Background : Although open aortic repair (OAR) is still considered to be a standard treatment for thoracic aortic diseases, recently the indication of thoracic endovascular treatment (TEVAR) /hybrid aortic repair (HAR) is expanding. The purpose of this study is to review the current status of treatment of thoracic aortic diseases. Methods : The data concerning surgery for diseases in thoracic/thoracoabdominal aorta in 2013 and 2014 are extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality are evaluated for pathology (acute dissection, chronic dissection, ruptured aneurysm, un-ruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (＜5%, 5 to 10%, 10 to 15%, 15%≦) and their combination. Results : The total number of cases included in this study was 30,271 and the overall operative mortality was 5.9%. Among 3 types of treatment, 73.2% of patients underwent OAR (root, 98.3% ; ascending, 97.4% ; root to arch, 95.5% ; arch, 81.7% ; descending, 34.2% ; thoracoabdominal, 64.4%). Although the rate of OAR was in negative correlation with JapanSCORE (JS) in treatment for thoracoabdominal region (JS＜5%, 80.4% ; 5%≦JS＜10%, 67.6% ; 10%≦JS＜15%, 58.8% ; 15%≦JS, 55.7%), such relation was not observed in other regions. The operative mortality of OAR was well reflected by JS (JS＜5%, 2.1% ; 5%≦JS＜10%, 5.5% ; 10%≦JS＜15%, 10.2% ; 15%≦JS, 20.3%), however, those of TEVAR/HAR was less than the range of JS. Conclusions : The distribution of treatment differs depending on site of diseases and is not much influenced by JS. It has become clear that JapanSCORE is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than JS in TEVAR/HAR and a new risk score for TEVAR/HAR should be established.

Herein is reported our experience of radiation therapy using a real-time tumor-tracking and gated radiotherapy (RTRT) system for inoperable pancreatic cancer. Three unresectable pancreatic cancer patients were treated with intraoperative electron beam radiation therapy, at the time of open biopsy, and postoperative external beam radiation therapy using an RTRT system with a 2.0 mm diameter gold ball implanted into the pancreas. The total BED's (alpha/beta=10) was intended to be equivalent to that of delivering 60 Gy by 2.0 Gy/fraction, while the actual dose schedules were individualized. The movement of the pancreas was analyzed based on the 3-dimensional marker positions during the RTRT. The side effects and tumor responses were evaluated. During the RTRT course, the average movement of markers in the x (left to right), y (cranial to caudal) and z (dorsal to ventral) directions were 3.0 mm (1.7- 5.2 mm), 5.2 mm (3.5 - 6.8 mm) and 3.5 mm (2.7 - 5.1 mm), respectively. During and after the course of postoperative radiation therapy, no acute side effects of RTOG grade II or higher were detected. The objective tumor responses, as evaluated by CT scans 3 months after the treatment, were 2 partial responses and no response in one patient. Using the RTRT technique the margin of treatment planning and the possible errors in target localization were reduced, and the 3-dimensional movement of the internal marker implanted in the pancreas was able to be analyzed.
Aged ; Computer Systems ; Female ; Humans ; Middle Aged ; Pancreas ; Pancreatic Neoplasms/*radiotherapy ; Radiotherapy/*methods ; Radiotherapy Planning, Computer-Assisted/*methods

PURPOSE: The purpose of this study is to evaluate the clinical results of treatment with a high dose of 3-dimensional conformal boost (3DCB) using a real-time tracking radiation therapy (RTRT) system in cervical cancer patients. MATERIALS AND METHODS: Between January 2001 and December 2004, 10 patients with cervical cancer were treated with a high dose 3DCB using RTRT system. Nine patients received whole pelvis radiation therapy (RT) with a median dose of 50 Gy (range, 40-50 Gy) before the 3DCB. The median dose of the 3DCB was 30 Gy (range, 25-30 Gy). Eight patients received the 3DCB twice a week with a daily fraction of 5 Gy. The determined endpoints were tumor response, overall survival, local failure free survival, and distant metastasis free survival. The duration of survival was calculated from the time of the start of radiotherapy. RESULTS: All patients were alive at the time of analysis and the median follow-up was 17.6 months (range, 4.9-27.3 months). Complete response was achieved in nine patients and one patient had a partial response. The 1- and 2-year local failure free survival was 78.8% and 54%, respectively. The 1- and 2-year distant metastasis free survival was 90% and 72%, respectively. Late toxicity of a grade 2 rectal hemorrhage was seen in one patient. A subcutaneous abscess was encountered in one patient. CONCLUSION: The use of the high dose 3DCB in the treatment of cervical cancer is safe and feasible where intracavitary brachytherapy (ICBT) is unable to be performed. The escalation of the 3DCB dose is currently under evaluation.
Adult ; Aged ; *Brachytherapy ; Female ; Humans ; Middle Aged ; Radiotherapy Planning, Computer-Assisted/adverse effects/*methods ; Treatment Outcome ; Uterine Cervical Neoplasms/mortality/pathology/*radiotherapy

Background : Thoracic and thoracoabdominal aortic diseases are treated using operative procedures like open aortic repair (OAR), thoracic endovascular aortic repair (TEVAR) or even hybrid aortic repair (HAR), a combination of OAR and TEVAR. The surgical approach to aortic repair is evolving over the decades. The purpose of this study was to examine the current trends in treatment. Methods : We extracted the nationwide data of aortic repair procedures performed between 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also classified the cases based on various criteria such as operative mortality, associated major morbidities (e.g. stroke, spinal cord insufficiency, renal failure), disease pathology (e.g. acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), site of operative repair (e.g. aortic root, ascending aorta, aortic root to arch, aortic arch, descending aorta, thoracoabdominal aorta) and the preferred surgical approach (i.e. OAR, HAR or TEVAR). Results : The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. In comparison to the data in our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and numbers of OAR, HAR, and TEVAR have increased by 17.0%, 2.4%, 126.1% and 34.9%, respectively. While the overall stroke rates following aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3% respectively. OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9% and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. Conclusions The number of operated thoracic and thoracoabdominal aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting aortic arch aneurysms.

Purpose : The current status of treatment for thoracic/thoracoabdominal aortic diseases in Japan was analyzed. Methods : Using the Japan Cardiovascular Surgery Database (JCVSD), the number of cases, operative mortality and major morbidities (stroke, renal failure, pneumonia, paraplegia) of thoracic and thoracoabdominal aortic surgery in 2017 and 2018 were analyzed by surgical site (root-ascending, arch, descending, thoracoabdominal aorta), surgical procedure and age group. Results : The total number of cases was approximately 40,000 and aortic dissection and non-dissection were almost the same. The number of cases was highest in the 70s, and in the elderly, the rates of root replacement (particularly valve-sparing operation) in the root-ascending aorta and open-chest surgery (prosthetic graft replacement, OAR ; open stent graft, Open SG) in the arch, descending and thoracoabdominal aorta were lower. The outcome by procedure showed the lowest mortality and morbidity rate of valve-sparing in the root-ascending region, and lower mortality and morbidity (cerebral infarction, renal failure, and pneumonia) in non-open-chest procedures (TEVAR with/without branch reconstruction) than those in open-chest procedures in the arch, descending and thoracoabdominal regions. Unlike other complications, the incidence of paraplegia in the arch was lower in OAR than in non-open-chest procedures. With regards to age, the operative mortality in patients aged 80 or older was significantly higher than those under 80 for all surgical procedures in the root-ascending, arch and descending regions. Conclusions : Thoracic and thoracoabdominal aortic surgery in Japan was most often performed in elderly patients in their 70s with an overall good mortality rate of 5.3%. Mortality and postoperative morbidity in patients aged 80 or older were still high. Further improvement of surgical results is required.