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Author(s): Kosuke Morishima [1]; Hideomi Yamashita (corresponding author) [1]; Yosuke Miki [1]; Subaru Sawayanagi [1]; Ryosuke Takenaka [1]; Atsuto Katano [1] INTRODUCTION Lung cancer is the most common cause of [...], Background: This study aimed to identify the efficacy of increasing the dose of stereotactic body radiotherapy (SBRT) for lung cancer. Method and Materials: Patients who received SBRT for primary lung cancer between 2002 and 2021 were evaluated retrospectively. The patients were categorized into the 48, 50, and 55 Gy groups according to the prescribed dose. Analyses were performed for all matched patients. Result: A total of 323 patients underwent SBRT for lung lesions at doses of 48, 50, and 55 Gy in four fractions. The median follow-up period in the 55 Gy group (32.3 months; Interquartile range (IQR), 15.1-54.1 months, P = 0.01) was significantly shorter than in the 48 Gy (47.0 months; IQR, 16,2-107.7 months) and 50 Gy (78.9 months; IQR 47.2-104.2 months) groups. The 3-year local progression-free survival (LPFS) was 90 in the 55 Gy group (95 confidence interval (CI), 62.4-94.0), 75.7 in the 48 Gy group (62.1-85.0), and 79.1 in the 50 Gy group (62.2-89.1). LPFS in the 55 Gy group was significantly higher than that in the 48 Gy group (hazard ratio (HR), 0.40; 95 CI, 0.20-0.79; P = 0.025). There is no significant difference in the local control rate between the 55 Gy group and the 50 Gy group (HR 0.60, CI 0.27-1.39). After propensity score matching, the 3-year LPFS in the 55 Gy group was 88.3 (CI, 71.2-95.5). LPFS in the 55 Gy group did not significantly differ from that of the 48 Gy group (HR, 0.47; CI, 0.17-1.35) and the 50 Gy group (HR, 0.83; CI, 0.28-2.51). Conclusion: We conducted the analysis using propensity score matching. It was not apparent whether there was a significant difference in the effect of increasing the dose, owing to a lack of power caused by the small number of cases after propensity score matching. A prospective study is in progress, and the results are awaited. Keywords: IMRT, lung cancer, stereotactic body radiotherapy, VMAT

Author(s): Atsuto Katano (corresponding author) [1]; Hideomi Yamashita [1] INTRODUCTION The incidence of extra-mammary Paget's disease (EMPD), originating from the apocrine glands, is 0.01-0.24 in 100,000 population per year.[sup.[1]] According [...], Localized extra-mammary Paget's disease (EMPD) is mainly treated with surgical resection. Curative radiation therapy (CRT) is an alternative to surgery. Electron beams and conventional X-ray methods have been used in patients with EMPD for radiotherapy. The present report describes the case of a very elderly patient with perineal EMPD who was treated with definitive radiotherapy consisting of 60 Gy in 30 fractions. Surgery was deemed too difficult because of his age and comorbidities. We adopted volumetric modulated arc therapy as the radiotherapy modality, a recent, advanced form of intensity-modulated radiation therapy. Grade 3 dermatitis was observed as an acute phase adverse event, and he achieved a complete response and maintained remission for over one-year post-treatment. Our radiotherapy treatment protocol resulted in good clinical outcomes; therefore, it may be a candidate for inoperable patients with EMPD. Keywords: Definitive radiation therapy, Extra-mammary Paget's disease, Volumetric modulated arc therapy

Author(s): Atsuto Katano (corresponding author) [1]; Hideomi Yamashita [1] INTRODUCTION Erdheim-Chester disease (ECD) is a type of non-Langerhans cell histiocytosis, first reported in 1930 by Jakob Erdheim and William Chester. [...], Erdheim-Chester disease (ECD) is a rare type of non-Langerhans cell histiocytosis, which is reported in less than a thousand cases. Although palliative radiotherapy is the principal treatment of patients with painful bone metastasis, there is very limited evidence for the efficacy of palliative radiotherapy for ECD. A 50-year-old female patient with ECD was referred to our department with a complaint of back pain and numbness in the lower limbs owing to spinal cord compression. She underwent several courses of palliative radiation therapy, some of which resulted in a marked response. She was treated with palliative radiotherapy of 30 Gy in 10 fractions for the knee. Almost complete disappearance of the pain was achieved after radiation therapy. Radiotherapy comprising 20 Gy in five fractions was performed for spinal cord compression in the upper thoracic spine. Post-treatment magnetic resonance imaging showed marked improvement in spinal compression. The present case report represented the effect of radiotherapy on bone lesions associated with ECD. Further research on radiotherapy for ECD should be conducted in the future. Keywords: Erdheim-Chester disease, palliative radiotherapy, spinal cord compression

Author(s): Atsuto Katano (corresponding author) [1]; Masanari Minamitani [2]; Hideomi Yamashita [1] INTRODUCTION Keloids and hypertrophic scars (KHSs) are non-malignant skin diseases that can occur on any body part. They [...], Objective: Keloids and hypertrophic scars are benign fibroproliferative lesions that occur as a result of skin injury. Postoperative radiation therapy is used to reduce the recurrence rate because of the high recurrence rate with surgical treatment alone. This study aimed to identify the risk factors for recurrence after postoperative electron beam radiotherapy. Materials and Methods: Patients with keloid or hypertrophic scars with at least one lesion and who underwent postoperative electron beam radiotherapy at our institution from June 2013 to March 2022 were included in the study, while patients with a follow-up period of fewer than three months were excluded. Results: A retrospective analysis was performed on 94 lesions in 81 patients. Exactly two years after the treatment, the actuarial local control rate was 86.4%. The chest wall, shoulder, and suprapubic area were identified as high-risk recurrence sites. Compared to other body sites, these sites had significantly lower local control rates (two-year local control rates: 75.5% vs. 95.2%, P = 0.005). After multivariate analysis, treatment site (P = 0.014), male gender (P = 0.019), and younger age (P = 0.029) were revealed to be statistically significant risk factors for local recurrence. Risk factors for keloid recurrence after postoperative electron beam radiotherapy were therefore identified. Conclusion: This result could be used for follow-up and as a determinant for the optimal dose/fractionation of postoperative radiotherapy. Keywords: Hypertrophic scars, keloid, postoperative, radiotherapy

Author(s): Haruka Jinnouchi [1]; Hideomi Yamashita (corresponding author) [1]; Yuki Nozawa [1]; Takahiro Nakamoto [1]; Subaru Sawayanagi [1]; Atsuto Katano [1] INTRODUCTION Esophageal cancer (EC) is the sixth most common [...], Background: The aim of the present study was to evaluate the prognostic value of radiomic features in patients who underwent chemoradiotherapy for esophageal cancer. Methods: In this retrospective study, two independent cohorts of esophageal cancer patients treated with chemoradiotherapy were included. Radiomics features of each patient were extracted from pre-treatment computed tomography (CT) images. Radiomic features were selected by employing univariate and multivariate analyses in the test cohort. Selected radiomic features were verified in the validation cohort. The endpoint of the present study was overall survival. Results: A total of 101 esophageal cancer patients were included in our study, with 71 patients in the test cohort and 30 patients in the validation cohort. Univariate analysis identified 158 radiomic features as prognostic factors for overall survival in the test cohort. A multivariate analysis revealed that root mean squared and Low-High-High (LHH) median were prognostic factors for overall survival with a hazard ratio of 2.23 (95% confidence interval [CI]: 1.16-4.70, P = 0.017) and 0.26 (95% CI: 0.13-0.54, P < 0.001), respectively. In the validation cohort, root mean squared high/LHH median low group had the most preferable prognosis with a median overall survival of 73.30 months (95% CI: 32.13-NA), whereas root mean squared low/LHH median low group had the poorest prognosis with a median overall survival of 9.72 months (95% CI: 2.50-NA), with a P value of < 0.001. Conclusions: We identified two radiomic features that might be independent prognostic factors of overall survival of esophageal cancer patients treated with chemoradiotherapy. Keywords: Chemoradiotherapy, esophageal cancer, prognosis, radiomics

Author(s): Atsuto Katano (corresponding author) [1]; Hideomi Yamashita [1] INTRODUCTION The incidence of clinically significant tumor bleeding in patients with advanced-stage cancer is approximately 6-14.[sup.[1]] Prolonged tumor bleeding results in [...], Objective: We aimed to evaluate the usefulness of palliative radiotherapy in reducing the frequency of red blood cell (RBC) transfusions in patients with malignant tumor bleeding as a quantitative value to evaluate the hemostatic effect. Materials and Methods: In this study, we conducted a retrospective review of patients visiting our department between June 2013 and April 2021. All patients underwent RBC transfusions for 30 days before the initiation of radiotherapy. We determined the overall survival (OS) time and RBC transfusion-free (RBCTF) time using statistical tests. Results: In total, 21 patients were enrolled in our study, including 13 women and 8 men; the median patient age was 63 years (range: 32-82 years). After radiotherapy, 19 of the 21 patients had a decreased frequency of requirement for RBC transfusion compared to that before radiotherapy. Fourteen patients had achieved an RBCTF state 1 month after radiotherapy. The estimated 1-year OS and RBCTF rates were 36.3 (95 confidence interval [CI]: 14.2) and 66.7 (95 CI: 42.5-42.5), respectively. Conclusion: The present study revealed a reduction in RBC transfusion after palliative radiotherapy in patients with malignant tumor bleeding. We believe that reducing the frequency of blood transfusions in patients with terminal conditions would have significant clinical benefits. Keywords: Hemostatic radiotherapy, palliative care, red blood cell transfusion