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Yang WC, Koto M, Ikawa H, Imai R, Shinoto M, Takiyama H, Isozaki T, Yamada S. Clinical target volume design and dose in carbon-ion radiation therapy for sinonasal mucosal melanoma. Radiother Oncol 2024; 200:110511. [PMID: 39216826 DOI: 10.1016/j.radonc.2024.110511] [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: 02/24/2024] [Revised: 08/07/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND PURPOSE No guidelines exist for the clinical target volume (CTV) and radiotherapy dose in sinonasal mucosal melanoma (SNMM). Thus, we aimed to determine the carbon-ion radiotherapy (CIRT) CTV and dose for SNMM. MATERIALS AND METHODS In total, 135 patients with SNMM who received CIRT were reviewed. The relative biological effectiveness-weighted dose was 57.6 or 64 Gy in 16 fractions. CTV was classified into small CTV, which included the gross tumor and visible melanosis with a certain margin, and extended CTV, which included the tumor site and adjacent anatomical structures. Local recurrence (LR) patterns were pattern I, II, and III, defined as recurrence over the gross tumor, visible melanosis and subclinical area, which would be covered if extended CTV was applied, and outside the extended CTV, respectively. RESULTS The 5-year LR rate was 35.3 %. The prescribed dose was not a significant risk factor for pattern I LR; however, 57.6 Gy for a large tumor was insufficient for local control. Using an extended CTV was significantly associated with a lower risk of pattern II LR, and these recurrences did not occur in regions that received > 40 Gy. The 5-year pattern III LR rate was 6.4 %. CONCLUSION Utilizing an extended CTV in CIRT for SNMM is appropriate even for small tumors. Using a smaller CTV after an extended CTV of at least 40 Gy is recommended to reduce adverse events. Although the optimal dose for gross tumors remains unclear, the latest technology with 64 Gy showed good outcomes.
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Affiliation(s)
- Wan-Chin Yang
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan; Department of Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan; Department of Radiation Oncology, Yamagata University, Faculty of Medicine, Yamagata, Japan.
| | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Reiko Imai
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Makoto Shinoto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Tetsuro Isozaki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
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2
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Mizoguchi N, Kano K, Okuda T, Koge H, Shima S, Tsuchida K, Takakusagi Y, Kawashiro S, Yoshida M, Kitani Y, Hashimoto K, Furukawa M, Shirai K, Kamada T, Yoshida D, Katoh H. Adjuvant Therapy with Immune Checkpoint Inhibitors after Carbon Ion Radiotherapy for Mucosal Melanoma of the Head and Neck: A Case-Control Study. Cancers (Basel) 2024; 16:2625. [PMID: 39123353 PMCID: PMC11311030 DOI: 10.3390/cancers16152625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
The development of new treatment strategies to improve the prognosis of mucosal malignant melanoma of the head and neck (MMHN) after carbon ion radiotherapy (CIRT) is essential because of the risk of distant metastases. Therefore, our objective was to evaluate the outcomes of immune checkpoint inhibitor (ICI) treatment to justify its inclusion in the regimen after CIRT. Thirty-four patients who received CIRT as an initial treatment were included in the analysis and stratified into three groups: those who did not receive ICIs (Group A), those who received ICIs after recurrence or metastasis (Group B), and those who received ICIs as adjuvant therapy after CIRT (Group C). In total, 62% of the patients (n = 21) received ICIs. The 2-year local control and overall survival (OS) rates for all patients were 90.0% and 66.8%, respectively. The 2-year OS rates for patients in Groups A, B, and C were 50.8%, 66.7%, and 100%, respectively. No significant differences were observed between Groups A and B (p = 0.192) and Groups B and C (p = 0.112). However, a significant difference was confirmed between Groups A and C (p = 0.017). Adjuvant therapy following CIRT for MMHN may be a promising treatment modality that can extend patient survival.
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Affiliation(s)
- Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan;
| | - Kio Kano
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Tatsuya Okuda
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Hiroaki Koge
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Satoshi Shima
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Keisuke Tsuchida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Yosuke Takakusagi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Shohei Kawashiro
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Manatsu Yoshida
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (M.Y.); (Y.K.); (K.H.); (M.F.)
| | - Yuka Kitani
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (M.Y.); (Y.K.); (K.H.); (M.F.)
| | - Kaori Hashimoto
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (M.Y.); (Y.K.); (K.H.); (M.F.)
| | - Madoka Furukawa
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (M.Y.); (Y.K.); (K.H.); (M.F.)
| | - Katsuyuki Shirai
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan;
- Department of Radiation Oncology, Jichi Medical University Hospital, Tochigi 329-0498, Japan
| | - Tadashi Kamada
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Daisaku Yoshida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-8515, Japan; (K.K.); (T.O.); (H.K.); (S.S.); (K.T.); (Y.T.); (S.K.); (T.K.); (D.Y.); (H.K.)
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3
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Koto M, Ikawa H, Inaniwa T, Imai R, Shinoto M, Takiyama H, Isozaki T, Mizuno H, Kohno R, Takahashi I, Yoshida N, Yamada S. Dose-averaged LET optimized carbon-ion radiotherapy for head and neck cancers. Radiother Oncol 2024; 194:110180. [PMID: 38403023 DOI: 10.1016/j.radonc.2024.110180] [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: 01/03/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
This feasibility study confirmed the initial safety and efficacy of a novel carbon-ion radiotherapy (CIRT) using linear energy transfer (LET) painting for head and neck cancer. This study is the first step toward establishing CIRT with LET painting in clinical practice and making it a standard practice in the future.
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Affiliation(s)
- Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.
| | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Reiko Imai
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Makoto Shinoto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Tetsuro Isozaki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hideyuki Mizuno
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Ryosuke Kohno
- Department of Radiologic Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Tokyo, Japan
| | | | | | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
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4
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Thwaites DI, Prokopovich DA, Garrett RF, Haworth A, Rosenfeld A, Ahern V. The rationale for a carbon ion radiation therapy facility in Australia. J Med Radiat Sci 2024; 71 Suppl 2:59-76. [PMID: 38061984 PMCID: PMC11011608 DOI: 10.1002/jmrs.744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
Australia has taken a collaborative nationally networked approach to achieve particle therapy capability. This supports the under-construction proton therapy facility in Adelaide, other potential proton centres and an under-evaluation proposal for a hybrid carbon ion and proton centre in western Sydney. A wide-ranging overview is presented of the rationale for carbon ion radiation therapy, applying observations to the case for an Australian facility and to the clinical and research potential from such a national centre.
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Affiliation(s)
- David I. Thwaites
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Radiotherapy Research Group, Institute of Medical ResearchSt James's Hospital and University of LeedsLeedsUK
| | | | - Richard F. Garrett
- Australian Nuclear Science and Technology OrganisationLucas HeightsNew South WalesAustralia
| | - Annette Haworth
- Institute of Medical Physics, School of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, School of PhysicsUniversity of WollongongSydneyNew South WalesAustralia
| | - Verity Ahern
- Department of Radiation OncologySydney West Radiation Oncology NetworkWestmeadNew South WalesAustralia
- Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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5
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Ronchi S, Cicchetti A, Bonora M, Ingargiola R, Camarda AM, Russo S, Imparato S, Castelnuovo P, Pasquini E, Nicolai P, Ansarin M, Del Vecchio M, Benazzo M, Orlandi E, Vischioni B. Curative carbon ion radiotherapy in a head and neck mucosal melanoma series: Facing the future within multidisciplinarity. Radiother Oncol 2024; 190:110003. [PMID: 37956889 DOI: 10.1016/j.radonc.2023.110003] [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: 04/26/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To evaluate efficacy and toxicity of carbon ion radiotherapy (CIRT) in locally advanced head and neck mucosal melanoma (HNMM) patients treated at our Institute. MATERIALS AND METHODS Between June 2013 and June 2020, 40 HNMM patients were treated with CIRT. Prescription dose was 65.6-68.8 Gy relative biological effectiveness [RBE] in 16 fractions. Twelve (30%) patients received only biopsy, 28 (70%) surgical resection before CIRT. Immunotherapy was administered before and/or after CIRT in 45% of patients, mainly for distant progression (89%). RESULTS Median follow-up was 18 months. 2-year Local Relapse Free Survival (LRFS), Overall Survival (OS), Progression Free Survival (PFS) and Distant Metastasis Free Survival (DMFS) were 84.5%, 58.6%, 33.2% and 37.3%, respectively. At univariate analysis, LRFS was significantly better for non-recurrent status, < 2 surgeries before CIRT and treatment started < 9 months from the initial diagnosis, with no significant differences for operated versus unresected patients. After relapse, immunotherapy provided longer median OS (17 months vs 3.6, p-value<0.001). Late toxicity ≥ G3 (graded with CTCAE 5.0 scale) was reported in 10% of patients. CONCLUSION CIRT in advanced HNMM patients is safe and locally effective. Prospective trials are warranted to assess the role of targeted/immune- systemic therapy to improve OS.
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Affiliation(s)
- Sara Ronchi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefania Russo
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Ernesto Pasquini
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Del Vecchio
- Unit of Melanoma Medical Oncology, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan 20133, Italy
| | - Marco Benazzo
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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6
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Tamura K, Kumabe Y, Kishimoto Y, Kitamura M, Mizuta M, Tamaki H, Honda K, Yamada K, Tanaka S, Kojima T, Asato R, Ushiro K, Shinohara S, Takebayashi S, Maetani T, Ichimaru K, Kitani Y, Omori K. Mucosal melanoma of the head and neck: a retrospective analysis of 34 cases in Japan. Acta Otolaryngol 2024; 144:82-89. [PMID: 38362716 DOI: 10.1080/00016489.2024.2314590] [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: 11/09/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Mucosal melanoma of the head and neck (MMHN) is a rare condition. This study aimed to investigate oncological outcomes of surgical intervention in patients with MMHN. MATERIALS AND METHODS The study included 34 patients with MMHN who underwent surgical resection as initial treatment at 10 institutions in Japan between July 2005 and June 2015. Results: The 5-year overall survival (OS), local control rate (LCR), disease-free survival (DFS), and disease-specific survival (DSS) rates were 48.7%, 53.4%, 32.4%, and 55.1%, respectively. Based on multivariate analysis, no independent prognostic factors for the 5-year OS and DSS were found. Based on univariate analysis, the 5-year LCR was worse in patients with lesions in the nasal cavity and paranasal sinuses than in the oral cavity and pharynx. However, no differences in oncological outcomes were identified in relation to primary sites, and postoperative radiotherapy (PORT) and adjuvant systemic therapy did not contribute to improvements in the 5-year OS. CONCLUSIONS No independent prognostic factors for the 5-year OS or DSS were identified. Regional or distant recurrences are often identified, regardless of local control with surgical resection. Difficult control of MMHN with conventional therapeutic strategies, such as surgical intervention, PORT, and systemic therapy, has been suggested.
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Affiliation(s)
- Keiichi Tamura
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Kumabe
- Department of Otolaryngology-Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Morimasa Kitamura
- Department of Head and Neck Surgery, Kanazawa Medical University, Ishikawa, Japan
| | | | - Hisanobu Tamaki
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Keigo Honda
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichiro Yamada
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Shinzo Tanaka
- Department of Otolaryngology-Head & Neck Surgery, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Asato
- Department of Otolaryngology-Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Koji Ushiro
- Department of Otolaryngology-Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shogo Shinohara
- Department of Otolaryngology-Head & Neck Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Shinji Takebayashi
- Department of Otorhinolaryngology-Head & Neck Surgery, Shiga General Hospital, Shiga, Japan
| | - Toshiki Maetani
- Department of Otolaryngology-Head and Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazuyuki Ichimaru
- Department of Otolaryngology-Head & Neck Surgery, Kokura Memorial Hospital, Fukuoka, Japan
| | - Yoshiharu Kitani
- Department of Otorhinolaryngology-Head & Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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7
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Kohno R, Koto M, Ikawa H, Lee SH, Sato K, Hashimoto M, Inaniwa T, Shirai T. High-Linear Energy Transfer Irradiation in Clinical Carbon-Ion Beam With the Linear Energy Transfer Painting Technique for Patients With Head and Neck Cancer. Adv Radiat Oncol 2024; 9:101317. [PMID: 38260238 PMCID: PMC10801634 DOI: 10.1016/j.adro.2023.101317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/10/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Dose-averaged linear energy transfer (LETd) is one of the important factors in determining clinical outcomes for carbon-ion radiation therapy. Innovative LET painting (LP) has been developed as an advanced form of conventional intensity modulated carbon-ion radiation therapy (IMIT) at the QST Hospital. The study had 2 motivations: to increase the minimum LETd (LETdmin) and to improve uniformity of the LETd distribution within the gross tumor volume (GTV) by using LP treatment plans for patients with head and neck cancer while maintaining the relative biologic effectiveness (RBE)-weighted dose coverage within the planning tumor volume (PTV) the same as in the conventional IMIT plan. Methods and Materials The LP treatment plans were designed with the in-house treatment planning system. For the plans, LETd constraints and LETdmin, goal-LETd, and maximum-LETd (LETdmax) constraints for the GTV were added to the conventional dose constraints in the IMIT prescription. For 13 patients with head and neck cancer, the RBE-weighted dose to 90% (D90) and 50% (D50) of the PTV and the LETdmin, mean (LETdmean), and LETdmax values within the GTV in the LP plans were evaluated by comparing them with those in the conventional IMIT plans. Results The LP for 13 patients with head and neck cancer could keep D90s and D50s for the PTV within 1.0% of those by the conventional IMIT. Among the 13 patients, the mean LETdmin of the LP plans for the GTV was 59.2 ± 7.9 keV/μm, whereas that of the IMIT plans was 45.9 ± 6.0 keV/μm. The LP increased the LETdmin to 8 to 24 keV/μm for the GTV compared with IMIT. Conclusions While maintaining the dose coverage to the PTV as comparable to that for IMIT, the LP increased the mean LETdmin to 13.2 keV/μm for the GTV. For a GTV up to 170 cm3, LETd > 44 keV/μm could be achieved using LP, which according to previous studies was associated with lower recurrence. In addition, the LP method delivered more uniform LETd distributions compared with IMIT.
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Affiliation(s)
- Ryosuke Kohno
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institute for Quantum Science and Technology, Chiba, Japan
- Department of Radiologic Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Masashi Koto
- QST Hospital, National Institute for Quantum Science and Technology, Chiba, Japan
| | - Hiroaki Ikawa
- QST Hospital, National Institute for Quantum Science and Technology, Chiba, Japan
| | - Sung Hyun Lee
- Department of Heavy Particle Medical Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
| | - Kana Sato
- Department of Radiology, IUHW Narita Hospital, Chiba, Japan
| | - Mitsuyasu Hashimoto
- Department of Radiologic Sciences, Graduate School of Health and Welfare Sciences, International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Taku Inaniwa
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institute for Quantum Science and Technology, Chiba, Japan
| | - Toshiyuki Shirai
- Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institute for Quantum Science and Technology, Chiba, Japan
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8
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Nomura M. Definitive treatment for head and neck mucosal melanoma. Jpn J Clin Oncol 2023; 53:1112-1118. [PMID: 37609679 DOI: 10.1093/jjco/hyad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Head and neck mucosal melanoma is a rare clinical subtype of melanoma or head and neck cancer. Mucosal melanoma is aetiologically and molecularly distinct from cutaneous melanoma. The therapeutic efficacy of immune checkpoint inhibitors for head and neck mucosal melanoma remains unclear. Surgery is considered as the mainstay of treatment for locally advanced head and neck mucosal melanoma, and adjuvant radiotherapy has a role in local disease control. New treatment modalities, such as targeted therapy and immunotherapy, have changed the treatment of cutaneous melanoma. However, patients with mucosal melanoma have been excluded from most Phase III clinical trials. Due to its rarity, outcome data for locally advanced head and neck mucosal melanoma are scarce and are mainly based on retrospective studies with limited case numbers. The objective of this review was to provide an update and overview of clinical trials, prospective observational studies and retrospective studies and discuss future directions for multimodal treatment of locally advanced head and neck mucosal melanoma.
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Affiliation(s)
- Motoo Nomura
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
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9
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Endo M. Creation, evolution, and future challenges of ion beam therapy from a medical physicist's viewpoint (Part 3): Chapter 3. Clinical research, Chapter 4. Future challenges, Chapter 5. Discussion, and Conclusion. Radiol Phys Technol 2023; 16:443-470. [PMID: 37882992 DOI: 10.1007/s12194-023-00748-9] [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: 05/26/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
Clinical studies of ion beam therapy have been performed at the Lawrence Berkeley Laboratory (LBL), National Institute of Radiological Sciences (NIRS), Gesellschaft für Schwerionenforschung (GSI), and Deutsches Krebsforschungszentrum (DKFZ), in addition to the development of equipment, biophysical models, and treatment planning systems. Although cancers, including brain tumors and pancreatic cancer, have been treated with the Bevalac's neon-ion beam at the LBL (where the first clinical research was conducted), insufficient results were obtained owing to the limited availability of neon-ion beams and immaturity of related technologies. However, the 184-Inch Cyclotron's helium-ion beam yielded promising results for chordomas and chondrosarcomas at the base of the skull. Using carbon-ion beams, NIRS has conducted clinical trials for the treatment of common cancers for which radiotherapy is indicated. Because better results than X-ray therapy results have been obtained for lung, liver, pancreas, and prostate cancers, as well as pelvic recurrences of rectal cancer, the Japanese government recently approved the use of public medical insurance for carbon-ion radiotherapy, except for lung cancer. GSI obtained better results than LBL for bone and soft tissue tumors, owing to dose enhancement enabled by scanning irradiation. In addition, DKFZ compared treatment results of proton and carbon-ion radiotherapy for these tumors. This article summarizes a series of articles (Parts 1-3) and describes future issues of immune ion beam therapy and linear energy transfer optimization.
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Affiliation(s)
- Masahiro Endo
- Association for Nuclear Technology in Medicine, Nikkei Bldg., 7-16 Nihombashi-Kodemmacho, Chuo-ku, Tokyo, 103-0001, Japan.
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Omura G, Namikawa K, Sakai T, Eguchi K, Matsumoto Y, Sakai A, Kobayashi K, Nakano E, Ogata D, Matsumoto F, Mori T, Yamazaki N, Yoshimoto S. Clinical outcomes of head and neck mucosal melanoma treated with surgery: a single-center study in Japan. Jpn J Clin Oncol 2023; 53:1045-1050. [PMID: 37551022 DOI: 10.1093/jjco/hyad096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Head and neck mucosal melanomas are rare malignancies. Although the prognosis is poor owing to the high incidence of distant metastases, locoregional control remains important. It is difficult to obtain results in a large cohort because of its rarity. This study aimed to elucidate the survival outcomes of patients with head and neck mucosal melanoma treated with surgery in Japan. METHODS Patients with head and neck mucosal melanoma who were surgically treated between 2007 and 2021 at the National Cancer Center Hospital were retrospectively analyzed. RESULTS A total of 47 patients were included in this study. The 5-year overall survival, disease-specific survival, locoregional control and relapse-free survival rates were 42%, 50%, 79% and 13%, respectively. The disease-specific survival of the oral mucosal melanoma group was significantly better than that of the sinonasal mucosal melanoma group (5-year disease-specific survival rate: 70% versus 37%, respectively; P = 0.04). Multivariate analyses revealed that sinonasal mucosal melanoma were independently significant adverse prognostic factor, for overall survival and disease-specific survival. Patients with oral mucosal melanoma patients had a higher incidence of lymph node metastasis than those with sinonasal mucosal melanoma patients (P < 0.0001). CONCLUSION This study demonstrated the survival outcomes of the largest cohort of patients with head and neck mucosal melanomas treated surgically at a single institution within the past 20 years in Japan. We found that survival outcomes and incidence of nodal metastases varied by site.
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Affiliation(s)
- Go Omura
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshihiko Sakai
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kohtaro Eguchi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshifumi Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Azusa Sakai
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kenya Kobayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
- Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Eiji Nakano
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
- Department of Otorhinolaryngology Head and Neck Surgery, Juntendo University, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
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Orlandi E, Barcellini A, Vischioni B, Fiore MR, Vitolo V, Iannalfi A, Bonora M, Chalaszczyk A, Ingargiola R, Riva G, Ronchi S, Valvo F, Fossati P, Ciocca M, Mirandola A, Molinelli S, Pella A, Baroni G, Pullia MG, Facoetti A, Orecchia R, Licitra L, Vago G, Rossi S. The Role of Carbon Ion Therapy in the Changing Oncology Landscape-A Narrative Review of the Literature and the Decade of Carbon Ion Experience at the Italian National Center for Oncological Hadrontherapy. Cancers (Basel) 2023; 15:5068. [PMID: 37894434 PMCID: PMC10605728 DOI: 10.3390/cancers15205068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. METHODS To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO's clinical activity over the last 10 years of CIRT. RESULTS The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. CONCLUSIONS After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.
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Affiliation(s)
- Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Alberto Iannalfi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Agnieszka Chalaszczyk
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Giulia Riva
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Francesca Valvo
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Haematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Mario Ciocca
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Alfredo Mirandola
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Guido Baroni
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Marco Giuseppe Pullia
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Angelica Facoetti
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO-European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Lisa Licitra
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Head & Neck Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Oncology & Haemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gianluca Vago
- Presidency, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- School of Pathology, University of Milan, 20122 Milan, Italy
| | - Sandro Rossi
- General Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
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12
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Ahern V, Adeberg S, Fossati P, Garrett R, Hoppe B, Mahajan A, Orlandi E, Orecchia R, Prokopovich D, Seuntjens J, Thwaites D, Trifiletti D, Tsang R, Tsuji H. An international approach to estimating the indications and number of eligible patients for carbon ion radiation therapy (CIRT) in Australia. Radiother Oncol 2023; 187:109816. [PMID: 37480996 DOI: 10.1016/j.radonc.2023.109816] [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: 03/21/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND PURPOSE To establish the treatment indications and potential patient numbers for carbon ion radiation therapy (CIRT) at the proposed national carbon ion (and proton) therapy facility in the Westmead precinct, New South Wales (NSW), Australia. METHODS An expert panel was convened, including representatives of four operational and two proposed international carbon ion facilities, as well as NSW-based CIRT stakeholders. They met virtually to consider CIRT available evidence and experience. Information regarding Japanese CIRT was provided pre- and post- the virtual meeting. Published information for South Korea was included in discussions. RESULTS There was jurisdictional variation in the tumours treated by CIRT due to differing incidences of some tumours, referral patterns, differences in decisions regarding which tumours to prioritise, CIRT resources available and funding arrangements. The greatest level of consensus was reached that CIRT in Australia can be justified currently for patients with adenoid cystic carcinomas and mucosal melanomas of the head and neck, hepatocellular cancer and liver metastases, base of skull meningiomas, chordomas and chondrosarcomas. Almost 1400 Australian patients annually meet the consensus-derived indications now. CONCLUSION A conservative estimate is that 1% of cancer patients in Australia (or 2% of patients recommended for radiation therapy) may preferentially benefit from CIRT for initial therapy of radiation resistant tumours, or to boost persistently active disease after other therapies, or for re-irradiation of recurrent disease. On this basis, one national carbon ion facility with up to four treatment rooms is justified for Australian patients.
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Affiliation(s)
- Verity Ahern
- Sydney West Radiation Oncology Network, Westmead, Australia; Westmead Clinical School, The University of Sydney, Australia.
| | - Sebastian Adeberg
- Marburg Ion-Beam Therapy Center (MIT), Department of Radiation Oncology, Heidelberg University Hospital, Marburg, Germany; Department of Radiation Oncology, Marburg University Hospital, Marburg, Germany
| | - Piero Fossati
- MedAustron Ion Therapy Center, Austria; Karl Landsteiner University of Health Sciences, Austria
| | - Richard Garrett
- Australian Nuclear Science and Technology Organisation, Australia
| | | | | | - Ester Orlandi
- National Center for Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Jan Seuntjens
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Canada; Radiation Oncology, University of Toronto, Toronto, Canada
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Australia; Radiotherapy Research Group, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - Richard Tsang
- Radiation Oncology, University of Toronto, Toronto, Canada; Department of Radiation Oncology and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Hiroshi Tsuji
- National Institutes for Quantum Science and Technology, Chiba, Japan
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13
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Musha A, Kubo N, Kawamura H, Okano N, Sato H, Okada K, Tomizawa K, Ota N, Adachi A, Shino M, Nikkuni O, Ida S, Shirai K, Saitoh JI, Yokoo S, Chikamatsu K, Ohno T. Efficacy of immune checkpoint inhibitor treatment for head and neck mucosal melanoma recurrence in patients treated with carbon-ion radiotherapy. Cancer Rep (Hoboken) 2023:e1825. [PMID: 37115713 PMCID: PMC10363791 DOI: 10.1002/cnr2.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Carbon-ion radiotherapy (C-ion RT) is effective for head and neck mucosal melanoma (HN-MM), including radioresistant mucosal melanoma. Melanoma also responds effectively to immune checkpoint inhibitors (ICIs). Data on the efficacy and safety of ICIs for HN-MM are insufficient. AIMS To analyze the efficacy and safety of ICI salvage therapy in patients with HN-MM recurrence after C-ion RT. METHODS AND RESULTS This retrospective study analyzed the medical records of 52 patients with HN-MM treated with C-ion RT between 2012 and 2020. A dose of 57.6 or 64.0 Gy (relative biological effectiveness) was provided in 16 fractions. The primary endpoint was 3-year overall survival (OS) rate. The median follow-up time was 26.8 months for all patients. A total of 29 patients had local recurrence or distant metastasis, and 16 patients who received ICI therapy. The 3-year OS rate in the ICI group (n = 16) and best supportive care group (n = 13) were 53.8% and 0.0%, respectively (p = 0.837); the difference was not statistically significant. There were no deaths after 1 year among patients who underwent ICI therapy. No adverse events associated with C-ion RT were related to or exacerbated by ICI. CONCLUSION ICI salvage therapy is effective and safe for patients with HN-MM recurrence after C-ion RT.
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Affiliation(s)
- Atsushi Musha
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
- Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Maebashi, Japan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Naoko Okano
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Hiro Sato
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Kohei Okada
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Kento Tomizawa
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Norichika Ota
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Akiko Adachi
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Masato Shino
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Nikkuni
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shota Ida
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Katsuyuki Shirai
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
- Department of Radiology, Jichi Medical University Hospital, Tochigi, Japan
| | - Jun-Ichi Saitoh
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Maebashi, Japan
| | - Kazuaki Chikamatsu
- Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
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14
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Ohshima S, Ueki Y, Yokoyama Y, Takahashi T, Shodo R, Yamazaki K, Okabe R, Matsuyama H, Togashi T, Takatsuka S, Takenouchi T, Horii A. Treatment outcomes of mucosal melanoma of head and neck: Efficacy of immune checkpoint inhibitors for advanced disease. Front Surg 2022; 9:1032626. [PMID: 37082097 PMCID: PMC10112385 DOI: 10.3389/fsurg.2022.1032626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022] Open
Abstract
BackgroundHead and neck mucosal melanoma (HNMM) is a rare and aggressive subtype of melanoma. HNMM often develops as a recurrent or metastatic disease, and its prognosis is worse than that of cutaneous melanoma. Recent large-scale clinical studies have reported favorable outcomes with immune checkpoint inhibitors (ICIs) for melanoma. However, these clinical trials included only a small number of HNMM cases. This study aimed to estimate treatment outcomes and prognostic predictors of ICIs for advanced HNMM.MethodsCases of advanced HNMM, defined as unresectable or metastatic HNMM at the initial diagnosis (five patients) or development of recurrent/metastatic HNMM after initial treatment (27 patients), were included in this study. Survival analysis and a search for prognostic factors were performed for these 32 patients. Furthermore, the detailed clinical course of patients who received ICI treatment was investigated.ResultsThe median overall survival (OS) of 32 patients with advanced HNMM was 25.3 months. The estimated 1-, 3-, and 5-year OS rates were 68.4%, 42.8%, and 34.3%, respectively. Fourteen patients (43.7%) received ICIs, whereas 18 (56.3%) did not. Univariate analysis showed that ICI treatment was the only factor associated with a better 1-year OS. Patients who received ICI treatment had significantly longer OS (median OS: not reached, 1-year OS: 85.7%) than those who did not (median OS: 11.3 months, 1-year OS: 54.5%). The overall response and disease control rates of patients who received ICI treatment were 50% and 64.3%, respectively. Patients who achieved complete response (CR) or partial response (PR) to ICI treatment survived significantly longer (1-year OS: 100%) than those who did not (1-year OS: 71.4%). Among the five patients who discontinued ICI treatment due to severe immune-related adverse events (irAEs), four did not receive salvage treatments but showed durable treatment effects and survived for 9.8–54.2 months at the end of the follow-up period.ConclusionsICI treatment achieved a favorable OS for advanced HNMM. CR/PR to ICI treatment and discontinuation owing to severe irAEs were favorable predictors of OS.
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Affiliation(s)
- Shusuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yushi Ueki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Correspondence: Yushi Ueki
| | - Yusuke Yokoyama
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeshi Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryusuke Shodo
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keisuke Yamazaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryuichi Okabe
- Division of Otorhinolaryngology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Hiroshi Matsuyama
- Division of Otorhinolaryngology, Niigata City General Hospital, Niigata, Japan
| | - Takafumi Togashi
- Division of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Sumiko Takatsuka
- Division of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | | | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kaneko T, Koto M, Ikawa H, Shinoto M, Takiyama H, Yamada S, Nemoto K, Tsuji H. Dosimetric analysis for otitis media with effusion due to Eustachian tube dysfunction after carbon-ion radiotherapy for head and neck cancers. Adv Radiat Oncol 2022; 8:101115. [DOI: 10.1016/j.adro.2022.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
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16
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Shiba S, Okamoto M, Sakai M, Ohno T. Visualizing Bioabsorbable Spacer Effectiveness by Confirming the Distal-Tail of Carbon-Ion Beams: First-In-Human Report. Tomography 2022; 8:2339-2346. [PMID: 36287794 PMCID: PMC9610790 DOI: 10.3390/tomography8050195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 01/01/2023] Open
Abstract
In particle therapy, bioabsorbable polyglycolic acid (PGA) spacer was developed to reduce the healthy organ irradiation dose, especially in the gastrointestinal tract. The PGA spacer is safe and effective; however, there are no reports that have confirmed whether the PGA spacer which inserted in the body actually stops the carbon-ion (C-ion) beams. Here, we visualized and confirmed that the PGA spacer stops the C-ion beams in the body based on the dose distribution using auto-activation positron emission tomography (AAPET). A 59-year-old dedifferentiated retroperitoneal liposarcoma patient underwent C-ion radiotherapy (C-ion RT) on referral. A month before C-ion RT initiation, the patient underwent PGA spacer placement. Postoperatively, the patient received 4.4 Gy (RBE) per fraction of C-ion RT, followed by AAPET. AAPET revealed lower positron emitter concentrations at the distal tissue ventral to the PGA spacer than in the planning target volume. In observing the efficacy of the PGA spacer, the AAPET images and the average count per second of the positron emitter suggested that the PGA spacer stopped the C-ion beams in the body in accordance with the dose distribution. Therefore, AAPET was useful in confirming the PGA spacer's effectiveness in this study, and the PGA spacer stopped the C-ion beams.
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Affiliation(s)
- Shintaro Shiba
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura-City 247-8533, Kanagawa, Japan
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi-City 371-8511, Gunma, Japan
- Correspondence: ; Tel.: +81-467-46-1717
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi-City 371-8511, Gunma, Japan
| | - Makoto Sakai
- Gunma University Heavy Ion Medical Center, 3-39-22, Showa-Machi, Maebashi-City 371-8511, Gunma, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-Machi, Maebashi-City 371-8511, Gunma, Japan
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Takahashi D, Demizu Y, Koto M, Kubo N, Suefuji H, Ikawa H, Ohno T, Shioyama Y, Okimoto T, Tsuji H. Multicenter study of re-irradiation using carbon-ions for head and neck malignancies after photon radiotherapy. Cancer Med 2022; 11:3593-3601. [PMID: 35393701 PMCID: PMC9554451 DOI: 10.1002/cam4.4741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The goal of this multicenter retrospective study of patients with head and neck malignancies was to evaluate the efficacy and safety of carbon‐ion (C‐ion) radiotherapy (RT) after photon RT. Methods We enrolled 56 patients with head and neck malignancies who underwent re‐irradiation (re‐RT) using C‐ions between November 2003 and March 2019, treated previously with photon RT. The tumors at re‐RT were located in the sinonasal cavities (n = 20, 35.7%), skull base (n = 12, 21.4%), and orbit (n = 7, 12.5%). The tumors at the initial RT were located in the sinonasal cavities (n = 13, 23.2%), skull base (n = 9, 16.1%), and orbit (n = 9, 16.1%). The median period between the initial RT and re‐RT was 41 (4–568) months. The most common histology of re‐RT was squamous cell carcinoma (n = 11, 19.6%). The most commonly used protocol was 57.6 Gy (relative biological effectiveness) in 16 fractions (n = 23, 41.1%). Surgery preceded re‐RT in three patients (5.4%). One patient with malignant melanoma received concurrent chemotherapy. Results The 2‐year local control, progression‐free survival, and overall survival rates were 66.5%, 36.9%, and 67.9%, respectively. The median follow‐up time was 28 months. Two patients (3.6%) developed grade ≥ 3 acute toxicities, and 14 (25.0%) developed grade ≥ 3 late toxicities. A single patient had confirmed grade 5 dermatitis with infection. Conclusion Re‐RT using C‐ions for head and neck malignancies after photon RT is an effective treatment with tolerable toxicity.
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Affiliation(s)
- Daiki Takahashi
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan.,Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Sciences and Technology, Chiba, Japan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Sciences and Technology, Chiba, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Sciences and Technology, Chiba, Japan
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18
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Hartzell S, Guan F, Taylor P, Peterson C, Taddei P, Kry S. Uncertainty in tissue equivalent proportional counter assessments of microdosimetry and RBE estimates in carbon radiotherapy. Phys Med Biol 2021; 66. [PMID: 34252894 DOI: 10.1088/1361-6560/ac1366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/12/2021] [Indexed: 11/11/2022]
Abstract
Microdosimetry is an important tool for assessing energy deposition distributions from ionizing radiation at cellular and cellular nucleus scales. It has served as an input parameter for multiple common mathematical models, including evaluation of relative biological effectiveness (RBE) of carbon ion therapy. The most common detector used for microdosimetry is the tissue-equivalent proportional counter (TEPC). Although it is widely applied, TEPC has various inherent uncertainties. Therefore, this work quantified the magnitude of TEPC measurement uncertainties and their impact on RBE estimates for therapeutic carbon beams. Microdosimetric spectra and frequency-, dose-, and saturation-corrected dose-mean lineal energy (****) were calculated using the Monte Carlo toolkit Geant4 for five monoenergetic and three spread-out Bragg peak carbon beams in water at every millimeter along the central beam axis. We simulated the following influences on these spectra from eight sources of uncertainty: wall effects, pulse pile-up, electronics, gas pressure, W-value, gain instability, low energy cut-off, and counting statistics. Statistic uncertainty was quantified as the standard deviation of perturbed values for each source. Bias was quantified as the difference between default lineal energy values and the mean of perturbed values for each systematic source. Uncertainties were propagated to RBE using the modified microdosimetric kinetic model (MKM). Variance introduced by statistic sources iny¯Fandy¯Daveraged 3.8% and 3.4%, respectively, and 1.5% iny*across beam depths and energies. Bias averaged 6.2% and 7.3% iny¯Fandy¯D,and 4.8% iny*.These uncertainties corresponded to 1.2 ± 0.9% on average in RBEMKM. The largest contributors to variance and bias were pulse pile-up and wall effects. This study established an error budget for microdosimetric carbon measurements by quantifying uncertainty inherent to TEPC measurements. It is necessary to understand how robust the measurement of RBE model input parameters are against this uncertainty in order to verify clinical model implementation.
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Affiliation(s)
- Shannon Hartzell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fada Guan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Paige Taylor
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Christine Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Phillip Taddei
- Radiation Oncology Department, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Stephen Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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19
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Kim KS, Wu HG. Who Will Benefit from Charged-Particle Therapy? Cancer Res Treat 2021; 53:621-634. [PMID: 34176253 PMCID: PMC8291184 DOI: 10.4143/crt.2021.299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
Charged-particle therapy (CPT) such as proton beam therapy (PBT) and carbon-ion radiotherapy (CIRT) exhibit substantial physical and biological advantages compared to conventional photon radiotherapy. As it can reduce the amount of radiation irradiated in the normal organ, CPT has been mainly applied to pediatric cancer and radioresistent tumors in the eloquent area. Although there is a possibility of greater benefits, high set-up cost and dearth of high level of clinical evidence hinder wide applications of CPT. This review aims to present recent clinical results of PBT and CIRT in selected diseases focusing on possible indications of CPT. We also discussed how clinical studies are conducted to increase the number of patients who can benefit from CPT despite its high cost.
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Affiliation(s)
- Kyung Su Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul,
Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul,
Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
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20
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Kaneko T, Suefuji H, Koto M, Demizu Y, Saitoh JI, Tsuji H, Okimoto T, Ohno T, Shioyama Y, Nemoto K, Nakano T, Kamada T. Multicenter Study of Carbon-ion Radiotherapy for Oropharyngeal Non-squamous Cell Carcinoma. In Vivo 2021; 35:2239-2245. [PMID: 34182502 DOI: 10.21873/invivo.12496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate treatment outcomes of carbon-ion radiotherapy for oropharyngeal non-squamous cell carcinoma at four carbon-ion facilities in Japan. PATIENTS AND METHODS We retrospectively analyzed the cases of 33 patients with oropharyngeal non-squamous cell carcinoma who were treated with carbon-ion radiotherapy between November 2003 and December 2014. RESULTS The histology included adenoid cystic carcinoma (n=25) and mucosal malignant melanoma (n=4). No patients had T1 tumors; 23 had T4 tumors. The most-commonly prescribed dose was 57.6 Gy (RBE) in 16 fractions. The median follow-up period was 34.8 months (range=4.2-122.8 months). The 3-year local control and overall survival rates were 94.7% and 90.7%, respectively. There were no grade ≥4 acute adverse events. Only one patient experienced a grade ≥4 late adverse event. No patients experienced late adverse events related to swallowing or salivary function. CONCLUSION Carbon-ion radiotherapy appears to be a promising treatment option for oropharyngeal non-squamous cell carcinoma.
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Affiliation(s)
- Takashi Kaneko
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan.,QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Hiroaki Suefuji
- Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan;
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Jun-Ichi Saitoh
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takashi Nakano
- Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tadashi Kamada
- Ion-beam Radiation Oncology Center, Kanagawa Cancer Center, Kanagawa, Japan
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21
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Ebner DK, Malouff TD, Frank SJ, Koto M. The Role of Particle Therapy in Adenoid Cystic Carcinoma and Mucosal Melanoma of the Head and Neck. Int J Part Ther 2021; 8:273-284. [PMID: 34285953 PMCID: PMC8270088 DOI: 10.14338/ijpt-d-20-00076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
Particle irradiation is suitable for resistant histologies owing to a combination of improved dose delivery with potential radiobiologic advantages in high linear energy transfer radiation. Within the head and neck, adenoid cystic carcinoma and mucosal melanoma are two such histologies, being radioresistant and lying closely proximal to critical structures. Here, we review the use of particle irradiation for adenoid cystic carcinoma and mucosal melanoma of the head and neck.
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Affiliation(s)
- Daniel K Ebner
- Hospital of the National Institutes of Quantum and Radiological Science and Technology (QST Hospital), Chiba, Japan
| | - Timothy D Malouff
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Steven J Frank
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masashi Koto
- Hospital of the National Institutes of Quantum and Radiological Science and Technology (QST Hospital), Chiba, Japan
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22
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Fossati P, Perpar A, Stock M, Georg P, Carlino A, Gora J, Martino G, Hug EB. Carbon Ion Dose Constraints in the Head and Neck and Skull Base: Review of MedAustron Institutional Protocols. Int J Part Ther 2021; 8:25-35. [PMID: 34285933 PMCID: PMC8270085 DOI: 10.14338/ijpt-20-00093.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dose constraints are of paramount importance for the outcome of any radiotherapy treatment. In this article, we report dose-volume constraints as well as currently used fractionation schedules for carbon ion radiotherapy as applied in MedAustron (Wiener Neustadt, Austria). MATERIALS AND METHODS For fractionation schedules, both German and Japanese regimes were used. From the clinical experience of National Institute of Radiological Sciences (Chiba, Japan) and Heidelberg Ion Therapy (Heidelberg, Germany; formerly GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany) and the work by colleagues in Centro Nazionale Adroterapia Oncologica (Pavia, Italy) recalculating the dose from the microdosimetric kinetic model to the local effect model, we have set the dose constraints for critical organs of the head and neck area. Where no clinical data was available, an educated guess was made, based on data available from photon and proton series. RESULTS We report the constraints for the optic nerve and chiasm, brainstem, spinal cord, cochlea, brain parenchyma, salivary gland, eye and adnexa, and mandibular/maxillary bone; constraints are grouped based on a fractionation scheme (German versus Japanese) and the risk of toxicity (safe, low to middle, and middle to high). CONCLUSION We think validation of dose constraints should present a relevant part of the activity of any carbon ion radiotherapy facility, and we anticipate future multicentric, joint evaluations.
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Affiliation(s)
- Piero Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Ana Perpar
- Oncology Institute Ljubljana, Ljubljana, Slovenia
| | - Markus Stock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Petra Georg
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Joanna Gora
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Eugen B. Hug
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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23
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Takakusagi Y, Yoshida D, Kusano Y, Kano K, Anno W, Tsuchida K, Mizoguchi N, Serizawa I, Katoh H, Imura K, Takayama Y, Minohara S, Kamada T. Dosimetric Comparison Between Carbon-ion Radiotherapy and Photon Radiotherapy for Stage I Esophageal Cancer. In Vivo 2021; 35:447-452. [PMID: 33402495 DOI: 10.21873/invivo.12277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM The present study aimed to compare the radiation dose distribution of carbon-ion radiotherapy (CIRT) for stage I esophageal cancer with three-dimensional conformal radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT). PATIENTS AND METHODS Fifteen patients with cT1bN0M0 esophageal cancer who received 3DCRT at Kanagawa Cancer Center between January 2014 and April 2019 were enrolled. The dose-volume histogram parameters of the target volume and normal organs planned with CIRT, 3DCRT, and VMAT were evaluated. RESULTS The homogeneity index for the target volume of CIRT was significantly lower than that of 3DCRT and VMAT. In addition, the radiation dose of CIRT to the heart, lungs, spinal cord, and skin was significantly lower than that of 3DCRT and VMAT. CONCLUSION Favorable dose distributions with CIRT were demonstrated compared with 3DCRT and VMAT for esophageal cancer.
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Affiliation(s)
- Yosuke Takakusagi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan;
| | - Daisaku Yoshida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yohsuke Kusano
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Japan
| | - Kio Kano
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Wataru Anno
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Keisuke Tsuchida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Itsuko Serizawa
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Koh Imura
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshiki Takayama
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Japan
| | - Shinichi Minohara
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Japan
| | - Tadashi Kamada
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan
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24
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Ebner DK, Frank SJ, Inaniwa T, Yamada S, Shirai T. The Emerging Potential of Multi-Ion Radiotherapy. Front Oncol 2021; 11:624786. [PMID: 33692957 PMCID: PMC7937868 DOI: 10.3389/fonc.2021.624786] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022] Open
Abstract
Research into high linear energy transfer (LET) radiotherapy now spans over half a century, beginning with helium and deuteron treatment in 1952 and today ranging from fast neutrons to carbon-ions. Owing to pioneering work initially in the United States and thereafter in Germany and Japan, increasing focus is on the carbon-ion beam: 12 centers are in operation, with five under construction and three in planning. While the carbon-ion beam has demonstrated unique and promising suitability in laboratory and clinical trials toward the hypofractionated treatment of hypoxic and/or radioresistant cancer, substantial developmental potential remains. Perhaps most notable is the ability to paint LET in a tumor, theoretically better focusing damage delivery within the most resistant areas. However, the technique may be limited in practice by the physical properties of the beams themselves. A heavy-ion synchrotron may provide irradiation with multiple heavy-ions: carbon, helium, and oxygen are prime candidates. Each ion varies in LET distribution, and so a methodology combining the use of multiple ions into a uniform LET distribution within a tumor may allow for even greater treatment potential in radioresistant cancer.
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Affiliation(s)
- Daniel K Ebner
- National Institute of Radiological Science (NIRS), National Institutes of Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - Steven J Frank
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Taku Inaniwa
- National Institute of Radiological Science (NIRS), National Institutes of Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - Shigeru Yamada
- National Institute of Radiological Science (NIRS), National Institutes of Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - Toshiyuki Shirai
- National Institute of Radiological Science (NIRS), National Institutes of Quantum and Radiological Science and Technology (QST), Chiba, Japan
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25
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Fiorentino A, Gregucci F, Desideri I, Fiore M, Marino L, Errico A, Di Rito A, Borghetti P, Franco P, Greto D, Donato V. Radiation treatment for adult rare cancers: Oldest and newest indication. Crit Rev Oncol Hematol 2021; 159:103228. [PMID: 33508447 DOI: 10.1016/j.critrevonc.2021.103228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 12/10/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
AIM Aim of this analysis is to review the role of RT in the management of several rare tumors for adult patients. METHODS Collection data regarding RT and rare tumors was made by Pubmed. RESULTS For mucosal melanomas, RT is prescribed, being associated with lower local recurrence rate. For trachea tumors, RT was used as adjuvant or salvage treatment for unresectable disease. For pNET, RT can be a suitable option for post-surgical or unresectable/borderline. For bronchopulmonary neuroendocrine tumors the role of adjuvant treatments is uncertain. For hepatobiliary and ovarian malignancy, stereotactic body RT (SBRT) is a promising approach. For soft tissue sarcoma, perioperative treatments are indicated, and a growing role of SBRT in oligometastatic disease is recognized. For endocrine tumors, adjuvant RT has demonstrated benefits through reducing recurrence risk. CONCLUSION The radiotherapy is a frequent indication in adult rare cancers; thus the role of Radiation Oncologist must not be neglected.
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Affiliation(s)
- Alba Fiorentino
- Radiation Oncology Department, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Lorenza Marino
- Radiation Oncology Department, Humanitas Istituto Clinico Catanese, Misterbianco, Catania, Italy
| | - Angelo Errico
- Radiotherapy Oncology Department, R. Dimiccoli Hospital, Barletta, Italy
| | - Alessia Di Rito
- Radiotherapy Oncology Department, IRCCS "Giovanni Paolo II", Bari, Italy
| | - Paolo Borghetti
- Radiation Oncology Department University and Spedali Civili, Brescia, Italy
| | | | - Daniela Greto
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Section of Radiation Oncology, University of Florence, Italy
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
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26
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Hiratsuka J, Kamitani N, Tanaka R, Tokiya R, Yoden E, Sakurai Y, Suzuki M. Long-term outcome of cutaneous melanoma patients treated with boron neutron capture therapy (BNCT). JOURNAL OF RADIATION RESEARCH 2020; 61:945-951. [PMID: 32990318 PMCID: PMC7674695 DOI: 10.1093/jrr/rraa068] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/15/2020] [Indexed: 05/11/2023]
Abstract
Our aim was to assess the long-term clinical outcome of boron neutron capture therapy (BNCT) using 10B-para-boronophenylalanine (BPA) as the boron delivery agent for cutaneous melanoma. Eight patients (eight lesions) were treated between October 2003 and April 2014. Their ages ranged from 48 to 86 years at the time of treatment. All of the targets were primary lesions and they were located on the sole or face. No patient had evidence of regional lymph node involvement, distant metastases or an active secondary cancer. The clinical stage was cT1-2N0M0 and performance scores were <2. BNCT was carried out at the Kyoto University Research Reactor (KUR). The patients were irradiated with an epithermal neutron beam between the curative tumor dose and the tolerable skin dose. Eight patients were evaluated and six showed a complete response (CR), while two patients had a partial response (PR). Of the two patients with a PR, one has remained a PR with brown spots persisting for 7.5 years following BNCT. The tumor in the other patient recurred after 6 years at the site of persisting brown macula. The overall control rate (CR + PR without recurrence) for the cohort was 88% (7/8). There have never been any adverse events >Grade 2 for the long follow-up period. Our results suggest that BNCT may be a promising treatment modality in the management of early stage cutaneous melanoma when wide local excision is not feasible.
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Affiliation(s)
- Junichi Hiratsuka
- Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Nobuhiko Kamitani
- Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Ryo Tanaka
- Department of Dermatology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Ryoji Tokiya
- Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Eisaku Yoden
- Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Yosinori Sakurai
- Department of Particle Radiation Oncology, Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka 590-0494, Japan
| | - Minoru Suzuki
- Department of Particle Radiation Oncology, Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka 590-0494, Japan
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27
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Hagiwara Y, Yamada S, Isozaki Y, Takiyama H, Shinoto M, Kawashiro S, Bhattacharyya T, Nemoto K, Tsuji H. Efficacy and feasibility of re-irradiation using carbon ions for pancreatic cancer that recurs after carbon-ion radiotherapy. Clin Transl Radiat Oncol 2020; 26:24-29. [PMID: 33294643 PMCID: PMC7691119 DOI: 10.1016/j.ctro.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 12/19/2022] Open
Abstract
Carbon-ion re-irradiation for pancreatic cancer; feasibility and efficacy. Adjuvant chemotherapy improve local control of re-irradiation using carbon ions. Carbon-ion radiotherapy for recurrent pancreatic cancer; reasonable option.
Background and purpose Patients who receive carbon-ion radiotherapy (C-ion RT) for primary pancreatic cancer may experience locoregional recurrence; however, the treatment options for such patients are limited. We aimed to investigate the feasibility and efficacy of carbon-ion re-irradiation for patients with pancreatic cancer who experienced recurrence after initial C-ion RT. Materials and methods Twenty-one patients with recurrent pancreatic cancer who underwent repeat C-ion RT between December 2010 and November 2016 at our institute were retrospectively evaluated. The sites of post-initial C-ion RT failure were in-field central in 16 patients (76.2%) and marginal in 5 (23.8%). The median doses of initial and repeat C-ion RT were both 52.8 Gy (relative biological effectiveness [RBE]). Thirteen patients (61.9%) received concurrent chemotherapy with re-irradiation, while 11 (52.4%) received adjuvant chemotherapy. Results The median follow-up period after re-irradiation was 11 months. The 1-year local control, progression-free survival, and overall survival rates were 53.5%, 24.5%, and 48.7%, respectively. Toxicity data was obtained from the patients’ charts. Only 1 patient (4.8%) developed grade 3 acute toxicities and none developed grade ≥3 late toxicities. Univariate analysis indicated that patients who received adjuvant chemotherapy had significantly improved local control rates compared with those who did not; the 1-year local control rates were 80.0% and 0.0%, respectively (P = 0.0469). Conclusion Repeating C-ion RT may be a reasonable option with tolerable toxicity for patients with recurrent pancreatic cancers. Adjuvant chemotherapy appears to improve the local control rate. This is the first study to examine re-irradiation using C-ion for recurrent pancreatic cancer after initial C-ion RT.
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Key Words
- 18F-FDG-PET, 18F-fluorodeoxyglucose positron emission tomography
- C-ion RT, carbon-ion radiotherapy
- CT, computed tomography
- CTV, clinical target volume
- Carbon-ion radiotherapy
- D2cc, dose covering 2 cc
- EBRT, external beam radiation therapy
- GS, gemcitabine plus S1
- GTV, gross tumour volume
- IMRT, intensity-modulated radiotherapy
- LAPC, locally advanced pancreatic cancer
- LC, local control
- LET, linear energy transfer
- MRI, magnetic resonance imaging
- OS, overall survival
- PFS, progression-free survival
- PTV, planning target volume
- Pancreatic cancer
- RBE, relative biological effectiveness
- Re-irradiation
- S-1, tegafur, gimeracil, and oteracil
- SBRT, stereotactic body radiation therapy
- Survival
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Affiliation(s)
- Yasuhito Hagiwara
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan.,Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan.,Department of Charged Particle Therapy Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yuka Isozaki
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Makoto Shinoto
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Shohei Kawashiro
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tapesh Bhattacharyya
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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28
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Grant‐Freemantle MC, Lane O'Neill B, Clover AJP. The effectiveness of radiotherapy in the treatment of head and neck mucosal melanoma: Systematic review and meta‐analysis. Head Neck 2020; 43:323-333. [DOI: 10.1002/hed.26470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | - Anthony James P. Clover
- School of Medicine University College Cork Cork Ireland
- Department of Plastic Surgery Cork University Hospital Cork Ireland
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Takahashi D, Demizu Y, Park SC, Matsuo Y, Sulaiman NS, Terashima K, Tokumaru S, Akashi M, Okimoto T. Phase I dose-escalation trial of S-1 combined with carbon-ion radiotherapy for sinonasal squamous cell carcinoma. JOURNAL OF RADIATION RESEARCH 2020; 61:733-739. [PMID: 32642753 PMCID: PMC7482161 DOI: 10.1093/jrr/rraa037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/19/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to determine the maximum tolerance dose (MTD) and to estimate the recommended dose (RD) of concomitant S-1 with carbon-ion radiotherapy (RT) for sinonasal squamous cell carcinoma (SCC). Nine patients with sinonasal SCC received carbon-ion RT with escalating doses of S-1 according to phase I methods. Doses of 40, 60 and 80 mg/m2/day were administered twice daily in dose levels 1, 2 and 3, respectively, from days 1 to 14 and 22 to 35. Carbon-ion RT was administered at a dose of 70.4 Gy (relative biological effectiveness) in 32 fractions, 5 days a week. Two patients developed grade 3 acute dermatitis. However, none developed dose-limiting toxicities. Therefore, the MTD of S-1 could not be determined; the RD was estimated to be 80 mg/m2/day with concurrent carbon-ion RT. Partial response and stable disease were noted in 5 and 4 patients, respectively. The 2-year overall survival and local control rates were 56 and 74%, respectively. Overall, 2 patients developed ≥grade 3 late toxicities; among them, 1 patient developed grade 3 cataract and the other developed grade 4 cataract, optic nerve disorder and hearing impairment. To the best of our knowledge, this phase I study is the first clinical trial to evaluate concomitant S-1 with carbon-ion RT for sinonasal SCC. The MTD of S-1 could not be determined, and the RD was estimated to be 80 mg/m2/day. This study demonstrated a manageable safety profile for this combination. The observed outcomes may facilitate further evaluation of this novel therapy.
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Affiliation(s)
- Daiki Takahashi
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Sung Chul Park
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Yoshiro Matsuo
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Nor Shazrina Sulaiman
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan, 650-0017
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
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Li C, Zhang Q, Li Z, Feng S, Luo H, Liu R, Wang L, Geng Y, Zhao X, Yang Z, Li Q, Yang K, Wang X. Efficacy and safety of carbon-ion radiotherapy for the malignant melanoma: A systematic review. Cancer Med 2020; 9:5293-5305. [PMID: 32524777 PMCID: PMC7402834 DOI: 10.1002/cam4.3134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022] Open
Abstract
Malignant melanomas (MMs) were the fifth most common cancer in men and the sixth most common cancer in women in 2018, respectively. These are characterized by high metastatic rates and poor prognoses. We systematically reviewed safety and efficacy of carbon-ion radiotherapy (CIRT) for treating MMs. Eleven studies were eligible for review, and the data showed that MM patients showed better local control with low recurrence and mild toxicities after CIRT. Survival rates were slightly higher in patients with cutaneous or uveal MMs than in those with mucosal MMs. CIRT in combination with chemotherapy produced higher progression-free survival rates than CIRT only. In younger patients, higher rates of distant metastases of gynecological MMs were observed. The data indicated that CIRT is effective and safe for treating MMs; however, a combination with systemic therapy is recommended to ensure the best possible prognosis for MMs.
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Affiliation(s)
- Chengcheng Li
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Qiuning Zhang
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
- Lanzhou Heavy Ions HospitalLanzhouChina
| | - Zheng Li
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Shuangwu Feng
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Hongtao Luo
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Ruifeng Liu
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Lina Wang
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Yichao Geng
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Xueshan Zhao
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
| | - Zhen Yang
- Basic Medical CollegeLanzhou UniversityLanzhouChina
| | - Qiang Li
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
| | - Kehu Yang
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouChina
| | - Xiaohu Wang
- The First School of Clinical MedicineLanzhou UniversityLanzhouChina
- Institute of Modern PhysicsChinese Academy of SciencesLanzhouChina
- Lanzhou Heavy Ions HospitalLanzhouChina
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Koto M, Ikawa H, Kaneko T, Hagiwara Y, Hayashi K, Tsuji H. Long-term outcomes of skull base chordoma treated with high-dose carbon-ion radiotherapy. Head Neck 2020; 42:2607-2613. [PMID: 32472716 PMCID: PMC7496814 DOI: 10.1002/hed.26307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background We evaluated the long‐term efficacy and safety of carbon‐ion radiotherapy (C‐ion RT) for skull base chordoma, a rare neoplasm. Methods Thirty‐four patients with skull base chordoma who were treated with C‐ion RT were prospectively enrolled and analyzed retrospectively. C‐ion RT was delivered with 60.8 Gy (relative biological effectiveness [RBE]) in 16 fractions at four fractions per week. Results The median follow‐up period was 108 months. The 5‐ and 9‐year local control rates were 76.9% and 69.2%, respectively. The 5‐ and 9‐year overall survival rates were 93.5% and 77.4%, respectively. Regarding grade 3 or more severe late reactions, one patient developed a grade 3 mucosal ulcer, two developed grade 4 ipsilateral optic nerve injuries, and one developed a grade 5 mucosal ulcer at 9 years and 3 months after C‐ion RT. Conclusion C‐ion RT with 60.8 Gy (RBE)/16 fractions is a promising treatment option for inoperable skull base chordoma.
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Affiliation(s)
- Masashi Koto
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Hiroaki Ikawa
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Takashi Kaneko
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Yasuhito Hagiwara
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Kazuhiko Hayashi
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Hiroshi Tsuji
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
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32
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Hanaoka Y, Tanemura A, Takafuji M, Kiyohara E, Arase N, Suzuki O, Isohashi F, Ogawa K, Fujimoto M. Local and disease control for nasal melanoma treated with radiation and concomitant anti-programmed death 1 antibody. J Dermatol 2020; 47:423-425. [PMID: 32030784 DOI: 10.1111/1346-8138.15256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022]
Abstract
Mucosal melanoma of the nasal cavity is a rare disease that has been consistently associated with poor outcome. While complete surgical excision offers the only prospect of a cure, it is associated with a high risk of surgical morbidity due to the challenging anatomical location, and most patients still develop incurable metastatic disease. The efficacy of immunotherapy on mucosal melanoma is lower in comparison with cutaneous melanoma, and mucosal melanoma rarely has BRAF mutations. Although preclinical data have shown that combination treatment with immune checkpoint inhibitors and radiotherapy (RT) improve the response, there have been few reports on the combination of RT and anti-programmed death 1 therapy for mucosal melanoma of the nasal cavity. We retrospectively investigated 10 cases of mucosal melanoma of the nasal cavity in which combined treatment was applied. The local control (LC) rate of the primary lesion and regional lymph nodes was favorably 100%. On the other hand, the median progression-free survival (PFS) time was 29.6 weeks (range, 2-82). The 6-month PFS rate was 60%. Although severe mucositis occurred in one patient, the incidence of treatment-related adverse events was not significantly increased. RT with anti-programmed death 1 antibody therapy for mucosal melanoma of the nasal cavity was tolerable and had the potential to improve LC and PFS.
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Affiliation(s)
- Yuma Hanaoka
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Tanemura
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Madoka Takafuji
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriko Arase
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Osamu Suzuki
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
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Takayasu Y, Kubo N, Shino M, Nikkuni O, Ida S, Musha A, Takahashi K, Hirato J, Shirai K, Saitoh J, Yokoo S, Chikamatsu K, Ohno T, Nakano T. Carbon-ion radiotherapy combined with chemotherapy for head and neck mucosal melanoma: Prospective observational study. Cancer Med 2019; 8:7227-7235. [PMID: 31621203 PMCID: PMC6885871 DOI: 10.1002/cam4.2614] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/28/2019] [Accepted: 10/03/2019] [Indexed: 02/03/2023] Open
Abstract
This study aimed to evaluate the efficacy of carbon-ion radiotherapy in combination with chemotherapy using dacarbazine, nimustine, and vincristine (DAV therapy) in mucosal melanoma. Twenty-one patients with clinically localized mucosal melanoma of the head and neck were enrolled. The primary endpoint was 3-year overall survival (OS). Secondary endpoints included local control, progression-free survival (PFS), and adverse event occurrence. Carbon-ion radiotherapy with a dose of 57.6-64.0 Gy (relative biological effectiveness) in 16 fractions was delivered concurrently with DAV therapy, and 2 cycles of adjuvant DAV therapy were administered every 6 weeks. The median follow-up periods were 15.5 months for all patients, and 31.2 months for 12 surviving patients. All patients had locally advanced T4a or T4b disease in the rhino-sinus area. In 16 patients (76.2%), 3 cycles of planned DAV therapy were completed. The 3-year OS and PFS rates were 49.2% and 37.0% respectively. The 3-year local control rate was 92.3%. Eleven patients (52%) developed distant metastasis, which was the most frequent pattern of the first failure. Commonly presenting acute grade 2-3 toxicities associated with radiotherapy and chemotherapy were mucositis (11 patients [53%]) and leukopenia (9 patients [43%]), which improved with conservative therapy. None of the patients developed grade 3 or greater late toxicities. Carbon-ion radiotherapy in combination with DAV therapy led to excellent local control for advanced mucosal melanoma within acceptable toxicities. The efficacy of additional DAV therapy in improving survival was weaker than expected as distant metastases still occurred frequently. Trial registration no. UMIN000007939.
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Affiliation(s)
- Yukihiro Takayasu
- Department of Otolaryngology‐Head and Neck SurgeryGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical CenterMaebashiJapan
| | - Masato Shino
- Department of Otolaryngology‐Head and Neck SurgeryGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Osamu Nikkuni
- Department of Otolaryngology‐Head and Neck SurgeryGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Shota Ida
- Department of Otolaryngology‐Head and Neck SurgeryGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Atsushi Musha
- Gunma University Heavy Ion Medical CenterMaebashiJapan
- Department of Oral and Maxillofacial Surgery, Plastic SurgeryGunma University Graduate School of MedicineMaebashiJapan
| | - Katsumasa Takahashi
- Department of OtolaryngologyTakasaki General Medical CenterNational Hospital OrganizationTakasakiJapan
| | - Junko Hirato
- Department of PathologyGunma University HospitalMaebashiJapan
| | - Katsuyuki Shirai
- Department of RadiologyJichi Medical University Saitama CenterSaitamaJapan
| | - Jun‐ichi Saitoh
- Department of RadiologyGraduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery, Plastic SurgeryGunma University Graduate School of MedicineMaebashiJapan
| | - Kazuaki Chikamatsu
- Department of Otolaryngology‐Head and Neck SurgeryGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical CenterMaebashiJapan
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Assessment of risk factors associated with development of oronasal fistula as a late complication after carbon-ion radiotherapy for head and neck cancer. Radiother Oncol 2019; 144:53-58. [PMID: 31733488 DOI: 10.1016/j.radonc.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Oronasal fistulae (ONF) are one of the rare but serious complications of conventional photon radiotherapy. This study aimed to identify the risk factors for the development of ONF after carbon-ion radiotherapy (C-ion RT). MATERIALS AND METHODS The data of 62 cases of sinonasal and oral cavity cancers treated with C-ion RT and followed-up in excess of 5 years were retrospectively reviewed. The correlation between the clinical and dosimetric parameters and the development of ONF was analysed. RESULTS A total of 80.6% cases had sinonasal malignancies, and most tumours had advanced T stages (96.8%). Maxillary invasion was observed in 16 cases (25.8%), and malignant melanoma was the most common histology (46.8 %). All the cases received a dose of between 57.6 Gy (RBE) and 64 Gy (RBE) in 16 fractions over 4 weeks. At a median follow up of 88.8 months, 23 cases (37.1%) developed small localised ONF; however, none were of grade III severity. On separate multivariate analyses of clinical parameters in the entire cohort and in cases without maxillary invasion, the number of teeth irradiated with more than 50 Gy (RBE) was found to be the common significant independent risk factor for development of ONF. CONCLUSION The number of teeth irradiated with more than 50 Gy (RBE) is a significant independent risk factor for the development of ONF, which is a late complication of C-ion RT delivered in 16 fractions.
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Katagiri K, Shiga K, Saito D, Oikawa S, Ikeda A, Tsuchida K, Miyaguchi J. Amplification and attenuation of lung metastases depending on glucocorticoid dosage implicating long-acting activated memory cells induced by nivolumab against malignant melanoma. Clin Case Rep 2019; 7:1709-1713. [PMID: 31534732 PMCID: PMC6745446 DOI: 10.1002/ccr3.2349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022] Open
Abstract
Firstly, glucocorticoids such as prednisolone can attenuate the effect of anti-PD-1 antibody nivolumab. Secondly, malignant melanoma cells survived latently and unnoticeably in places other than those of previous metastatic lesions. Thirdly, effector T cells activated by nivolumab sustained their memory to attack malignant melanoma cells for several months.
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Affiliation(s)
| | - Kiyoto Shiga
- Department of Head and Neck SurgeryIwate Medical UniversityMoriokaJapan
| | - Daisuke Saito
- Department of Head and Neck SurgeryIwate Medical UniversityMoriokaJapan
| | - Shin‐ichi Oikawa
- Department of Head and Neck SurgeryIwate Medical UniversityMoriokaJapan
| | - Aya Ikeda
- Department of Head and Neck SurgeryIwate Medical UniversityMoriokaJapan
| | - Kodai Tsuchida
- Department of Head and Neck SurgeryIwate Medical UniversityMoriokaJapan
| | - Jun Miyaguchi
- Department of Head and Neck SurgeryIwate Medical UniversityMoriokaJapan
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Ikawa H, Koto M, Demizu Y, Saitoh JI, Suefuji H, Okimoto T, Ohno T, Shioyama Y, Takagi R, Hayashi K, Nemoto K, Nakano T, Kamada T. Multicenter study of carbon-ion radiation therapy for nonsquamous cell carcinomas of the oral cavity. Cancer Med 2019; 8:5482-5491. [PMID: 31369213 PMCID: PMC6745861 DOI: 10.1002/cam4.2408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to evaluate the efficacy and safety of carbon‐ion radiation therapy for nonsquamous cell carcinomas of the oral cavity in a multicenter study. Methods Retrospective analysis of the clinicopathological features and outcomes of 76 patients with oral nonsquamous cell carcinomas with N0‐1 M0 status and were treated with carbon‐ion radiation therapy at four institutions in Japan between November 2003 and December 2014 was performed. Results Salivary gland carcinoma, mucosal melanoma, and three other carcinomas were found in 46, 27, and 3 patients, respectively. T1‐3, T4a, and T4b disease was diagnosed in 27, 18, and 31 patients, respectively. Median follow‐up period was 31.1 months (range, 3‐118 months). Three‐year local control, progression‐free survival, and overall survival of all patients were 86.8%, 63.1%, and 78.4%, respectively. Multivariate analysis showed T classification (T4) to be a significant independent poor prognostic factor for local control. Acute grade 3 mucositis was observed in 38 patients. Grades 3 and 4 late morbidities were observed in 9 and 4 patients, respectively. No grade 5 late toxicity was observed. Conclusions Oral nonsquamous cell carcinomas could be treated effectively, with acceptable toxicity, by carbon‐ion radiation therapy.
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Affiliation(s)
- Hiroaki Ikawa
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Masashi Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | | | | | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Ryo Takagi
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | - Kazuhiko Hayashi
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takashi Nakano
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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Aninditha KP, Weber KJ, Brons S, Debus J, Hauswald H. In vitro sensitivity of malignant melanoma cells lines to photon and heavy ion radiation. Clin Transl Radiat Oncol 2019; 17:51-56. [PMID: 31211251 PMCID: PMC6562297 DOI: 10.1016/j.ctro.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/18/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023] Open
Abstract
Superior proliferation inhibiting effects of heavy ions compared to photons. Increased G2/M arrest on heavy ion radiation compared to photon irradiation. Heavy ions might overcome radioresistance in malignant melanoma cells.
Background The role of radiotherapy in malignant melanoma is still in discussion due to its relative resistance to radiation. In various literature, heavy ions show a higher relative biological effectiveness than photons. The aim of this work is to evaluate the radiotherapeutical effect from photons as well as heavy ions on malignant melanoma cells and to indicate the possible radiosensitivity based on its proliferation-inhibitory effect. Methods Two different cell lines of malignant melanoma, WM115 (primary tumor) and WM266-4 (metastatic site, skin) were used in this in vitro study. The cells were treated with photons or heavy ions (C12 and O16 ions). Cell-proliferation assay using hemocytometer was used for the quantitative and qualitative evaluation of cell growth. Furthermore, flow cytometry was also used to analyze the cell cycle distribution. Results Heavy ions compared to photons and between the two heavy ion modalities, O16 ions showed an improved suppression of cell growth in both cell lines. Furthermore, a G2/M arrest was detected in both cell lines after all radiotherapy modalities – with the arrest increasing with the dose applied. Conclusion Heavy ions showed a greater inhibitory effect on cell proliferation compared to photons and an increased G2/M arrest. Therefore, C12 and O16 heavy ions might overcome the relative radioresistance of malignant melanoma to photons. Further research is warranted.
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Key Words
- Cell experiment
- DMEM, Dulbecco’s modified Eagle’s Medium
- DNA, deoxyribonucleic acid
- EDTA, ethylendiamin-tetraacetate
- FCS, fetal calf serum
- HIT, Heidelberg Ion-Beam Therapy Centre
- In vitro
- Ion beam therapy
- KeV, kilo electron volt
- LET, linear energy transfer
- MM, malignant melanoma
- Malignant melanoma
- MeV, mega electron volt
- PBS, phosphate-buffered saline
- Particle beam therapy
- RBE, relative biological effectiveness
- RNA, ribonucleic acid
- RT, radiotherapy
- Radiotherapy
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Affiliation(s)
- K P Aninditha
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - K J Weber
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - S Brons
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - J Debus
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany.,Clinical Cooperation Unit E050, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.,DKTK Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - H Hauswald
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany.,Clinical Cooperation Unit E050, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Hahn HM, Lee KG, Choi W, Cheong SH, Myung KB, Hahn HJ. An updated review of mucosal melanoma: Survival meta-analysis. Mol Clin Oncol 2019; 11:116-126. [PMID: 31281645 PMCID: PMC6589937 DOI: 10.3892/mco.2019.1870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/10/2019] [Indexed: 12/12/2022] Open
Abstract
Mucosal melanoma (MM) is a highly lethal variant of melanoma that carries a poor prognosis. Extremely low incidence and survival rates have led to few clinical trials, and a lack of protocols and guidelines. The present study performed a survival meta-analysis for the quantitative synthesis of available evidence to search for key patterns that would help clinicians tailor optimal therapeutic strategies in MM. PubMed, EMBASE, Cochrane, MEDLINE, Google Scholar and other databases were searched. Hazard ratios, in disease-specific and overall survival, were calculated for each of the survival-determining variables. MM was 2.25 times more lethal than cutaneous melanoma (CM). The most significant threats to survival were advanced Tumor-Node-Metastasis stage, sino-nasal location, and old age. Chemotherapy was the most effective form of adjuvant therapy. Disease-specific survival, the primary measure of the effect sizes, can fluctuate depending on the accuracy of the reported cause of mortality. In conclusion, MM is a peculiar type of melanoma, with clinical and molecular profile vastly different from the much-familiar CM. In the wake of the era of precision oncology, further studies on driver mutations and oncogenic pathways would likely lead to improved patient survival.
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Affiliation(s)
- Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Gyeonggi 16499, Republic of Korea
| | - Kyoung Geun Lee
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Won Choi
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Seung Hyun Cheong
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Ki Bum Myung
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
| | - Hyung Jin Hahn
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea.,Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Chungcheongnam 35365, Republic of Korea
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Hayashi K, Koto M, Ikawa H, Hagiwara Y, Tsuji H, Ogawa K, Kamada T. Feasibility of Re-irradiation using carbon ions for recurrent head and neck malignancies after carbon-ion radiotherapy. Radiother Oncol 2019; 136:148-153. [PMID: 31015117 DOI: 10.1016/j.radonc.2019.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/01/2019] [Accepted: 04/04/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Locoregional recurrence after carbon-ion radiotherapy (CIRT) for primary head and neck malignancies, such as malignant mucosal melanoma, adenoid cystic carcinoma, and sarcoma, occurs occasionally. However, the treatment options are limited. We report on the toxicity and efficacy of re-irradiation using carbon ions for recurrent head and neck malignancies after CIRT. MATERIALS AND METHODS Data of 48 patients with recurrent head and neck malignancies treated with re-irradiation with CIRT at our institution (2007-2016) were retrospectively analyzed. Twenty-one patients (43.8%) had malignant mucosal melanoma, 17 (35.4%) had adenoid cystic carcinoma, six (12.5%) had bone and soft tissue sarcomas, and four patients (8.3%) had other disease types. Tumor recurrences at re-irradiation were located in the paranasal cavity (n = 18, 37.5%), nasal cavity (n = 9, 18.8%), nasopharynx (n = 4, 8.3%), orbit (n = 3, 6.3%), cavernous sinus (n = 3, 6.3%), and at other sites (n = 11, 22.9%). The median dose of initial CIRT and that at re-irradiation were 57.6 Gy and 54.0 Gy (relative biological effectiveness [RBE]), respectively. None of the patients received concurrent chemotherapy. RESULTS The median follow-up period after re-irradiation was 27.1 months. Five patients (10.4%) developed Grade 3 acute toxicities and 18 (37.5%) developed Grade ≥3 late toxicities, including Grade 5 central nervous system necrosis in one patient. The 2-year local control, locoregional control, progression-free survival, and overall survival rates were 40.5, 33.5%, 29.4%, and 59.6%, respectively. CONCLUSION Re-irradiation using carbon ions may be a reasonable treatment option with tolerable toxicity for patients with recurrent head and neck malignancies after CIRT.
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Affiliation(s)
- Kazuhiko Hayashi
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan; Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masashi Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan.
| | - Hiroaki Ikawa
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yasuhito Hagiwara
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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Murata H, Okonogi N, Wakatsuki M, Kato S, Kiyohara H, Karasawa K, Ohno T, Nakano T, Kamada T, Shozu M, The Working Group Of Gynecological Tumors TWGOG. Long-Term Outcomes of Carbon-Ion Radiotherapy for Malignant Gynecological Melanoma. Cancers (Basel) 2019; 11:cancers11040482. [PMID: 30987391 PMCID: PMC6520847 DOI: 10.3390/cancers11040482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022] Open
Abstract
Surgical resection is considered a standard therapy for malignant melanoma (MM). However, it has not yet been established as an optimal treatment strategy for gynecological MMs, particularly owing to their very low incidence rates. We retrospectively analyzed clinical outcomes of carbon-ion radiotherapy (C-ion RT) for gynecological MMs. The eligibility criterion was the presence of histologically confirmed gynecological MM. Patients with pelvic or inguinal lymph node metastases were included, while those with distant metastases were excluded. The pelvic and inguinal lymph node regions were irradiated with up to 36 gray relative biological effectiveness (Gy (RBE)) followed by a gross tumor volume boost of up to 57.6 Gy (RBE) or 64 Gy (RBE) in 16 fractions over 4 weeks. Thirty-seven patients (median age: 71 years) were examined. In total, 22 patients had vaginal tumors, 12 had vulval tumors, and 3 had cervical uterine tumors. The median follow-up periods were 23 months (range: 5-103 months) for all patients and 53 months (range: 16-103 months) for survivors. Thirty of 37 patients (81%) achieved complete tumor disappearance. The 2-year local control, overall survival, and progression-free survival rates were 71%, 53%, and 29%, respectively. C-ion RT may be a definitive treatment option for patients with gynecological MM.
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Affiliation(s)
- Hiroto Murata
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan.
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan.
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, Tochigi 329-0498, Japan.
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Japanese Red Cross Maebashi Hospital, Maebashi 371-0811, Japan.
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University School of Medicine, Tokyo 162-8666, Japan.
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Tadashi Kamada
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan.
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan.
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Kong L, Gao J, Hu J, Lu R, Yang J, Qiu X, Hu W, Lu JJ. Carbon ion radiotherapy boost in the treatment of glioblastoma: a randomized phase I/III clinical trial. Cancer Commun (Lond) 2019; 39:5. [PMID: 30786916 PMCID: PMC6383247 DOI: 10.1186/s40880-019-0351-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/14/2019] [Indexed: 12/22/2022] Open
Abstract
Background Glioblastoma (GBM) is a highly virulent tumor of the central nervous system, with a median survival < 15 months. Clearly, an improvement in treatment outcomes is needed. However, the emergence of these malignancies within the delicate brain parenchyma and their infiltrative growth pattern severely limit the use of aggressive local therapies. The particle therapy represents a new promising therapeutic approach to circumvent these prohibitive conditions with improved treatment efficacy. Methods and design Patients with newly diagnosed malignant gliomas will have their tumor tissue samples submitted for the analysis of the status of O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. In Phase I, the patients will undergo an induction carbon ion radiotherapy (CIRT) boost followed by 60 GyE of proton irradiation with concurrent temozolomide (TMZ) at 75 mg/m2. To determine the maximal dose of safe induction boost, the tolerance, and acute toxicity rates in a dose-escalation manner from 9 to 18 GyE in three fractions will be used. In Phase III, GBM-only patients will be randomized to receive either 60 GyE (2 GyE per fraction) of proton irradiation with concurrent TMZ (control arm) or a CIRT boost (dose determined in Phase I of this trial) followed by 60 GyE of proton irradiation with concurrent TMZ. The primary endpoints are overall survival (OS) and toxicity rates (acute and long-term). Secondary endpoints are progression-free survival (PFS), and tumor response (based upon assessment with C-methionine/fluoro-ethyl-tyrosine positron emission tomography [MET/FET PET] or magnetic resonance imaging [MRI] and detection of serologic immune markers). We hypothesize that the induction CIRT boost will result in a greater initial tumor-killing ability and prime the tumor microenvironment for enhanced immunologic tumor clearance, resulting in an expected 33% improvement in OS rates. Discussion The prognosis of GBM remains grim. The mechanism underpinning the poor prognosis of this malignancy is its chronic state of tumor hypoxia, which promotes both immunosuppression/immunologic evasion and radio-resistance. The unique physical and biological properties of CIRT are expected to overcome these microenvironmental limitations to confer an improved tumor-killing ability and anti-tumor immune response, which could result in an improvement in OS with minimal toxicity. Trial registration number This trial has been registered with the China Clinical Trials Registry, and was allocated the number ChiCTR-OID-17013702.
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Affiliation(s)
- Lin Kong
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Shanghai Cancer Center, Shanghai, 201321, P. R. China
| | - Jing Gao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China
| | - Jiyi Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China
| | - Rong Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China
| | - Jing Yang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China
| | - Xianxin Qiu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China
| | - Weixu Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China
| | - Jiade J Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Pudong, 4365 Kangxin Road, Shanghai, 201321, P. R. China.
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Ikawa H, Koto M, Hayashi K, Tonogi M, Takagi R, Nomura T, Tsuji H, Kamada T. Feasibility of carbon-ion radiotherapy for oral non-squamous cell carcinomas. Head Neck 2019; 41:1795-1803. [PMID: 30676669 PMCID: PMC6590439 DOI: 10.1002/hed.25618] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023] Open
Abstract
Background This study evaluated carbon‐ion radiotherapy (C‐ion RT) for oral non‐squamous cell carcinomas (non‐SCC). Methods We retrospectively obtained data from 74 patients who underwent C‐ion RT for oral malignancies between April 1997 and March 2016. The C‐ion RT was administered in 16 fractions at a total dose of 57.6 or 64.0 Gy (relative biological effectiveness). Results Forty‐three patients had salivary gland carcinomas, 29 patients had mucosal melanoma, and 2 patients had other types of pathologies. The tumors were classified as T1‐T3 (24 cases), T4a (21 cases), or T4b (29 cases). The median follow‐up was 49 months. The 5‐year rates were 78.8% for local control, 36.2% for progression‐free survival, and 58.3% for overall survival. Although 10 patients developed grade 3 osteoradionecrosis after C‐ion RT, all patients maintained their mastication and deglutition functions after sequestrectomy and prosthesis placement. Conclusion C‐ion RT was effective for oral non‐SCC and had acceptable toxicities.
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Affiliation(s)
- Hiroaki Ikawa
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masashi Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kazuhiko Hayashi
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | - Ryo Takagi
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Tokyo, Japan
| | - Takeshi Nomura
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, Tokyo, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Mizuno H, Fukumura A, Kanematsu N, Yonai S, Shirai T, Yusa K, Yanou T, Suga M, Mizota M, Minohara S, Kanai T, Kamada T. External dosimetry audit for quality assurance of carbon-ion radiation therapy clinical trials. J Appl Clin Med Phys 2019; 20:31-36. [PMID: 30387294 PMCID: PMC6333139 DOI: 10.1002/acm2.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/16/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The QA team of the Japan carbon-ion radiation oncology study group (J-CROS) was organized in 2015 to enhance confidence in the accuracy of clinical dosimetry and ensure that the facility QA procedures are adequate. The team conducted onsite dosimetry audits in all the carbon-ion radiation therapy centers in Japan. MATERIALS AND METHODS A special phantom was fabricated for the onsite dosimetry audit. Target volumes such as the GTV, CTV, and PTV were contoured to the obtained CT images, and two plans with different isocenter depths were created. The dose at the isocenter was measured by an ionization chamber, in the onsite audit and compared with the calculated dose. RESULTS For all the centers, the average of the percentage ratio between the measured and calculated doses (measured/calculated) was 0.5% (-2.7% to +2.6%) and the standard deviation, 1.7%. In all the centers, the beams were within the set tolerance level of 3%. CONCLUSIONS The audit demonstrated that the dose at a single point in the water phantom was within tolerance, but it is a big step to say that all doses are correct. In addition, this external dosimetry audit encouraged centers to improve the quality of their dosimetry systems.
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Affiliation(s)
| | | | | | - Shunsuke Yonai
- National Institute of Radiological Sciences, QSTChibaJapan
| | | | - Ken Yusa
- Gunma University Heavy Ion Medical CenterGunmaJapan
| | | | - Masaki Suga
- Hyogo Ion Beam Medical CenterTatsunoHyōgoJapan
| | - Manabu Mizota
- Ion Beam Therapy CenterSAGA HIMAT FoundationSagaJapan
| | | | - Tatsuaki Kanai
- Gunma University Heavy Ion Medical CenterGunmaJapan
- Present address:
Tatsuaki KanaiOsaka Heavy Ion Therapy CenterOsakaJapan
| | - Tadashi Kamada
- National Institute of Radiological Sciences, QSTChibaJapan
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Hayashi K, Koto M, Demizu Y, Saitoh JI, Suefuji H, Okimoto T, Ohno T, Shioyama Y, Takagi R, Ikawa H, Nemoto K, Nakano T, Kamada T. A retrospective multicenter study of carbon-ion radiotherapy for external auditory canal and middle ear carcinomas. Cancer Med 2018; 8:51-57. [PMID: 30548207 PMCID: PMC6346229 DOI: 10.1002/cam4.1830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022] Open
Abstract
Background We conducted a retrospective multicenter study to assess the clinical outcomes of carbon‐ion radiotherapy (CIRT) for head and neck malignancies (Japan Carbon‐Ion Radiation Oncology Study Group [J‐CROS] study: 1402 HN). We aimed to evaluate the safety and efficacy of CIRT in patients with external auditory canal (EAC) and middle ear (ME) carcinomas. Methods Thirty‐one patients treated with CIRT at four Japanese institutions were analyzed. Fourteen patients (45.2%) had squamous cell carcinomas, 13 (41.9%) had adenoid cystic carcinomas, and four (12.9%) had other types. Nineteen (61.3%), six (19.4%), three (9.7%), and three (9.7%) patients had T4, T3, T2, and T1 disease, respectively. All patients had N0M0 status. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 33.3 mL. Results The median follow‐up period was 18.4 months (range, 5.1‐85.6). The 1‐ and 3‐year local control and overall survival rates were 75.0% and 55.0% and 79.3% and 58.7%, respectively. Regarding grade 3 or higher toxicities, three patients (9.7%) had grade 3 dermatitis, one (3.2%) had grade 3 mucositis, and two (6.5%) had grade 3 central nervous necrosis (ie, radiation‐induced brain necrosis). No grade 4 or worse reactions were observed. Conclusion CIRT was effective for EAC and ME carcinomas.
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Affiliation(s)
- Kazuhiko Hayashi
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Masashi Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Jun-Ichi Saitoh
- Department of Radiology, University of Toyama, Toyama, Japan
| | | | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Tatsuya Ohno
- Medicine & Biology Division, Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Ryo Takagi
- Department of Oral Surgery, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | - Hiroaki Ikawa
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takashi Nakano
- Medicine & Biology Division, Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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Abe T, Ohno T, Koto M, Demizu Y, Suefuji H, Tsuji H, Okimoto T, Shioyama Y, Saitoh JI, Shirai K, Nemoto K, Nakano T, Kamada T. A multi-institutional retrospective study of carbon-ion radiotherapy for non-squamous cell malignant tumors of the nasopharynx: Subanalysis of Japan Carbon-Ion Radiation Oncology Study Group study 1402 HN. Cancer Med 2018; 7:6077-6083. [PMID: 30449067 PMCID: PMC6308058 DOI: 10.1002/cam4.1884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background This multi‐institutional retrospective study focused on the clinical outcome of carbon‐ion radiotherapy (C‐ion RT) for non‐squamous cell malignant tumors of the nasopharynx. Methods The Japan Carbon‐ion Radiation Oncology Study Group collected and analyzed data for 43 patients with non‐squamous cell malignant tumors of the nasopharynx treated with C‐ion RT at four institutions in Japan. Results Twenty‐nine patients had adenoid cystic carcinomas, seven had malignant melanomas, three had adenocarcinomas, two had mucoepidermoid carcinomas, and two had other pathologies. Twenty‐six of the 43 patients (61%) had T4 tumors. The most common dose‐fractionation schedule was 64 Gy (relative biological effectiveness) in 16 fractions. The median follow‐up period was 30 months. The 2‐year local control (LC) and overall survival (OS) rates were 88% and 84%, respectively. For late toxicity, one patient developed grade 4 optic nerve disorder and two developed grade 5 pharyngeal hemorrhage. Actual incidence of grade 3 or higher late adverse events was 19%, and included cranial nerve dysfunction, jaw bone necrosis, central nervous system necrosis, and ear inflammation. Conclusions C‐ion RT provided good LC and OS rates with acceptable toxicity for treatment of non‐squamous cell malignant tumors of the nasopharynx.
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Affiliation(s)
- Takanori Abe
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Masashi Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | | | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | | | - Jun-Ichi Saitoh
- Department of Radiation Oncology, Toyama University, Toyama, Japan
| | - Katsuyuki Shirai
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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Akbaba S, Lang K, Held T, Bulut OC, Mattke M, Uhl M, Jensen A, Plinkert P, Rieken S, Herfarth K, Debus J, Adeberg S. Accelerated Hypofractionated Active Raster-Scanned Carbon Ion Radiotherapy (CIRT) for Laryngeal Malignancies: Feasibility and Safety. Cancers (Basel) 2018; 10:cancers10100388. [PMID: 30340397 PMCID: PMC6211114 DOI: 10.3390/cancers10100388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022] Open
Abstract
(1) Background: The authors present the first results of active raster-scanned carbon ion radiotherapy (CIRT) for radioresistant laryngeal malignancies regarding efficacy and toxicity. (2) Methods: 15 patients with laryngeal adenoid cystic carcinoma (ACC; n = 8; 53.3%) or chondrosarcoma (CS; n = 7; 46.7%) who underwent radiotherapy with carbon ions (C12) at the Heidelberg Ion Beam Therapy Center (HIT) between 2013 and 2018 were identified retrospectively and analyzed for local control (LC), overall survival (OS), and distant progression-free survival using the Kaplan–Meier method. CIRT was applied either alone (n = 7, 46.7%) or in combination with intensity modulated radiotherapy (IMRT) (n = 8, 53.3%). The toxicity was assessed according to the Common Toxicity Terminology Criteria for Adverse Events (CTCAE) v4.03. (3). Results: the median follow-up was 24 months (range 5–61 months). Overall, the therapy was tolerated very well. No grade >3 acute and chronic toxicity could be identified. The most reported acute grade 3 side effects were acute dysphagia (n = 2; 13%) and acute odynophagia (n = 3; 20%), making supportive nutrition via gastric tube (n = 2; 13.3%) and via high caloric drinks (n = 1; 6.7%) necessary due to swallowing problems (n = 4; 27%). Overall, chronic grade 3 toxicity in the form of chronic hoarseness occurred in 7% of the patients (n = 1; 7%). At the last follow-up, all the patients were alive. No local or locoregional recurrence could be identified. Only one patient with laryngeal ACC developed lung metastases three years after the first diagnosis. (4) Conclusions: the accelerated hypofractionated active raster-scanned carbon ion radiotherapy for radioresistant laryngeal malignancies is feasible in practice with excellent local control rates and moderate acute and late toxicity. Further follow-ups are necessary to evaluate the long-term clinical outcome.
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Affiliation(s)
- Sati Akbaba
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Kristin Lang
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Thomas Held
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Olcay Cem Bulut
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Matthias Mattke
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Matthias Uhl
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Alexandra Jensen
- Department of Radiation Oncology, University Hospital Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
| | - Peter Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Klaus Herfarth
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Juergen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
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Abstract
PURPOSE OF REVIEW Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. RECENT FINDINGS In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. SUMMARY Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity.
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Definitive Carbon-Ion Radiation Therapy for Locally Advanced Sinonasal Malignant Tumors: Subgroup Analysis of a Multicenter Study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS). Int J Radiat Oncol Biol Phys 2018; 102:353-361. [PMID: 30191869 DOI: 10.1016/j.ijrobp.2018.05.074] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of carbon-ion radiation therapy (C-ion RT) for locally advanced sinonasal malignant tumors in a multicenter retrospective study (J-CROS 1402 HN). METHODS AND MATERIALS Clinical data were collected for patients who had sinonasal malignant tumors of stage N0-1M0 and received C-ion RT at 4 institutions in Japan between November 2003 and December 2014. Of the 458 patients, 393 had naïve tumors and 65 had recurrent tumors. The tumors were located in the nasal cavity (n = 263), maxillary sinus (n = 109), ethmoid sinus (n = 71), and other locations (n = 15). The histologic types were mucosal melanoma (n = 221, 48%), adenoid cystic carcinoma (n = 122, 27%), squamous cell carcinoma (n = 31, 7%), olfactory neuroblastoma (n = 30, 7%), adenocarcinoma (n = 21, 5%), and other types (n = 33, 7%). Of the 458 patients, 300 (66%) had T4 tumors. All patients received definitive C-ion RT. RESULTS The median follow-up period was 25.2 months for all patients (range, 1.4-132.3 months). The 2-year overall survival and local control rates were 79.6% and 84.1%, respectively. As analyzed according to histology, the 2-year overall survival rate was 68.0% for mucosal melanoma, 96.8% for adenoid cystic carcinoma, 70.0% for squamous cell carcinoma, 96.7% for olfactory neuroblastoma, and 89.7% for adenocarcinoma. Regarding late toxicities, 17% of patients developed grade 3 and 4 toxicities, of which visual impairment was the most common. CONCLUSION The results of our multicenter study have demonstrated that C-ion RT can provide excellent clinical outcomes with acceptable late toxicities in patients who have locally advanced sinonasal malignant tumors.
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Mohamad O, Yamada S, Durante M. Clinical Indications for Carbon Ion Radiotherapy. Clin Oncol (R Coll Radiol) 2018; 30:317-329. [DOI: 10.1016/j.clon.2018.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022]
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Hayashi K, Koto M, Demizu Y, Saitoh J, Suefuji H, Okimoto T, Ohno T, Shioyama Y, Takagi R, Ikawa H, Nemoto K, Nakano T, Kamada T. A retrospective multicenter study of carbon-ion radiotherapy for major salivary gland carcinomas: Subanalysis of J-CROS 1402 HN. Cancer Sci 2018; 109:1576-1582. [PMID: 29493851 PMCID: PMC5980152 DOI: 10.1111/cas.13558] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/21/2018] [Accepted: 02/24/2018] [Indexed: 01/10/2023] Open
Abstract
A retrospective multicenter study was carried out to assess the clinical outcomes of carbon-ion radiotherapy for head and neck malignancies (Japan Carbon-Ion Radiation Oncology Study Group [J-CROS] study: 1402 HN). We evaluated the safety and efficacy of carbon-ion radiotherapy in patients with major salivary gland carcinoma. Sixty-nine patients treated with carbon-ion radiotherapy at four Japanese institutions were analyzed. Thirty-three patients (48%) had adenoid cystic carcinomas, 10 (14%) had mucoepidermoid carcinomas, and 26 (38%) had other disease types. Three patients (4%) had T1 disease, 8 (12%) had T2, 25 (36%) had T3, and 33 (48%) had T4. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 27 mL. The median follow-up period was 32.7 months. The 3-year local control rate and overall survival rate were 81% and 94%, respectively. Regarding acute toxicities, seven patients had grade 3 mucositis and seven had grade 3 dermatitis. Regarding late toxicities, one patient had grade 3 dysphagia and one had a grade 3 brain abscess. No grade 4 or worse late reactions were observed. In conclusion, definitive carbon-ion radiotherapy was effective with acceptable toxicity for major salivary gland carcinomas.
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Affiliation(s)
- Kazuhiko Hayashi
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Masashi Koto
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Yusuke Demizu
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
| | - Jun‐ichi Saitoh
- Medicine and Biology DivisionGunma University Heavy Ion Medical CenterMaebashiJapan
| | | | - Tomoaki Okimoto
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
| | - Tatsuya Ohno
- Medicine and Biology DivisionGunma University Heavy Ion Medical CenterMaebashiJapan
| | | | - Ryo Takagi
- Department of Oral SrgeryTokyo Dental College Sudobashi HospitalTokyoJapan
| | - Hiroaki Ikawa
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
| | - Kenji Nemoto
- Department of Radiation OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Takashi Nakano
- Medicine and Biology DivisionGunma University Heavy Ion Medical CenterMaebashiJapan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Sciences and TechnologyChibaJapan
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