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論文 - 大家　基嗣

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The clinical impact of the classification of carcinoma in situ on tumor recurrence and their clinical course in patients with bladder tumor

Hayakawa Nozomi, Kikuchi Eiji, Mikami Shuji, Matsumoto Kazuhiro, Miyajima Akira, Oya Mototsugu

Japanese Journal of Clinical Oncology 41 （ 3 ） 424 - 429 2011年03月

ISSN 0368-2811

Objective: To evaluate recurrence and clinical course of bladder carcinoma in situ according to the current carcinoma in situ classification by analyzing the patients with diagnosed carcinoma in situ in our hospital. Methods: Between January 1993 and September 2008, 93 patients were initially diagnosed with bladder carcinoma in situ in our hospital. All specimens underwent an additional review by one uro-pathologist. Primary, secondary and concurrent carcinoma in situ were found in 26, 21 and 46 patients, respectively. Sixty-nine patients (74.2%) underwent bacillus Calmette-Guérin instillation therapy. Results: The multivariate analysis determined that the secondary carcinoma in situ and the absence of bacillus Calmette-Guérin therapy were the independent unfavorable risk factors for tumor recurrence. The 5-year recurrence-free survival rates on primary, concurrent and secondary carcinoma in situ were 60.9, 63.2 and 25.4%, respectively, and the differences between secondary and primary carcinoma in situ, and secondary and concurrent were significant (P= 0.023 and P= 0.006, respectively). During the median follow-up period of 47 months, 19 patients had tumor recurrence in the bladder after the first bacillus Calmette-Guérin therapy, and 13 of them were treated with a second bacillus Calmette-Guérin therapy. After the second bacillus Calmette-Guérin therapy six patients eventually had distant metastasis and three had upper tract recurrence, whereas totally four had a tumor-free status after the second bacillus Calmette-Guérin therapy. Conclusions: The first induction course of bacillus Calmette-Guérin therapy proved to be effective for the prevention of bladder cancer recurrence, however, the efficacy of a second bacillus Calmette-Guérin therapy on a recurrent tumor was somewhat limited.

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The Clinical Impact of the Classification of Carcinoma In Situ on Tumor Recurrence and their Clinical Course in Patients with Bladder Tumor

Hayakawa Nozomi, Kikuchi Eiji, Mikami Shuji, Matsumoto Kazuhiro, Miyajima Akira, Oya Mototsugu

JAPANESE JOURNAL OF CLINICAL ONCOLOGY 41 （ 3 ） 424 - 429 2011年03月

研究論文（学術雑誌）, 共著, ISSN 0368-2811

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Urinary pH is highly associated with tumor recurrence during intravesical mitomycin c therapy for nonmuscle invasive bladder tumor

Maeda Takahiro, Kikuchi Eiji, Matsumoto Kazuhiro, Miyajima Akira, Oya Mototsugu

Journal of Urology 185 （ 3 ） 802 - 806 2011年03月

ISSN 0022-5347

Purpose In recent years some reports have suggested without any significant evidence that mitomycin C instillation would be more effective with urinary alkalinization. We investigated the association between urinary pH and the efficiency of mitomycin C instillation. Materials and Methods We identified 130 patients treated with transurethral resection of a bladder tumor and adjuvant intravesical mitomycin C instillation between 1985 and 2008 at Keio University Hospital. Urinary pH was determined in 124 of the 130 patients just before mitomycin C administration during the scheduled instillation period. These 124 patients were assigned to groups according to urinary pH in increments of 0.5 and the association between urinary pH and clinicopathological characteristics was evaluated. Results Mean ± SD urinary pH was 5.77 ± 0.05 (range 5.00 to 7.66) during the scheduled instillation period. Urinary pH was 5.00 to 5.49, 5.50 to 5.99, 6.00 to 6.49, 6.50 to 6.99 and 7.00 in 39, 46, 25, 7 and 7 patients, respectively. Patients were further divided into 2 groups by urinary pH using a cutoff of 5.5, including 39 with pH less than 5.5 and 85 with pH 5.5 or more. Age, gender, tumor grade, primary/recurrent disease, pathological stage and the presence or absence of concomitant carcinoma in situ were not significantly difference between the 2 groups. Multivariate analysis revealed that categorical urinary pH was an independent risk factor for tumor recurrence (HR 1.75, p = 0.032). Three and 5-year recurrence-free rates were 64.2% and 52.9% in patients with pH 5.5 or greater, and 41.9% and 38.4% in those with pH less than 5.5, respectively (p = 0.046). Multivariate analysis showed that the HR of urinary pH for tumor recurrence was 1.84 and 2.54 at the 5.4 and 5.2 cutoffs, respectively. Conclusions Results suggest that urinary pH more than 5.5 is associated with a decreased risk of tumor recurrence in patients treated with intravesical mitomycin C for nonmuscle invasive bladder cancer. Monitoring urinary pH during mitomycin C adjuvant treatment and modifying pH for urine alkalization may improve the therapeutic efficacy of mitomycin C instillation.

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Benefit of laparoscopic radical nephrectomy in patients with a high BMI

Hagiwara Masayuki, Miyajima Akira, Matsumoto Kazuhiro, Kikuchi Eiji, Nakagawa Ken, Oya Mototsugu

Japanese Journal of Clinical Oncology 41 （ 3 ） 400 - 404 2011年03月

ISSN 0368-2811

Objective: The aim of the present study was to analyze all relevant data collected thus far at our hospital in order to compare the laparoscopic vs. open techniques in terms of the intraoperative results and to analyze whether patients with a higher BMI may derive greater benefit from laparoscopy. Methods: We reviewed the medical records of 93 patients treated with laparoscopic nephrectomy and 91 patients treated with the open method at our institution. We analyzed the data with the aim of determining what kind of factor would be associated with an increase in estimated blood loss and prolongation of operative time, and we compared the results for laparoscopic and open nephrectomy. Results: A statistically significant correlation was observed between body mass index and operating time (P = 0.018) or estimated blood loss (P = 0.017) in laparoscopic nephrectomy. Multivariate analysis demonstrated that body mass index was an independent risk factor for prolonged operating time (P = 0.030, odds ratio = 1.174). In the open nephrectomy patients, body mass index also had a significant correlation with operating time (P < 0.001) and estimated blood loss (P < 0.001). Multivariate analysis also revealed that operating time depended on body mass index (P < 0.001, odds ratio = 1.348) and tumor size (P = 0.030, odds ratio = 1.320), and the odds ratio of body mass index was higher than that in laparoscopic nephrectomy. Conclusions: As body mass index increases, both laparoscopic nephrectomy and open nephrectomy become technically more difficult. However, our data showed that for patients with a high body mass index, the laparoscopic approach is comparatively safer and of greater benefit.

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Frequency of tumor recurrence

Tanaka Nobuyuki, Kikuchi Eiji, Matsumoto Kazuhiro, Miyajima Akira, Nakagawa Ken, Oya Mototsugu

Journal of Urology 185 （ 2 ） 450 - 455 2011年02月

ISSN 0022-5347

Purpose Patients with nonmuscle invasive bladder cancer usually experience multiple instances of tumor recurrence until stage progression occurs. However, it has not yet been fully evaluated whether the timing and/or pattern of tumor recurrence could affect subsequent stage progression. We examined whether the frequency of tumor recurrence provides additional predictive information concerning stage progression. Materials and Methods A total of 484 patients with initially diagnosed nonmuscle invasive bladder cancer were identified between 1985 and 2006 at our institution. Median followup was 7.2 years. Frequency of tumor recurrence was analyzed to determine if it affected subsequent stage progression. Results Of these patients 40 (8.3%) experienced stage progression during followup. Using Kaplan-Meier analysis subsequent stage progression could be most strongly predicted in patients with a recurrence rate of 1 or more per year during the first 2 years, although similar results were observed for various cutoff periods and recurrence rates. The 10-year progression-free survival rate was 58.0% in patients with a recurrence rate of 1 or more per year and 93.3% in their counterparts (p <0.001). Multivariate analysis demonstrated that the appearance of tumor grade 3 (p = 0.027, risk ratio 2.36), carcinoma in situ (p = 0.045, risk ratio 2.44) and a recurrence rate of 1 or more per year during the first 2 years (p <0.001, risk ratio 7.40) were independent risk factors for subsequent stage progression. Conclusions Frequency of tumor recurrence is a strong predictor of subsequent stage progression in patients initially diagnosed with nonmuscle invasive bladder cancer. More appropriate followup and aggressive treatment due to a higher malignant potential for stage progression might be recommended in patients with a recurrence rate of 1 or more per year during the first 2 years.

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Frequency of Tumor Recurrence: A Strong Predictor of Stage Progression in Initially Diagnosed Nonmuscle Invasive Bladder Cancer

Tanaka Nobuyuki, Kikuchi Eiji, Matsumoto Kazuhiro, Miyajima Akira, Nakagawa Ken, Oya Mototsugu

JOURNAL OF UROLOGY 185 （ 2 ） 450 - 455 2011年02月

研究論文（学術雑誌）, 共著, ISSN 0022-5347

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Torsion of the spermatic cord

Asanuma Hiroshi, Oya Mototsugu, Satoh Hiroyuki, Ezaki Taisuke

Japanese Journal of Clinical Urology 65 （ 1 ） 7 - 13 2011年01月

ISSN 0385-2393

Enhanced antitumor effect of combination intravesical mitomycin c and bacillus calmette-guerin therapy in an orthotopic bladder cancer model

Matsushima Masashi, Horinaga Minoru, Fukuyama Ryuichi, Yanaihara Hitoshi, Kikuchi Eiji, Kawachi Makoto, Iida Masahiro, Nakahira Yoko, Oya Mototsugu, Asakura Hirotaka

Oncology Letters 2 （ 1 ） 13 - 19 2011年01月

ISSN 1792-1074

Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is currently the most successful adjuvant agent for the treatment and/or prophylaxis of non-muscle-invasive bladder cancer (NMIBC). However, NMIBCs recur in 60-70% of cases and 30% of these recurrent tumors present with a higher grade and more invasive properties. Patients that do not respond to intravesical BCG therapy are considered to be a challenge for urologists. Thus, novel conservative possibilities should be explored. To test the efficacy of a novel therapeutic approach, we examined the antitumor effect of combination therapy by intravesical administration of mitomycin C (MMC) plus BCG, infusing the two drugs simultaneously, in an orthotopic bladder cancer model. Intravesical BCG and MMC administration showed a dose-dependent survival (n=8 per group). The combination of MMC and BCG provided a significant survival advantage compared to the BCG-alone (p=0.035) and MMC-alone groups (p=0.040) (n=8 per group). The group with combined MMC/BCG exhibited a survival period similar to that achieved with an amount eight times higher that of BCG (n=10 per group). Ki-67 labeling index of cancer cells, showing tumor proliferation, was significantly lower in the combined group compared to the BCG-alone (p<0.05), MMC-alone (p<0.01) and control groups (p<0.01). No difference was detected between the combined group and the BCG-alone group with regard to CD3, T-cell infiltration and CD68 macrophage activity. The combined MMC/BCG treatment decreased the tumor appearance rate, improved the survival period and reduced the cellular proliferation rate in tumors compared to the BCG-alone treatment. The results suggest that the combined intravesical MMC/BCG treatment induced an enhanced antitumor effect against bladder tumors. The combined MMC/BCG treatment also showed a survival period similar to that achieved using a dose eight times higher of BCG-alone.

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Recurrence of bladder cancer in remnant urethra and inguinal lymph node metastasis nine years after total cystectomy

Obata Jun, Kikuchi Eiji, Kaneko Gou, Miyajima Akira, Kameyama Kaori, Jinzaki Masahiro, Oya Mototsugu

Japanese Journal of Urology 102 （ 1 ） 34 - 38 2011年01月

ISSN 0021-5287

A 68-year-old man underwent total cystectomy, urethrectomy preserving fossa naviculars, and an Indiana pouch urinary diversion in 1997. The histopathology was UC, G3, pT4 (prostate). Nine years after the operation, he had multiple metastases to the inguinal and paraaortic lymph nodes (LNs), and he complained of erosion around the glans. Histological diagnosis of the glans revealed recurrent UC to the urethra of the glans. We considered the possibility that the inguinal LN metastasis was due to lymphatic spread from a remnant urethral recurrence. Thus, a partial penectomy and inguinal LN dissection were undertaken. Systemic chemotherapy was administered. Remnant urethral recurrence after urethrectomy preserving the fossa navicularis and inguinal LN metastasis are rare.

Transumbilical laparo-endoscopic single site surgery for adrenal cortical adenoma inducing primary aldosteronism

Miyajima Akira, Maeda Takahiro, Hasegawa Masanori, Takeda Toshikazu, Ishida Masaru, Kosaka Takeo, Kikuchi Eiji, Nakagawa Ken, Oya Mototsugu

BMC Research Notes 4 2011年

Background: We have started using laparo-endoscopic single-site surgery (LESS) in urologic surgery, although its use has not gained momentum due to its level of difficulty. We here report our initial experience with transumbilical LESS for adrenal cortical adenoma by using a single port with a multichannel cannula (SILS port) and bent laparoscopic instrumentation. Findings. A multichannel port (SILS port), bent laparoscopic instrument (Roticulator Endo Mini-Shears) and Opti4 laparoscopic electrodes were used in all cases. The intraperitoneal space was approached through the umbilicus. The SILS port was placed through a 2 cm incision at the inner edge of the umbilicus. A 5 mm flexible laparoscope was introduced to keep the laparoscope outside, and surgical specimens were extracted using an Endocatch bag. In addition, as a case control study, we compared perioperative data of LESS adrenalectomy (LESS-A) with that of conventional laparoscopic adrenalectomy (LA). We performed transumbilical LESS-A for adrenal cortical adenoma in 12 cases, beginning in December, 2009. All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time for LESS-A was 121.2± 7.8 min, which was slightly longer than LA (110.2± 7.3 min). For right adrenal tumors, we used a miniport (2 mm port) in addition to a SILS port, and were able to successfully perform adrenalectomy "with no visible scaring". Tumor laterality and patient BMI did not affect surgical morbidity in these procedures. Moreover, there was no significant difference between LESS-A and LA in blood loss, analgesic requirement, hospital stay, and scar satisfaction. Conclusions: The transumbilical approach in LESS for adrenalectomy is safe and feasible and also improves cosmetic outcome compared with standard laparoscopic procedures. Improvements in surgical devices may aid the further development of this approach.

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Renal cell carcinoma accompanied by left-sided IVC

Maeda Takahiro, Miyajima Akira, Kikuchi Eiji, Oya Mototsugu

Internal Medicine 50 （ 10 ） 1127 2011年

ISSN 0918-2918

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Imaging findings of renal angiomyolipoma with epithelial cysts

Akita Hirotaka, Jinzaki M., Tanimoto A., Sugiura H., Osugi K., Kuribayashi S., Mikami S., Oya M.

Japanese Journal of Clinical Radiology 55 （ 13 ） 1695 - 1698 2010年12月

ISSN 0009-9252

Expression of snail in upper urinary tract urothelial carcinoma

Kosaka Takeo, Kikuchi Eiji, Mikami Shuji, Miyajima Akira, Shirotake Suguru, Ishida Masaru, Okada Yasunori, Oya Mototsugu

Clinical Cancer Research 16 （ 23 ） 5814 - 5823 2010年12月

ISSN 1078-0432

Purpose: There are few molecular markers known to predict upper urinary tract urothelial carcinomas (UTUC) prognosis. Snail, which contributes to epithelial-mesenchymal transition (EMT), has been documented in cancer progression, but not clear yet in UTUC. We therefore addressed the expression and biological significance of Snail in UTUC. Experimental Design: To elucidate the biological significance of Snail in UTUC, we examined the immunohistochemical expression of snail in UTUC and analyzed its clinical significance in 150 patients with UTUC. Biological effects of Snail in EMT and invasion were evaluated by using small interfering RNA (siRNA) specific for Snail in urothelial carcinoma cell lines and the Matrigel invasion assay. Results: Nuclear Snail staining was very weak in superficial UTUC. In contrast, strong Snail staining was observed in many of the nucleus of invasive UTUC. Snail expression was significantly higher in the high tumor stage, high grade, and in tumors showing lymphovascular invasion (LVI). Multivariate Cox regression analysis revealed that elevated Snail expression was a significant and an independent prognostic predictor of recurrence-free survival and cancer-specific survival. Patients with positive LVI and high Snail expression showed the worse outcome. Targeting of Snail mRNA expression in UMUC-3 cells with Snail-specific siRNA downregulated the mRNA expression of Snail, Vimentin, MMP2, and MMP9. Furthermore, the cells with siRNA for Snail showed decreased invasion activity in comparison with the cells transfected with a nontargeting siRNA. Conclusion: Snail-induced EMT represents a clinically relevant mechanism of UTUC progression and an attractive target for the treatment of patients with UTUC.

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Non-muscle invasive bladder cancer with concomitant vaginal urothelial carcinoma

Kaneko Gou, Kikuchi Eiji, Hasegawa Masanori, Miyajima Akira, Nakagawa Ken, Kameyama Kaori, Oya Mototsugu

International Journal of Clinical Oncology 15 （ 6 ） 626 - 630 2010年12月

ISSN 1341-9625

A 74-year-old female was referred to our hospital for non-muscle invasive bladder tumors initially treated at another hospital. Preoperatively, computed tomography and magnetic resonance imaging demonstrated non-muscle invasive bladder tumors and a vaginal tumor. A second transurethral resection of the bladder tumors, transvaginal tumor resection, and systemic chemotherapy were performed. The histopathological appearances of both tumors were very similar and the diagnoses were urothelial carcinoma (UC). The pathogenesis of the vaginal UC was considered to be the primary UC or metastasis from the bladder UC. Vaginal UC is extremely rare and this is only the 15th report in the literature.

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Non-muscle invasive bladder cancer with concomitant vaginal urothelial carcinoma: a case report and review of the literature

Kaneko Gou, Kikuchi Eiji, Hasegawa Masanori, Miyajima Akira, Nakagawa Ken, Kameyama Kaori, Oya Mototsugu

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 15 （ 6 ） 626 - 630 2010年12月

研究論文（学術雑誌）, 共著, ISSN 1341-9625

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Cis-dichlorodiammineplatinum upregulates angiotensin II type 1 receptors through reactive oxygen species generation and enhances VEGF production in bladder cancer

Tanaka Nobuyuki, Miyajima Akira, Kosaka Takeo, Shirotake Suguru, Hasegawa Masanori, Kikuchi Eiji, Oya Mototsugu

Molecular Cancer Therapeutics 9 （ 11 ） 2982 - 2992 2010年11月

ISSN 1535-7163

We previously reported that angiotensin II type 1 receptor (AT1R) antagonists enhanced the cytotoxity of cis-dichlorodiammineplatinum (CDDP) in a bladder cancer xenograft model. To elucidate the synergistic mechanism, we investigated whether reactive oxygen species (ROS) generation induced by CDDP may affect the regulation of AT1R expression. Five invasive human bladder cancer cell lines, T24, UMUC-3, 5637, KU-1, and KU-19-19, were used in the in vitro study. For the in vivo study, T24 cells were used. We also examined AT1R and vascular endothelial growth factor (VEGF) expression in human bladder cancer specimens that had been treated with CDDP-based chemotherapy. The in vitro study showed that AT1R expression was significantly upregulated by CDDP in T24, KU-1, and KU-19-19 cells. On the other hand, AT1R expression was not changed in UMUC-3 and 5637 cells. ROS generation was also significantly upregulated by CDDP in T24, KU-1, and KU-19-19 cells. The upregulation of AT1R expression induced by CDDP was significantly suppressed by scavenging free radicals. Angiotensin II induced VEGF production in CDDP-treated cells; however, the AT1R antagonist significantly inhibited the increase in VEGF. The in vivo study results also showed that CDDP treatment upregulated AT1R expression, resulting in increased VEGF. Clinical specimens from patients who underwent cystectomy after neoadjuvant CDDP-based chemotherapy showed significantly higher AT1R and VEGF expression than corresponding transurethral resection specimens. Our findings indicate that CDDP upregulates AT1R expression though ROS generation and enhances VEGF production. Therefore, AT1R blockade may be an effective strategy for bladder cancer in combination with CDDP-based chemotherapy.

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Contrast-enhanced ultrasonography of the prostate with sonazoid

Matsumoto Kazuhiro, Nakagawa Ken, Hashiguchi Akinori, Kono Hidaka, Kikuchi Eiji, Nagata Hirohiko, Miyajima Akira, Oya Mototsugu

Japanese Journal of Clinical Oncology 40 （ 11 ） 1099 - 1104 2010年11月

ISSN 0368-2811

Objective: The diagnosis of prostate cancer is based on the results of ultrasonography-guided needle biopsy of the prostate, but cancer foci are often not visible in conventional transrectal ultrasonography. Sonazoid is a new microbubble contrast agent. The purpose of our study was to compare areas of contrast material enhancement in the prostate at ultrasonography with whole-mount radical prostatectomy specimens to determine if the use of Sonazoid improves the detection rate of prostate cancer. Methods: Fifty patients with biopsy-proven cancer of the prostate who were scheduled to undergo radical prostatectomy were recruited for this study. The day before the operation, each patient was evaluated with ultrasonography at baseline and again during intravenous infusion of Sonazoid. A map of ultrasonography findings was created prospectively at the time of imaging. Following radical prostatectomy, independent mapping of the pathologic results was performed and the maps were compared. Results: Ultrasonography evaluation at baseline demonstrated that at least one focus of cancer was identified in 20 of the 50 subjects (40.0%). Meanwhile at least one cancer focus was enhanced in 31 of the 50 patients (62.0%) when Sonazoid was used. The combination of baseline grayscale imaging and contrast-enhanced imaging allowed identification of at least one focus of cancer in 40 patients (80.0%). Contrast-enhanced ultrasonography can improve sensitivity, especially for the detection of large cancer, peripheral zone cancer and highly malignant cancer. Conclusions: Our study has demonstrated significantly improved detection of prostate cancer with the combination of baseline grayscale imaging and contrast-enhanced imaging compared with conventional ultrasonography techniques only, and this technique may be applicable to targeted biopsy.

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Everolimus and tacrolimus

Kono Hidaka, Nakagawa Ken, Oya Mototsugu

Biotherapy 24 （ 6 ） 520 - 524 2010年11月

ISSN 0914-2223

The mammalian target of rapamycin (mTOR) protein complex functions as a key protein for proliferation, cell survival, and angiogenesis in intracellular signaling pathways. Everolimus (RAD001), which is one of the mTOR inhibitors, is applied to treat patients with unresectable or metastatic renal cell cancers as second-line treatment for those refractory to sorafenib or sunitinib. Tacrolimus (FK506), which is one of the calcineurin inhibitors, is a strong immunosuppressive agent. Tacrolimus is known as an immunosuppressive agent greatly increasing the risk of malignancy by impairing cancer surveillance, and the drug enhances the production of transforming growth factor β1 (TGF-β1). In cytoplasm, everolimus and tacrolimus bind to the same target, which is called FK506 binding protein 12 (FKBP12), and the complexes play different roles in the cell. We here describe the mechanism of action, the side effects, biomarker, and the role of the two drugs in the future.

Gemcitabine and cisplatin chemotherapy induced reversible posterior leukoencephalopathy syndrome in a bladder cancer patient

Maeda Takahiro, Kikuchi Eiji, Matsumoto Kazuhiro, Yazawa Satoshi, Hagiuda Jun, Miyajima Akira, Nakagawa Ken, Fujiwara Hirokazu, Hoshino Haruhiko, Oya Mototsugu

International Journal of Clinical Oncology 15 （ 5 ） 508 - 511 2010年10月

ISSN 1341-9625

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical entity, the common clinical symptoms of which are headache, disturbance of consciousness, altered mental status, seizures, and visual disturbance. Recently, some cases have been reported in association with the increased use of cytotoxic and immunosuppressive agents in cancer patients, and relevant reports have increased with advances in radiological examinations. We describe here the case of a 50-year-old man with advanced bladder cancer who suddenly experienced diminished spontaneity and speech, and finally became semicomatose. Two months previously, he had received gemcitabine and cisplatin chemotherapy. Computed tomography and magnetic resonance imaging revealed symmetrical edema of the posterior occipital lobe and thalamus. Based on these findings, we made a diagnosis of RPLS and treated him with supportive measures. His mental status gradually improved in 2 weeks, although slight neurological symptoms persisted. When the level of consciousness of a cancer patient worsens rapidly, this syndrome should be included in the differential diagnosis and recognized at an early stage. Early supportive management and discontinuation of the causative medication may reverse the clinical and radiological manifestations of the syndrome.

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Preimplant factors affecting postimplant CT-determined prostate volume and the CT/TRUS volume ratio after transperineal interstitial prostate brachytherapy with ¹²⁵I free seeds

Sugawara Akitomo, Nakashima Jun, Kunieda Etsuo, Nagata Hirohiko, Asakura Hirotaka, Oya Mototsugu, Shigematsu Naoyuki

Radiation Oncology 5 （ 1 ） 2010年09月

Background: The aim was to identify preimplant factors affecting postimplant prostate volume and the increase in prostate volume after transperineal interstitial prostate brachytherapy with ¹²⁵I free seeds.Methods: We reviewed the records of 180 patients who underwent prostate brachytherapy with ¹²⁵I free seeds for clinical T1/T2 prostate cancer. Eighty-one (45%) of the 180 patients underwent neoadjuvant hormonal therapy. No patient received supplemental external beam radiotherapy. Postimplant computed tomography was undertaken, and postimplant dosimetric analysis was performed. Univariate and multivariate analyses were performed to identify preimplant factors affecting postimplant prostate volume by computed tomography and the increase in prostate volume after implantation.Results: Preimplant prostate volume by transrectal ultrasound, serum prostate-specific antigen, number of needles, and number of seeds implanted were significantly correlated with postimplant prostate volume by computed tomography. The increase in prostate volume after implantation was significantly higher in patients with neoadjuvant hormonal therapy than in those without. Preimplant prostate volume by transrectal ultrasound, number of needles, and number of seeds implanted were significantly correlated with the increase in prostate volume after implantation. Stepwise multiple linear regression analysis showed that preimplant prostate volume by transrectal ultrasound and neoadjuvant hormonal therapy were significant independent factors affecting both postimplant prostate volume by computed tomography and the increase in prostate volume after implantation.Conclusions: The results of the present study show that preimplant prostate volume by transrectal ultrasound and neoadjuvant hormonal therapy are significant preimplant factors affecting both postimplant prostate volume by computed tomography and the increase in prostate volume after implantation.

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