Publications by authors named "Miho Watanabe Nemoto"

9 Publications

  • Page 1 of 1

Comparison of CT-based and MRI-based high-risk clinical target volumes in image guided-brachytherapy for cervical cancer, referencing recommendations from the Japanese Radiation Oncology Study Group (JROSG) and consensus statement guidelines from the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC ESTRO).

Jpn J Radiol 2020 Sep 24;38(9):899-905. Epub 2020 Apr 24.

Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

Purpose: The Working Group of the Gynecological Tumor Committee of the Japanese Radiation Oncology Study Group (JROSG) published recommendations for contouring high-risk clinical target volumes (HR-CTV) on CT for 3-dimentional image-guided brachytherapy for cervical cancer. The purpose of this study was to compare HR-CTV delineated on CT, referencing recommendations from JROSG, with HR-CTV delineated on MRI, referencing consensus guidelines from the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC ESTRO).

Material And Methods: Fourteen patients were evaluated. After the insertion of the CT/MR applicator into the patient, CT and MRI were performed. HR-CTV was delineated on MRI for clinical examination and HR-CTV was delineated on CT retrospectively referencing the MRI just before brachytherapy within a week. The volume and dosimetry of HR-CTV based on a 6 Gy dose of the Manchester system were evaluated.

Results: The median volumes of HR-CTV and HR-CTV were 24.4 ml (range, 13.6-50.4 ml) and 29.9 ml (range, 13.2-49.2 ml), respectively. Median D of HR-CTV and HR-CTV were 6.7 Gy (range, 5.8-10.1 Gy) and 6.8 Gy (range, 5.1-10.4 Gy), respectively.

Conclusion: Somewhat difference could be seen between HR-CTV and HR-CTV.
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http://dx.doi.org/10.1007/s11604-020-00980-yDOI Listing
September 2020

A multi-scanner study of MRI radiomics in uterine cervical cancer: prediction of in-field tumor control after definitive radiotherapy based on a machine learning method including peritumoral regions.

Jpn J Radiol 2020 Mar 6;38(3):265-273. Epub 2020 Jan 6.

Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan.

Purpose: This study aimed to identify the most appropriate volume of interest (VOI) setting in prognostic prediction using pretreatment magnetic resonance imaging (MRI) radiomic analysis for cervical cancer (CC) treated with definitive radiotherapy.

Materials And Methods: The study participants were 87 patients who had undergone pretreatment MRI and definitive radiotherapy for CC. VOI was created with tumor alone and VOI-VOI mechanically expanded by 4-20 mm around each VOI in axial T2-weighted images (T2WI) and an apparent diffusion coefficient (ADC) map. A model was constructed to predict recurrence within the irradiation field within 2 years after treatment using imaging features from the VOI of each sequence. Sorting ability was evaluated by area under the receiver operator characteristic curve (AUC-ROC) analysis.

Results: VOI expansion improved AUC-ROCs compared with the predictive models of VOI (0.59 and 0.67 in T2WI and ADC, respectively). The AUC-ROCs of the models with imaging features from expanded VOI in T2WI and VOI and VOI in ADC were 0.82, 0.82, and 0.86, respectively.

Conclusion: Recurrence could be predicted with high accuracy using expanded VOI for CC treated with definitive radiotherapy, suggesting that including the pathological characteristics of invasive margins in radiomics may improve predictive ability.
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http://dx.doi.org/10.1007/s11604-019-00917-0DOI Listing
March 2020

Radiation Therapy for Extrapelvic Lymph Node Recurrence After Curative Treatment for Cervical Cancer.

Anticancer Res 2019 Feb;39(2):891-895

Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.

Background/aim: To investigate outcomes of patients with cervical cancer who received radiation therapy for extrapelvic lymph node recurrence after initial pelvic radiotherapy.

Patients And Methods: The treatment charts of 20 patients were retrospectively reviewed, and factors influencing patient's prognosis were statistically analyzed.

Results: The three-year in-field tumor control rate was 55% and overall survival (OS) at 2, 3, and 5 years was 55%, 45%, and 37.5%, respectively. The rate of the three-year OS in patients with recurrence within and after 9 months was 20% and 70%, respectively (p=0.016). None of the 4 patients who were diagnosed with supraclavicular lymph node recurrence alone at more than 9 months after initial treatment experienced further recurrence. Five-year survival of the remaining 16 patients was only 21% (p=0.021).

Conclusion: Time to recurrence significantly influenced survival in patients with cervical cancer who received radiotherapy for extra-pelvic lymph node recurrence. Supraclavicular lymph node recurrence alone had a favorable impact on patient's prognosis.
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http://dx.doi.org/10.21873/anticanres.13190DOI Listing
February 2019

Preliminary results of a new workflow for MRI/CT-based image-guided brachytherapy in cervical carcinoma.

Jpn J Radiol 2017 Dec 16;35(12):760-765. Epub 2017 Oct 16.

Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

Purpose: We propose a method of image-guided brachytherapy (IGBT) that combines MRI-based target volume delineation for the first fraction with CT datasets of subsequent fractions, using an automatic, applicator-based co-registration, and report our preliminary experience.

Materials And Methods: The MRI of the first fraction was used for the first brachytherapy planning. For each subsequent brachytherapy fraction, after the same applicator insertion, a new CT scan with the applicator in place was obtained. The MR image set was registered to the subsequent brachytherapy treatment planning CT using the applicator for rigid body registration. To demonstrate the registration quality, we used here the Dice index as a measurement of tandem delineation overlap between CT and MRI.

Results: The median Dice index was 0.879 (range 0.610-0.932), which indicated that the contours on CT and MRI fitted well. With this combination method, the median D90 of HR CTV and the calculated D2 cm of the bladder, rectum, and sigmoid in each fraction were 7.2 (4.0-10.4), 5.9 (2.3-7.7), 4.0 (1.9-6.7), and 3.8 (0.6-7.2) Gy, respectively.

Conclusion: Our described method of MRI-guided IGBT offers a practical option for the benefits of target delineation.
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http://dx.doi.org/10.1007/s11604-017-0690-3DOI Listing
December 2017

Initial experience of radiotherapy plus cetuximab for Japanese head and neck cancer patients.

J Radiat Res 2015 Sep 9;56(5):849-55. Epub 2015 Jul 9.

Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan.

In Japan, cetuximab with concurrent bioradiotherapy (BRT) for squamous cell carcinoma of head and neck (SCCHN) was approved in December 2012. We herein report our initial experience of BRT, with special emphasis on acute toxicities of this combination therapy. Thirty-one non-metastatic SCCHN patients who underwent BRT using cetuximab between July 2013 and June 2014 were retrospectively evaluated. All patients received cetuximab with a loading dose of 400 mg/m(2) one week before the start of radiotherapy, followed by 250 mg/m(2) per week during radiotherapy. The median cycle of cetuximab was seven cycles and the median dose of radiotherapy was 70 Gy. Twenty-five patients (80.6%) accomplished planned radiotherapy and six cycles or more cetuximab administration. Six patients (19.4%) discontinued cetuximab. Grade 3 dermatitis, mucositis and infusion reaction occurred in 19.4%, 48.3% and 3.2%, respectively. One patient experienced Grade 3 gastrointestinal bleeding caused by diverticular hemorrhage during BRT. Grade 3 drug-induced pneumonitis occurred in two patients. The response rate was 74%, including 55% with a complete response. BRT using cetuximab for Japanese patients with SCCHN was feasible as an alternative for cisplatin-based concurrent chemoradiation, although longer follow-up is necessary to evaluate late toxicities.
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http://dx.doi.org/10.1093/jrr/rrv038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577007PMC
September 2015

New approach to relieving pain and distress during high-dose-rate intracavitary irradiation for cervical cancer.

Brachytherapy 2015 Sep-Oct;14(5):642-7. Epub 2015 May 27.

Department of Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Radiology, Chiba University Hospital, Chiba, Japan.

Background And Purpose: To relieve the pain and distress experienced by women who undergo high-dose-rate intracavitary radiotherapy (HDR-ICRT) for cervical cancer and to improve the current status of gynecologic brachytherapy in Japan, a new intravenous anesthetic protocol involving the administration of a combination of propofol and ketamine was developed. The primary aim of this study is to investigate the efficacy and safety of this new anesthetic protocol during HDR-ICRT for cervical cancer.

Methods And Materials: All the patients who were diagnosed with cervical cancer between December 2008 and February 2011, treated with three-channel brachytherapy and subjected to the new sedation protocol, were evaluated. A visual analog scale (VAS) was used to assess the pain during brachytherapy, and we collected VAS score at the next HDR-ICRT. Toxicities were graded using the Common Toxicity Criteria, version 3.

Results: A total of 178 sessions of HDR-ICRT were delivered to 57 patients. The patients' median VAS pain score was 0 (range, 0-10). The most frequent side effect was Grade 1-2 nausea, which occurred in 33 sessions (34%). However, 13 of 14 patients received concurrent cisplatin chemotherapy. None of the patients experienced Grade 3 or 4 adverse events.

Conclusions: We have demonstrated that our new intravenous anesthetic protocol produces appropriate effects and can be performed by radiation oncologists who were required to finish training in basic life support and the cooperative system of emergency according to in-house guideline.
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http://dx.doi.org/10.1016/j.brachy.2015.04.009DOI Listing
May 2016

Daily low-dose Cisplatin-based concurrent chemoradiotherapy for the treatment of cervical cancer in patients 70 years or older.

Int J Gynecol Cancer 2015 Jun;25(5):891-6

Departments of *Reproductive Medicine and †Radiology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.

Objectives: It has been established that concurrent chemoradiotherapy (CCRT) is efficacious for cervical cancer, but adherence is unsatisfactory among elderly patients. To improve adherence, we have developed and initiated a daily low-dose cisplatin-based CCRT regimen. Here, we retrospectively evaluated the use of CCRT, especially for elderly patients.

Methods: The study included a total of 53 patients who were 70 years or older, had stage IB-IVA cervical cancer, and were initially treated with daily CCRT. The daily CCRT comprised pelvic external beam radiotherapy (2 Gy/d × 25) with daily low-dose cisplatin (8.0 mg/m(2) per day) and either low- or high-dose-rate intracavitary brachytherapy.

Results: The median age was 72 years (range, 70-85 years). The median follow-up duration was 32 months (range, 2-104 months). The 3-year overall survival rate was 79.0%. Daily cisplatin chemotherapy was successfully completed in 32 (60.4%) of the 53 patients. Grade 3 or 4 neutropenia was observed in 19 patients (36%). A late complication of grade 3 rectal hemorrhage occurred in 3 patients who received high-dose-rate brachytherapy. All primary tumors responded to daily CCRT; complete response was observed in 43 patients (91.5%) and partial response was observed in 4 patients (8.5%).

Conclusions: Daily CCRT in patients 70 years and older had acceptable compliance and safety. Daily CCRT is suggested to be a good treatment option for elderly patients who have advanced cervical cancer and require concurrent cisplatin.
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http://dx.doi.org/10.1097/IGC.0000000000000436DOI Listing
June 2015

The Efficacy of Palonosetron Plus Dexamethasone in Preventing Chemoradiotherapy-induced Nausea and Emesis in Patients Receiving Daily Low-dose Cisplatin-based Concurrent Chemoradiotherapy for Uterine Cervical Cancer: A Phase II Study.

Am J Clin Oncol 2017 Apr;40(2):118-121

Departments of *Reproductive Medicine †Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Objectives: The prevention of chemotherapy-induced and radiotherapy-induced emesis is recommended by several guidelines; however, there are no evidence-based recommendations for the use of antiemetics in concurrent chemoradiotherapy (CCRT). The aim of the present study was to evaluate the efficacy and safety of antiemetic therapy comprising palonosetron and dexamethasone during CCRT.

Methods: This is a nonrandomized, prospective, single-center, open phase II study.Twenty-six consecutive patients with cervical carcinoma were treated with daily low-dose cisplatin (8 mg/m/d)-based CCRT (2 Gy/d, 25 fractions, 5 times a week). All patients received 0.75 mg of palonosetron on day 1 of each week and 4 mg of oral dexamethasone daily. The primary endpoint was the percentage of patients achieving a complete response, which was defined as no emetic episodes and no antiemetic rescue medication during treatment.

Results: Planned daily low-dose cisplatin-based CCRT was successful without delay or interruption in 46% (12/26) of the patients. The mean dose of total cisplatin was 184 (range, 136 to 200) mg/m.No patient vomited during the treatment period. The complete response rate during CCRT was 100%. A total of 81% patients were completely free from nausea. All patients tolerated the combination of palonosetron and dexamethasone and completed the scheduled regimen. Five patients exhibited grade 1 Cushingoid features that resolved after treatment.

Conclusions: Antiemetic therapy comprising palonosetron and dexamethasone provided complete protection from nausea and vomiting in patients with cervical cancer receiving daily low-dose cisplatin-based CCRT.
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http://dx.doi.org/10.1097/COC.0000000000000117DOI Listing
April 2017

Delayed renal dysfunction after total body irradiation in pediatric malignancies.

J Radiat Res 2014 Sep 8;55(5):996-1001. Epub 2014 Jun 8.

Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan Department of Radiology, Chiba University Hospital, Chiba, Japan.

The purpose of this study was to retrospectively evaluate the incidence of delayed renal dysfunction after total body irradiation (TBI) in long-term survivors of TBI/hematopoietic stem cell transplantation (HSCT). Between 1989 and 2006, 24 pediatric patients underwent TBI as part of the conditioning regimen for HSCT at Chiba University Hospital. Nine patients who survived for more than 5 years were enrolled in this study. No patient had any evidence of renal dysfunction prior to the transplant according to their baseline creatinine levels. The median age at the time of diagnosis was 6 years old (range: 1-17 years old). The follow-up period ranged from 79-170 months (median: 140 months). Renal dysfunction was assessed using the estimated glomerular filtration rate (eGFR). The TBI dose ranged from 8-12 Gy delivered in 3-6 fractions over 2-3 d. The patients were treated with linear accelerators in the supine position, and the radiation was delivered to isocentric right-left and left-right fields via the extended distance technique. The kidneys and the liver were not shielded except in one patient with a left adrenal neuroblastoma. No patient required hemodialysis. The eGFR of four patients (44.4%) progressively decreased. The remaining patients did not demonstrate any eGFR deterioration. Only one patient developed hypertension. By evaluating the changes in eGFR, renal dysfunction among long-term survivors of TBI/HSCT could be detected. Our results suggested that the TBI schedule of 12 Gy in 6 fractions over three consecutive days affects renal function.
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http://dx.doi.org/10.1093/jrr/rru041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202299PMC
September 2014