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1.
Background
Aneurysmal bone cysts (ABC) are rapidly growing benign osseous lesions composed of blood-filled channels separated by fibrous septa. Since the value of external beam radiotherapy (EBRT) for ABC has not been well defined, the German Cooperative Group on Radiotherapy for Benign Diseases performed the national register study described herein.Patients and methods
Five German institutions collected data regarding clinical features, treatment concepts, and outcome for patients with ABC who had been referred for local EBRT over the past 30 years.Results
Between 1990 and 2015, 10 patients with ABC were irradiated (5 female/5 male). Median age was 23 years (range 14–40 years). Involved sites were: spine (n = 3), sacrum/pelvis (n = 2), shoulder/scapula (n = 2), humerus (n = 1), femur (n = 1), and radius (n = 1). The median EBRT total and fractional doses were 28?Gy (range 5–40?Gy) and 2?Gy (range 1–2?Gy), respectively. Median follow-up was 65 months (range 12–358 months). Persistent pain relief was achieved for all patients. However, long-term follow-up response data were only available for 7/10 patients. All 7 patients exhibited a radiological response and experienced no recurrent disease activity or pain during follow-up. Acute and late radiogenic toxicities ≥ grade 3 and secondary malignancies were also not observed.Conclusion
Primary or adjuvant EBRT seems to be an effective and safe treatment option for persistent or recurrent ABC. Fractionated doses below 30?Gy may be recommended.2.
3.
Aim
This article gives an overview on the current status of hypofractionated radiotherapy in the treatment of prostate cancer with a special focus on the applicability in routine use.Methods
Based on a recently published systematic review the German Society of Radiation Oncology (DEGRO) expert panel added additional information that has become available since then and assessed the validity of the information on outcome parameters especially with respect to long-term toxicity and long-term disease control.Results
Several large-scale trials on moderate hypofractionation with single doses from 2.4–3.4 Gy have recently finished recruiting or have published first results suggestive of equivalent outcomes although there might be a trend for increased short-term and possibly even long-term toxicity. Large phase 3 trials on extreme hypofractionation with single doses above 4.0 Gy are lacking and only very few prospective trials have follow-up periods covering more than just 2–3 years.Conclusion
Until the results on long-term follow-up of several well-designed phase 3 trials become available, moderate hypofractionation should not be used in routine practice without special precautions and without adherence to the highest quality standards and evidence-based dose fractionation regimens. Extreme hypofractionation should be restricted to prospective clinical trials.4.
Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy
Introduction
For high-dose radiation therapy (RT) of prostate cancer, image-guided (IGRT) and intensity-modulated RT (IMRT) approaches are standard. Less is known regarding comparisons of different IGRT techniques and the resulting residual errors, as well as regarding their influences on dose distributions.Patients and methods
A total of 58 patients who received tomotherapy-based RT up to 84?Gy for high-risk prostate cancer underwent IGRT based either on daily megavoltage CT (MVCT) alone (n = 43) or the additional use of gold markers (n = 15) under routine conditions. Planned Adaptive (Accuray Inc., Madison, WI, USA) software was used for elaborated offline analysis to quantify residual interfractional prostate positioning errors, along with systematic and random errors and the resulting safety margins after both IGRT approaches. Dosimetric parameters for clinical target volume (CTV) coverage and exposition of organs at risk (OAR) were also analyzed and compared. Interfractional as well as intrafractional displacements were determined.Results
Particularly in the vertical direction, residual interfractional positioning errors were reduced using the gold marker-based approach, but dosimetric differences were moderate and the clinical relevance relatively small. Intrafractional prostate motion proved to be quite high, with displacements of 1–3?mm; however, these did not result in additional dosimetric impairments.Conclusion
Residual interfractional positioning errors were reduced using gold marker-based IGRT; however, this resulted in only slightly different final dose distributions. Therefore, daily MVCT-based IGRT without markers might be a valid alternative.5.
Ming-Hui Mao Jian-Guo Zhang Lei Zheng Hong Gao Jie Zhang Shu-ming Liu Ming-wei Huang Yan Shi 《Strahlentherapie und Onkologie》2015,191(1):26-33
Background
We studied the incidence and dose–response relationship of radioepidermitis in parotid gland carcinoma patients treated with [125I] seed brachytherapy in the hopes of designing an optimized pre-implant treatment plan that would reduce the incidence and severity of radioepidermitis in patients receiving this therapy.Patients and methods
Between January 2007 and May 2010, 100 parotid gland cancer patients were treated postoperatively with [125I] seed brachytherapy. The matched peripheral dose (MPD) was 80–140 Gy, and [125I] seed activity was 0.7–0.8 mCi. The mean dose delivered to the skin was calculated in the post-implant CT on day 0 following implantation. Grades of acute and late dermatitis were evaluated at 2, 6, 12, and 18 months post-implantation.Results
Most patients experienced grade 0–2 acute and late skin side effects (86 and 97?%, respectively), though a small subset developed severe complications. Most grade 1–3 effects resolved within 6 months of implantation, though some grade 1–3 effects and all grade 4 effects remained unchanged throughout the 18-month follow-up period. Grade 3 and 4 effects were most prominent (75 and 25?%, respectively) with doses of 110–140 Gy; doses higher than 140 Gy produced only grade 4 effects.Conclusion
[125I] seed brachytherapy produced acceptable levels of acute and late radioepidermitis with a good clinical outcome. A mean dose under 100 Gy delivered to the skin was safe, though doses of 110–140 Gy should be given with caution and extra monitoring; doses greater than 140 Gy are dangerous and likely to produce grade 4–5 effects.6.
Purpose
To report our results of computed tomography-guided interstitial high-dose-rate (HDR) brachytherapy (BRT) in the treatment of patients with recurrent inoperable glioblastoma multiforme (GBM).Patients and methods
Between 1995 and 2014, 135 patients were treated with interstitial HDR BRT for inoperable recurrent GBM located within previously irradiated volumes. Patient’s median age was 57.1 years (14–82 years). All patients were pretreated with surgery, postoperative external beam radiation therapy (EBRT) and systemic chemotherapy (ChT). The median recurrent tumor volume was 42?cm3 (2–207?cm3). The prescribed HDR dose was median 40?Gy (30–50?Gy) delivered in twice-daily fractions of 5.0?Gy over consecutive days. No repeat surgery or ChT was administered in conjunction with BRT. Survival from BRT, progression-free survival (PFS), toxicity as well as the impact of several prognostic factors were evaluated.Results
At a median follow-up of 9.2 months, the median overall survival following BRT and the median PFS were 9.2 and 4.6 months, respectively. Of the prognostic variables evaluated in univariate analysis, extent of surgery at initial diagnosis, tumor volume at recurrence, as well as time from EBRT to BRT reached statistical significance, retained also in multivariate analysis. Eight patients (5.9%) developed treatment-associated complications including intracerebral bleeding in 4 patients (2.9%), symptomatic focal radionecrosis in 3 patients (2.2%), and severe convulsion in 1 patient (0.7%).Conclusions
For patients with recurrent GBM, interstitial HDR BRT is an effective re-irradiation method for even larger tumors providing palliation without excessive toxicity.7.
Takuyo Kozuka Masahiro Nakano Masatoshi Hashimoto Kotaro Gomi Keiko Nemoto Murofushi Minako Sumi Junji Yonese Masahiko Oguchi 《Japanese journal of radiology》2017,35(5):269-278
Purpose
The present study compared the complications associated with hypofractionated intensity-modulated radiation therapy (Hypo-IMRT) of prostate cancer to conventionally fractionated IMRT (Conv-IMRT).Materials and methods
Hypo-IMRT delivered 70 Gy in 28 fractions, whereas Conv-IMRT delivered 78 Gy in 39 fractions. Toxicity was graded with the Common Terminology Criteria for Adverse Events, version 4.0, weekly during radiotherapy, 1 month after radiotherapy, and annually in both patient groups.Results
The median follow-ups were 39.1 and 38.7 months for patients in the Hypo- and Conv-IMRT groups, respectively. There was no significant difference in rates of acute and late adverse events. The proportions of grade 2 acute genitourinary complications were 48.4 and 51.2% in the Hypo- and Conv-IMRT groups, respectively. The presence of a baseline International Prostate Symptom Score (IPSS) of ten or more was the only significant prognostic factor for grade 2 acute genitourinary toxicity. The incidence of grade 2 late rectal hemorrhage at 3 years was 3.2 and 3.5% in the Hypo- and Conv-IMRT groups, respectively. Small rectal volume was significantly associated with grade 2 late rectal hemorrhage.Conclusion
Regarding acute and late adverse events, hypofractionated IMRT for prostate cancer was well tolerated and comparable with conventionally fractionated IMRT.Clinical trial registration no. UMIN000003218.8.
Background
External beam radiation therapy (EBRT) with concomitant chemotherapy (cCT) (=RCT) plus intracavitary (±interstitial) brachytherapy (iBT) is standard of care for advanced cervical cancer. The aim of this study was to evaluate morbidity and survival outcome of simple adjuvant hysterectomy (AH) after EBRT/cCT and to compare it with the standard treatment.Patients and methods
Patients with FIGO stage III cervical cancer were treated with EBRT/cCT and then divided in two groups: group 1 was further treated with standard intracavitary/interstitial BT, while group 2 underwent AH.Results
From 881 women with cervical cancer, 248 were eligible for analysis: 161 received iBT and 87 underwent AH. The median follow-up of the study was 53 months. Clinical and pathological characteristics were well balanced in the two groups. After EBRT/cCT, complete clinical response was observed in 121 (48.8%) of 246 patients. Clinical complete response was observed in 81 (50.3%) of 161 patients in group 1. At 6 weeks after EBRT/cCT, 40 (46.0%) of 87 patients in the surgery group had pathological complete response. Intra- and postoperative complications were observed in 10 (11.5%) of 87 cases. The rates of locoregional recurrence and metastasis were similar in both groups. Progression-free (PFS) and disease-specific overall survival (DOS) for these patients were similar between the control and surgery group. Interestingly, PFS and DOS were significantly improved by AH for the patients with residual tumor.Conclusion
AH could improve survival in patients with residual disease after RCT and is characterized by a low complication rate.9.
Purpose
To assess the effect of a shrinking rectal balloon implant (RBI) on the anorectal dose and complication risk during the course of moderately hypofractionated prostate radiotherapy.Methods
In 15 patients with localized prostate cancer, an RBI was implanted. A weekly kilovolt cone-beam computed tomography (CBCT) scan was acquired to measure the dynamics of RBI volume and prostate–rectum separation. The absolute anorectal volume encompassed by the 2?Gy equieffective 75?Gy isodose (V75Gy) was recalculated as well as the mean anorectal dose. The increase in estimated risk of grade 2–3 late rectal bleeding (LRB) between the start and end of treatment was predicted using nomograms. The observed acute and late toxicities were evaluated.Results
A significant shrinkage of RBI volumes was observed, with an average volume of 70.4% of baseline at the end of the treatment. Although the prostate–rectum separation significantly decreased over time, it remained at least 1?cm. No significant increase in V75Gy of the anorectum was observed, except in one patient whose RBI had completely deflated in the third week of treatment. No correlation between mean anorectal dose and balloon deflation was found. The increase in predicted LRB risk was not significant, except in the one patient whose RBI completely deflated. The observed toxicities confirmed these findings.Conclusions
Despite significant decrease in RBI volume the high-dose rectal volume and the predicted LRB risk were unaffected due to a persistent spacing between the prostate and the anterior rectal wall.10.
Minglun?Li Nina-Sophie?Hegemann Farkhad?Manapov Anne?Kolberg Patrick?Dominik?Thum Ute?Ganswindt Claus?Belka Hendrik?Ballhausen
Objective
In image-guided EBRT of the prostate, transperineal ultrasound (US) probes exert pressure on the perineum both during planning and treatment. Through tissue deformation and relaxation, this causes target and risk organ displacement and drift. In this study, prefraction shift and intrafraction drift of the prostate are quantified during robotic transperineal 4DUS.Methods
The position of the prostate was recorded for different positions of the probe before treatment in 10 patients (16 series of measurements). During treatment (15 patients, 273 fractions), intrafraction motion of the prostate was tracked (total of 27?h and 24?min) with the transperineal probe in place.Results
Per 1?mm shift of the US probe in the cranial direction, a displacement of the prostate by 0.42 ± 0.09?mm in the cranial direction was detected. The relationship was found to be linear (R² = 0.97) and highly significant (p < 0.0001). After initial contact of the probe and the perineum (no pressure), a shift of the probe of about 5–10?mm was typically necessary to achieve good image quality, corresponding to a shift of the prostate of about 2–4?mm in the cranial direction. Tissue compression and prostate displacement were well visible. During treatment, the prostate drifted at an average rate of 0.075?mm/min in the cranial direction (p = 0.0014).Conclusion
The pressure applied by a perineal US probe has a quantitatively similar impact on prostate displacement as transabdominal pressure. Shifts are predominantly in the cranial direction (typically 2–4?mm) with some component in the anterior direction (typically <1?mm). Slight probe pressure can improve image quality, but excessive probe pressure can distort the surrounding anatomy and potentially move risk organs closer to the high-dose area.11.
Tomokazu?Hasegawa Masanori?Someya Masakazu?Hori Yoshihisa?Matsumoto Kensei?Nakata Masanori?Nojima Mio?Kitagawa Takaaki?Tsuchiya Naoya?Masumori Tadashi?Hasegawa Koh-ichi?Sakata
Background and purpose
Therapeutic strategy for prostate cancer is decided according to T stage, Gleason score, and prostate-specific antigen (PSA) level. These clinical factors are not accurate enough to predict individual risk of local failure of prostate cancer after radiotherapy. Parameters involved with radiosensitivity are required to improve the predictive capability for local relapse.Patients and methods
We analyzed 58 patients with localized adenocarcinoma of the prostate between August 2007 and October 2010 treated with 76 Gy of intensity-modulated radiotherapy (IMRT) as a discovery cohort and 42 patients between March 2001 and May 2007 treated with three-dimensional conformal radiotherapy (3D-CRT) as a validation cohort. Immunohistochemical examination for proteins involved in nonhomologous end-joining was performed using biopsy specimens.Results
Ku70 expression was not correlated with various clinical parameters, such as the Gleason score and D’amico risk classification, indicating that Ku70 expression was an independent prognostic factor. The predictive value for PSA relapse was markedly improved after the combination of Gleason score and Ku70 expression, as compared with Gleason score alone. In patients treated with radiotherapy and androgen deprivation therapy (ADT), no relapses were observed in patients with Gleason score ≤7 or low Ku70 expression. In contrast, patients with Gleason score ≥8 and high Ku70 expression had high PSA relapse rates. In the validation cohort, similar results were obtained.Conclusion
Treatment with 76 Gy and ADT can be effective for patients with Gleason score ≤7 or low Ku70 expression, but is not enough for patients with Gleason score ≥8 and high Ku70 expression and, thus, require other treatment approaches.12.
Miho Watanabe Nemoto Yuma Iwai Gentaro Togasaki Marie Kurokawa Rintarou Harada Hiroki Kobayashi Takashi Uno 《Japanese journal of radiology》2017,35(12):760-765
Purpose
We propose a method of image-guided brachytherapy (IGBT) that combines MRI-based target volume delineation for the first fraction with CT datasets of subsequent fractions, using an automatic, applicator-based co-registration, and report our preliminary experience.Materials and methods
The MRI of the first fraction was used for the first brachytherapy planning. For each subsequent brachytherapy fraction, after the same applicator insertion, a new CT scan with the applicator in place was obtained. The MR image set was registered to the subsequent brachytherapy treatment planning CT using the applicator for rigid body registration. To demonstrate the registration quality, we used here the Dice index as a measurement of tandem delineation overlap between CT and MRI.Results
The median Dice index was 0.879 (range 0.610–0.932), which indicated that the contours on CT and MRI fitted well. With this combination method, the median D90 of HR CTV and the calculated D2 cm3 of the bladder, rectum, and sigmoid in each fraction were 7.2 (4.0–10.4), 5.9 (2.3–7.7), 4.0 (1.9–6.7), and 3.8 (0.6–7.2) Gy, respectively.Conclusion
Our described method of MRI-guided IGBT offers a practical option for the benefits of target delineation.13.
Purpose
To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS).Methods
Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10?cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50?Gy) or followed (median 66?Gy) by EBRT.Results
Median follow-up was 37 months (range 1–128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3? and 5?year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%.Conclusion
Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.14.
Shigeo Takahashi Yuji Murakami Nobuki Imano Yuko Kaneyasu Yoshiko Doi Masahiro Kenjo Tomoki Kimura Takayuki Kadoya Koji Arihiro Tsuyoshi Kataoka Morihito Okada Yasushi Nagata 《Japanese journal of radiology》2016,34(9):595-604
Purpose
The long-term outcomes of whole-breast and boost irradiation after breast-conserving surgery (BCS) for patients with breast cancer were retrospectively analyzed.Materials and methods
Patients who received whole-breast and boost irradiation after BCS from 1990 to 2002 were included. Boost irradiation was administered to each tumor bed, regardless of the surgical margin status. The median doses of whole-breast and boost irradiation were 45 Gy in 25 fractions (range 36–45 Gy), and 14 Gy in 7 fractions (range 0–14 Gy), respectively.Results
Data for 306 patients were analyzed. With a median follow-up time of 144 months, the 10-year overall survival, disease-free survival, ipsilateral breast tumor recurrence (IBTR), and metachronous contralateral breast cancer (MCBC) occurrence rates were 93.0, 84.1, 2.1, and 4.1 %, respectively. In the multivariate analysis, pT2 was a significant risk factor for IBTR (p = 0.041), while age ≤ 50 years and pT2 were significant risk factors for MCBC occurrence (p = 0.003 and 0.043, respectively). One patient (0.3 %) developed angiosarcoma in the irradiated region 120 months after the completion of radiation therapy.Conclusion
The 12-year outcome of breast-conserving therapy using whole-breast and boost irradiation with doses of 45 and 14 Gy, respectively, was favorable.15.
Introduction
The use of targeted intraoperative radiotherapy (TARGIT-IORT) as a tumour bed boost during breast-conserving surgery (BCS) for breast cancer has been reported since 1998. We present its use in patients undergoing breast conservation following neoadjuvant therapy (NACT).Method
In this retrospective study involving 116 patients after NACT we compared outcomes of 61 patients who received a tumour bed boost with IORT during lumpectomy versus 55 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Local recurrence-free survival (LRFS), disease-free survival (DFS), distant disease-free survival (DDFS), breast cancer mortality (BCM), non-breast cancer mortality (NBCM) and overall mortality (OS) were compared.Results
Median follow up was 49 months. The differences in LRFS, DFS and BCM were not statistically significant. The 5?year Kaplan–Meier estimate of OS was significantly better by 15% with IORT: IORT 2 events (96.7%, 95%CI 87.5–99.2), EBRT 9 events (81.7%, 95%CI 67.6–90.1), hazard ratio (HR) 0.19 (0.04–0.87), log rank p = 0.016, mainly due to a reduction of 10.1% in NBCM: IORT 100%, EBRT 89.9% (77.3–95.7), HR (not calculable), log rank p = 0.015. The DDFS was as follows: IORT 3 events (95.1%, 85.5–98.4), EBRT 12 events (69.0%, 49.1–82.4), HR 0.23 (0.06–0.80), log rank p = 0.012.Conclusion
IORT during lumpectomy after neoadjuvant chemotherapy as a tumour bed boost appears to give results that are not worse than external beam radiotherapy boost. These data give further support to the inclusion of such patients in the TARGIT-B (boost) randomised trial that is testing whether IORT boost is superior to EBRT boost.16.
Purpose
Injection of a hydrogel spacer before prostate cancer radiotherapy (RT) is known to reduce the dose to the rectal wall. Clinical results from the patient’s perspective are needed to better assess a possible benefit.Methods
A group of 167 consecutive patients who received prostate RT during the years 2010 to 2013 with 2?Gy fractions up to 76 Gy (without hydrogel, n = 66) or 76–80 Gy (with hydrogel, n = 101) were included. The numbers of interventions resulting from bowel problems during the first 2 years after RT were compared. Patients were surveyed prospectively before RT, at the last day of RT, and at a median of 2 and 17 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite).Results
Baseline patient characteristics were well balanced. Treatment for bowel symptoms (0 vs. 11?%; p < 0.01) and endoscopic examinations (3 vs. 19?%; p < 0.01) were performed less frequently with a spacer. Mean bowel function scores did not change for patients with a spacer in contrast to patients without a spacer (mean decrease of 5 points) >1 year after RT in comparison to baseline, with 0 vs. 12?% reporting a new moderate/big problem with passing stools (p < 0.01). Statistically significant differences were found for the items “loose stools”, “bloody stools”, “painful bowel movements” and “frequency of bowel movements”.Conclusion
Spacer injection is associated with a significant benefit for patients after prostate cancer RT.17.
Objective
To investigate the impact of 5?alpha-reductase inhibitor (5-ARI) use on radiotherapy outcomes for localized prostate cancer.Patients and methods
We included 203 patients on a 5-ARI from our institutional database comprising over 2500 patients who had been treated with either external beam radiotherapy (EBRT) or brachytherapy for localized prostate cancer. Patients received a 5-ARI for urinary symptoms or active surveillance. Cancer progressions at the time of definitive treatment were analyzed according to the following criteria: (a) progression of Gleason score or increase in cancer volume on biopsy, (b) first biopsy positive for cancer after being treated for urinary symptoms with a 5-ARI, and (c) prostate-specific antigen (PSA) progression with or without a previous cancer diagnosis. Biochemical failure (BF) was defined by the Phoenix definition. Log-rank test was used for survival analysis.Results
At a median follow-up of 38.2 months (standard deviation 22.2 months), 10 (4.9%) patients experienced BF. Concerning prostate cancer progression criteria, 52% of men demonstrated none, 37% showed only one criterion, and 11% showed two. Using univariate analysis, PSA progression (p = 0.004) and appearance of a positive biopsy (p < 0.001) were significant predictive factors for BF, while Gleason progression (p = 0.3) was not. In multivariate analysis adjusted for cancer aggressiveness, rising PSA (hazard ratio, HR, 5.7; 95% confidence interval, CI, 1.1–28.8; p = 0.04) and the number of cancer progression factors (HR 2.9, 95% CI 1.2–7.0, p = 0.02) remained adverse risk factors.Conclusion
PSA progression experienced during 5?ARI treatment before radiotherapy is predictive of worse biochemical outcome. Such details should be considered when counseling men prior to radiation therapy.18.
Keiichiro Koiwai Shigeru Sasaki Eriko Yoshizawa Hironobu Ina Ayumu Fukazawa Katsuya Sakai Takesumi Ozawa Hirohide Matsushita Masumi Kadoya 《Japanese journal of radiology》2016,34(2):125-129
Purpose
This study aimed to clarify the significance of palliative radiotherapy for Japanese patients with malignant melanoma based on the experience of our institution.Materials and methods
Twenty-nine patients with malignant melanoma who underwent palliative radiotherapy at our facility were included in the investigation. Median radiation dose was 30 Gy (4–30).Results
Median follow-up time was 4.2 months (range 2.7–40.5 months). Twenty-two patient (75.9 %) died during the follow-up. The response rate of overall symptoms to radiotherapy was 63.0 %. The rate of completely resolved hemorrhage was relatively high (81.8 %). The median time of freedom from progression in completely resolved symptoms was 3.1 months (range 0.2–27.8 months). Radiation dose <30 Gy and poor performance status tended to be associated with poor symptomatic relief in treatment site (p = .080 and p = .068, respectively). There were very few severe toxic events.Conclusion
Two thirds of symptoms were safely alleviated by palliative radiotherapy for Japanese patients with malignant melanoma. The therapeutic effect was retained for a substantial duration. Further domestic studies are warranted.19.
Keisuke Yoshida Tomohiro Kaneta Shoko Takano Madoka Sugiura Tsuyoshi Kawano Ayako Hino Tou Yamamoto Kazuya Shizukuishi Masato Kaneko Christian Zurth Tomio Inoue 《Annals of nuclear medicine》2016,30(7):453-460
Objective
This open-label, non-randomized, phase I study examined the pharmacokinetics (PK) and radiation dosimetry of a single dose of radium-223 in Japanese patients with castration-resistant prostate cancer (CRPC) and bone metastases.Methods
Six male Japanese patients (mean age 72.5 years, range 65–79 years) with histologically or cytologically confirmed stage IV adenocarcinoma of the prostate were recruited. A single IV dose of radium-223 was delivered intravenously (IV) via slow bolus over a 2–5 min period: Cohort 1 received 50 kBq/kg and Cohort 2 received 100 kBq/kg.Results
Following IV injection, radium-223 was rapidly eliminated from the blood in a multi-phasic manner. The fraction of the injected activity of radium-223 retained in the whole body 24 h following injection was 85 %. Biodistribution results showed initial bone uptake was 52 % (range 41–57 %). The maximum activity of radium-223 in the bone was observed within 2 h of dosing. Activity of radium-223 passed through the small intestine within 24 h. No activity was detected in other organs. The major radiation dose from radium-223 was found in osteogenic cells; calculated absorbed doses in osteogenic cells and in the red marrow were 0.76 Gy/MBq and 0.09 Gy/MBq, respectively.Conclusions
In Japanese patients with CRPC and bone metastases, radium-223 (IV) achieved maximum activity in the bone rapidly and passed through the intestine within 24 h, without signs of activity in other organs. The PK profile and absorbed radiation dose in organs and tissues in Japanese patients were similar to data from non-Japanese patients.Trial registration identification: NCT01565746.20.
Marsha?Schlenter Vanessa?Berneking Barabara?Krenkel Felix?M.?Mottaghy Thomas-Alexander?V?geli Michael?J.?Eble Michael?Pinkawa