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Kato T, Narita Y, Takemasa K, Suzuki M, Yokota K, Yamaguchi H, Murakami M. Evaluation of Diaphragm Position Variations During Proton Therapy for Pediatric Patients With Neuroblastoma. Cureus 2024; 16:e58317. [PMID: 38752098 PMCID: PMC11095581 DOI: 10.7759/cureus.58317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Background To evaluate the respiratory-induced intrafractional diaphragm motion and interfractional diaphragm displacement in pediatric patients with neuroblastoma (NBL). Materials and methods Ten pediatric patients with a mean age of 4.5 years (range: 1.8-8.7 years) with abdominal NBL treated with proton therapy (PT) have been evaluated. Intrafractional motion and interfractional displacement have been analyzed by using cine radiography and orthogonal X-ray images, respectively. In each case, the cranio-caudal positions of the diaphragm have been measured as an index. This study has investigated the possible correlations between intrafractional diaphragm motion and height. Additionally, interfractional displacement and its time trend during the treatment course have been analyzed. Results The average right and left diaphragm intrafractional motions of 8.3 mm (range: 4.4-11.5 mm) and 6.4 mm (range: 2.2-11.8 mm) were observed, respectively; however, no significant correlation has been observed with height. An interfractional displacement of 5 mm or more has been observed in 20 out of 152 fractions (13%). The average absolute value of the interfractional displacement was 2.5 mm (range: 0-8.6 mm). Interfractional displacement did not show a peculiar tendency throughout the treatment period. Conclusions It was suggested that respiratory-induced diaphragm position variation in children varies greatly among individuals, and accurately estimating it based on height is difficult. Thus, these individual evaluations are considered indispensable.
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Affiliation(s)
- Takahiro Kato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, JPN
| | - Yuki Narita
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Kimihiro Takemasa
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Masaki Suzuki
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Katsuji Yokota
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
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Kato T, Takemasa K, Ikeda T, Sakagami H, Kato R, Narita Y, Oyama S, Komori S, Yamaguchi H, Murakami M. Analysis of respiratory-induced motion trajectories of individual liver segments in patients with hepatocellular carcinoma. J Appl Clin Med Phys 2024; 25:e14257. [PMID: 38303539 PMCID: PMC11005968 DOI: 10.1002/acm2.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE To analyze the respiratory-induced motion trajectories of each liver segment for hepatocellular carcinoma (HCC) to derive a more accurate internal margin and optimize treatment protocol selection. MATERIALS AND METHODS Ten-phase-gated four-dimensional computed tomography (4DCT) scans of 14 patients with HCC were analyzed. For each patient, eight representative regions of interest (ROI) were delineated on each liver segment in all 10 phases. The coordinates of the center of gravity of each ROI were obtained for each phase, and then the respiratory motion in the left-right (LR), anteroposterior (AP), and craniocaudal (CC) directions was analyzed. Two sets of motion in each direction were also compared in terms of only two extreme phases and all 10 phases. RESULTS Motion of less than 5 mm was detected in 12 (86%) and 10 patients (71%) in the LR and AP directions, respectively, while none in the CC direction. Motion was largest in the CC direction with a maximal value of 19.5 mm, with significant differences between liver segment 7 (S7) and other segments: S1 (p < 0.036), S2 (p < 0.041), S3 (p < 0.016), S4 (p < 0.041), and S5 (p < 0.027). Of the 112 segments, hysteresis >1 mm was observed in 4 (4%), 2 (2%), and 15 (13%) in the LR, AP, and CC directions, respectively, with a maximal value of 5.0 mm in the CC direction. CONCLUSION A significant amount of respiratory motion was detected in the CC direction, especially in S7, and S8. Despite the small effect of hysteresis, it can be observed specifically in the right lobe. Therefore, caution is required when using 4DCT to determine IM using only end-inspiration and end-expiration. Understanding the respiratory motion in individual liver segments can be helpful when selecting an appropriate treatment protocol.
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Affiliation(s)
- Takahiro Kato
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
- Department of Radiological SciencesSchool of Health SciencesFukushima Medical UniversityFukushimaJapan
| | - Kimihiro Takemasa
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Tomohiro Ikeda
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Hisanori Sakagami
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Ryohei Kato
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Yuki Narita
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Sho Oyama
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Shinya Komori
- Department of Radiation Physics and TechnologySouthern Tohoku Proton Therapy CenterFukushimaJapan
| | - Hisashi Yamaguchi
- Department of Radiation OncologySouthern Tohoku Proton Therapy CenterFukushimaJapan
- Department of Minimally Invasive Surgical and Medical OncologyFukushima Medical UniversityFukushimaJapan
| | - Masao Murakami
- Department of Radiation OncologySouthern Tohoku Proton Therapy CenterFukushimaJapan
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Yamaguchi H, Kato T, Honda M, Hamada K, Seto I, Tominaga T, Takagawa Y, Takayama K, Suzuki M, Kikuchi Y, Teranishi Y, Murakami M. Effectiveness of proton beam therapy for liver oligometastatic recurrence in patients with postoperative esophagus cancer. JOURNAL OF RADIATION RESEARCH 2023; 64:582-589. [PMID: 36913708 DOI: 10.1093/jrr/rrad009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Indexed: 05/27/2023]
Abstract
There are several reports of hepatic resection for postoperative hepatic metastatic recurrence of esophageal cancer. However, it is unclear whether surgery is the best local treatment for liver metastases. Thus, this study aimed to retrospectively analyze proton beam therapy (PBT) for postoperative liver metastatic recurrence of esophageal cancer without extrahepatic lesions and examine outcomes and adverse events. This single-center historical cohort study selected patients who underwent PBT at our proton therapy center between 2012 and 2018. The patients were selected based on the following criteria: primary esophagus carcinoma was resection and metachronous liver oligometastasis recurrence without extrahepatic tumors and no more than three liver metastases. This study included seven males with a median age of 66 (range, 58-78) years, and 15 lesions were included in the study. The median tumor size was 22.6 (7-55.3) mm. The most frequent dose was 72.6 Gy relative biological effect (RBE)/22 fractions (fr) for four lesions and 64 Gy (RBE)/8 fr for four lesions. The median survival time was 35.5 (13.2-119.4) months. The 1-, 2- and 3-year overall survival (OS) rates were 100%, 57.1% and 42.9%, respectively. The median progression-free survival (PFS) time was 8.7 (1.2-44.1) months. The 1-, 2- and 3-year PFS rates were 28.6%. The 1-, 2- and 3-year local control (LC) rates were 100%. No grade ≥4 radiation-induced adverse events (AEs) were observed. We conclude that PBT can be considered an alternative to hepatic resection for recurrent liver metastases postoperative esophageal cancer.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Takahiro Kato
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima 963-8563, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Gastroenterology, Southern Tohoku General Hospital, Koriyama City, Fukushima 963-8563, Japan
| | - Ichiro Seto
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Takuya Tominaga
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Kanako Takayama
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Yasuhiro Kikuchi
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima 963-8563, Japan
| | - Masao Murakami
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
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Dionisi F, Scartoni D, Fracchiolla F, Giacomelli I, Siniscalchi B, Goanta L, Cianchetti M, Sanguineti G, Brolese A. Proton therapy in the treatment of hepatocellular carcinoma. Front Oncol 2022; 12:959552. [PMID: 36003769 PMCID: PMC9393743 DOI: 10.3389/fonc.2022.959552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022] Open
Abstract
Liver cancer represents one of the most common causes of death from cancer worldwide. Hepatocellular carcinoma (HCC) accounts for 90% of all primary liver cancers. Among local therapies, evidence regarding the use of radiation therapy is growing. Proton therapy currently represents the most advanced radiation therapy technique with unique physical properties which fit well with liver irradiation. Here, in this review, we aim to 1) illustrate the rationale for the use of proton therapy (PT) in the treatment of HCC, 2) discuss the technical challenges of advanced PT in this disease, 3) review the major clinical studies regarding the use of PT for HCC, and 4) analyze the potential developments and future directions of PT in this setting.
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Affiliation(s)
- Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Francesco Dionisi,
| | - Daniele Scartoni
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | - Irene Giacomelli
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | | | - Lucia Goanta
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Napoli, Italy
| | - Marco Cianchetti
- Proton Therapy Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alberto Brolese
- General Surgery & Hepato-Pancreato-Biliary Unit, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
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Analysis of diaphragm movements to specify geometric uncertainties of respiratory gating near end-exhalation for irradiation fields involving the liver dome. Radiother Oncol 2022; 171:146-154. [DOI: 10.1016/j.radonc.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022]
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