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学位論文

Background: We retrospectively evaluated the outcome of brachytherapy with permanent iodine-125 seed implantation for prostate cancer. Methods: From 2009 to2016, 150 patients（49 in low risk, 81 intermediate, 20 high），mean age 67.1 y, which were performed brachytherapy in our hospital were enrolled in this study. Results: The average prostate volume was 27.4cc, mean International Prostate Symptom Score 9 in these patients. In postplan evaluation, mean prostate V100 93.8%, D90 in brachytherapy alone 173.9Gy, combined with external beam radiation 116.8Gy, rectum V100 in brachytherapy alone 0.27cc, combined with external beam radiation 0.13cc, urethraD90 in brachytherapy alone 89.9Gy, combined with external beam radiation 64.4Gy. The biochemical progression-free survival in 5 years was 97.0% in low risk, while 96.3% in intermediate and no patients in high risk demonstrated PSA relapse during the observation. Migration of seeds was occurred in 3.3%. Adverse event was urinary retention in 2, hematuria in 2, proctitis in 2, rectal bleeding in 2, more than grade 3 was noted in only one patient. Conclusions: The outcome of brachytherapy in our hospital was safe and feasible with low side effects.

Background: Several studies have shown favourable treatment outcomes for Japanese patients with cervical cancer treated with definitive radiotherapy (RT) at low cumulative doses. However, a midline block (MB) used in whole pelvic RT (WPRT) hinders accurate interpretation of the treatment outcome due to uncertainty of the RT dose delivered to cervical tumours. Methods: Patients with cervical cancer of FIGO stages IB1u2013IVA were eligible for this prospective study. The treatment protocol consisted of WPRT (non-IMRT) without a MB (45 Gy/25 fractions) and high-dose-rate intracavitary brachytherapy (HDR-ICBT; 15 Gy/3 fractions or 20 Gy/4 fractions, prescribed to point A). The total EQD2 to point A was 63 or 69.3 Gy. CT-based planning was performed for HDR-ICBT. Organs at risk were contoured for each ICBT application. The HR-CTV was contoured at the time of the present analyses. If optimisation (manual adjustment of the dwell times) was inadequate to meet the organ-at-risk dose constraints, the point A dose was decreased. Graphical optimisation was not allowed. Results: A total of 40 patients were enrolled in the study. The FIGO stage distribution was IB1 in 11 patients, IB2 in 13, IIA2 in 1, IIB in 11, IIIB in 3 and IVA in 1 patient. The median pretreatment tumour diameter was 47 mm (14u201381 mm). No patients received hybrid ICBT. The point A dose was decreased in 19 of 153 ICBT sessions (12%). After a median follow-up of 33 months, the 2-year pelvic progression-free survival, disease-free survival and overall survival rates were 83%, 75% and 85%, respectively. A HR-CTV D90 threshold of 70 Gy was correlated with the pelvic progression-free survival rate: 93% for patients receiving u2265 70 Gy (n=29) versus 64% for those receiving < 70 Gy (n=11) (P=0.018). Late adverse events (grade u2265 3) were observed in three patients (bladder in two, rectum in one). Conclusions: Definitive RT consisting of WPRT without a MB and HDR-ICBT was feasible in our cohort of Japanese patients. A low RT dose might be adequate for patients with non-bulky tumours. Proper 3D-IGBT using graphical optimisation and a suitable hybrid technique, based on appropriate HR-CTV contouring, is recommended to improve outcomes further.

Background: We retrospectively evaluated the outcome of brachytherapy with permanent iodine-125 seed implantation for prostate cancer. Methods: From 2009 to2016, 150 patients（49 in low risk, 81 intermediate, 20 high），mean age 67.1 y, which were performed brachytherapy in our hospital were enrolled in this study. Results: The average prostate volume was 27.4cc, mean International Prostate Symptom Score 9 in these patients. In postplan evaluation, mean prostate V100 93.8%, D90 in brachytherapy alone 173.9Gy, combined with external beam radiation 116.8Gy, rectum V100 in brachytherapy alone 0.27cc, combined with external beam radiation 0.13cc, urethraD90 in brachytherapy alone 89.9Gy, combined with external beam radiation 64.4Gy. The biochemical progression-free survival in 5 years was 97.0% in low risk, while 96.3% in intermediate and no patients in high risk demonstrated PSA relapse during the observation. Migration of seeds was occurred in 3.3%. Adverse event was urinary retention in 2, hematuria in 2, proctitis in 2, rectal bleeding in 2, more than grade 3 was noted in only one patient. Conclusions: The outcome of brachytherapy in our hospital was safe and feasible with low side effects., 論文