PURPOSE: We describe the daily bladder volume change observed by mega-voltage computed tomography (MVCT) during pelvic radiotherapy with potential predictors of increased bladder volume variations. MATERIALS AND METHODS: For 41 patients who received pelvic area irradiation, the volumes of bladder and pelvic body contour were measured twice a day with pre- and post-irradiation MVCT from the 1st to the 10th fraction. The median prescription dose was 20 Gy (range, 18 to 30 Gy) up to a 10th fraction. The upper and lower margin of MVCT scanning was consistent during the daily treatments. The median age was 69 years (range, 33 to 86 years) and 10 patients (24.4%) were treated postoperatively. RESULTS: Overall bladder volume on planning computed tomography was 139.7 ± 92.8 mL. Generally, post-irradiation bladder volume (POSTBV) was larger than pre-irradiation bladder volume (PREBV) (p < 0.001). The mean PREBV and POSTBV was reduced after 10 fraction treatments by 21.3% (p = 0.028) and 25.4% (p = 0.007), respectively. The MVCT-scanned body contour volumes had a tendency to decrease as the treatment sessions progressed (p = 0.043 at the 8th fraction and p = 0.044 at the 10th fraction). There was a statistically significant correlation between bladder filling time and PREBV (p = 0.001). CONCLUSION: Daily MVCT-based bladder volume assessment was feasible both intra- and inter-fractionally.
Humans ; Pelvic Neoplasms ; Prescriptions ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Urinary Bladder

PURPOSE: This study was done to confirm the reference point variation according to variation in applicator configuration in each fractioation of HDR ICR. MATERIALS AND METHODS: We analyzed the treatment planning of HDRICR for 33 uterine cervical cancer patients treated in department of therapeutic radiology from January 1992 to February 1992. Analysis was done with respect to three view points-Interfractionation A point variation, interfractionation bladder and rectum dose ratio varidation, interfractionation treatment volume variation. Interfractionation A point variation was defined as difference between maximum and minimum distance from fixed rectal point to A point in each patient. Interfractionation bladder and rectum dose ration variation was defined as difference between maximum and minimum doe ratio of bladder or rectum to A point dose in each patient.. Interfractionation treatment volume variation was defined as difference between maximum and minimum treatment volume which absorbed over the described dose that is, 350 cGy or 400 cGy-in each patient. RESULTS: The mean of distance from rectum to A point was 4.44cm , and the mean of interfractionation distance variation was 1.14cm in right side, 1.09cm in left side. The mean of bladder and rectum dose ratio was 63.8% and 63.1% and the mean of interfractionation variation was 14.9% and 15.8% respectively. With fixed planning administration of same planning to all fractionations as in first fractionation planning mean of bladder and rectum dose ration was 64.9% and 72.3% and the mean of interfraction variation was 28.1% and 48.1% respectively. The mean of treatment volume was 84.15cm3 and the interfractionation variation was 21.47 cm3. CONCLUSION: From these data, it was confirmed that there should be adapted planning for every fractionation, and that confirmation device installed in ICR room would reduce the interfractionation variation due to more stable applicator configuration.
Humans ; Radiation Oncology ; Radiotherapy* ; Rectum ; Urinary Bladder ; Uterine Cervical Neoplasms*

OBJECTIVE: To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity. METHODS: Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200－400 mL. After 2－4 weeks of training, the prescribed volume of the bladder was determined according to the patient's bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient's bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment. RESULTS: The mean bladder volume of simulation (V_CT01) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (V_EVA01) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (V_BVI01) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (V_CBCT) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between V_EVA01 and V_BVI01, V_CT01 and V_BVI01, V_CT01, and V_BVI01, and there was no significant difference in paired t-test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(V_EVA01) and simulation CT (V_CT01) and differences of self-evaluation bladder volume before radiotherapy (V_EVA01) and cone-beam CT (V_CBCT), and there was no significant difference in paired samples by t-test. CONCLUSION During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.
Cone-Beam Computed Tomography ; Humans ; Male ; Prostatic Neoplasms ; Radiotherapy Planning, Computer-Assisted ; Urinary Bladder Neoplasms/radiotherapy*

PURPOSE: The aim of this study was to identify volume changes and dose variations of rectum and bladder during radiation therapy in prostate cancer (PC) patients. MATERIALS AND METHODS: We analyzed 20 patients with PC treated with helical tomotherapy. Daily image guidance was performed. We re-contoured the entire bladder and rectum including its contents as well as the organ walls on megavoltage computed tomography once a week. Dose variations were analyzed by means of Dmedian, Dmean, Dmax, V₁₀ to V₇₅, as well as the organs at risk (OAR) volume. Further, we investigated the correlation between volume changes and changes in Dmean of OAR.
Humans ; Organs at Risk ; Prostate ; Prostatic Neoplasms ; Radiotherapy, Image-Guided ; Radiotherapy, Intensity-Modulated ; Rectum ; Urinary Bladder

The effect of prophylactic postoperative radiotherapy on peripheral lymphocyte count was determined for 20 cases of urogenital malignant tumors (bladder cancer-13 cases, prostatic cancer-4 cases, renal cancer-3 cases). The results were obtained as follows, l) Radiotherapy decreased the white blood cell count by a mean percentage of 16.7% (14.0% for bladder cancer, 16.4% for prostatic cancer. 36.8% for renal cancer, respectively) during the period of first month, but did not alter the granulocyte count. 2) Radiotherapy brought about high degree of decrease of peripheral lymphocyte count by a mean percentage of 47.9% (47. 3% for bladder cancer. 50.0% for prostatic cancer. 32.3% for renal cancer, respectively). 3) The recovery of the radiation-induced lymphocyte deficiency to pre-irradiation level was observed in 1-2 years after completion of radiation therapy (2 years for bladder cancer. 1 1/2 years for prostatic cancer. 1 year for renal cancer. respectively).
Granulocytes ; Kidney Neoplasms ; Leukocyte Count ; Lymphocyte Count* ; Lymphocytes* ; Prostatic Neoplasms ; Radiotherapy ; Urinary Bladder Neoplasms

PURPOSE: Apurinic/apyrimidinic endonuclease 1/redox factor-1 (APE1/Ref-1) is a multifunctional protein that shows elevated expression in a number of cancers. We attempted to determine whether serum APE1/Ref-1 is elevated in patients with bladder cancer. MATERIALS AND METHODS: Serum APE1/Ref-1 levels were determined using enzyme-linked immunosorbent assay in serum from patients with bladder cancer who had not received chemotherapy or radiotherapy (n=51) and non-tumor controls (n=55). The area under the receiver operating characteristic area under the curve was applied to determine the correlation between clinical factors and the serum levels of APE1/Ref-1. RESULTS: Serum levels of APE1/Ref-1 in bladder cancer patients were significantly elevated compared to those of the control group (3.548+/-0.333 ng/100 muL [n=51] for bladder cancer vs. 1.547+/-0.319 ng/100 muL [n=55] for the control group), with a sensitivity and specificity of 93% and 59%, respectively. Serum APE1/Ref-1 levels are associated with tumor stage, grade, muscle invasion, and recurrence. CONCLUSION: Serum APE1/Ref-1 might be useful as a potential serologic biomarker for bladder cancer.
Biological Markers ; Drug Therapy ; Enzyme-Linked Immunosorbent Assay ; Humans ; Radiotherapy ; Recurrence ; ROC Curve ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Eight patients with superficial stage O or A transitional cell carcinoma and 1 patient with infiltrating stage B2 or C transitional cell carcinoma of the bladder were treated with intravesical bleomycin sulfate every 5 or 7 Jays for 8 treatments. No hematologic, skin reaction and pulmonary fibrosis were observed in all patients. Doxorubicia hydrochloride was combined in 1 patient and definitive radiotherapy was added in the case with infiltrating transitional cell carcinoma, who was not a candidate for radical surgery. Follow-up cystoscopy and urine cytology should be done with at least 3 months interval in proof of effectiveness of intravesical chemotherapy. The possibility of obtaining even temporary regression and pronounced palliative effects or permanent cure using intravesical chemotherapy should not be underestimated and its clinical trial in superficial bladder tumor should be considered along with surgical therapy. General concept of intravesical chemotherapy is reviewed and discussed.
Bleomycin ; Carcinoma, Transitional Cell* ; Cystoscopy ; Drug Therapy ; Follow-Up Studies ; Humans ; Pulmonary Fibrosis ; Radiotherapy ; Skin ; Urinary Bladder Neoplasms ; Urinary Bladder*

The CISCA regimen (Cis-platinum, Cyclophosphamide and Adriamycin combination), first reported by Sternberg et al. at 1977 is most excellent combination chemotherapy regimen for treatment of advanced bladder carcinoma other than single or combination chemotherapy regimen ever reported and its overall response rate was average 46%. We experienced two cases of advanced bladder carcinoma, treated with CISCA regimen, followed by radiotherapy and/or cystectomy. All 3 drugs (70mg/m2 Cis-platinum in five divided dose, 400mg/m2 Cyclophosphamide and 40mg/m2 Adriamycin) were given as a single dose every 1 weeks. During enforcement of each 3 and 2 cycles, the definite symptomatic relief was observed. The complications were minimal and were relatively well tolerated by patients. The chemotherapy of transitional cell carcinoma of the bladder with CISCA regimen appears to be effective.
Carcinoma, Transitional Cell ; Cisplatin ; Cyclophosphamide ; Cystectomy ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Radiotherapy ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: This study analyzed the tumor response, overall survival, progression free survival and related prognostic factors in patients with muscle invasive bladder cancer subjected to bladder preserving treatment. MATERIALS AND METHODS: Between August 1995 and June 2004, 37 patients with muscle invasive (transitional cell carcinoma, clinically stage T2-4) bladder cancer were enrolled for the treatment protocol of bladder preservation. There were 33 males and 4 females, and the median age was 67 years (range 38~86 years). Transurethral resection of the bladder (TURB) was performed in 17 patients who underwent complete resection. The median radiation dose administered was 64.8 Gy (range 55.8~67 Gy). The survival rate was calculated by the Kaplan-Meier method. RESULTS: An evaluation of the response rate was determined by abdomen-pelvic CT and cystoscopy at three months after radiotherapy. A complete response was seen in 17 patients (46%). The survival rate at three years was 54.7%, with 54 months of median survival (range 3~91 months). During the study, 17 patients died and 13 patients had died from bladder cancer. The progression free survival rate at three years was 37.2%. There were 24 patients (64.9%) who had disease recurrence: 16 patients (43.2%) had local recurrence, 6 patients (16.2%) had a distant recurrence, and 2 patients (5.4%) had both a local and distant recurrence. The survival rate (p=0.0009) and progression free survival rates (p=0.001) were statistically significant when compared to the response rate after radiotherapy. CONCLUSION: The availability of complete TURB and appropriate chemoradiotherapy were important predictors for bladder preservation and survival.
Chemoradiotherapy ; Clinical Protocols ; Cystoscopy ; Disease-Free Survival ; Female ; Humans ; Male ; Radiotherapy ; Recurrence ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. MATERIALS AND METHODS: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. RESULTS: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). CONCLUSION: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.
Anastomotic Leak ; Colon* ; Humans ; Prone Position ; Radiotherapy ; Rectal Neoplasms ; Urinary Bladder*