Although much care is required in delivering extremely high doses of radiotherapy to the tumor, modified SIB radiotherapy was shown to be effective against extremely large tumors that could not be controlled using conventional radiotherapy. In future, an increase in the number of study patients and establishment of the technique will be required.
A clinical trial of radiotherapy with modified simultaneous integrated boost (SIB) technique against huge tumors was conducted. A 58-year-old male patient who had a huge pelvic tumor diagnosed as a rectal adenocarcinoma due to familial adenomatous polyposis was enrolled in this trial. The total dose of 77 Gy (equivalent dose in 2 Gy/fraction) and 64.5 Gy was delivered to the center of the tumor and the surrounding area respectively, and approximately 20% dose escalation was achieved with the modified SIB technique. The tumor with an initial maximum size of 15 cm disappeared 120 d after the start of the radiotherapy. Performance status of the patient improved from 4 to 0. Radiotherapy with modified SIB may be effective for patients with a huge tumor in terms of tumor shrinkage/disappearance, improvement of QOL, and prolongation of survival.
IntroductionMany patients with endometriosis are treated with medication or by surgical approaches. However, a small number of patients do not respond to medication and are inoperable because of comorbidities. This case report shows the effectiveness of radiotherapy for refractory endometriosis and includes a time series of serum estradiol levels.Case presentationA 47-year-old Asian woman presented to our facility with uncontrolled endometriosis refractory to medication. Our patient was considered inoperable because of severe idiopathic thrombocytopenic purpura, and underwent radiotherapy for massive genital bleeding requiring blood transfusions. A radiation dose of 20Gy in 10 fractions was delivered to the pelvis, including the bilateral ovaries, uterus, and myomas. An additional 10Gy in five fractions was delivered to the endometrium to control residual bleeding. Genital bleeding was completely inhibited on day 46 after radiotherapy. Hormonal analysis revealed that radiotherapy induced post-menopausal status. Two years after radiotherapy, atypical genital bleeding had not recurred and has been well controlled without side effects.ConclusionsDisrupted ovarian function is an adverse effect of radiotherapy. However, radiotherapy can be useful for inducing menopause. In cases of medication-refractory or inoperable endometriosis, radiotherapy would be an effective treatment option.
Abstract. The current study reports the case of a large retroperitoneal tumor treated with modified simultaneous integrated boost (SIB) radiotherapy. A 45-year-old female presented to the emergency department complaining of left abdominal pain and fever. A computed tomography scan detected a retroperitoneal tumor of 12x16x16 cm, and a biopsy revealed a poorly-differentiated adenocarcinoma. The patient was diagnosed with a large adenocarcinoma originating from the left ureter, with no distant metastasis. Due to the patient's poor physical condition, surgery was not recommended, and the patient was referred to the Department of Radiation Oncology (Yamagata University Hospital, Yamagata, Japan). Modified SIB radiotherapy was administered following the acquisition of written consent from the patient. The total irradiation dose to the center of the tumor and to the surrounding healthy tissue was ~96 Gy/33 fractions and <60 Gy/33 fractions, respectively. At the end of the radiotherapeutic course, the tumor volume was reduced by ≥80%, and the residual tumor was surgically resected. As a result of the resection, a complete pathological response was confirmed; the patient has been recurrence-free for >3 years with no complications. Modified SIB radiotherapy may be safely administered, with favorable outcomes. Complete recovery can be achieved with this technique, even in a patient with a large radioresistant tumor. IntroductionRetroperitoneal tumors arise from the tissues of the retroperitoneal space, which includes the following structures: The adrenal glands, kidneys, ureter, aorta, inferior vena cava, pancreas (part), duodenum, colon (part), rectum, esophagus, lymph nodes, and soft tissue. Although in other sites the incidence of a benign tumor is higher than that of a malignant tumor, the incidence of a malignant tumor in the peritoneum is ~4 times higher than that of a benign tumor (1). The majority of retroperitoneal tumors are malignant soft tissue tumors, lymphoproliferative disorders, and malignancies arising from parenchymal tissues (1).Approximately one-third of retroperitoneal tumors are soft tissue sarcomas, with liposarcoma and leiomyosarcoma accounting for ~70% and 15% of reteroperitoneal sarcomas, respectively (2). The retroperitoneum is the second most common site of origin of soft tissue tumors (2), with 10-15% of soft tissue sarcomas arising from the retroperitoneum (3,4). More rarely, Castleman's tumors (5), adult neuroblastoma (6), gastrinoma (7), solitary fibrous tumor of the pancreas (8), teratoma (9) and neurogenic tumors (10) have been reported to occur in this region. Due to the rarity of retroperitoneal large adenocarcinoma, literature regarding the surgical treatment of large retroperitoneal tumors is limited (11). Furthermore, no standard treatment exists for patients with inoperable large retroperitoneal tumors and thus, only palliative chemotherapy or radiotherapy or best supportive care is administered for these patients.Retroperitoneal tumors show few clinical symptoms in the early phase,...
Cu-0.78 mass%Si bicrystals are internally oxidized at various conditions and morphological evolution of amorphous SiO 2 formed on a grain boundary (GB) is observed. After the reaction of Si atoms with oxygen, a film-like SiO 2 phase with holes is initially formed on GB of Cu. At temperatures used for the internal oxidation, the holes rapidly grow and the morphology of the film-like SiO 2 changes to a particulate equilibrium shape through formation of two-dimensional SiO 2 network and its subsequent breakup. During the morphological evolution, the volume of SiO 2 on GB is conserved. The morphological evolution of SiO 2 on GB is caused by diffusional flow of matter to decrease the sum of Cu/SiO 2 interface and Cu grain-boundary energies. The activation energy Q of the morphological evolution is obtained as Q % 290 kJ/mol. Among the values of activation energies reported in the previous studies on diffusion in SiO 2 , Q % 290 kJ/mol is close to that for the volumediffusion of SiO in SiO 2 , Q SiO % 268 kJ/mol. This supports that the morphological evolution of SiO 2 on GB is controlled by the volumediffusion of SiO in SiO 2 .
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