Language：English   Publisher：Japanese Journal of Radiology  

Purpose: This study evaluated the efficacy and safety of high-dose pelvic radiotherapy combined with chemotherapy, including bevacizumab and immune checkpoint inhibitors (ICI) in patients with stage IVB cervical cancer (CC) based on the 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging system. Materials and methods: A retrospective analysis was conducted on 38 patients with stage IVB CC, as classified by the 2018 FIGO cervical cancer staging system, who received pelvic external beam radiotherapy (≥ 40 Gy) with or without brachytherapy and chemotherapy. Data were collected from two centers. The 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) rates were analyzed using the Kaplan–Meier method. Symptom relief, including reductions in genital bleeding and pain from the primary lesion, was assessed. Acute and late adverse events were also evaluated. Results: The median follow-up period was 17.5 months. The 2-year LC, PFS, and OS were 82%, 11%, and 47%, respectively. Although the evaluation method has limitations, most patients with genital bleeding and pain from the primary lesion showed improvement in symptoms. Late adverse events of grade ≥ 2 related to both pelvic radiotherapy and bevacizumab included one case of grade 3 gastrointestinal bleeding and two cases of grade 2 fistula. Conclusion: This two-center study demonstrated that high-dose pelvic radiotherapy combined with chemotherapy, including bevacizumab and ICI, may achieve favorable local control and symptom relief in patients with stage IVB CC while maintaining an acceptable safety profile.

DOI： 10.1007/s11604-025-01923-1

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Publisher：医歯薬出版  

DOI： 10.32118/ayu295111075

CiNii Research

Language：Japanese   Publisher：医歯薬出版(株)  

＜文献概要＞放射線治療は患者の体を切らない局所治療で,機能・形態温存と非侵襲性の利点がある.放射線治療の主な適応は,中枢神経,頭頸部,胸部,消化器,泌尿器,婦人科領域,血液,リンパ,皮膚,骨・軟部組織,疼痛緩和,良性疾患であり,臓器横断的に適用可能である.放射線治療の目的は,非侵襲的に腫瘍領域に十分な線量を投与し,腫瘍に近接するリスク臓器(放射線感受性の高い臓器)を含む正常組織には線量をできるだけ減らすことである.この目的のために非侵襲的画像を用いた放射線治療が標準となっている.画像情報を学習できるAI(人工知能)との親和性は高く,切らない高精度放射線治療がAIを応用することで,さらなる高みを目指せる可能性が高い.本稿では,AIが放射線治療へ貢献できること,つまり治療方針決定支援,腫瘍とリスク臓器の輪郭抽出支援,治療計画支援,治療実施支援,フォローアップ支援および予後予測支援を概説し,最後に未来の高精度放射線治療を予測する.

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Technical Innovations and Patient Support in Radiation Oncology  

Introduction: This study evaluated dosimetric values of cone beam computed tomography (CBCT)-guided online adaptive radiotherapy (oART) in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, accounting for interfractional and intrafractional motion. Methods: Four patients with stage I gastric MALT lymphoma received CBCT-guided oART. For each of the 60 treatment sessions, scheduled (SCH) and adapted (ADP) plans were generated. Dosimetric evaluation focused on clinical target volume (CTV) and organs at risk (OARs). Metrics included CTV D98 % and D95 %, mean dose to the liver and left and right kidneys, maximum dose to the spinal cord, and V5Gy for bilateral kidneys. Adaptive planning CBCT-based contours were propagated to synthetic CTs of SCH and ADP plans to assess interfractional motion. Post-treatment CBCT-based contours were propagated to synthetic CTs of the ADP plan to evaluate intrafractional motion. Results: ADP plans significantly improved CTV coverage: mean D98% increased from 94.7 % in the SCH plan to 98.6 %, and D95% from 97.3 % to 99.2 % (p < 0.001). Most OAR doses were reduced in the ADP plans, including bilateral kidney V5Gy (11.3 % vs. 8.3 %, p < 0.001) and spinal cord Dmax (9.8 Gy vs. 7.9 Gy, p < 0.001). Liver Dmean was slightly higher in the ADP plan (11.4 Gy vs. 11.1 Gy, p = 0.002). No significant differences were observed in CTV and OAR dosimetric parameters between adaptive planning and post-treatment CBCTs (e.g., CTV D98%: 98.6 % vs. 98.5 %, p = 0.629). Conclusion: CBCT-guided oART improved target coverage and maintained post-treatment dosimetric stability in gastric MALT lymphoma, supporting clinical feasibility.

DOI： 10.1016/j.tipsro.2025.100321

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Authorship：Last author   Language：English   Publisher：Health and Technology  

Purpose: Applying new treatments to real patients to verify therapeutic efficacy may induce various risks, such as critical adverse events. Additionally, there are ethical and financial issues in real-world randomized controlled trials (RCTs). This study aimed to develop mathematical models of time-variant tumor growth trajectories (TGTs) for in silico RCTs targeting patients with stage I non-small cell lung cancer (NSCLC) to optimize stereotactic body radiation therapy (SBRT). Methods: The basic idea of the in silico RCT was to evaluate the endpoint of progression-free survival (PFS) curves for the two regimens derived from TGTs for virtual patient data produced via mathematical models. TGT models with a relative number of tumor cells were proposed by integrating the Bertalanffy-Pütter (BP) model and linear quadratic model into tumor growth models. To validate the proposed models, we performed three RCTs, 30 Gy/1 fraction (Fr) versus 60 Gy/3 Fr, 48 Gy/4 Fr versus 75 Gy/25 Fr, and 34 Gy/1 Fr versus 48 Gy/4 Fr. Results: The three in silico RCTs showed no statistically significant differences in PFS curves, which was similar to the results of three previous studies. Conclusions: The proposed mathematical models could be leveraged for in silico RCTs to optimize SBRT.

DOI： 10.1007/s12553-025-01005-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Practical Radiation Oncology  

Purpose: We hypothesized that online adaptive radiation therapy (oART) could eliminate errors associated with interfractional deformation in gastric mucosa-associated lymphoid tissue (MALT) lymphoma, but errors in intrafractional deformation remained in 6 directions (anterior, posterior, superior, inferior, left, and right). This study aimed to quantify the anisotropic deformation errors of the clinical target volume (CTV) for MALT lymphoma using oART to determine deformations in the planning target volume (PTV) margins. Methods and Materials: Thirty fractional scans from 4 consecutive patients (a total of 120 cone beam computed tomography scans) with gastric MALT lymphoma treated with oART were chosen for this retrospective study. The CTV contours were manually delineated on the pretreatment and posttreatment cone beam computed tomography images. The center-of-mass matching of the CTVs was performed following the bone anatomy matching. Systematic and random errors of intrafractional deformations of the CTV were quantified using displacement vectors between the pretreatment and posttreatment CTV surfaces for each fraction. The PTV margins for oART were anisotropically calculated using the van Herk formula: 2.5Σ + 0.7σ, accounting for intrafractional errors. Results: For intrafractional deformation, the means of standard deviations of systematic errors ranged from 1.2 mm to 2.2 mm, whereas those of random errors ranged from 2.9 mm to 3.6 mm. The PTV margins were up to 13.1 mm in the inferior direction, whereas in other directions, they ranged from 9.7 mm to 12.8 mm. The PTV margin in integer achieved posttreatment CTV coverage for 90% of the fractions, with undercoverage volumes remaining below 0.6 cm³ in all fractions. Conclusions: This study suggests that the impact of intrafractional CTV deformation can not be eliminated even with oART. This highlights the need to set the appropriate anisotropic PTV margins.

DOI： 10.1016/j.prro.2025.05.008

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：MEDICAL IMAGING AND INFORMATION SCIENCES  

DOI： 10.11318/mii.42.xxxv

CiNii Research

Language：Japanese   Publisher：大道学館出版部  

Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メディカ出版  

症例は40歳代女性で、頭痛、嘔吐、失語を主訴とした。15年前より小腸原発の消化管間質腫瘍(GIST)の治療中であり、主訴にて紹介入院し、頭部単純CTでは左中頭蓋窩に強い造影効果を伴う境界明瞭な高吸収域(48×36×47mm)と左前頭部の傍矢状洞部の病変(最大径14mm大)を認めた。MRIではT1で低信号から等信号、T2で等信号から高信号を呈する腫瘍と、腫瘍内のflow void、左中硬膜動脈の拡張、左側頭葉の広範な浮腫性変化、右側へ13mmの正中偏位と鉤ヘルニアを認め、入院2日目に開頭腫瘍摘出術を行った。術中迅速病理検査ではGISTの頭蓋内転移と診断され、病理標本と過去の肝転移標本の組織所見からGISTの脳転移と診断した。術後、失名詞失語症状は経時的に改善したが、術後8ヵ月目に局所再発をきたし、再手術後にも頭蓋内病変の再発を認め、頭蓋内転移診断後のOSは19ヵ月であった。

Language：English   Publisher：Clinical Lung Cancer  

The incidence of brain radiation necrosis is increasing in NSCLC patients undergoing radiotherapy for brain metastases. • [11C] methionine–PET and MRS are valuable tools for diagnosing brain radiation necrosis. • Bevacizumab is an effective treatment for brain radiation necrosis in patients with nonsquamous NSCLC.

DOI： 10.1016/j.cllc.2024.06.010

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Language：English   Publisher：Neuro-Oncology Advances  

Background. Homozygous deletion of the tumor suppression genes cyclin‑dependent kinase inhibitor 2A/B (CDKN2A/B) is a strong adverse prognostic factor in IDH‑mutant gliomas, particularly astrocytoma. However, the impact of hemizygous deletion of CDKN2A/B is unknown. Furthermore, the influence of CDKN2A/B status in IDH‑ mutant and 1p/19q‑codeleted oligodendroglioma remains controversial. We examined the impact of CDKN2A/B status classification, including hemizygous deletions, on the prognosis of IDH‑mutant gliomas. Methods. We enrolled 101 adults with IDH‑mutant glioma between December 2002 and November 2021. CDKN2A/B deletion was evaluated with multiplex ligation‑dependent probe amplification (MLPA). Immunohistochemical anal‑ ysis of p16/MTAP and promoter methylation analysis with methylation‑specific MLPA was performed for cases with CDKN2A/B deletion. Kaplan − Meier plots and Cox proportion hazards model analyses were performed to evaluate the impact on overall (OS) and progression‑free survival. Results. Of 101 cases, 12 and 4 were classified as hemizygous and homozygous deletion, respectively. Immunohistochemistry revealed p16‑negative and MTAP retention in cases with hemizygous deletion, whereas homozygous deletions had p16‑negative and MTAP loss. In astrocytoma, OS was shorter in the order of homozy‑ gous deletion, hemizygous deletion, and copy‑neutral groups (median OS: 38.5, 59.5, and 93.1 months, respec‑ tively). Multivariate analysis revealed hazard ratios of 9.30 (P = .0191) and 2.44 (P = .0943) for homozygous and hemizygous deletions, respectively. Conclusions. CDKN2A/B hemizygous deletions exerted a negative impact on OS in astrocytoma. Immunohistochemistry of p16/MTAP can be utilized to validate hemizygous or homozygous deletions in combina‑ tion with conventional molecular diagnosis.

DOI： 10.1093/noajnl/vdae069

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Language：English   Publisher：(一社)日本放射線影響学会  

胃粘膜関連リンパ組織(MALT)リンパ腫に対し、オンライン適応放射線治療(oART)における計画標的体積(PTV)マージンについて検討した。2023年9～12月までの期間内に、当院で30Gy/15分割のoARTが施行された胃MALTリンパ腫患者4例を対象に、治療前後に得たコーンビームCT画像を用いて、分割照射中および分割照射間の胃の移動を評価した。なお、PTVマージンは分割照射中および分割照射間の移動をカバーする分割照射の累積比率から推定し、分割照射90%の臨床標的体積(CTV)をカバーする拡大範囲をPTVマージンとした。その結果、oARTを用いた場合の息止めによる分割照射中移動のPTVマージンは14mmであったが、oARTを用いない場合は25mmであった。以上の結果から、oARTによりPTVマージンを10mm超減少できることが確認された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Radiation Research  

The aim of this study was to investigate planning target volume (PTV) margin in online adaptive radiation therapy (oART) for gastric mucosa-associated lymphoid tissue (MALT) lymphomas. Four consecutive patients with gastric MALT lymphoma who received oART (30 Gy in 15 fractions) on the oART system were included in this study. One hundred and twenty cone-beam computed tomography (CBCT) scans acquired pre- and post-treatment of 60 fractions for all patients were used to evaluate intra- and interfractional motions. Patients were instructed on breath-holding at exhalation during image acquisition. To assess the intrafraction gastric motion, different PTVs were created by isotropically extending the CTV contoured on a pre-CBCT image (CTVpre) at1 mm intervals. Intrafraction motion was defined as the amount of expansion covering the contoured CTV on post-CBCT images (CTVpost). Interfractional motion was defined as the amount of reference CTV expansion that could cover each CTVpre, as well as the evaluation of the intrafractional motion. PTV margins were estimated from the cumulative proportion of fraction covering the intra- and interfractional motions. The extent of expansion covering the CTVs in 90% of fractions was adopted as the PTV margin. The PTV margin for intrafractional gastric motion using the oART system with breath-holding was 14 mm. In contrast, the PTV margin for interfractional gastric organ motion without the oART system was 25 mm. These results indicated that the oART system can reduce the PTV margin by >10 mm. Our results could be valuable data for oART cases.

DOI： 10.1093/jrr/rrae052

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Applied Sciences (Switzerland)  

This study aimed to propose an automated prediction approach of the consolidation tumor ratios (CTRs) of part-solid tumors of patients treated with radiotherapy on treatment planning computed tomography images using deep learning segmentation (DLS) models. For training the DLS model for cancer regions, a total of 115 patients with non-small cell lung cancer (NSCLC) who underwent stereotactic body radiation therapy were selected as the training dataset, including solid, part-solid, and ground-glass opacity tumors. For testing the automated prediction approach of CTRs based on segmented tumor regions, 38 patients with part-solid tumors were selected as an internal test dataset A (IN) from a same institute as the training dataset, and 49 patients as an external test dataset (EX) from a public database. The CTRs for part-solid tumors were predicted as ratios of the maximum diameters of solid components to those of whole tumors. Pearson correlations between reference and predicted CTRs for the two test datasets were 0.953 (IN) and 0.926 (EX) for one of the DLS models (p < 0.01). Intraclass correlation coefficients between reference and predicted CTRs for the two test datasets were 0.943 (IN) and 0.904 (EX) for the same DLS models. The findings suggest that the automated prediction approach could be robust in calculating the CTRs of part-solid tumors.

DOI： 10.3390/app14083275

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Language：English   Publisher：Springer  

The recommended post-operative radiotherapy dose of approximately 60 Gy may be reduced during treatment planning, and the optimal irradiation method and dose remain unclear. We aimed to clarify the usefulness and safety of post-operative radiotherapy for soft tissue sarcomas. Forty-five patients with soft-tissue sarcomas who underwent adjuvant radiotherapy at two institutions from June 2014 to August 2020 were included. Patients with a high risk of recurrence underwent post-operative irradiation, with doses of 60–70 Gy and 50 Gy used in patients with positive and negative resection margins, respectively. The median patient age was 72 (21–88) years. The most common histological types of sarcomas were myxofibrosarcoma (n = 12) and dedifferentiated liposarcoma (n = 11), followed by other sarcomas. Thirty patients were newly diagnosed, and 15 underwent surgery for localized recurrent disease. Thirty-two and 13 patients underwent wide and marginal resection, respectively. Surgical margins were negative in 12 patients and positive in 33 patients. Chemotherapy was administered before or after radiotherapy in 16 patients. The 2-year local control, progression-free survival, and overall survival rates after post-operative radiotherapy were 88%, 78%, and 93%, respectively. In patients with positive resection margins, doses of ≥ 60 Gy contributed to local control (p = 0.0002, log-rank test) and progression-free survival (p = 0.0033). Late grade 3 adverse events were observed in 7% of the patients. Post-operative radiotherapy for soft tissue sarcomas is safe and effective, with high doses (≥ 60 Gy) contributing to reduced recurrence among patients with positive resection margins.

DOI： 10.1007/s42399-024-01648-8

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CiNii Research

Language：English   Publisher：(公社)日本医学放射線学会  

局所進行子宮頸癌(LACC)に対し、経直腸超音波(TRUS)ガイド下経腟的アプローチによる組織内照射併用腔内照射(IC/IS BT)を行い、有効性と安全性を後向きに調査した。外照射療法とTRUSガイド下で経腟アプローチによりIC/IS BTの治療を受けたLACC患者30例(年齢31～82歳)を調査対象とし、2年局所制御率(LC)、無増悪生存率(PFS)および全生存率(OS)をKaplan-Meier法で分析した。また、遅発性有害事象に基づきIC/IS BTの安全性についても評価した。その結果、経過観察期間の中央値は22ヵ月で、2年LC、PFSおよびOSはそれぞれ90%、61%、82%であった。また、IC/IS BT法に関連した重篤な合併症例はみられず、グレード3以上の遅発性有害事象としては、グレード4の結腸穿孔が認められた。以上より、経腟的アプローチによるTRUSガイド下でのIC/IS BTは、LACCにおいて、安全且つ良好な局所腫瘍制御が得られることが確認された。

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(公社)日本放射線技術学会  

3次元CT(3DCT)及び4次元CT(4DCT)により定義された体内標的体積(ITV)の有効性を評価し、治療時における腫瘍の呼吸性移動と比較した。2017年2月～2019年4月に肺上葉に非小細胞肺癌を有する患者5名(男性3名、女性2名、77～86歳)に対して48Gyで4分割の体幹部定位放射線治療(SBRT)を実施した。治療計画用の3DCT画像は呼気ピーク時及び吸気ピーク時の息止めで取得し、4DCT画像は自由呼吸下でのシネモードで取得した。シネ画像は照射時に電子的放射線治療照合装置を用いて取得した。tumor coverageは左右、前後及び頭尾方向の照射時に治療計画CT画像上のピーク間呼吸振幅が腫瘍可動域(±3SD)をどのようにカバーしているか評価した。頭尾方向における4DCTベースのITVは3DCTベースのITVと比べて平均tumor coverageが良好であった。また、4DCT用に照射野を設定する場合には体内マージンを考慮する必要があった。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Anticancer Research  

Background/aim: Radiomics, which links radiological image features with patient prognoses, is expected to be applied for the prediction of the clinical outcomes of radiotherapy. We investigated the clinical and radiomic factors associated with recurrence patterns after stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC).

Patients and methods: We retrospectively analyzed 125 patients with histologically confirmed NSCLC who underwent SBRT between April 2003 and June 2017 at our institution. A radiomic score was calculated from five radiomics features (histogram and texture features) selected using the LASSO Cox regression model. These features were extracted from the gross tumor volume (GTV) in three-dimensional wavelet decomposition CT images. We used univariate and multivariate analyses to determine the associations between local control (LC) time and metastasis-free survival (MFS), clinical factors (age, sex, performance status, operability, smoking, histology, and tumor diameter), and the radiomic score.

Results: With a median follow-up of 37 months, the following 3-year rates were observed: overall survival, 80.9%; progression-free survival, 61.7%; LC, 75.1%, and MFS; 74.5%. In multivariate analysis, histology (squamous cell carcinoma vs. non-squamous cell carcinoma, p=0.0045), tumor diameter (>3 cm vs. ≤3 cm, p=0.039); and radiomic score (>0.043 vs. ≤0.043, p=0.042) were significantly associated with LC, and the radiomic score (>0.304 vs. ≤0.304, p<0.001) was significantly associated with MFS.

Conclusion: Histology, tumor diameter, and radiomic score could be significant factors for predicting NSCLC recurrence patterns after SBRT.

DOI： 10.21873/anticanres.16699

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DOI： 10.1016/j.annonc.2023.09.205

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMC Cancer  

Background: Rhabdomyosarcoma is the most common soft tissue sarcoma in children, but rare in adults. Para-meningeal rhabdomyosarcoma in head and neck (PM-HNRMS) is less applicable for surgery due to the anatomic reason. PM-HNRMS has a poor prognosis in children. However, its clinical outcomes remain unclear in adults due to the rarity. Further, there is almost no detailed data about salvage therapy.

Methods: We retrospectively examined the adult patients with PM-HNRMS treated at institutions belonging to the Kyushu Medical Oncology Group from 2009 to 2022. We evaluated the overall survival (OS) and progression-free survival (PFS) of the patients who received a first-line therapy. We also reviewed the clinical outcomes of patients who progressed against a first-line therapy and received salvage therapy.

Results: Total 11 patients of PM-HNRMS received a first-line therapy. The characteristics were as follows: median age: 38 years (range 25 - 63 years), histology (alveolar/spindle): 10/1, and risk group (intermediate/high): 7/4. As a first-line therapy, VAC and ARST0431-based regimen was performed in 10 and 1 patients, respectively. During a first-line therapy, definitive radiation for all lesions were performed in seven patients. The median PFS was 14.2 months (95%CI: 6.0 - 25.8 months): 17.1 months (95%CI: 6.0 - not reached (NR)) for patients with stage I-III and 8.5 months (95%CI: 5.2 - 25.8 months) for patients with stage IV. The 1-year and 3-year PFS rates were 54.5% and 11.3% for all patients. Median OS in all patients was 40.8 months (95%CI: 12.1 months-NR): 40.8 months (95%CI: 12.1 - NR) for patients with stage I-III and NR for patients with stage IV. The 5-year OS rate was 48.5% for all patients. Among seven patients who received salvage therapy, three are still alive, two of whom remain disease-free for over 4 years after completion of the last therapy. Those two patients received multi-modal therapy including local therapy for all detected lesions.

Conclusion: The cure rate of adult PM-HNRMS is low in spite of a first-line therapy in this study. Salvage therapy might prolong the survival in patients who received the multi-modal therapy including local therapy for all detected lesions.

DOI： 10.1186/s12885-023-11528-4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Physical and Engineering Sciences in Medicine  

This study aimed to investigate the robustness of a deep learning (DL) fusion model for low training-to-test ratio (TTR) datasets in the segmentation of gross tumor volumes (GTVs) in three-dimensional planning computed tomography (CT) images for lung cancer stereotactic body radiotherapy (SBRT). A total of 192 patients with lung cancer (solid tumor, 118; part-solid tumor, 53; ground-glass opacity, 21) who underwent SBRT were included in this study. Regions of interest in the GTVs were cropped based on GTV centroids from planning CT images. Three DL models, 3D U-Net, V-Net, and dense V-Net, were trained to segment the GTV regions. Nine fusion models were constructed with logical AND, logical OR, and voting of the two or three outputs of the three DL models. TTR was defined as the ratio of the number of cases in a training dataset to that in a test dataset. The Dice similarity coefficients (DSCs) and Hausdorff distance (HD) of the 12 models were assessed with TTRs of 1.00 (training data: validation data: test data = 40:20:40), 0.791 (35:20:45), 0.531 (31:10:59), 0.291 (20:10:70), and 0.116 (10:5:85). The voting fusion model achieved the highest DSCs of 0.829 to 0.798 for all TTRs among the 12 models, whereas the other models showed DSCs of 0.818 to 0.804 for a TTR of 1.00 and 0.788 to 0.742 for a TTR of 0.116, and an HD of 5.40 ± 3.00 to 6.07 ± 3.26 mm better than any single DL models. The findings suggest that the proposed voting fusion model is a robust approach for low TTR datasets in segmenting GTVs in planning CT images of lung cancer SBRT.

DOI： 10.1007/s13246-023-01295-8

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japan Neurosurgical Society  

<p>We aimed to retrospectively determine the resection rate of fluid-attenuated inversion recovery (FLAIR) lesions to evaluate the clinical effects of supramaximal resection (SMR) on the survival of patients with glioblastoma (GBM). Thirty-three adults with newly diagnosed GBM who underwent gross total tumor resection were enrolled. The tumors were classified into cortical and deep-seated groups according to their contact with the cortical gray matter. Pre- and postoperative FLAIR and gadolinium-enhanced T1-weighted imaging tumor volumes were measured using a three-dimensional imaging volume analyzer, and the resection rate was calculated. To evaluate the association between SMR rate and outcome, we subdivided patients whose tumors were totally resected into the SMR and non-SMR groups by moving the threshold value of SMR in 10% increments from 0% and compared their overall survival (OS) change. An improvement in OS was observed when the threshold value of SMR was 30% or more. In the cortical group (n = 23), SMR (n = 8) tended to prolong OS compared with gross total resection (GTR) (n = 15), with the median OS of 69.6 and 22.1 months, respectively (p = 0.0945). Contrastingly, in the deep-seated group (n = 10), SMR (n = 4) significantly shortened OS compared with GTR (n = 6), with median OS of 10.2 and 27.9 months, respectively (p = 0.0221). SMR could help prolong OS in patients with cortical GBM when 30% or more volume reduction is achieved in FLAIR lesions, although the impact of SMR for deep-seated GBM must be validated in larger cohorts.</p>

DOI： 10.2176/jns-nmc.2022-0351

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CiNii Research

Language：English   Publisher：(一社)日本脳神経外科学会  

膠芽腫患者を対象とした後ろ向き研究を実施し、FLAIR病変切除率を評価することで、supramaximal resection(SMR)の臨床効果について検討した。2006年12月～2018年8月に神経膠腫と診断された成人患者のうち、肉眼的全切除(GTR)が施行された成人33例(年齢中央値64歳、男性19例)を対象とした。評価項目は腫瘍切除率(手術前後のFLAIRおよびガドリニウム強調T1強調画像の腫瘍体積を3D画像体積分析装置により測定)、SMR率(0%から10%刻み)などとした。腫瘍を皮質灰白質との接触により、皮質群23例(SMR 8例、GTR 15例)、深在性群10例(SMR 4例、全切除6例)に分けて検討した。その結果、SMR閾値が30%以上の場合に全生存期間の改善が観察された。皮質群ではGTRと比較してSMRで全生存期間が延長する傾向が認められた(69.6ヵ月対22.1ヵ月)。一方、深在群ではGTRと比較してSMRで全生存期間が有意に短縮していた(10.2ヵ月対27.9ヵ月、p=0.0221)。以上から、FLAIR病変のsupramaximal resectionは神経膠腫患者の生存期間を延長可能であることが示された。

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

2013年7月～2017年12月に日本の14施設で体幹部定位放射線療法(SBRT)を行った治療歴のない初発小型肝細胞癌(HCC)患者76例の83病変のうち、SBRT分割数が10超であった患者を除外後の73例の79病変を対象に、SBRTの有効性と安全性を評価した。年齢中央値は77歳(範囲50～89歳)、腫瘍サイズ中央値は23mm(範囲6～50mm)、照射線量中央値は5分割(範囲4～8分割)での40Gy(範囲35～60Gy)であった。追跡期間中央値は45ヵ月(範囲0～103ヵ月)で、3年後の全生存率、無再発生存率、局所再発の累積発生率はそれぞれ69.9%、57.9%、20.0%であった。グレード3以上の有害事象は4例(5.5%)で認められ(グレード3が3例、グレード4が1例)、グレード5の毒性を認めた患者はいなかった。標準治療が不適格の初発小型HCCに対し、SBRTは有望な治療法であることが示された。

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/hepr.13908

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Interdisciplinary cardiovascular and thoracic surgery  

OBJECTIVES: Sarcopenia correlates with poor prognosis in various malignancies. However, the prognostic significance of sarcopenia remains to be determined in patients with non-small-cell lung cancer who undergo surgery after receiving neoadjuvant chemoradiotherapy (NACRT). METHODS: We retrospectively reviewed the patients with stage II/III non-small-cell lung cancer who underwent surgery following NACRT. The paravertebral skeletal muscle area (SMA) (cm2) at the 12th thoracic vertebra level was measured. We calculated the SMA index (SMAI) as SMA/squared height (cm2/m2). Patients were divided into low and high SMAI groups, and the association of SMAI with clinicopathological factors and prognosis was assessed. RESULTS: The patients' [men, 86 (81.1%)] median age was 63 (21-76) years. There were 106 patients including 2 (1.9%), 10 (9.4%), 74 (69.8%), 19 (17.9%) and 1 (0.9%) patients with stage IIA, IIB, IIIA, IIIB and IIIC, respectively. Of the patients, 39 (36.8%) and 67 (63.2%) were classified in the low and the high SMAI groups, respectively. Kaplan-Meier analysis showed that the low group had a significantly shorter overall survival and disease-free survival than the high group. Multivariable analysis identified low SMAI as an independent poor prognostic factor for overall survival. CONCLUSIONS: Pre-NACRT SMAI correlates with poor prognosis; therefore, assessing sarcopenia based on pre-NACRT SMAI may help determine optimal treatment strategies and suitable nutritional and exercise interventions.

DOI： 10.1093/icvts/ivad020

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：(株)日本臨床社  

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：金原出版(株)  

70歳代男性。胸部中部食道癌に対する化学放射線療法から7ヵ月後、縦隔リンパ節再発が認められた。FP療法を1コース施行するも効果なく、重粒子線治療を施行したところ、奏効した。最終治療から5年以上経過現在、再発や重篤な有害事象はみられない。

Language：Japanese   Publisher：日本メディカルセンター  

DOI： 10.19020/cg.0000002324

CiNii Research

Language：Japanese   Publisher：(株)日本メディカルセンター  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Thoracic Cancer  

Background: This study aimed to explore the predictability of topological signatures linked to the locoregional relapse (LRR) and distant metastasis (DM) on pretreatment planning computed tomography images of stage I non-small cell lung cancer (NSCLC) patients before treatment with stereotactic ablative radiotherapy (SABR). Methods: We divided 125 primary stage I NSCLC patients (LRR: 34, DM: 22) into training (n = 60) and test datasets (n = 65), and the training dataset was augmented to 260 cases using a synthetic minority oversampling technique. The relapse predictabilities of the conventional wavelet-based features (WF), topology-based features [BF, Betti number (BN) map features; iBF, inverted BN map features], and their combined features (BWF, iBWF) were compared. The patients were stratified into high-risk and low-risk groups using the medians of the radiomics scores in the training dataset. Results: For the LRR in the test, the iBF, iBWF, and WF showed statistically significant differences (p < 0.05), and the highest nLPC was obtained for the iBF. For the DM in the test, the iBWF showed a significant difference and the highest nLPC. Conclusion: The iBF indicated the potential of improving the LRR and DM prediction of stage I NSCLC patients prior to undergoing SABR.

DOI： 10.1111/1759-7714.14483

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)   Publisher：World Neurosurgery  

Background: Controversies exist regarding the aggressive recurrence of glioblastoma after bevacizumab treatment. We analyzed the clinical impact of bevacizumab approval in Japan by evaluating the clinical course and relapse pattern in patients with glioblastoma. Methods: We included 100 patients with IDH-wild-type glioblastoma from September 2006 to February 2018 in our institution. The patients were classified into the pre-bevacizumab (n = 51) and post-bevacizumab (n = 49) groups. Overall, progression-free, deterioration-free, and postprogression survivals were compared. We analyzed the relapse pattern of 72 patients, whose radiographic progressions were evaluated. Results: Significant improvement in progression-free (pre-bevacizumab, 7.5 months; post-bevacizumab, 9.9 months; P = 0.0153) and deterioration-free (pre-bevacizumab, 8.5 months; post-bevacizumab, 13.8 months; P = 0.0046) survivals was seen. These survival prolongations were strongly correlated (r: 0.91, P < 0.0001). The nonenhancing tumor pattern was novel in the post-bevacizumab era (5 of 33). The presence of a nonenhancing tumor did not indicate poor postprogression survival (hazard ratio: 0.82 [0.26–2.62], P = 0.7377). The rate of early focal recurrence was significantly lower (P = 0.0155) in the post-bevacizumab (4 of 33) than in the pre-bevacizumab (18 of 39) era. There was a significant decrease in early focal recurrence after approval of bevacizumab in patients with unresectable tumors (P = 0.0110). The treatment era was significantly correlated with a decreased rate of early focal recurrence (P = 0.0021, univariate analysis; P = 0.0144, multivariate analysis). Conclusions: Approval of first-line bevacizumab in Japan for unresectable tumors may prevent early progression and clinical deterioration of glioblastoma without worsening the clinical course after relapse.

DOI： 10.1016/j.wneu.2021.12.075

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PLoS ONE  

Objectives We aimed to explore the synergistic combination of a topologically invariant Betti number (BN)-based signature and a biomarker for the accurate prediction of symptomatic (grade ≥2) radiation-induced pneumonitis (RP+) before stereotactic ablative radiotherapy (SABR) for lung cancer. Methods A total of 272 SABR cases with early-stage non-small cell lung cancer were chosen for this study. The occurrence of RP+ was predicted using a support vector machine (SVM) model trained with the combined features of the BN-based signature extracted from planning computed tomography (pCT) images and a pretreatment biomarker, serum Krebs von den Lungen-6 (BN+KL-6 model). In all, 242 (20 RP+ and 222 RP–(grade 1)) and 30 cases (8 RP+ and 22 RP–) were used for training and testing the model, respectively. The BN-based features were extracted from BN maps that characterize topologically invariant heterogeneous traits of potential RP+ lung regions on pCT images by applying histogram- and texture-based feature calculations to the maps. The SVM models were built to predict RP+ patients with a BN signature that was constructed based on the least absolute shrinkage and selection operator logistic regression model. The evaluation of the prediction models was performed based on the area under the receiver operating characteristic curves (AUCs) and accuracy in the test. The performance of the BN+KL-6 model was compared to the performance based on the BN, conventional original pCT, and wavelet decomposition (WD) models. Results The test AUCs obtained for the BN+KL-6, BN, pCT, and WD models were 0.825, 0.807, 0.642, and 0.545, respectively. The accuracies of the BN+KL-6, BN, pCT, and WD models were found to be 0.724, 0.708, 0.591, and 0.534, respectively. Conclusion This study demonstrated the comprehensive performance of the BN+KL-6 model for the prediction of potential RP+ patients before SABR for lung cancer.

DOI： 10.1371/journal.pone.0263292

Web of Science

Scopus

PubMed

Language：Japanese  

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese  

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00261-004-0202-7

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publishing type：Research paper (scientific journal)  

Event date： 2022.2

Language：Japanese  

Venue：福岡市   Country：Japan  

Event date： 2019.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：名古屋市   Country：Japan  

Event date： 2018.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：京都市   Country：Japan  

Event date： 2017.11

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：大阪市   Country：Japan  

Event date： 2017.4

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：横浜市   Country：Japan  

Event date： 2011.7

Presentation type：Public lecture, seminar, tutorial, course, or other speech  

Venue：神戸市   Country：Japan  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

腎癌の脳転移における放射線治療戦略についての総説