Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures

To investigate the incidence, clinical and imaging finding of insufficiency fractures (IF) of the female pelvis following radiation therapy. We reviewed the radiation oncology records of 158 patients with gynecologic malignancies who underwent external beam radiation therapy of the whole pelvis between April 1993 and March 2004. All patients underwent computed tomography (CT) scan every 6 months in follow-up after radiation therapy and magnetic resonance imaging (MRI) and radionuclide bone scan were added when the patients complained of a pelvic pain. Eighteen of 158 patients (11.4%) developed IF in the irradiated field with a median interval of 6 months (range 3-51) from the completion of external beam radiation therapy. The cumulative incidence of symptomatic IF at 5 years calculated with Kaplan-Meyer methods was 13%. Median age of the patients who developed IF was 70 years (range 48-88), and all of them were postmenopausal. IF occurred in the sacloiliac joints, upper limb of pubic bone, acetabulum, sacral body and 5th lumbar vertebra. Twelve of 18 patients had multiple lesions and 8 had symmetric longitudinal fracture lines parallel to the sacroiliac joints. Avoidance of weight bearing by bed rest and analgesics provided good pain relief in all patients, although symptoms lasted from 3 to 20 months. Radiation-induced pelvic IF following radiation therapy for gynecologic malignancies were frequently observed in the postmenopausal patients within 1 year after external beam radiation therapy. Symmetric fractures of the both sacroiliac joints were the characteristic pattern of pelvic IF. Knowledge of characteristic imaging pattern of IF is essential in order to rule out the bone metastasis. Therapy recommendations are conservative with analgesics.


Quality Assurance of I-125 Seed for Prostate Brachytherapy Using an Imaging Plate

OncoSeed is delivered in a sterile environment in the form of a cartridge, so it is impractical to resterilize and reload seeds after calibration. We investigated a new method using an imaging plate dosimetry system to characterize all seeds in the OncoSeed cartridge in a sterile environment. Seeds within the cartridge were placed on an imaging plate, and the imaging plate irradiated. To remove scatter radiation, and improve spatial resolution of seed images, we used X-ray parallel cross grids. The irradiated imaging plate was scanned using a Bio-imaging Analyzer System, and radioactivity intensities of seed images were given in counts. Counts could be translated to profiles, and each seed within the cartridge was analyzed. Results showed a good correlation between counts and total radioactivity of the seeds within the cartridge. Thus, using a least-squares line, it was possible to characterize a cartridge with unknown apparent activity. By analyzing the profiles, it was possible not only to detect a miscalibrated seed in the cartridge from its relative difference in counts, but also to identify its position in the cartridge. No significant changes in counts were seen between sterile and nonsterile environments. Using an imaging plate dosimetry system, all seeds in a cartridge could be characterized in a sterile environment.

International Journal of Radiation Oncology*Biology*Physics


Chemoradiation Therapy for Cervical Cancer:Toxicity of Concurrent Weekly Cisplatio

To retrospectively evaluate the toxicity of concurrent weekly cisplatin and radiation therapy (RT) for locally advanced cervical cancer. Between April 2001 and December 2004, 21 consecutive previously untreated patients with locally advanced cervical cancer were treated with concurrent chemoradiation therapy (CCRT) at the Tokushima University Hospital. Clinical stages were II: 5, III: 15, IVA: 1. External beam radiation therapy (EBRT) was delivered with 10 MV X-rays, 2 Gy fraction per day; total dose to the whole pelvis was 50 Gy. Iridium-192 high-dose-rate (HDR) intracavitary radiation therapy was performed with 10-30 Gy (median, 24 Gy) targeted at point A. Concurrent chemotherapy consisted of cisplatin, administered weekly at a dose of 40 mg/m2 for patients who were younger than 65 years and 30 mg/m2 for those 65 years or over. A maximum single dose of cisplatin, up to 70 mg/body, was administered in 5 cycles during EBRT. A total of 86 cycles of cisplatin were administered to the 21 patients, with a median of 4 cycles (range, 2-5). Severe hematological toxicity occurred in 18 patients (86%), including grade 3 in 17 patients (81%) and grade 4 in one patient (4.8%). Moderate or severe gastrointestinal toxicity occurred in 11 patients (52%), including grade 2 in 10 patients (48%) and grade 3 in one patient (4.8%). The grades of hematological toxicity were significantly greater in the 40 mg/m2 group than in the 30 mg/m2 group. All of the patients who were administered 40 mg/m2 of cisplatin developed grade 3 or greater hematological toxicity, including one patient with grade 4 toxicity. In the 30 mg/m2 group, 3 of 10 patients developed less than grade 3 toxicity, and all patients completed radiation therapy without interruption. The incidence of severe acute hematological toxicity was significantly higher in this study than in previously reported randomized controlled trials (RCTs), especially in the group of 40 mg/m2 cisplatin. A dose of 30 mg/m2 of cisplatin was considered to be feasible in weekly cisplatin and radiation therapy.


Quality Assurance of I-125 Seed Permanent Implant Therapy Using a Self-color Developing Reflection-type Dosimetry Sheet Film

We evaluated a self-color developing sheet-type film for the detection of dead seeds in I-125 permanent implant therapy for prostate cancer. As a preliminary study, we irradiated X-rays to a self-developing reflection-type sheet film and created a relational curve between absorbed dose and film density. I-125 seeds were placed on a film and the approximate absorbed dose of I-125 was calculated from the relational curve of X-rays. A cartridge in which a dead seed was loaded among 10 I-125 seeds was placed on the film and the detectability of the dead seed was evaluated. Using the relational curve of X-rays, it was possible to measure the approximate absorbed dose of I-125 seeds and to easily detect a dead seed at a glance. Using sterilized film, it was possible to detect a dead seed. The self-developing film method is feasible for the detection of a dead seed in a cartridge without re-sterilization of seeds.


Insufficiency fractures following radiation therapy for gynecologic malignancies

The Official Jpurnal of The Japanese Society for Therapeutic Radiology and Oncology


Fractionated stereotactic radiation therapy for brain metastasis from renal cell carcinoma


A comparison of the results of radiotherapy and surgical treatment of tangue cancer


Radiotherapy for Carcinoma of the Uterine Cervix using Low-Dose-Rate Intercavitary Brachytherapy- A Retrospective Analysis of Pretreatment and Treatment Prognostic Factore-


Radiation Complications Following Breast Conserving Therapy


A study of skeletal metastasis of Carcinoma of the Uterine Cervix

子宮頸癌の骨転移例の検討


Eight Cases of Intracranial Arteriovenous Malformations Conducted Conventional Radiation Therapy

放射線療法を行った頭蓋内動静脈奇形について


限局性前立腺癌に対する密封小線源療法のリスク分類別治療成績

限局性前立腺癌に対する密封小線源療法のリスク分類別治療成績


Clinical results of radiotherapy and B-M therapy for advanced cervical cancer

進行子宮頸癌に対する放射線+化学療法(B-M療法)併用における成績

Bulletin of School of Medical Sciences, the University of Tokushima

徳島大学医療技術短期大学部紀要


Radiation therapy and Chinese immunotherapy of malignant tumor - from clinical aspects -

放射線と中医免疫ー臨床面からー

徳島大学医療技術短期大学部紀要