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We describe a 30-year-old man in whom upper endoscopy revealed multiple gastric carcinoids. The peripheral blood gastrin level was 2400 ng/ml (normal range

自治医科大学放射線科における20年に及ぶ加速多分割照射accelerated hyperfractionation（AHF）の経験から，頭頸部癌の治療成績と有害事象について報告する。1985年から2002年にAHFを行った喉頭癌237例，上咽頭癌50例，中咽頭癌34例，下咽頭癌38例が対象である。AHFは1日2回，週10回照射で総線量60～63Gy/40回/4週である。各疾患の5年局所制御率は，声門癌I期65例では98%，II期59例では85%，III・IV期28例では73%であった。中咽頭癌I・II期5例では80%，III期11例では69%，IV期18例では50%，下咽頭癌I・II期4例では75%，III期6例では100%，IV期28例では40%であった。上咽頭癌では標準治療と比較し治療成績の改善はなかった。AHFにより早期粘膜炎は増強するが耐容可能な範囲であり，晩期障害の発生率は標準分割照射と同程度であった。AHFは上咽頭癌を除く頭頸部癌に有用な治療法と考えられる。

A 58-year-old Japanese man complained of dysphagia, and esophagography and endoscopy showed a 7.5-cm-long protruding tumor in his middle esophagus. Biopsy diagnosed the lesion as basaloid squamous carcinoma. We assessed the tumor as T3N0M0 stage II. Preoperative chemoradiotherapy was started, consisting of 3 weeks of intravenous chemotherapy with 10 mg/day cisplatin and 750 mg/day 5-fluorouracil and concurrent total 45-Gy external irradiation applied to the tumor. We evaluated the effectiveness as a partial response and performed curative resection with radical esophagectomy 23 days after the completion of chemoradiotherapy. The pathological findings showed necrosis and degeneration over two-thirds of the tumor. Postoperatively, he returned to physical labor and has had no evidence of recurrence for 5 years. Although basaloid squamous carcinoma of the esophagus is associated with poor prognosis because of its highly malignant potential, preoperative chemoradiotherapy followed by radical esophagectomy may allow for the possibility of improving the prognosis of a fatal process.

近年放射線治療単独と比較し化学放射線治療の有効性を示す報告がある。docetaxel (DOC) はチューブリンの合成を阻害し, 放射線に感受性を有するG2/M期に細胞周期を停止させる作用がある。よって放射線照射と併用することより有効な放射線増感効果が期待される。Stage III/IV頭頸部癌19症例を対象にDOC併用加速多分割放射線治療をおこなった。17例が治療を完遂できた。症例に対する治療効果は complete response (CR) 10例, partial response (PR) 7例であり, 奏功率100%, CR率58%であった。T分類別の効果ではCRをT1T2では11例中10例に認めたのに対し, T3T4では6例中0例であった。有害事象では全例に Grade 3以上の粘膜炎を認めた。疼痛管理に9例に麻薬の投与が必要であった。補助療法として末梢補液が8例, 経管栄養が2例, 中心静脈栄養が1例に必要であった。PR例では後治療として化学療法をおこないCRを得られた症例を認めた。

Accelerated repopulation is a reason for loco-regional failure after radiotherapy for head and neck carcinoma. Accelerated fractionation(AF) is a radiotherapy regimen reducing the total treatment time, with the aim of counteracting tumor cell repopulation. AF administers the same or a similar total dose as conventional treatment in a reduced overall time by giving conventionally-sized or smaller fractions more than once daily. Several different clinical trials on AF have proved to be of benefit in loco-regional control, although no benefit in survival was generally detected. The metaanalysis of altered fractionated radiotherapy in head and neck cancer has showed a benefit with AF with conventional fractionation(CF). However, the magnitude of the survival benefit is lower with AF than with hyperfractionation (HF). In particular, AF using reduced total doses or a split course does not improve treatment benefits. AF that employs continuous RT schedules, without compromising the total dose, improves local control. More data on this AF regimen are needed. Acute morbidity is significantly more frequent with AF. Whether late toxicity is also worse with AF is unclear. Some trials suggest no increase in late toxicity, while others suggest the opposite. The effect of AF seems to be greater for the primary tumor than for the metastatic lymph-nodes. Also, the reduction of the treatment time is more beneficial in well- to moderately-differentiated tumors.

To evaluate the reliability and validity of the Japanese translation of Quality of Life Radiation Therapy Instrument (QOL-RTI) and the head and neck module (HN) for Japanese patients being treated with radiotherapy for head and neck malignancies.The QOL-RTI/HN was translated into Japanese by a preliminary QOL research working group of JASTRO and was used in this clinical trial. From 1998 to 2001, 70 patients with head and neck malignancies for whom radical radiotherapy was planned were entered into this study. Patients were requested to answer the questions before radiotherapy at baseline, twice during week 4 of therapy (for test-retest reliability), at the end of treatment, and 3 months, 6 months, 1 year and 2 years from the beginning of radiotherapy. Internal consistency was assessed by Cronbach's alpha coefficient. Validity was assessed by comparing the results with EORTC-QLQ-C30 and with QOL questionnaire for cancer patients treated with anticancer drugs (QOL-ADC). Patient compliance and test sensitivity were also analyzed.Cronbach's alpha coefficient was 0.79 to 0.93 depending on the time point for the evaluation. Test-retest reliability was acceptable, with a Pearson coefficient of 0.83 for QOL-RTI and 0.92 for HN module. Compliance with this scheme was 98.2%. The QOL-RTI was sensitive enough to detect significant changes in the QOL score during and after the course of radiotherapy. Agreement with the EORTC-C30 was good with a high Pearson correlation coefficient of 0.648 and that with QOL-ADC was also good with a coefficient of 0.566. The factors analyzed consisted of 11 functional/health-oriented questions, 5 emotional/ psychological, 5 socio-economic/ family and 2 general.The Japanese version of QOL-RTI with HN module was found to be reliable and sensitive enough to evaluate variation of QOL in patients with head and neck malignancies during and after radiotherapy.

15079 Background: The morbidity and survival advantage treated with the combination of hyperfractionated radiotherapy (HF) and biliary stenting has not yet established for patients with unresectable biliary tract cancers. A prospective study was carried out using HF and metallic stent in consecutive patients over 10 years in a single institution. Methods: From 1993 to 2003, consecutive 162 pts (radical 74, postoperative 83, postoperative relapse 5) were treated with HF. Out of 74 radical cases, 71 pts (36 male/35 female; median age 70yrs, range 35–88) were analyzed except 3 cases (manifestation of liver metastasis 1, ascites 1, rejection of treatment 1). Primary sites were; extrahepatic bile duct 56, gall bladder 15. Bile cytology showed adenocarcinoma in every case. HF was administered twice daily by 10MV photon, using 2 portals (ant-post), 3 portals (ant-post-right lateral) or wedged pairs (ant-lateral) with relatively small radiation fields (PTV was CTV +1∼1.5cm). Fractional dose was 1.4Gy with the interfractional interval of 4.5 hrs to a total median dose of 59.8Gy. Endpoints were overall survival and acute and late complications. Results: 1) Obstructive jaundice was relieved before HF through endoscopic biliary drainage in 92.9% (66/71). Metallic stent was applied in 66.2%(47/71), before HF in 35.2% (25/71) and after HF in 31.0% (22/71). 2) Median survival was 8 months (1–90) and 5-year survival was 28%. Multivariate analysis showed total HF dose as a sole significant prognostic factor (p=0.0347). 3) Acute complication was observed mainly in digestive tract, i.e., Grade 1–2 symptoms (anorexia, nausea) in 50.7% (36/71). Late complications were Grade 1–2 gastritis in 9.9% (7/71), Grade 3 gastric ulcer in 2.8% (2/71) and cholangitis in 1.4% (1/71). Conclusions: HF combined with meticulous biliary drainage and stenting by G-I specialists for advanced biliary tract cancers demonstrated excellent pt’s quality of life with less serious morbidities. This modality would offer useful baseline data further with appropriate systemic chemotherapy. No significant financial relationships to disclose.