In this study, AHF-TRT of 54 Gy with concurrent PE- or CE-based regimens resulted in a good OS and PFS without increasing severe toxicity. Although this regimen needs to be evaluated in more patients to fully confirm its efficacy, these outcomes suggest that dose escalation to 54 Gy may be a promising radical treatment for LS-SCLC.

Purpose: This phase II study aimed to evaluate the efficacy and safety of hypofractionated involved-field radiation therapy (HypoFx-IFRT) in 2.5 Gy fractions and concurrent chemotherapy for locally advanced stage IIIA and B nonsmall cell lung cancer (LA-NSCLC) without prolonging treatment delivery time beyond 6 weeks. We analyzed the overall survival (OS), progression-free survival, and safety of the treatment. Methods and Materials: This prospective, single center, single-arm trial was initiated in 2010. All LA-NSCLC patients were treated with HypoFx-IFRT using 3-dimensional conformal radiation therapy. The median total dose of HypoFx-IFRT was 67.5 Gy (range, 60-70). Results: From December 2010 to October 2016, 36 patients were ultimately enrolled and evaluated. The trial closed early owing to slow accrual. The median follow-up duration was 50 months in all patients and 65 months in surviving patients. The 1-, 3-, and 5-year OS rates were 88.9% (95% confidence interval [CI], 78.6%-99.2%), 61.1% (95% CI, 45.2%-77.0%), and 54.1% (95% CI, 37.3%-70.9%), respectively. The median time for OS was not reached. The median time for progression-free survival was 10.7 months. The incidence rates of grade 3 radiation pneumonitis, esophagitis and esophageal stenosis were 8.3%, 2.8%, and 2.8%, respectively, and no acute or late toxicities of grade 4 or 5 were observed. Conclusions: This study indicated that HypoFx-IFRT with concurrent chemotherapy yielded an acceptable safety profile and might be beneficial in the survival outcomes of patients with LA-NSCLC. (C) 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

PURPOSE:This study aimed to evaluate the relationship between chronic kidney disease (CKD) after radiation therapy for gastric/duodenal mucosa-associated lymphoid tissue lymphoma and dose-volume histogram of the kidneys.METHODS AND MATERIALS:We retrospectively reviewed 40 patients who received 3-dimensional conformal radiation therapy. CKD was evaluated using the Common Terminology Criteria for Adverse Events version 5.0. The mean dose of bilateral kidneys/right kidney/left kidney (Dmean of b-kidneys) (Dmean of r-kidney) (Dmean of l-kidney), bilateral kidneys/right kidney/left kidney volume receiving ≥ x Gy (Vx of b-kidneys) (Vx of r-kidney) (Vx of l-kidney), and patients' baseline clinical characteristics were analyzed.RESULTS:The median radiation therapy dose was 28 (range, 24-44.8) Gy in 14 fractions. The median follow-up period was 63.1 months, and the 5-year cumulative incidence of grade 2 CKD rate was 14.8%. Among several factors, V5 of b-kidneys was most strongly associated with grade 2 or worse CKD, with an area under the curve of 0.81 in the receiver operating characteristic curve. The 5-year incidence rate in patients with V5 of b-kidneys ≥ 58% was significantly higher than that in other patients (24.5% and 9.8%, respectively; P < .05).CONCLUSIONS:In this study using 3-dimensional conformal radiation therapy, the rate of adverse events at 5 years was low, many patients showed toxicity after 5 years; thus, continuous follow-up is necessary to detect potential nephrotoxicity. Our data demonstrate that V5 of b-kidneys was most strongly associated with the risk of CKD. With lower doses and more advanced techniques in recent years, the incidence of CKD may be further reduced.

The combination of accelerated hyperfractionated thoracic radiotherapy (AHF-TRT) of 45 Gy and concurrent chemotherapy is the standard treatment for limited-stage small-cell lung cancer (LS-SCLC); however, the optimal dose and fractionation remains controversial. We herein report the results of a prospective preliminary study investigating the efficacy of dose escalation to 54 Gy in AHF-TRT for LS-SCLC. A total of 13 patients who were diagnosed to have LS-SCLC at our institution between 2013 and 2016 were enrolled in the present study. The radiation dose was 54 Gy in 36 fractions in 18 treatment days over 3.6 weeks. The chemotherapy regimens were either cisplatin and etoposide (PE) or carboplatin and etoposide (CE) regimens. AHF-TRT was given in 2 phases: patients initially received 36 Gy to the gross tumor plus uninvolved mediastinal nodes, followed by a boost to the gross tumor of 18 Gy. All patients were treated with three-dimensional conformal radiation therapy with multiple fields to reduce the dose volume delivered to the surrounding tissues, such as the lungs and esophagus, as much as possible. All patients were evaluated for their overall survival (OS), progression-free survival (PFS), and development of pneumonitis and esophagitis. The median follow-up for all patients was 35 months (range, 13-62), and that for surviving patients was 39 months (range, 30-62). The patterns of failure were locoregional-only recurrence in 0% (0 patients), both locoregional and distant in 7.7% (1 patient), and distant-only in 38.5% (5 patients). The 1-, 2-, and 3-year OS rates were 100%, 92.3%, and 72.5%, respectively, and the median OS has not yet been reached. The 1-, 2-, and 3-year PFS rates were 76.9%, 53.9%, and 53.9%, respectively, and the median PFS has not yet been reached. No patient experienced grade 3 or greater non-hematological adverse effects, such as esophagitis or pneumonitis, during treatment or follow-up. Grade 2 pneumonitis was observed in 2 patients (9%). Grade 2 esophagitis was observed in 21 patients (91%). In this study, AHF-TRT of 54 Gy with concurrent PE or CE regimens resulted in a better OS and PFS without an increase in the severity of toxicity. Although more studies in a larger number of patients are needed to fully evaluate the efficacy, these outcomes suggest that a dose escalation to 54 Gy may be a promising radical treatment for LS-SCLC.

In the present study, we evaluated the appropriate schedule of S-1 administration in combination with radiotherapy for T2N0 glottic cancer by investigating the safety and efficacy. Between 2007 and 2016 23 patients diagnosed with T2N0 glottic cancer and treated with chemoradiotherapy (CRT) were enrolled in this study. Sixteen patients were treated with daily administration of S-1 (80-120 mg/day) during the course of radiotherapy between March 2007 and June 2013. Briefly, they received the drug for 4 weeks followed by 2-week drug-free intervals, or for 2 weeks followed by 1-week drug-free intervals. The remaining 7 patients were treated with an alternate-day regimen (80 mg/day) intended to reduce severe mucositis between July 2013 and December 2016. Radiotherapy was given as a once-daily fraction at 2 Gy up to a total median dose of 70 Gy (range, 66-70). The rates of survival and local control were estimated by the Kaplan-Meier method, and the Log Rank test was used to evaluate the significance of the survival and local control. The CTCAE ver. 4.0 was used to grade toxicities, and the chi-squared test was used to compare the toxicity between the daily and alternate-day administration groups. The median follow-up of the daily and alternate-day administration groups was 76 months (range: 44-104 months) and 40 months (range: 14-50 months), respectively. One patient in the alternate-day administration group experienced local recurrence and underwent total laryngectomy at eight months after the completion of CRT. A comparison between the daily administration and alternate-day administration groups at 2 years showed that the overall survival rate was 100% vs. 100%, (p = 0.68), and the local control rate was 100% vs. 86% (p = 0.13). Grade 2+ mucositis was observed in 13 patients (81%) in the daily administration group and in 3 patients (43%) in the alternate-day administration group (p=0.0656). No Grade 3 mucositis was encountered in the alternate-day administration group. Opioid pain medication to reduce symptoms was used in 9 patients (69%) in the daily administration group and in 1 patient (14%) in the alternate-day administration group (p = 0.0618). An interruption of radiotherapy due to mucosal pain was carried out in 4 patients (25%) in the daily administration group and in no patients (0%) in the alternate-day administration group (p = 0.1455). Our results suggest that an alternate-day administration regimen of S-1 for CRT might reduce mucositis without compromising the therapeutic effectiveness compared to a daily administration regimen. CRT with alternate-day administration of S-1 may therefore be a viable standard treatment option for T2N0 glottic cancer.

The combination of accelerated hyperfractionated thoracic radiotherapy (AHF-TRT) and chemotherapy has been established as the current standard therapy for limited-stage small-cell lung cancer (LS-SCLC). Although 45 Gy in 30 fractions is commonly used for dose-fractionation, the optimal dose of AHF-RT remains unknown. In this study, we evaluated the efficacy on AHF-TRT of escalating the dose to 54 Gy. Between 2006 and 2012, 19 patients diagnosed with LS-SCLC and treated with AHF-TRT and chemotherapy were enrolled in this study. The chemotherapy regimens were cisplatin and etoposide (PE) or carboplatin and etoposide (CE). Nine patients treated between 2006 and 2010 were irradiated with 45 Gy in 30 fractions for 3 weeks. Ten patients treated between 2011 and 2012 were irradiated with 54 Gy in 36 fractions for 3 and a half weeks. AHF-RT was given in 2 phases: patients initially received 36 Gy to the gross tumor plus uninvolved mediastinal nodes, followed by a boost to the gross tumor of 9 or 18 Gy. All patients were treated with three-dimensional conformal radiation therapy with multiple fields to reduce the volume of the surrounding normal tissues, such as the esophagus, from receiving a high dose, as much as possible. Variables related to the survival were estimated by the Kaplan-Meier method, and the log rank test was used to evaluate the significance of the survival, using a p value of 0.05 to indicate significance. The CTCAE ver. 3.0 was used to grade toxicities. The median follow-up of the 45 and 54 Gy groups was 23.6 months (range: 6.3-93.7 months) and 46.1 months (range: 8.1-67.7 months), respectively. No significant differences between the two groups regarding the patient and tumor characteristics were noted. The median duration of AHF-TRT was 22 days (range: 19-27 days) in the 45 Gy group and 29 days (range: 23-30 days) in the 54 Gy group. Prophylactic cranial irradiation was administered to 4 patients (44%) in the 45 Gy group and 8 (80%) in the 54 Gy group. The median survival time (MST) was 23.6 months in the 45 Gy group and 41.5 months in the 54 Gy group. A comparison between the 45 and 54 Gy groups at 4 years showed that the overall survival rate was 22.2% vs. 50.0% (p = 0.1559), the progression-free survival (PFS) was 0% vs. 40.0% (p = 0.0191), the in-field progression-free survival (IFPFS) was 11.1% vs. 40.0% (p = 0.0318) and the distant metastasis-free survival (DMFS) was 0% vs. 50.0% (p = 0.0293), respectively. No Grade 3+ non-hematological adverse effects, such as acute esophagitis, pneumonitis or lung fibrosis, were encountered in either group. AHF-TRT at 54 Gy with concurrent PE or CE regimens significantly improved the PFS, IFPFS and DMFS without increasing the toxicity compared with 45 Gy. Although more patients with longer follow-up periods are needed to fully evaluate the usefulness and safety of this 9 Gy dose escalation, these outcomes suggest that increasing the dose to 54 Gy in AHF-TRT for LS-SCLC may be a promising modality for improving the treatment results.

PURPOSE:This phase II study aimed to evaluate the efficacy and safety of hypofractionated involved-field radiation therapy (HypoFx-IFRT) in 2.5 Gy fractions and concurrent chemotherapy for locally advanced stage IIIA and B nonsmall cell lung cancer (LA-NSCLC) without prolonging treatment delivery time beyond 6 weeks. We analyzed the overall survival (OS), progression-free survival, and safety of the treatment.METHODS AND MATERIALS:This prospective, single center, single-arm trial was initiated in 2010. All LA-NSCLC patients were treated with HypoFx-IFRT using 3-dimensional conformal radiation therapy. The median total dose of HypoFx-IFRT was 67.5 Gy (range, 60-70).RESULTS:From December 2010 to October 2016, 36 patients were ultimately enrolled and evaluated. The trial closed early owing to slow accrual. The median follow-up duration was 50 months in all patients and 65 months in surviving patients. The 1-, 3-, and 5-year OS rates were 88.9% (95% confidence interval [CI], 78.6%-99.2%), 61.1% (95% CI, 45.2%-77.0%), and 54.1% (95% CI, 37.3%-70.9%), respectively. The median time for OS was not reached. The median time for progression-free survival was 10.7 months. The incidence rates of grade 3 radiation pneumonitis, esophagitis and esophageal stenosis were 8.3%, 2.8%, and 2.8%, respectively, and no acute or late toxicities of grade 4 or 5 were observed.CONCLUSIONS:This study indicated that HypoFx-IFRT with concurrent chemotherapy yielded an acceptable safety profile and might be beneficial in the survival outcomes of patients with LA-NSCLC.

e20104 Background: The optimal dose of accelerated hyperfractionated radiotherapy (AHF-RT) for limited-stage small-cell lung cancer (L-SCLC) remains unknown. The purpose of this study was to evaluate the efficacy and safety of AHF-TRT with 54 Gy. Methods: Between 2006 and 2012, 19 patients, diagnosed with L-SCLC and treated with chemotherapy and thoracic radiation therapy (TRT), were enrolled in this study. The chemotherapy regimens were PE (cisplatin and etoposide) or CE (carboplatin and etoposide) regimens. Nine patients treated between 2006 and 2010 were irradiated with 45 Gy in 30 fractions for 3 weeks with AHF. Ten patients treated between 2011 and 2012 were irradiated with 54 Gy in 36 fractions for 3.6 weeks with AHF. AHF-RT was given in two phases: patients initially received 36 Gy to gross tumor plus uninvolved mediastinal nodes, followed by a boost to gross tumor of 9 or 18 Gy. All patients were treated with three-dimensional conformal radiation therapy with multiple fields to reduce irradiated volume of surrounding organ to a minimum as far as possible, such as esophagus. Results: The median survival time (MST) of 45 Gy group was 24 months, while MST of 54 Gy group was 41 months. A comparison between the 45 Gy and 54 Gy groups at three years showed that the overall survival rate was 33.3% vs 60.0%, (p = 0.3036); the progression-free survival (PFS) rate was 0% vs 40.0% (p = 0.0191); the in-field progression-free survival rate was 11.1% vs. 50.0% (p = 0.0917) and the distant metastasis-free survival (DMFS) rate was 60.0% vs. 0% (p = 0.0293). No Grade 3+ non-hematological adverse effects, such as acute esophagitis, pneumonitis or lung fibrosis were encountered. Conclusions: TRT with AHF of 54 Gy with concurrent PE or CE regimens significantly improved PFS and DMFS controls without increasing severe toxicity, compared with 45 Gy. Although more patients with longer follow-up periods are needed to evaluate the usefulness and safety of dose escalation of 9 Gy, these outcomes suggest that the dose escalation to 54 Gy on AHF-RT for L-SCLC could be a promising modality to improve the treatment results with low incidence of severe toxicity.

We analyzed 16 cases (23 therapeutic sites) of post-operative recurrence of esophageal cancers that were treated with high-precise radiation therapies.The recurrence sites were cervical lymph nodes (5 cases), superior mediastinal lymph nodes (5 cases), posterior mediastinal lymph nodes (3 cases), regional lymph nodes with anastomosis (2 cases), abdominal paraaortic lymph node (3 cases), and regions with hematogenous metastasis (5 cases: liver, lung, spleen, and dissemination to the diaphragm bottom).By recurrence number, 10 cases presented with a single lesion, and 6 cases had multiple lesions.The effect of the treatment was complete response (CR) in all cases, and 6 cases maintained CR.The median of the overall survival after radiotherapy was 562 (132-1,231) days.Analysis of the prognostic factors for the overall survival from a recurrence revealed that the metastatic number (single) (p=0.003), and the metastatic pattern(hematogenous metastasis) (p= 0.004), significantly improved prognosis.We conclude that radiotherapy is an option to extend prognosis in some recurrence cases.

A combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) is well established as the standard radical radiotherapy (RT) for cervical cancer. However, it is sometimes necessary to perform EBRT alone for patients where ICBT is not feasible. For these patients, we initiated EBRT alone with three-dimensional conformal radiotherapy (3DCRT). The purpose of this study is to evaluate the results of EBRT alone without ICBT for patients with cervical cancer. Sixteen patients were treated with EBRT alone between 2002 and 2009. There were three stage IIB, six stage IIIB and seven patients with stage IVA disease. A total of 10 patients were treated with a median dose of 66 Gy with a median overall treatment time (OTT) of 40 days delivered by a concomitant boost (CCB), and a median dose of 60 Gy with a median OTT of 47 days was administered for six patients by conventional fractionation (CF). The 3-year overall survival (OAS) and local control (LC) rates were 43.8% and 75.0%, respectively. The 3-year LC rate was 90.0% for the CCB group, 50.0% for the CF group (P = 0.0692); 100% for OTT ≤42 days, 42.9% for OTT ≥43 days (P = 0.0095). No severe acute and late adverse effects were encountered for any of the patients. These outcomes suggest that EBRT with a CCB program may be a promising radical treatment for cervical cancer that provides better LC with minimal complications, especially in cases where ICBT cannot be performed.

The use of intracavitary brachytherapy (ICBT) was a factor significantly associated with decreased local failure according to results of a pattern of care study, and therefore it has been thought that the local control rate of external radiotherapy (ERT) alone without ICBT was poor. However, in the actual clinical setting one sometimes may need to treat with ERT alone in cases where ICBT is not feasible. In this presentation, the results of 3-dimensional conformal radiotherapy (3DCRT) alone in patients with cervical cancer were evaluated. Between 2002 and 2009, 19 patients with cervical cancer were treated with 3DCRT. Eighteen were squamous cell carcinoma, and 1 was adenocarcinoma. The median patient age was 74 years, ranging from 39 to 99 years. There were 1 stage IB, 3 stage IIB, 1 stage IIIA, 7 stage IIIB and 7 patients with stage IVA disease. A total of 6 patients were treated with a median dose of 60 Gy with a median overall treatment time (OTT) of 47 days delivered by conventional fractionation (CF), and a median dose of 66 Gy with a median OTT of 39 days was administered for 13 patients by altered fractionation (AF) with accelerated hyperfractionation or a concomitant boost program. Out of the 19 patients, 15 patients had a CR, 2 had a PR, and 2 had SD. At a median follow-up of 40 months for all patients and of 75 months for the surviving patients, 5-year overall survival, cause specific survival, and local control (LC) rate were 46%, 64%, and 79%, respectively. The 5 year LC rate was 91.7% for stage I-III, 57.1% for stage IVa (p = 0.0599); 100% for OTT ≤ 42 days, 42.9% for OTT ≥ 43 days (p = 0.0029); 92.3% for the AF group, 50.0% for the CF group (p = 0.0325); 100% for a maximum tumor diameter (MTD) ≤ 5 cm, and 55.6% for a MTD > 5cm (p = 0.0199). All patients tolerated the treatment very well, and no severe adverse effects (CTCAE 3.0 grade 3 or larger) were encountered. However, acute toxicity of grade 1 diarrhea was seen in 8 patients and acute toxicity of grade 1 and grade 2 urinary frequency were seen in 6 patients and in 1 patient, respectively. Grade 1/2 late toxicity was observed as follows: grade 2 rectal hemorrhage, 1; grade 2 bladder hemorrhage, 1; grade 2 vaginal stenosis, 1. Our outcomes suggest that ERT alone with 3DCRT sparing the rectum and bladder and with an AF program that can suppress the prolongation of OTT may be a promising radical treatment that provides better local control with minimal complications for cervical cancer, especially when ICBT cannot be performed.

PURPOSE The aim of this study was to evaluate retrospectively chemotherapy of weekly carboplatin and paclitaxel with concurrent radiation therapy for patients with locally advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Between January 2000 and March 2008, 38 patients were treated by chemotherapy with carboplatin and paclitaxel once a week, repeated for 6 weeks, with thoracic radiation therapy of 1 or 2 times a day on weekdays. After concurrent chemoradiotherapy, we planned consolidation chemotherapy of carboplatin(AUC 5-6)and weekly paclitaxel(70- 80 mg/m(2)) on day 1, 8 and 15, when possible. RESULTS The enrolled patients were 31 men and 7 women, with the median age of 59 years (39-76 years), stage III A/III B: 10/28, Ad/Sq/AdSq/Un: 17/17/2/2. The response rate of this chemoradiotherapy was 78. 9%. The median survival time and time to progression were 24. 7 months and 8. 1 months, respectively. Grade 3 or 4 hematological toxicities during concomitant chemoradiotherapy were leukocytopenia(5. 2%)and neutropenia(5. 2%). Grade 3 or 4 non-hematological toxicities were esophagitis(2. 6%)and pneumonitis (5. 2%). There was a therapy-associated death by radiation pneumonitis. CONCLUSION Carboplatin and paclitaxel with concurrent radiation therapy for a patient with stage III NSCLC showed a good response with relatively mild side effects. We reached the conclusion that concurrent chemoradiotherapy would be a useful choice for locally advanced non-small cell lung cancer on the practical clinic.

We aimed to evaluate the feasibility and efficacy of hypofractionated involved-field radiation therapy (IFRT) omitting elective nodal irradiation (ENI) with concurrent chemotherapy for locally advanced non-small-cell lung cancer (NSCLC).

BACKGROUND:The indications for and the efficacy of radiation therapy after radical operation for patients with prostate cancer are not clear. We analyzed the treatment results of adjuvant radiotherapy and salvage radiotherapy after radical prostatectomy.METHODS:Between September 1997 and November 2004, 57 patients received adjuvant radiotherapy or salvage radiotherapy after radical prostatectomy. Fifteen patients received radiation therapy because of positive margins and/or extracapsular invasion in surgical specimens (adjuvant group). Forty-two patients received radiation therapy because of rising prostate-specific antigen (PSA) during follow-up (salvage group). Radiation therapy was delivered to the fossa of the prostate +/- seminal vesicles by a three-dimensional (3-D) conformal technique to a total dose of 60-66 Gy (median, 60 Gy). Biochemical control was defined as the maintenance of a PSA level of less than 0.2 ng/ml.RESULTS:The median follow-up period after radiation therapy was 33 months (range, 12-98 months). Three-year biochemical control rates were 87% for the adjuvant group and 61% for the salvage group. For patients in the salvage group treated without hormone therapy, the preradiation PSA value was the most significant factor for the biochemical control rate. The 3-year biochemical control rate was 93% in patients whose preradiation PSA was 0.5 ng/ml or less and 29% in patients whose preradiation PSA was more than 0.5 ng/ml. No severe adverse effects (equal to or more than grade 3) were seen in treated patients.CONCLUSION:Radiation therapy after radical prostatectomy seemed to be effective for adjuvant therapy and for salvage therapy in patients with a preradiation PSA of 0.5 ng/ml or less. Also, radiation to the fossa of the prostate +/- seminal vesicles, to a total dose of 60-66 Gy, using a three-dimensional (3-D) conformal technique, seemed to be safe.

We evaluated the basic properties of a commercially available BANGkit™ gel dosimeter, which is a normoxic type of BANG® gel. This gel-kit has the same composition as the BANG®3 gel, but is fully oxygenated. To exclude oxygen, oxygen scavenging ascorbic acid and copper sulfate as a catalyst are used. The properties that we examined are the effects of the concentrations of copper sulfate and ascorbic acid on the response, the reproducibility, the long-term stability, the temperature effect at irradiation and the dose-rate effect. In our results, the excellent linear fit of the R2-dose response in a dose range for clinical use and its reproducibility were observed. The precision of a linear fit was preserved for about 3 weeks. The temperature at irradiation showed a significant effect on the dose response. Although the dose-rate dependence in the high-dose range was observed, it was negligible for the clinical dose range up to 270 cGy. In conclusion, this gel dosimeter is thought to be utilizable in clinical practice, while we have to pay attention to the temperature during the entire measurement processes, and additionally there is room for improvement in the linearity and the dose-rate dependence in the high-dose range.

1994～2005年にイリジウムヘアピンを用いた低線量率組織内照射を行った早期舌癌152例のうち，2004年以降に治療した20例に対して刺入操作中に超音波検査を行うことによって腫瘍に対する線源位置の改善を図った。この超音波検査が治療成績に与えた影響を検討した。局所再発は2003年以前では全例中17例（13%）に生じていたが，2004年以降では1例（5%）へと減少した。特にT2症例では14例の全例が制御された。放射線潰瘍は2003年以前では64例（57%）に生じていたが，2004年以降では9例（47%）に減少した。放射線潰瘍は1例を除き全例で保存的療法により6ヶ月未満で消退した。刺入操作中に超音波検査により線源位置を確認することによって腫瘍に対して確実に線量を投与できたことが局所制御の向上に寄与したものと思われた。

We report a rare case of mesenteric bleeding following blunt abdominal trauma successfully treated solely with transcatheter arterial embolization (TAE) of the right colic marginal artery. A 56-year-old woman presented with mesenteric bleeding after being involved in a car accident. Computed tomography (CT) showed a large mesenteric hematoma and hemoperitoneum with no associated major injuries to other organs. There was a pseudoaneurysm with extravasation inside the hematoma. TAE was attempted to control bleeding during the preparation for surgical laparotomy. A superior mesenteric angiogram revealed a right colic marginal artery pseudoaneurysm. After successful TAE with microcoils, the affected colon perfusion was preserved via collateral circulation from the ileocolic artery. No ischemic gastrointestinal complications have occurred, and laparotomy has not been necessary during the 6 months after TAE. In isolated mesenteric injury cases, TAE may be a reasonable alternative to emergency laparotomy.

Twenty-eight patients with oropharyngeal or hypopharyngeal carcinoma received concurrent chemoradiotherapy with CDDP or CDGP plus 5-FU between January 2001 and April 2006. The numbers of patients according to clinical stage were stage II:2; stage III:5; stage IVa:19 ; and stage IVb:2. Total radiation dose was 60-73.8 Gy (median 66 Gy) and overall treatment time was 41-57 days (median 47 days). Two courses of 5-FU 700 mg/m(2) on days 1-5 and CDDP or CDGP 70 mg/m(2) on day 4 were administered concurrently with radiotherapy. Median follow-up period was 26 months (range, 8-64 months). The incidences of grade 3 or greater acute toxicity were leukopenia 29%, anemia 21%, thrombocytopenia 7%, pharyngeal mucositis 43% and nausea 14%. No severe late toxicity was observed. Treatment responses of primary lesions were CR in 24 patients (86%) and PR in 4 patients (14%). The two-year local control rate was 87% and the 2-year overall survival rate was 72%. Concurrent chemoradiotherapy with CDDP or CDGP plus 5-FU seemed to be effective for advanced carcinomas of the oropharynx and hypopharynx.