebral or not). We then evaluated the relationship between these factors and treatment response. We defined “response” as the condition in which patients achieved pain relief or reduced the use of painkiller medicines. Results In total, 131 patients (78 men and 53 women) were included; the median age was 66 years (range, 24–89 years). Prescribed doses were 8–50 Gy/1–25 fractions with 2–8 Gy/fraction. Among the 131 patients, 105 were responders (response rate, 80%). The imaging modalities performed before irradiation were CT in 131 patients, MRI in 54, bone scintigraphy in 56, and 18FDG-PET-CT in 14. The Welch t-test and chi-square test showed no significant association between treatment response and each factor. Multiple logistic regression analysis including the imaging modality, metastatic site, and pathological fracture also showed no significant association with each factor. Conclusions There was no significant relationship between the type of pretreatment imaging and treatment response for painful bone metastases. Thus, setting the appropriate radiation field according to CT images and clinical findings could help avoiding further image inspection before palliative radiation for painful bone metastases.

Simple Summary This study aimed to clarify the efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy with three-field lymph node (LN) dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. We observed that NACRT followed by esophagectomy with three-field lymph node dissection is feasible and offers the potential for long-term survival of these patients. It is also suggested that supraclavicular LNs should be treated as regional LNs at least in patients with upper and middle thoracic esophageal squamous cell carcinoma (ESCC). Abstract Background: Neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy is now the standard treatment for patients with resectable advanced thoracic esophageal squamous cell carcinoma (ESCC) worldwide. However, the efficacy of NACRT followed by esophagectomy with three-field lymph node dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis has not yet been determined. Methods: Between 2008 and 2018, 94 ESCC patients diagnosed as clinical Stage III and 18 patients diagnosed as clinical Stage IVB with supraclavicular LN metastasis as the only distant metastatic factor were treated with NACRT followed by esophagectomy with extended lymph node dissection at Akita University Hospital. Long-term survival and the patterns of recurrence in these 112 patients were analyzed. Results: The median follow-up period of censored cases was 60 months. The five-year OS and DSS rates among the clinical Stage III patients were 57.6% and 66.6%, respectively. The five-year OS and DSS rates among the clinical Stage IVB patients were 41.3% and 51.6%, respectively. The most frequent recurrence pattern was distant metastasis (69.2%) in the Stage III patients and LN metastasis (75.0%) in the Stage IVB patients. Conclusion: NACRT followed by esophagectomy with three-field LN dissection is feasible and offers the potential for long-term survival of clinical Stage III ESCC patients and even clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. At least in patients with upper and middle thoracic ESCC, treating supraclavicular LNs as regional LNs seems to be appropriate.

The differences in prognoses or progression patterns between T4b non-N4 and non-T4b N4 esophageal squamous cell carcinoma post chemoradiotherapy (CRT) is unclear. This study compared the outcomes of CRT for stage IVa esophageal squamous cell carcinoma according to T/N factors. We retrospectively identified 66 patients with stage IVa esophageal squamous cell carcinoma who underwent definitive CRT at our center between January 2009 and March 2013. The treatment outcomes, i.e., progression patterns, prognostic factors, and toxicities based on version 5.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events, were studied. The patients (56 men and 10 women) had a median age of 67 (range: 37&ndash, 87) years. The T/N classifications were T4b non-N4 (28/66), non-T4b N4 (24/66), and T4b N4 (14/66). Objective response was achieved in 57 patients (86.4%, (95% confidence interval, 74.6&ndash, 94.1%)). There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, and progression pattern. We found no significant differences in prognoses or progression patterns among patients with T4b non-N4, non-T4b N4, and T4b N4 esophageal squamous cell carcinoma. Thus, it seems impractical to modify CRT regimens based on T/N factors.

Background: Based on the Japanese classification of esophageal cancer, Stage IVa involves locally advanced T4b disease and/or lymphatic spread (N4). Stage IVa disease is generally treated using chemoradiotherapy (CRT) for patients in good condition. However, it is unclear whether there are differences in prognoses or progression patterns between T4b non-N4 and non-T4b N4 cases. This study compared the outcomes of CRT for Stage IVa esophageal cancer according to T/N factors.Methods: We retrospectively identified 68 patients with Stage IVa esophageal cancer who underwent definitive CRT at our center between January 2009 and March 2013. The patients’ medical records, diagnostic images, and radiation plans were reviewed, as well as their treatment outcomes, progression patterns, prognostic factors, and toxicities evaluated based on version 5.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events.Results: The 68 patients (58 men and 10 women) included had a median age of 67 years (range: 37–87 years). The histological classifications were squamous cell carcinoma (66 patients), adenocarcinoma (one patient), and verrucous carcinoma (one patient). The T/N classifications were T4b non-N4 (29 patients), non-T4b N4 (25 patients), and T4b N4 (14 patients). Local control (complete or partial response) was achieved in 58 patients (85%). The median overall survival was 13 months (2-year rate: 32.1%) and the median progression-free survival was 7 months (2-year rate: 16.4%). We did not manage to detect significant differences between the T/N groups in terms of overall survival, progression-free survival, and progression pattern. Multivariate analyses revealed that independent prognostic factors were nadir hemoglobin and nadir albumin during the CRT period, as well as performance status at CRT initiation. Grade 3 or worse toxicities were observed in 55 patients (81%), and five patients died because of treatment-related adverse events.Conclusion: At our center, there were no significant differences in prognoses or progression patterns among patients with T4b non-N4, non-T4b N4, and T4b N4 esophageal cancer. Thus, it seems impractical to modify CRT regimens based on T/N factors, and delivering sufficient doses of both radiotherapy and chemotherapy is important for adequately treating Stage IVa esophageal cancer regardless of T/N factors.

Boron neutron capture therapy (BNCT) can potentially deliver high linear energy transfer particles to tumor cells without causing severe damage to surrounding normal tissue, and may thus be beneficial for cases with characteristics of infiltrative growth, which need a wider irradiation field, such as glioblastoma multiforme. Hypoxia is an important factor contributing to resistance to anticancer therapies such as radiotherapy and chemotherapy. In this study, we investigated the impact of oxygen status on 10B uptake in glioblastoma cells in vitro in order to evaluate the potential impact of local hypoxia on BNCT. T98G and A172 glioblastoma cells were used in the present study, and we examined the influence of oxygen concentration on cell viability, mRNA expression of L-amino acid transporter 1 (LAT1), and the uptake amount of 10B-BPA. T98G and A172 glioblastoma cells became quiescent after 72 h under 1% hypoxia but remained viable. Uptake of 10B-BPA, which is one of the agents for BNCT in clinical use, decreased linearly as oxygen levels were reduced from 20% through to 10%, 3% and 1%. Hypoxia with

A reliable marker of the sensitivity of esophageal cancer to chemoradiotherapy (CRT) as well as a personal biomarker predictive of adverse events during treatment has long been sought. The purpose of the present study was to test whether there is an association between interleukin-6 (IL-6) and/or monocyte chemoattractant protein-1 (MCP-1) polymorphisms and CRT-induced bone-marrow suppression––i.e., reductions in white blood cell and/or platelet counts. The study participants were 103 Japanese patients treated with definitive or pre-operative CRT for squamous cell esophageal cancer at Akita University Hospital. The patients were divided into two groups, with or without adverse events during or up to 1 month after CRT. Patient backgrounds––i.e., white blood cell and platelet counts before CRT and doses of chemotherapy and irradiation––did not differ between groups. However, there was a significantly higher incidence of grade 2–4 platelet count reductions ( G and MCP-1 −2518A>G polymorphisms were significantly associated with grade 2–4 platelet count reductions following CRT. These polymorphisms may thus be clinically relevant and should be taken into consideration when devising CRT regimens or treatment strategies for esophageal cancer.

This multi-institutional study was conducted to clarify the clinicopathological features of squamous cell carcinomas of the vulva.The medical records of vulvar cancer patients treated between 2002 and 2012 were retrospectively reviewed following approval by the Institutional Review Board of each institution.One hundred and eleven patients with vulvar malignancies were included. Of these, 63 patients had squamous cell carcinoma (57 %). Initial treatment was surgery, radiation therapy (RT), and concurrent chemoradiotherapy (CCRT) in 34 (54 %), 15 (24 %), and 11 (17 %) patients, respectively. Nineteen, 11, 26, and 7 patients had stage I, II, III, and IV disease, respectively. Of the 34 patients who had surgical treatment, 50 % had stage I disease, while 74 % of those who received CCRT had stage III or IV disease. Complete response (CR) rates for the surgery, RT, and CCRT groups were 73, 60, and 64 %, respectively. The 5-year survival rates for stage I/II and III/IV disease were 64 and 39 %, respectively (P = 0.019). The 5-year survival rates for the surgery, RT, and CCRT groups were 53, 38, and 50 %, respectively, and the prognosis of patients treated with surgery or CCRT was significantly better than that of patients who received RT (P0.05). In multivariate analysis, clinical response to initial treatment was an independent prognostic factor (P0.001).Although many patients had advanced-stage disease in the CCRT group, the therapeutic outcome for the surgery and CCRT groups was similar. Thus, CCRT may be a promising treatment for squamous cell carcinoma of the vulva.

Aim We investigated which is the stronger predictor, pathological response or metabolic response, for survival outcome in patients treated with neoadjuvant chemoradiotherapy (NACRT) plus esophagectomy for thoracic esophageal squamous cell carcinoma (TESCC). Patients and methods Fifty consecutive patients with cStage IIB-IV TESCC were enrolled. We analyzed the pathological response and metabolic response (fractional decrease in tumor maximum standardized uptake value) to NACRT. Independent prognostic factors predictive of 3-year survival were investigated using univariate and multivariate analyses. Results Among the 50 patients, 10 (20%) showed a pathological complete response (in both tumor and lymph nodes) and 36 (72%) showed grade 2-3 pathological response. Univariate analysis showed that age, gender, cT stage, pathological response and metabolic response to be significant prognostic factors. A subsequent multivariate analysis confirmed metabolic response and gender to be significant prognostic factors. Conclusion Metabolic response for NACRT was an independent prognostic factor and a more powerful predictor of survival compared to pathological response.

Small cell carcinoma (SCCB) of the bladder is rare and has a poor prognosis. Because of its rarity, gold standard care has not been established. The purpose of this study was to analyze the feasibility of a bladder-sparing approach. Data for treatments and outcomes in patients with a diagnosis of SCCB who received bladder-sparing treatment in our facility in the period from February 2007 to August 2012 were retrospectively analyzed. Six eligible patients received definitive radiotherapy in the cancer network of Tohoku region. Mean age of the patients was 69.5 years (range: 44 - 83 years), and median follow-up period was 29.2 months (range: 4.1 - 54.5 months). The mean dose was 60 Gy (range: 60 to 63 Gy), and 1.2 - 2.0 Gy was given per fraction. The initial CTV was the whole pelvis or the small pelvis, and it was shrunk to the bladder or tumor as a boost. The 1-year and 3-year overall survival rates were 83.3% and 55.6%, respectively. The 1-year and 3-year local control rates were both 80.0%. Only one patient had local failure. Recurrence or metastasis in sites other than the brain occurred in three (50%) of the patients after primary treatment. Two of those patients did not receive any chemotherapy. None of the patients had serious toxicities, and the bladder could be preserved in all patients. In this study, radiotherapy was effective for patients with SCCB. There was no recurrence in the bladder, and it was possible to preserve the bladder in all patients. Distant metastases were observed frequently, and chemotherapy was considered to be essential. Local treatment with radiotherapy has an important role from the point of view of the patient’s QOL.

We investigated the effectiveness of chemoradiotherapy for the treatment of lymph node recurrence and hematogenous metastasis after esophagectomy for esophageal squamous cell carcinoma. Between 2001 and 2006, 216 patients with thoracic esophageal squamous cell carcinoma had curative esophagectomy. Of those, 23 with lymph node recurrence received chemoradiotherapy (50.0-68.8 Gy). In addition, five patients had isolated recurrences in a distant organ and received chemoradiotherapy (50.0-60.0 Gy). We analyzed outcomes from the radiotherapy for recurrent esophageal cancer. The 1-, 2-, and 5-year survival rates after recurrence for the 23 patients whose lymph node recurrence was treated with chemoradiotherapy were 52, 31, and 24%, respectively, and the median survival time was 13 months. Among the five patients with recurrent tumors in a distant organ, chemoradiotherapy produced a complete response in two patients, a partial response in one patient, and stable disease in two patients, giving an effectiveness rate of 60% (complete response + partial response). Chemoradiotherapy has a beneficial prognostic effect in patients with lymph node recurrence of esophageal squamous cell carcinoma. Chemoradiotherapy for a metastatic tumor in a distant organ may be the treatment of choice in cases where systemic chemotherapy has proven ineffective.

The current study was a retrospective questionnaire survey of stage IIIb adenocarcinoma of the uterine cervix treated with high-dose-rate intracavitary brachytherapy combined with external beam radiation therapy in Japan aimed to investigate the optimal dose on the basis of the biological effective dose and prognostic factors.Between 1990 and 2000, 61 patients with stage IIIb adenocarcinoma of the uterine cervix underwent high-dose-rate intracavitary brachytherapy combined with external beam radiation therapy in 19 major hospitals in Japan. This retrospective questionnaire survey was performed by mail including survey charts to be fulfilled by radiation oncologists in these 19 major hospital. Fifty had only adenocarcinoma components and 11 had adenosquamous cell carcinoma components. All patients were treated with high-dose-rate intracavitary brachytherapy combined with external beam radiation therapy. Total biological effective dose (T-BED(10)) was calculated from the sum of the biological effective doses of the external beam radiation therapy and the intracavitary brachytherapy. Thirty-two patients underwent chemotherapy.The 5-year overall survival rate of all patients was 20.2%. Stratified by total biological effective dose, the 5-year overall survival rate was 0% for T-BED(10)75 Gy, 24.7% for T-BED(10) between 75 and 100 Gy and 0% for T-BED(10)110 Gy (P = 0.15). Stratified by histopathology, the 5-year overall survival rate was 22.1% for adenocarcinoma and 13.6% for adenosquamous cell carcinoma (P = 0.43). Stratified by chemotherapy, the 5-year overall survival rate was 20.3% in patients who received chemotherapy and 20.4% in patients who did not receive chemotherapy (P = 0.96).The 5-year overall survival rate of stage IIIb adenocarcinoma of the uterine cervix in this retrospective questionnaire survey was 20.2%. The optimal T-BED(10) and evident prognostic factors were not clear from this questionnaire survey.

A reliable marker of chemoradiosensitivity that would enable appropriate and individualized treatment of thoracic squamous cell esophageal cancer has long been sought. We investigated whether regenerating gene (REG) Ialpha is such a marker.We assessed expression of REG Ialpha in untreated endoscopic biopsy specimens and examined the correlation between REG Ialpha expression and the clinical responses to definitive chemoradiotherapy and prognosis. We also examined the relationship between REG Ialpha expression in the resected tumor and the prognosis of patients who received esophagectomy for thoracic squamous cell esophageal cancer.Among the 42 patients treated with definitive chemoradiotherapy, 8 of the 23 REG I-positive patients (35%) showed complete responses to chemoradiotherapy, while only one of the 19 REG I-negative patients did so. The survival rate among the REG I-positive patients was significantly better than among the REG I-negative patients. For the 76 patients treated surgically, there was no significant difference in the survival rates among the REG I-positive and REG I-negative patients.REG Ialpha expression in squamous cell esophageal carcinoma may be a reliable marker of chemoradiosensitivity. We anticipate that it will enable us to provide more appropriate and individualized treatment to patients of advanced esophageal squamous cell carcinoma.

In 216 patients who underwent stereotactic irradiation (STI), MRI was performed 4–12 times for 17–29 months after STI. Frequency of new radiation-induced lesions more than 2 cm in diameter on sequential MRI following STI, and characteristics on sequential MRI findings were investigated. Ten patients displayed new lesions following STI. These patients comprised eight of 208 patients with intracranial neoplasm and two of seven patients with AVM. Lesions appeared 1–12 months after STI. The lesions appeared near primary lesions in nine patients. Contrast-enhancement was seen along the cerebral cortex in three patients. Sequential MRI is effective in detecting radiation-induced lesions following STI.

Purpose: To evaluate the treatment outcomes of chemoradiotherapy for patients with advanced esophageal cancer and estimate the prognostic factors. Materials and methods: Patients with advanced esophageal cancer, who were treated with chemoradiotherapy (CRT) between April 2003 and December 2010, were evaluated. Patients received concurrent chemoradiotherapy (cisplatin plus 5-fluorouracil and 61.2 Gy radiotherapy). Therapeutic response, overall survival time, and toxicity were examined and statistical evaluation was performed. Results: One hundred and fourteen patients were treated with CRT. Among them, 84 patients (77.2%) received the complete course of CRT. Eighteen patients (15.8%) had a complete response, 90 patients (78.9%) had a partial response and 6 patients (5.3%) exhibited progressive disease. The mean follow-up period was 14.6 months (range, 2-90 months). The median overall survival time was 13.0 months. The 2-year and 3-year overall survival rates were 38.1% and 19.2%, respectively. Severe hematological toxicities included Grade 3 leukopenia in 40 patients (35.1%). Treatment-related death was estimated to have occurred in 7 patients. Performance status and body weight loss were identified as significant prognostic factors. Conclusion: In our study, PS and body weight loss showed prognostic factors in CRT for advanced esophageal cancer.

To evaluate treatment outcomes of chemoradiotherapy for patients with stage IVA esophageal cancer and to estimate prognostic factors.Patients with stage IVA esophageal cancer treated with chemoradiotherapy between April 2003 and March 2009 were evaluated. Patients received concurrent chemoradiotherapy comprising cisplatin plus 5-fluorouracil and 61.2 Gy of radiotherapy. Therapeutic response, overall survival time, and toxicity were examined and statistical evaluation was performed.Ninety patients were treated using chemoradiotherapy. Among these, 71 patients (78.9 %) received the complete course of chemoradiotherapy. Seventeen patients (18.9 %) showed complete response, 64 patients (71.1 %) had partial response, 7 patients (7.8 %) experienced no change, and 2 patients (2.2 %) exhibited progressive disease. Mean duration of follow-up was 16.1 months (range 2-88 months). Median overall survival was 12.8 months. Two- and 3-year overall survival rates were 35.1 and 18.6 %, respectively. Severe hematological toxicities included Grade 3 leukopenia in 33 patients (36.7 %). Treatment-related death was estimated to have occurred in 7 patients. Performance status and body weight loss were identified as significant prognostic factors.Our treatment outcomes appeared similar to those of previous studies that used chemoradiotherapy for advanced esophageal cancer. This treatment is useful for stage IVA esophageal cancer.

Objective Changes in apparent diffusion coefficient (ADC) in a tumor and peritumoral tissue after stereotactic irradiation (STI) were evaluated, and then the therapeutic efficacy of ADC measurement was assessed. Methods In 20 tumors, diffusion-weighted imaging within 1 week before and 2-4 weeks after STI was performed. The normalized ADC (nADC) was measured. The nADCs in the tumor and peritumoral region before STI were compared with those after STI and the change in tumor nADC compared with the change in tumor size. Results The nADC of the tumors was significantly higher 2-4 weeks after STI compared with that before STI. The nADC of the peritumoral regions 2-4 weeks after STI did not differ significantly from that before STI. A significant difference in the nADC at 2-4 weeks after STI was observed between the responder and nonresponder groups. Conclusions Changes in nADC as measured by diffusion-weighted imaging can predict response to STI.

Purpose: To determine whether thallium-201 SPECT can predict response to stereotactic irradiation (STI) earlier than magnetic resonance imaging (MRI), the change in tumor size measured by MRI was compared with the change in tumor activity measured by T1-201 SPECT before and after STI. Materials and Methods: Twenty-one tumors in 16 patients with intracranial tumors were treated by STI. T1-201 SPECT was performed within 1 week before the beginning of STI and within 1 week after the end of STI in all patients. All patients underwent MRI within 1 week before the beginning of STI, and 14 patients (19 tumors) underwent MRI within 1 week after the end of STI. Follow-up MRI was performed 1 to 2 months after the end of STI in 14 patients (16 tumors). The activity of T1-201 in the tumor divided by that of the uninvolved symmetric area was defined as the Tl-index. The change in tumor size immediately and I to 2 months after STI was compared with the change in T1-index immediately after STI. Results: No significant relationship between the ratio of tumor size immediately after STI and the ratio of T1-index immediately after STI was found. A significant correlation (r = 0.69, P

From January 1988 to January 1993, 45 patients with unresectable advanced hepatocellular carcinoma (HCC) were treated with a new combination therapy consisting of arterial infusion chemotherapy and TAE. The combination therapy was performed according to our treatment schedule as follows: two courses of arterial infusion chemotherapy were given first, and then transcatheter arterial embolization (TAE) using a mixture of Lipiodol and cisplatin powder was performed. Two arterial infusion chemotherapeutic regimens were employed: EPF (etoposide, cisplatin, and 5-fluorouracil) and EAP (etoposide, Adriamycin or Epi-adriamycin, and cisplatin). The anticancer drugs were infused through a catheter inserted into the proper or common hepatic artery. Assessment was made of the anticancer effect and survival rate of each treatment method. The response to each therapy was evaluated on the basis of CT performed prior to and after the treatment. In the EPF·TAE group, the response rate was about 46%, whereas in the EAP·TAE group it was 48%. Overall, 21 of 45 patients attained a regression rate of 50% or more. Furthermore, daughter nodules decreased in size or disappeared in about 67% of 15 patients. Additionally, tumor thrombi tended to show a similar response. In all of the cases, the average duration of survival was 30.3 months, and the 1-year survival value was 68%, the 2-year survival value was 44%, and the 3-year survival value was 35%. These results were superior to those obtained with TAE therapy alone.

Highlights • Two esophageal cancer patients developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil. • Volume expansion remains the most effective strategy for prevention of cisplatin nephrotoxicity. • The two patients described here received sufficient drip infusion and produced good urine volumes. • In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover., Introduction We experienced two esophageal cancer patients who developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil. Presentation of case After administration of cisplatin, their serum creatinine increased gradually until they required hemodialysis and their renal failure was permanent. In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover. After these events, one patient underwent definitive radiotherapy and the other underwent esophagectomy for their esophageal cancers, while continuing dialysis. Both patients are alive without cancer recurrence. Discussion In these two cases of cisplatin-induced renal failure, renal biopsy examination showed only slight disorder of proximal tubules and tendency to recover. Conclusion Although cisplatin-related nephrotoxicity is a well-recognized complication, there have been few reports of renal failure requiring hemodialysis in cancer patients. In this report, we present their clinical courses and the pathological findings of cisplatin-related renal failure.