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Purpose: We created a phantom and analysis program for the assessment of IGRT positional accuracy. We verified the accuracy of analysis and the practicality of this evaluation method at several facilities., Method: End-to-end test was performed using an in-house phantom, and EPID images were acquired after displacement by an arbitrary amount using a micrometer, with after image registration as the reference. The difference between the center of the target and the irradiated field was calculated using our in-house analysis program and commercial software. The end-to-end test was conducted at three facilities, and the IGRT positional accuracy evaluation was verified., Result: The maximum difference between the displacement of the target determined from the EPID image and the arbitrary amount of micrometer displacement was 0.24 mm for the in-house analysis program and 0.30 mm for the commercial software. The maximum difference between the center of the target and the irradiation field on EPID images acquired at the three facilities was 0.97 mm., Conclusion: The proposed evaluation method using our in-house phantom and analysis program can be used for the assessment of IGRT positional accuracy.

Image-guided radiation therapy using a gold marker-based tumor tracking technique provides precise patient setup and monitoring. However, the marker consists of high-Z material, and the resulting scattered rays tend to have adverse effects on the dose distribution of radiotherapy. The purpose of this study was to evaluate the dosimetric perturbation due to the use of a gold marker for radiotherapy in the lungs. The relative dose distributions were compared with film measurement, Monte Carlo simulation, and XiO calculation with the multi grid superposition algorithm using two types of virtual lung phantoms, which were composed of tough water phantoms, tough lung phantoms, cork boards, and a 2.0-mm-diameter gold ball. No dose increase and decrease in the vicinity of the gold ball was seen in the XiO calculations, although it was seen in the film measurements and the Monte Carlo simulation. The dose perturbation due to a gold marker cannot be evaluated using XiO calculation with the superposition algorithm when the tumor is near a gold marker (especially within 0.5 cm). To rule out the presence of such dose perturbations due to a gold marker, the distance between the gold marker and the tumor must therefore be greater than 0.5 cm.

We report a case of non-curatively resected gastric cancer successfully treated over 3 years with biweekly administration of paclitaxel. A 69-year-old man underwent non-curative resection with distal gastrectomy for advanced gastric cancer with remarkable lymph node metastasis on June 10, 2002. The metastatic lymph node (No. 8 a, 8 p and 12 a) linked up with the retroperitoneal node, making resection impossible. Postoperatively, he was initially treated with weekly administration of paclitaxel 100 mg/body (68 mg/m(2)) per week. However, due to grade 3 neutropenia in the first course, weekly administration was changed to biweekly administration with dose reduction to 60 mg/body (41 mg/m(2)), resulting in the continuation of paclitaxel therapy. Since then, no grade 3 or more severe adverse reactions have been observed. He has maintained NC for 3 years, and is still being treated on an outpatient basis at present. We believe that, in paclitaxel therapy for advanced gastric cancer, it is important for long-term survival to continue it perseveringly by dose reduction or change of schedule, when major adverse reactions are seen.

We describe two patients with multiple liver metastases of colon cancer, who simultaneously received systemic irinotecan and hepatic arterial injection of 5-FU. In both cases, a notable partial response (more than 80%) in the hepatic metastases was observed. The patients could undergo chemotherapy without remarkable side-effects as out-patients. In the future, we shall perform a clinical study to evaluate the safety and dose limiting toxicity for the present combined chemotherapy.

In the present study, 55 kidneys were obtained from 29 Japanese adults, sectioned frontally to expose their renal papillae, and were macroscopically observed. The average number of papillae per kidney was 12.87 +/- 3.09 (7 to 22); no differences by sex or laterality were found. The number of papillae was positively correlated with the number of minor calices (p < 0.01) and renal weight (p < 0.05). However, there was no correlation with the number of papillae and age. Additionally, a positive correlation was found between renal weight and the number of minor calices (p < 0.05). Based upon the number of the renal papillae in each renal calyx, the papillae were divided into "simple" and "complex" groups. The number of papillae in the complex group was 2 (bifid), 3 (trifid), or 4 (cruciate). These papillae were further grouped into two types, "separate" or "fused." Therefore, the papillae were classified into 7 types such as simple, bifid separate, bifid fused, trifid separate, trifid fused, cruciate separate, and cruciate fused. The appearance ratio of the above 7 types of papillae were as follow: simple (51.7%), bifid fused (23.4%), trifid fused (14.3%), bifid separate (6.0%), cruciate fused (4.1%), trifid separate (0.2%), and cruciate separate (0.2%). The number of simple papillae (214, 51.7%) was approximately the same as that of total complex papillae (200, 48.3%). In the complex group, the number of separate papillae (27, 13.5%) was quite fewer than that of fused papillae (173, 86.5%). The original papillae had the shape of a flat cone. The average long length of the bases of papillae were 6.7 mm in simple papilla, 10.3 mm in bifid fused papilla, 11.0 mm in bifid separate papilla, 11.9 mm in trifid fused papilla, and 13.7 mm in cruciate fused papilla. The more the number of papilla increases, the more the length of the bases of papilla becomes long. However, the short length of the bases and height in each papillae were not different. Simple and bifid papillae were mostly observed in the hilus, whereas trifid and cruciate were frequently found in the cranial part of the kidneys.

Five cases of the double renal pelvis and ureter were encountered among 340 cadavers for dissection practice. Number of minor calices and their surface area in these kidneys were calculated, and causal relationship to abnormal organogenesis was discussed. These 5 cases were formal exclusively in consist of males; 4 right sides and 1 left side, 2 complete duplications and 3 partial duplications. The 5 cases were divided into 2 groups by the number and surface area of minor calices in upper and lower pelvises as follows: 1) The number and surface area of minor calices in the upper pelvis and the lower pelvis were respectively equivalent to the mean value of those in one normal kidney (case 1). 2) The sum of the number and surface area of minor calices in the upper and those in the lower pelvises were equivalent to the mean value of those in one normal kidney (case 2-5). These cases give useful criteria for classification of the double renal pelvis and ureter.