研究者詳細 - 茂松　直之

論文 - 茂松　直之

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Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Body Radiotherapy for Pulmonary Nodular Lesions

Kawase Takatsugu, Takeda Atsuya, Kunieda Etsuo, Kokubo Masaki, Kamikubo Yoshifumi, Ishibashi Ryouchi, Nagaoka Tomoaki, Shigematsu Naoyuki, Kubo Atsushi

International Journal of Radiation Oncology Biology Physics 74 （ 2 ） 349 - 354 2009年06月

ISSN 0360-3016

Purpose: To clarify the incidence, symptoms, and timing of extrapulmonary fibrosis developing after hypofractionated stereotactic body radiotherapy. Patients and Methods: We analyzed 379 consecutive patients who underwent stereotactic body radiotherapy for lung tumors at four institutions between February 2001 and March 2007. The median follow-up time was 29 months (range, 1-72). We investigated the subjective and objective characteristics of the extrapulmonary masses, redelineated the origin tissue of each on the treatment planning computed tomography scan, and generated dose-volume histograms. Results: In 9 patients (2.4%), extrapulmonary masses were found 3-36 months (median, 14) after irradiation. Coexisting swelling occurred in 3 patients, chest pain in 2, thumb numbness in 1, and arm edema in 1 patient. Extrapulmonary masses occurred in 5 (5.4%) of 92 and 4 (1.4%) of 287 patients irradiated with a 62.5-Gy and 48.0-Gy isocenter dose, respectively. The mean and maximal dose to the origin tissue was 25.8-53.9 Gy (median, 43.7) and 47.5-62.5 Gy (median, 50.2), respectively. In 5 of 9 patients, the standardized uptake values on 18F-fluorodeoxyglucose-positron emission tomography was 1.8-2.8 (median, 2.2). Percutaneous needle biopsy was performed in 3 patients, and all the specimens showed benign fibrotic changes without malignant cells. Conclusion: All patients should be carefully followed after stereotactic body radiotherapy. The findings of any new lesion should prompt an assessment for radiation-induced extrapulmonary fibrosis before an immediate diagnosis of recurrence is made. Careful beam-shape modification and dose prescription near the thoracic outlet are required to prevent forearm neuropathy and lymphedema.

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Dose Distribution Analysis in Stereotactic Body Radiotherapy Using Dynamic Conformal Multiple Arc Therapy

Takeda Atsuya, Kunieda Etsuo, Sanuki Naoko, Ohashi Toshio, Oku Yohei, Sudo Yasunobu, Iwashita Hideo, Ooka Yoshikazu, Aoki Yosuke, Shigematsu Naoyuki, Kubo Atsushi

International Journal of Radiation Oncology Biology Physics 74 （ 2 ） 363 - 369 2009年06月

ISSN 0360-3016

Purpose: We have used dynamic conformal multiple arc therapy (DCMAT) for stereotactic body radiotherapy (SBRT) since 2001. We investigated the consistency of DCMAT for SBRT using dose-volume histogram analysis. Methods and Materials: A total of 50 patients with peripheral lung tumors underwent SBRT. The median tumor diameter was 2.4 cm (range, 0.9-5.9). Treatment planning was performed using a superposition algorithm. The prescribed 50 Gy dose was divided into five fractions. The prescribed dose was defined as 80% of the maximal dose in the planning target volume (PTV), and the leaf margins were modified to ensure the PTV was included in the 80% isodose surface. The dose-volume histogram analysis was used to assess the PTV and normal lung volume. Results: The median dose covering 95% of the PTV was 50.27 Gy (range, 46.14-52.67), essentially consistent with the prescribed dose. The median homogeneity and conformity index was 1.41 (range, 1.31-1.53) and 1.73 (range, 1.41-2.21), respectively. The median volume of lung receiving ≥20 Gy (V₂₀) was 4.2% (range, 1.4-10.2%). A linear correlation was found between the tumor diameter and V₂₀, and an even stronger correlation was found between the PTV/(normal lung volume) and V₂₀. The estimated V₂₀ was 7.1% (range, 3.9-10.4%) for a 5-cm-diameter tumor, assumed to be the maximal size limitation for SBRT. Conclusion: SBRT with DCMAT achieved high conformity and delivered adequate doses within the PTV. The median dose covering 95% of the PTV was consistent with the prescribed dose. V₂₀ can be estimated using the tumor diameter and normal lung volume. DCMAT was thus both a feasible and a reproducible method of SBRT delivery.

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Intense accumulation of Tc-99m MDP in pericardial metastasis from breast cancer

Kawase Takatsugu, Fujii Hirofumi, Nakahara Tadaki, Shigematsu Naoyuki, Kubo Atsushi, Kosuda Shigeru

Clinical Nuclear Medicine 34 （ 3 ） 173 - 174 2009年03月

ISSN 0363-9762

Extraosseous uptake often seen on Tc-99m methylene diphosphonate bone scintigraphy has clinical significance. In a routine follow-up study on a 54-year-old female patient with breast cancer, we encountered a rare finding of pericardial metastasis clearly demonstrated by Tc-99m methylene diphospho- nate bone scintigraphy. This incidental finding of increased uptake in the periphery of the cardiac contour on a bone scan reflects radionuclide accumulation in pericardium, myocardium, or pericardial effusion itself. In our case, an additional computed tomography examination of the chest was useful for making the definitive diagnosis of dystrophic calcification of the pericardium.

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Stereotactic Body Radiotherapy for Primary Lung Cancer at a Dose of 50 Gy Total in Five Fractions to the Periphery of the Planning Target Volume Calculated Using a Superposition Algorithm

Takeda Atsuya, Sanuki Naoko, Kunieda Etsuo, Ohashi Toshio, Oku Yohei, Takeda Toshiaki, Shigematsu Naoyuki, Kubo Atsushi

International Journal of Radiation Oncology Biology Physics 73 （ 2 ） 442 - 448 2009年02月

ISSN 0360-3016

Purpose: To retrospectively analyze the clinical outcomes of stereotactic body radiotherapy (SBRT) for patients with Stages 1A and 1B non-small-cell lung cancer. Methods and Materials: We reviewed the records of patients with non-small-cell lung cancer treated with curative intent between Dec 2001 and May 2007. All patients had histopathologically or cytologically confirmed disease, increased levels of tumor markers, and/or positive findings on fluorodeoxyglucose positron emission tomography. Staging studies identified their disease as Stage 1A or 1B. Performance status was 2 or less according to World Health Organization guidelines in all cases. The prescribed dose of 50 Gy total in five fractions, calculated by using a superposition algorithm, was defined for the periphery of the planning target volume. Results: One hundred twenty-one patients underwent SBRT during the study period, and 63 were eligible for this analysis. Thirty-eight patients had Stage 1A (T1N0M0) and 25 had Stage 1B (T2N0M0). Forty-nine patients were not appropriate candidates for surgery because of chronic pulmonary disease. Median follow-up of these 49 patients was 31 months (range, 10-72 months). The 3-year local control, disease-free, and overall survival rates in patients with Stages 1A and 1B were 93% and 96% (p = 0.86), 76% and 77% (p = 0.83), and 90% and 63% (p = 0.09), respectively. No acute toxicity was observed. Grade 2 or higher radiation pneumonitis was experienced by 3 patients, and 1 of them had fatal bacterial pneumonia. Conclusions: The SBRT at 50 Gy total in five fractions to the periphery of the planning target volume calculated by using a superposition algorithm is feasible. High local control rates were achieved for both T2 and T1 tumors.

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Biodistribution of immunoliposome labeled with Tc-99m in tumor xenografted mice

Kitamura Naoto, Shigematsu Naoyuki, Nakahara Tadaki, Kanoh Momoe, Hashimoto Jun, Kunieda Etsuo, Kubo Atsushi

Annals of Nuclear Medicine 23 （ 2 ） 149 - 153 2009年02月

ISSN 0914-7187

Objective: Immunoliposome (PEG, GAH, liposome; PGL), consisting of F(ab)₂ fragment of monoclonal antibody, GAH and polyethyleneglycol- coated (PEGylated) liposome was provided. Immunoliposome, PGL was labeled with technetium-99m (Tc-99m) by two methods: labeling F(ab)₂ fragment with Tc-99m; Tc-99m-PGL, and entrapping Tc-99m into liposome; PGL[Tc-99m]. The objective of this study was to compare the biodistribution of Tc-99m-PGL and PGL[Tc-99m] in human gastric cancer xenografted mice. Methods: Tc-99m-PGL, PGL[Tc-99m], and Tc-99m-entrapped liposome; Lipo[Tc-99m] were prepared. They were injected into human gastric cancer, MKN45, xenografted mice via the tail vein, and their biodistribution was studied. Results: No marked accumulation of either PGL[Tc-99m] or Lipo[Tc-99m] was observed in the stomach. The uptake of Tc-99m-PGL by the liver, spleen, and lung was higher than that by the tumor. On the other hand, the uptake of PGL[Tc-99m] by the lung and spleen was markedly lower as compared with that of Tc-99m-PGL; the accumulation of PGL[Tc-99m] was lower in the lung and higher in the spleen as compared with that of the tumor. Although the liver uptake of PGL[Tc-99m] was markedly decreased as compared with that of Tc-99m-PGL, it was higher than the uptake of the tumor. The Tc-99m-PGL was strongly taken up by the tumor, with a high level of incorporation also seen in the stomach. These findings suggest the need for further study of the labeling stability. Conclusions: PGL[Tc-99m] appears to show promise for high tumor uptake and retention. This is an important implication for the potential application of immunoliposomes entrapped with Re-186, instead of Tc-99m, in internal radiotherapy.

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Dose Distribution Analysis of Axillary Lymph Nodes for Three-Dimensional Conformal Radiotherapy With a Field-in-Field Technique for Breast Cancer

Ohashi Toshio, Takeda Atsuya, Shigematsu Naoyuki, Fukada Junichi, Sanuki Naoko, Amemiya Atsushi, Kubo Atsushi

International Journal of Radiation Oncology Biology Physics 73 （ 1 ） 80 - 87 2009年01月

ISSN 0360-3016

Purpose: We previously reported that most of axillary regions could be irradiated by the modified tangential irradiation technique (MTIT). The purpose of this study was to determine whether the three-dimensional conformal radiotherapy (3D-CRT) with a field-in-field technique improves dosimetry for the breast and axillary nodes. Methods and Materials: Fifty patients with left-sided breast cancer were enrolled. With MTIT, we planned the radiation field to be wider in the cranial direction than the standard tangential fields to include the axillary regions. With 3D-CRT, a field-in-field technique was used to spare the heart and contralateral breast to the extent possible by applying the multileaf collimator manually. Dose-volume histograms were compared for the breast, axillary region, heart, lung, and other normal tissues. Results: There were no significant differences in the percent volume of the breast receiving >90% of the prescribed dose (V90) between MTIT and 3D-CRT. The mean V90 of the level I to III axillary regions were increased from 93.7%, 48.2%, and 41.3% with MTIT to 97.6%, 85.8%, and 82.8% with 3D-CRT. 3D-CRT significantly reduced the volume of the heart receiving >30 Gy (mean, 7.6 vs. 15.9 mL), the percent volume of the bilateral lung receiving >20 Gy (7.4% vs. 8.9%), and the volume of other normal tissues receiving >107% of the prescribed dose (0.1 vs. 2.9 mL). Conclusion: The use of 3D-CRT with a field-in-field technique improves axillary node coverage, while decreasing doses to the heart, lungs, and the other normal tissues, compared with MTIT.

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Prediction of seed migration after transperineal interstitial prostate brachytherapy with I-125 free seeds

Sugawara Akitomo, Nakashima Jun, Shigematsu Naoyuki, Kunieda Etsuo, Kubo Atsushi

Brachytherapy 8 （ 1 ） 52 - 56 2009年01月

ISSN 1538-4721

Purpose: The present study was undertaken to determine the incidence and predictors of seed migration after transperineal interstitial prostate brachytherapy using I-125 free seeds. Methods and Materials: Between September 2004 and November 2007, 158 patients who underwent transperineal interstitial prostate brachytherapy as monotherapy for clinical T1/T2 carcinoma of the prostate gland were reviewed. Implants had been performed with standard techniques. All 158 patients underwent followup radiographs (orthogonal chest radiographs, a kidney-ureter-bladder radiograph, and a posteroanterior pelvic radiograph) to assess the presence of seed migration at 3 months after transperineal interstitial prostate brachytherapy. Patient characteristics and treatment status were recorded. Univariate and multivariate analyses were performed to identify predictors of seed migration. Results: Seed migration occurred in 35 of 158 patients (22.2%). Univariate analyses revealed that preoperative prostate volume estimated by transrectal ultrasound, the number of needles, the number of seeds implanted, and the presence or absence of pubic arch interference (PAI) were significantly associated with seed migration. These results indicated that larger prostate glands were more likely to have seed migration. However, the absolute difference in prostate size was not overly impressive (22.4 vs. 26.3 cm³). Multivariate analysis revealed that the number of seeds implanted and the presence or absence of PAI were significant predictors of seed migration. Conclusion: The number of seeds implanted and the presence or absence of PAI provide the most predictive information on seed migration.

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Development of a prototype semiconductor gamma-camera system

Ogawa Koichi, Ishikawa Takumi, Shuto Keisei, Kobayashi Hiroaki, Nakahara Tadaki, Shigematsu Naoyuki

3597 - 3601 2009年

We made a prototype gamma camera system with CdZnTe semiconductor detectors that work at room temperature. The effective field of view of this detector is 195 x 156 mm² with a pixel size of 2.46 x 2.46 mm². We evaluated the performance of the detector in terms of the energy resolution, intrinsic spatial resolution, system spatial resolution and system sensitivity. The performance of the detector was evaluated with methods based on the NEMA standard (NU1). The results showed that the mean energy resolution was 5.55 % FWHM for ^99mTc, the intrinsic spatial resolution 2.46 mm FWHM, the system spatial resolutions 7.1 mm FWHM (without scatterer) and 7.4 mm FWHM (with scatterer), and the system sensitivity 46.3 cps/MBq. The performance of the system was also evaluated with some SPECT phantoms and the feasibility of the detector was confirmed with the SPECT images.

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Pattern of tumor recurrence in initially nonmetastatic breast cancer patients – distribution and frequency of metastases at unusual sites.

Sanuki-Fujimoto N, Takeda A, Amemiya A, Ofuchi T, Ono M, Yamagami R, Hatayama J, Kunieda E, Shigematsu N

Cancer 113 （ 4 ） 677-682 2008年08月

研究論文（学術雑誌）, 共著, 査読有り

Phase II study of chemoradiotherapy with S-1 and low-dose cisplatin for inoperable advanced gastric cancer

Saikawa Y, Kubota T, Kumagai K, Nakamura R, Kumai K, Shigematsu N, Kubo A, Kitajima M, Kitagawa Y

Int J Radiation Oncology Biol Phys 71 （ 1 ） 173-179 2008年04月

研究論文（学術雑誌）, 共著, 査読有り

Possible misinterpretation of demarcated solid patterns of radiation fibrosis on CT scans as tumor recurrence in patients receiving hypofractionated stereotactic radiotherapy for lung cancer.

Takeda A, Kunieda E, Takeda T, Tanaka M, Sanuki N, Fujii H, Shigematsu N, Kubo A

Int J Radiat Oncol Biol Phys 70 （ 4 ） 1057-1065 2008年03月

研究論文（学術雑誌）, 共著, 査読有り

前立腺癌：1日で終わる放射線治療

茂松直之

第84回生涯教育研修セミナー 2008年02月

研究論文（研究会，シンポジウム資料等）, 単著

Dose-related fluorodeoxyglucose uptake in acute radiation-induced hepatitis.

Nakahara T, Takagi Y, Takemasa K, Mitsui Y, Tsuyuki A, Shigematsu N, Kubo A

Eur J Gastroenterol Hepatol 20 （ 10 ） 1040-1044 2008年

研究論文（学術雑誌）, 共著, 査読有り

Hypofractionated stereotactic radiotherapy with and without transarterial chemoembolization for small hepatocellular carcinoma not eligible for other ablation therapies: preliminary results for efficacy and toxicity

Takeda A, Takahashi M, Kunieda E, Takeda T, Sanuki N, Koike Y, Atsukawa K, Ohashi T, Saito H, Shigematsu N, Kubo A

Hepatol Res 38 （ 1 ） 60-69 2008年

研究論文（学術雑誌）, 共著

Effects of single or repeated administration of methamphetamine on immune response in mice

Saito M, Terada M, Kawata T, Ito H, Shigemtsu N, Kromkhun P, Yokosuka M, Saito R

Exp Anim 57 （ 1 ） 35-43 2008年

研究論文（学術雑誌）, 共著, 査読有り

Anti-tumor effects of water-soluble propolis on a mouse sarcoma cell line in vivo and in vitro.

Inoue K, Saito M, Kanai T, Kawata T, Shigematsu N, Uno T, Isobe K, Liu CH, Ito H

Am J Chin Med 36 （ 3 ） 625-634 2008年

研究論文（学術雑誌）, 共著, 査読有り

Intrafractional gastric motion and interfractional stomach deformity during radiation therapy.

Watanabe M, Isobe K, Takisima H, Uno T, Ueno N, Kawakami H, Shigematsu N, Yamashita M, Ito H

Radiother Oncol 87 （ 3 ） 425-431 2008年

研究論文（学術雑誌）, 共著, 査読有り

Long-term follow-up of allogeneic hematopoietic stem cell transplantation for de novo acute myelogenous leukemia with a conditioning regimen of total body irradiation and granulocyte colony-stimulating factor-combined high-dose cytarabine.

Mori T, Aisa Y, Watanabe R, Yamazaki R, Kato J, Shimizu T, Shigematsu N, Kubo A, Yajima T, Hibi T, Ikeda Y, Okamoto S

Biol Blood Marrow Transplant 14 （ 6 ） 651-657 2008年

研究論文（学術雑誌）, 共著, 査読有り

Detection of perineal tumor invasion of the head and neck: clinical use of thallium-201 SPECT/CT image fusion

Nakahara T, Suzuki T, Kunieda E, Momoshima S, Shigematsu N, Kubo A

Clin Nucl Med 33 （ 8 ） 567-570 2008年

研究論文（学術雑誌）, 共著, 査読有り

Takeda A, Takahashi M, Kunieda E, Takeda T, Sanuki N, Koike Y, Atsukawa K, Ohashi T, Saito H, Shigematsu N, Kubo A

Hepatol Res 38 （ 1 ） 60-69 2008年

研究論文（学術雑誌）, 共著, 査読有り

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茂松 直之

論文 - 茂松 直之

茂松　直之

論文 - 茂松　直之