In the clinical state of oligometastases or oligorecurrence, a transitional state between localized and widespread systemic disease, local control of the disease may yield improved systemic control. Radiotherapy may be a good means for controlling oligometastatic tumors, particularly in very old patients for whom surgery may be infeasible. A combination of systemic therapy and local therapy is necessary to prevent systemic progression. Some kinds of cancers found in the elderly are known to be somewhat indolent for systemic progression. So, for very old patients who refuse or cannot tolerate chemotherapy, the use of radical radiotherapy alone to treat oligorecurrences may be very helpful. We successfully treated an 87-year-old patient who had been diagnosed with oligorecurrences three times over six years with radiotherapy alone. The patient is now, about four years after his first radiotherapy for liver metastasis, alive without any evidence of cancer and with fully active performance status.
Aged ; Aged, 80 and over* ; Drug Therapy ; Humans ; Liver ; Neoplasm Metastasis ; Radiotherapy*

Five and half years ago, a 45-year-old female metastatic gastric cancer patient underwent a metastatectomy and chemotherapy. Over the last 4 years and 2 months, she received radiotherapy for every new distant metastasis with intermittent TS-1 oral chemotherapy. She received 8 courses of radiotherapy at 17 metastatic sites for more than 4 years. Metastatic sites which received a curative radiation dose achieved and maintained local control. The patient is now 51 years of age and lives without difficulty in performing her daily activities.
Female ; Humans ; Middle Aged ; Morphinans ; Neoplasm Metastasis ; Quality of Life ; Silicates ; Stomach Neoplasms ; Titanium

The author reports a bile duct cancer patient whose stent shifted significantly from right to left over the course of radiotherapy. The 80-year-old female patient had a short stature with thoracic kyphosis and mutiple spinal compression fractures. She was also emaciated and very lean. By comparing the weekly scanned computed tomography images, the author found her stent to have shifted by more than 4 cm from right to left over the course of external beam radiotherapy. The results of this case study suggest that for a very lean and emaciated kyphotic bile duct cancer patient, the possibility of large interfractional movement of the bile duct or stent during radiotherapy should be considered.
Aged, 80 and over ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Female ; Fractures, Compression ; Humans ; Kyphosis ; Stents

PURPOSE: Radiation proctitis and radiation cystitis are frequent and problematic late complications in patients treated with radiation for the uterine cervix cancer. Authors tried to find out the better patient's position in high dose rate intracavitary radiation to reduce the radiation dose of bladder and rectum. MATERIALS AND METHODS: In 13 patients, Foley catheters were inserted to patients' bladder and rectum and were ballooned with radioopaque dye. After insertion of a tandem and two ovoids, semi-orthogonal anteroposterior and lateral films were taken in both lithotomy and supine position. The rectal point and bladder point were defined according to the criteria recommended in the ICRU Report 38 with modification. Using these films, all patients' bladder and rectal dose were calculated in both positions (the radiation dose of A point was set to 400 cGy). And also, the distance of bladder and rectum from uterine cervical os was calculated in both positions. RESULTS: The average radiation dose of rectum was 240.7 cGy in lithotomy position and 278.3 cGy in supine position, and the average radiation dose of bladder was 303.5 cGy in lithotomy position and 255.8 cGy in supine position. After the paired t-test, the radiation dose of rectum in lithotomy position was marginally significantly lower than that in supine position, while the radiation dose of bladder in lithotomy position was significantly higher than that in supine position. On the other hand, the average distance between rectum and cervical os was 35.2 mm in lithotomy position and 32.3 mm in supine position. and the average distance between bladder and cervical os was 30.4 mm in lithotomy position and 34.0 mm in supine posi-tion. After the paired t-test, the distance between rectum and cervical os in lithotomy position was significantly longer than that in supine position, while the distance between bladder and cervical os in lithotomy position was significantly shorter than that in supine position. CONCLUSION: The radiation dose of bladder can be reduced in supine position and the radiation dose of rectum can be reduced in lithotomy position, so we can choose appropriate position in each patient.
Catheters ; Cervix Uteri* ; Cystitis ; Female ; Hand ; Humans ; Proctitis ; Rectum ; Supine Position ; Urinary Bladder

PURPOSE: To evaluate the significance of serum SCC for the monitoring of treatment response and the early detection of distant metastasis during radiotherapy (RT). MATERIALS AND METHODS: In 13 patients with histologically proven primary squamous cell carcinoma of uterine cervix, serum SCC values were checked in pre-RT point, weekly during RT, and in post-RT point. RESULTS: In 4 of 13 cases, metastasis appeared at the end of external RT, so that intracavitary radiation couldn't be performed. Of these 4 cases, 3 with elevated pre-RT SCC level, who resulted in lung metastasis on chest PA at the end of external RT showed decreased post-RT SCC value despite of metastasis. Of all 10 cases with elevated pre-RT SCC value (including 3 with metastasis at the end of external RT), SCC value was higher than pre-RT value in 7 at 9 Gy and the difference was statistically significant. At 18 Gy, SCC was higher in 4 and lower in 6 than pre-RT value. After 18 Gy, SCC value decreased continuously to the end of RT in all 10 cases. CONCLUSION: During RT, SCC value increased initially at 9 Gy. To 18 Gy, SCC value decreased to the nearly same with pre-RT value. After 18 Gy, to the end of RT, SCC value decreased continuously and normalized in completely responded cases. In cases with appearance of lung metastasis, SCC value also decreased with the disappearance of main mass of uterine cervix despite of metastasis.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Radiotherapy* ; Thorax ; Uterine Cervical Neoplasms

PURPOSE: To evaluate the significance of squaous cell carcinoma antigen (SCC) and carcinoembryonic anti antigen (CEA) as tumor markers in uterine cervix carcinoma. MATERIALS AND METHODS: In 22 patients with histologically proven primary squamous cell carcinoma of uterine cervix, tumor volume was checked either by using MRI (in 20 patients) or ultrasound (in 2 patients)or ultrasound (in 2 partients). Pre-treatment serum SCC levels were checked in 22 patients and CEA levels in 21 patients. Ather curative radiotherapy, post-treatment SCC and CEA were checked reqularly. RESULTS: SCC was raised in 68.2% and CEA was raised in 19.0% before treatment. The coefficinoma of correlation between tumor volume and pre-reatment SCC was 0.59382 when one extremely deviated case was excluded . And there was no correlation between tumor volume and CEA. After the treatment , SCC was raised in 9.1% and CEA. After the raise of SCC was associated with clinical relapse or persistence of disease. The specificity of raised SCC level in association with recurrent or persistent disease was 93.8%. The sencificity in association with recurrent or persistent disease was 100%. The positive predictive values was 85.7%. The median lead time for recurrence was 1.2 months. CONCLUSION: Both SCC and CEA were good tumor for monitoring treatment effect in patints with raised pre-treatment levels. But the sensitivity of pretreatment CEA was low, while that of pretreatment SCC was high. And there was no additional gain by adding CEA measurements to SCC measurements.
Carcinoembryonic Antigen* ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Magnetic Resonance Imaging ; Radiotherapy ; Recurrence ; Sensitivity and Specificity ; Tumor Burden ; Biomarkers, Tumor ; Ultrasonography

Trigeminal neuralgia is defined as an episodic electrical shock-like sensation in a dermatomal distribution of the trigeminal nerve. When medications fail to control pain, various procedures are used to attempt to control refractory pain. Of available procedures, stereotactic radiosurgery is the least invasive procedure and has been demonstrated to produce significant pain relief with minimal side effects. Recently, linear accelerators were introduced as a tool for radiosurgery of trigeminal neuralgia beneath the already accepted gamma unit. Author have experienced one case with trigeminal neuralgia treated with linear accelerator. The patient was treated with 85 Gy by means of 5 mm collimator directed to trigeminal nerve root entry zone. The patient obtained pain free without medication at 20 days after the procedure and remain pain free at 6 months after the procedure. He didn't experience facial numbness or other side effects.
Humans ; Hypesthesia ; Pain, Intractable ; Particle Accelerators* ; Radiosurgery* ; Sensation ; Trigeminal Nerve ; Trigeminal Neuralgia*

PURPOSE: This study explored the anal sphincter-saving rate and down-staging rate after preoperative chemoradiotherapy for treating lower rectal cancer. We also explored the prognosis of the patients who refused surgery after preoperative chemoradiotherapy. MATERIALS AND METHODS: Thirty seven patients with histologically proven lower rectal cancer who underwent preoperative chemoradiotherapy were retrospectively analyzed. In each case, the tumor location was 0 to 5 cm from the anal verge, and curative resection of the cancer with performing a sphincter-saving procedure was not feasible before chemoradiotherapy. In each case, the staging examinations, including biopsy, were done before starting radiotherapy and this was repeated at 1 month after radiation therapy. RESULTS: After chemoradiotherapy, among the 37 included patients, 56.8% and 32.4% were downstaged to the T stage and N stage, respectively, when comparing the postradiotherapy stage with pre-radiotherapy stage. Twenty five patients underwent complete resection of cancer at 6 weeks after radiotherapy: eleven, eight and six patients underwent abdominoperineal resection, low anterior resection and local excision, respectively. The sphincter-saving rate among the 24 completely resected cases was 54.2%. Twelve patients refused surgery after radiotherapy. Among 6 patients who refused surgery with biopsy-proven complete remission after chemoradiotherapy, 5 patients were alive without disease at a median follow up period of 31 months, and only 1 patient had local failure. CONCLUSION: For lower rectal cancer, a high sphincter-saving rate was accomplished with preoperative chemoradiotherapy. The prognosis of the patients who refused surgery with biopsy proven complete remission after chemoradiotherapy was good and these patients need to be kept under close surveillance.
Biopsy ; Chemoradiotherapy* ; Follow-Up Studies ; Humans ; Prognosis ; Radiotherapy ; Rectal Neoplasms* ; Retrospective Studies

PURPOSE: To evaluate the long term significance of the squamous cell carcinoma (SCC) antigen (Ag) as a tumor marker in uterine cervix carcinoma. MATERIALS AND METHODS: The SCC antigen levels of pre-radiotherapy and serial post-radiotherapy serum were analyzed in 48 patients who received radiotherapy with histologically proven primary SCC of the uterine cervix. RESULTS: Pre-radiotherapy SCC Ag level was high (>or=2 ng/ml) at 79.2%. After the treatment, the SCC Ag level was significantly decreased. The SCC Ag level measured at about 3 months after radiotherapy was high at 23.0%. In further follow up measurements, a rise of the SCC Ag to a high level was well associated with clinical relapse. The specificity of the elevated SCC Ag level in association with recurrent or persistent disease was 100%, and the sensitivity was 85.7%. In 3 of 4 lung metastasis cases, lung lesions were detected in chest PA before elevation of the SCC Ag level. The median lead time of the high SCC Ag level to clinical recurrence was 4 months. CONCLUSION: SCC Ag was a good tumor marker for monitoring treatment effect in patients with increased pre-treatment levels except in case of early lung metastasis. Elevation of the SCC Ag level after radiotherapy accurately predicted the treatment failure with lead time of 4 months. But, in early lung metastasis cases, the SCC level may be normal temporarily. Thus, chest PA should be checked to evaluate the presence of lung metastasis.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Follow-Up Studies* ; Humans ; Lung ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Sensitivity and Specificity ; Thorax ; Treatment Failure

PURPOSE: Authors tried to enhance the safety and accuracy of radiosurgery by verifying stereotctic target point in actual treatment position prior to irradiation. MATERIALS AND METHODS: Before the actual treatment, several sections of anthropomorphic head phantom were used to create a condition of unknown coordinated of the target point. A film was sandwitched between the phantom sections and punctured by sharp needle tip. The tip of the needle represented the target point. The head phantom was fixed to the stereotactic ring and CT scan was done with CT localizer attached to the ring. After the CT scanning, the stereotactic coordinates of the target point were determined. The head phantom was secured to accelerator's treatment couch and the movement of laser isocenter to the stereotactic coordinates determined by CT scanning was performed using target positioner. Accelerator's anteroposterior and lateral portal films were taken using angiographic localizers. The stereotactic coordinates determined by analysis of portal films were compared with the stereotactic coordinates previously determined by CT scanning. Following the correction of discrepancy, the head phantom was irradiated using a stereotactic thechnique of several arcs. After the irradiation, the film which was sandwitched between the phantom sections was developed and the degree of coincidence between the center of the radiation distribution with the target point represented by the hole in the film was measured. In the treatment of actual patients, the way of determining the stereotactic coordinates with CT localizers and angiographic localizers between two sets of coordinates, we proceeded to the irradiation of the actual patient. RESULTS: In the phantom study, the agreement between the center of the radiation distribution and the localized target point was very good. By measuring optical density profiles of the sandwitched film along axes that intersected the target point, authors could confirm the discrepancy was 0.3mm. In the treatment of an actual patient, the discrepancy between the stereotactic coordinates with CT localizers and angiographic localizers was 0.6mm. CONCLUSION: By verifying stereotactic target point in actual treatment position prio to irradiation, the accuracy and safety of streotactic radiosurgery procedure were established.
Head ; Humans ; Needles ; Radiosurgery* ; Tomography, X-Ray Computed