In recent years there has been a growing interest in total body, hemibody, total lymphoid irradiation. For refractory leukemia or lymphoma patients, various techniques and dose regimens were introduced, including high dose total body irradiation for destruction of leukemic or bone marrow cells and immunosuppression prior to bone marrow transplantation, and low dose total body irradiation for treatment of lymphocytic leukemias or lymphomas. Accurate provision for specified dose and the desired homogeneity are essential before clinical total body irradiation. Purposes of this paper are to discuss calibrating Cobalt Unit in 3m distance using Rando Phantom, to compare calculated dose, calibrated dose, and compensating filters for homogeneous dose distribution in the head and neck, the lung and the pelvis. Results were following. 1. Measured dose on the lung was 6% higher than on the abdomen. Measured dose on the head (10%) and neck (18%) were higher than the abdomen because of thinness. Pelvic dose was measured 12% less than the abdomen. Those date suggest that compensating filter was essential. 2. Measured dose according to distance was 3% less than calculated dose which suggest that all doses in clinical use should be compared with calculated dose for minimizing error.
Abdomen ; Bone Marrow Cells ; Bone Marrow Transplantation ; Cobalt ; Head ; Humans ; Immunosuppression ; Leukemia ; Leukemia, Lymphoid ; Lung ; Lymphatic Irradiation ; Lymphoma ; Neck ; Pelvis ; Thinness ; Whole-Body Irradiation*

PURPOSE: We assessed the risk of radiation pneumonitis (RP) in terms of dosimetric parameters in breast cancer patients, who received radiotherapy using the partially wide tangent technique (PWT), following breast conservation surgery (BCS). METHODS: We analyzed the data from 100 breast cancer patients who underwent radiotherapy using PWT. The entire breast, supraclavicular lymph node, and internal mammary lymph node (IMN) were irradiated with 50.4 Gy in 28 fractions. RP was scored on a scale of 0 to 5, based on Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity criteria. The dosimetric parameters, used in analysis for the ipsilateral lung, were the mean lung dose (MLD), V5 (percentage of lung volume that received a dose of 5 Gy or more)-V50, and normal tissue complication probability (NTCP). RESULTS: Of the 100 patients, three suffered from symptomatic RP (symptom grade > or =2), but were relieved by supportive care. The risk of RP was not correlated with the treatment regimen. RP associated mostly with asymptomatic minimal pulmonary radiologic change or mild dry cough developed more frequently in the group with MLD > or =20.5 Gy or NTCP > or =23% than in the group with MLD <20.5 Gy and NTCP <23% (48.6% vs. 25.4%, p=0.018). CONCLUSION: Dosimetric parameters of MLD and NTCP were correlated with the incidence of RP, but the clinical impact was minimal. We suggest that PWT is a safe technique for the treatment of IMN for BCS patients with low risk of symptomatic RP.
Breast ; Breast Neoplasms ; Cough ; Humans ; Incidence ; Lung ; Lymph Nodes ; Lymphatic Irradiation ; Mastectomy, Segmental ; Radiation Pneumonitis ; Radiotherapy, Conformal

PURPOSE: To evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Fifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4-72 Gy (39.6-45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed. RESULTS: The median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively. CONCLUSION: No patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.
Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Irradiation ; Neck ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Treatment Failure

PURPOSE: The aim of this study is to present the incidence of radiation pneumonitis (RP) reported within 6 months after treatment for breast cancer with or without internal mammary node irradiation (IMNI). METHODS: In the Korean Radiation Oncology Group (KROG) 08-06 phase III randomized trial, patients who were node-positive after surgery were randomly assigned to receive radiotherapy either with or without IMNI. A total of 747 patients were enrolled, and three-dimensional treatment planning with computed tomography simulation was performed for all patients. Of the 747 patients, 722 underwent chest X-rays before and within 6 months after radiotherapy. These 722 patients underwent evaluation, and RP was diagnosed on the basis of chest radiography findings and clinical symptoms. The relationship between the incidence of RP and clinical/dosimetric parameters was analyzed. RESULTS: RP developed in 35 patients (4.8%), including grade 1 RP in 26 patients (3.6%), grade 2 RP in nine patients (1.2%); there was no incidence of grade 3 or higher RP. Grade 2 RP cases were observed in only the IMNI group. The risk of developing RP was influenced by IMNI treatment; pneumonitis occurred in 6.5% of patients (n=23/356) who underwent IMNI and in 3.3% of patients (n=12/366) who did not (p=0.047). The differences in lung dosimetric parameters (mean lung dose, V10–40) were statistically significant between the two groups. CONCLUSION: IMNI treatment resulted in increased radiation exposure to the lung and a higher rate of RP, but the incidence and severity of RP was minimal and acceptable. This minor impact on morbidity should be balanced with the impact on survival outcome in future analyses.
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lung ; Lymphatic Irradiation ; Pneumonia ; Radiation Exposure ; Radiation Oncology ; Radiation Pneumonitis* ; Radiography ; Radiotherapy ; Thorax

The study was undertaken to detemine the effect of fractionated high-dose total lymphoid irradiation (TLI) onthe servival of skin allograft despite major histocompatibility difference. Total lymphoid irraditation is arelatively safe form of radiotherapy, has been used extensively to treat lymphoid malignancies in humans with fewside effects. A total of 90 rats, Sprague-Dawley rat as recipient and Wistar rat as donor, were used for theexperiment, of which 10 rats were used to determine mixed lymphocyte response (MLR) for antigenic difference andskin allografts was performed in 30 rats given total lymphoid irradiation to assess the immunosuppressive effectof total lymphoid irradiation despite major histocompatibility difference. In addition, the peripheral white bloodcell counts and the proportion of lymphocytes was studied in 10 rats given total lymphoid irradiation but no skingraft to determine the effects of bone marrow suppression. The results obtained are summerized as follows. 1. Theoptimum dose of total lymphoid irradiation was between 1800 rads to 2400 rads. 2. The survival of skin graft onrats given total lymphoid irradiation (23.2±6.0days) was prolonged about three folds as compared to unirradiated-control (8.7±1.3 days). 3. Total lymphoid irradiation resulted in a severe leukopneia with marked lymphopenia,but the count was normal by the end of 3rd week. 4. The study suggests that total lymphoid irradiation is anonlethal procedure that could be used successfully in animals to transplant allograft across major-histocompatibility barriers.
Allografts ; Animals ; Bone Marrow ; Histocompatibility ; Humans ; Lymphatic Irradiation ; Lymphocytes ; Radiotherapy ; Rats ; Rats, Sprague-Dawley ; Skin ; Tissue Donors ; Transplants

PURPOSE: This study aimed to report the clinical outcomes following selective neck irradiation (SNI) with lower elective radiation therapy (RT) dose in treating nasopharyngeal cancer (NPC) patients. MATERIALS AND METHODS: A total of 347 NPC patients received definitive RT according to our SNI policy and were retrospectively analyzed. The clinical target volumes (CTVs) were subdivided into CTV at high risk (CTV-HR) and CTV at low risk (CTV-LR). The typical doses to gross tumor volume (GTV), CTV-HR, and CTV-LR were 68.4-70.0 Gy, 54.0-60.0 Gy, and 36.0 Gy. RESULTS: With the median follow-up of 68.1 months (range, 2.3 to 197.1 months), the 5-year rates of loco-regional control and progression-free survival in all the patients were 85.0% and 70.8%, respectively. Thirty patients developed regional failure and the regional control rates at 3 and 5 years were 92.6% and 91.4%, respectively. The sites of regional failure in relation to the target volume were exclusively inside GTV/CTV-HR in 20, inside and outside GTV/CTVHR in three, and exclusively outside GTV/CTV-HR in seven, which were 5.7%, 0.9%, and 2.0% of total patients, respectively. CONCLUSION: The clinical outcomes by the current SNI policy were feasible and comparable to those following classic elective nodal irradiation policy.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymphatic Irradiation ; Nasopharyngeal Neoplasms ; Nasopharynx ; Neck ; Radiotherapy ; Retrospective Studies ; Tumor Burden

PURPOSE: This study evaluated the treatment results and the necessity to irradiate the supraclavicular lymph node (SCN) region in pathological N0-N1 (pN0-N1) patients with locally advanced breast cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery and radiotherapy (RT). METHODS: Between 1996 and 2008, 184 patients with initial tumor size >5 cm or clinically positive lymph nodes were treated with NAC followed by surgery and RT. Among these patients, we retrospectively reviewed 98 patients with pN0-N1. Mastectomy was performed in 55%. The pathological lymph node stage was N0 in 49% and N1 in 51%. All patients received adjuvant RT to chest wall or breast and 56 patients (57%) also received RT to the SCN region (SCNRT). RESULTS: At 5 years, locoregional recurrence (LRR)-free survival, distant metastasis-free survival, disease-free survival (DFS), and overall survival rates were 93%, 83%, 81%, and 91%, respectively. In pN0 patients, LRR was 7% in SCNRT- group and 5% in SCNRT+ group. In pN1 patients, LRR was 7% in SCNRT- group and 6% in SCNRT+ group. There was no significant difference of LRR, regardless of SCNRT. However, in pN1 patients, there were more patients with poor prognostic factors in the SCNRT+ group compared to SCNRT- group. These factors might be associated with worse DFS in the SCNRT+ group, even though RT was administered to the SCN region. CONCLUSION: Our study showed the similar LRR, regardless of SCNRT in pN0-pN1 breast cancer patients after NAC followed by surgery. Prospective randomized trial is called for to validate the role of SCNRT.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Humans ; Lymph Nodes ; Lymphatic Irradiation ; Mastectomy ; Neoadjuvant Therapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate ; Thoracic Wall

PURPOSE: This study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer. MATERIALS AND METHODS: Records for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. RESULTS: Median follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8. Independent prognostic factors for locoregional recurrence were ≥pT2 disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260–24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378–20.491; p < 0.001). CONCLUSION: Patients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.
Asian Continental Ancestry Group ; Follow-Up Studies ; Gallbladder Neoplasms* ; Gallbladder* ; Humans ; Lymph Nodes ; Lymphatic Irradiation ; Neoplasm Recurrence, Local ; Radiotherapy, Adjuvant* ; Recurrence ; Retrospective Studies

OBJECTIVETo investigate the feasibility of involved-field irradiation (IFI ) for stage III non-small cell lung cancer (NSCLC).

METHODSFrom September 1997 to November 2001, 200 stage-III NSCLC patients were randomly divided into two groups-- IFI and ENI (elective node irradiation). The IFI group was irradiated by 3DCR to a dose of 68-74 Gy/34-37f/7-9 w including the primary tumor and the lymph nodes of > or = 10 mm in short axis. The ENI group was irradiated to a dose of 60-64 Gy/30-32f/6-7.5 w including the primary tumor, ipsilateral hilum, subcarinal and mediastinal lymph nodes, even the supraclavicular area when the lymph nodes of superior mediastinum were involved.

RESULTSThe overall response (CR + PR) rates were 90.0% in IFI group and 79.0% in ENI group. Radiation pneumonitis developed in 29.0% of the patients in ENI group and 17.0% in IFI group (P = 0.04). The 1-year primary tumor failure rate in IFI group (13.0%) was lower than that (23.0%) in ENI group. The 1-year involved nodal failure rate was 20.0% in ENI group and 10.0% in IFI group (P = 0.048). The 1-year elective node failure rate was 16.0% in ENI group versus 21.0% in IFI group (P = 0.39). The 1-, 2-and 3-year overall survival rate was 67.2% , 38.7% , 27.3% , respectively, in IFI group; versus 59.7% , 25.6% , 19.2% in ENI group, with a difference significant in the 2-year overall survival rate between IFI and ENI group (P = 0.048).

CONCLUSIONInvolved-field 3D-CRT for stage-III non-small cell lung cancer is well tolerated. It does not increase the rate of lymph node failure in the elective node irradiation field, and may improve the survival due to dose escalation.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; pathology ; radiotherapy ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; pathology ; radiotherapy ; Lymphatic Irradiation ; methods ; Male ; Middle Aged ; Neoplasm Staging ; Radiotherapy Dosage ; Radiotherapy, Conformal ; methods ; Remission Induction ; Survival Analysis ; Treatment Outcome

PURPOSE: To retrospectively evaluate the outcome and toxicity of total lymphoid irradiation (TLI) based conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) patients who experienced an engraftment failure from prior HSCT or were heavily transfused. MATERIALS AND METHODS: Between 1995 and 2006, 20 SAA patients received TLI for conditioning of HSCT. All patients were multi-transfused or had long duration of disease. Fifteen (75%) patients had graft failure from prior HSCT. In 18 (90%) patients, the donors were human leukocyte antigen identical siblings. The stem cell source was the peripheral blood stem cell in 15 (75%) patients. The conditioning regimen was composed of antithymocyte globulin plus TLI with a median dose of 750 cGy in 1 fraction. The graft-versus-host disease (GVHD) prophylaxis used cyclosporine with methotrexate. RESULTS: With a median follow-up of 10.8 years, graft failures developed in 6 patients. Among them, 3 patients received their third HSCT to be engrafted finally. The Kaplan-Meier overall survival rate was 85.0% and 83.1% at 5 and 10 years, respectively. The incidence of acute and chronic GVHD was 20% and 20%, respectively. None of the patients have developed a malignancy after HSCT. CONCLUSION: In our study, TLI based conditioning in allogeneic HSCT was feasible with acceptable rates of GVHD in SAA patients who experienced graft failure from prior HSCT or was at a high risk of graft rejection. We achieved relatively better results of engraftment and survival with a long term follow-up.
Anemia, Aplastic ; Antilymphocyte Serum ; Cyclosporine ; Follow-Up Studies ; Graft Rejection ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Incidence ; Leukocytes ; Lymphatic Irradiation ; Retrospective Studies ; Siblings ; Stem Cells ; Survival Rate ; Tissue Donors ; Transplants