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Aminafshar B, Baghani HR, Mowlavi AA. Analytical parameterization of Bragg curves for proton beams in muscle, bone, and polymethylmethacrylate. Radiol Phys Technol 2024:10.1007/s12194-024-00816-8. [PMID: 38822972 DOI: 10.1007/s12194-024-00816-8] [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: 02/14/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
Proton dose calculation in media other than water may be of interest for either research purposes or clinical practice. Current study aims to quantify the required parameters for analytical proton dosimetry in muscle, bone, and PMMA. Required analytical dosimetry parameters were extracted from ICRU-49 report and Janni study. Geant4 Toolkit was also used for Bragg curve simulation inside the investigated media at different proton energies. Calculated and simulated dosimetry data were compared using gamma analysis. Simulated and calculated Bragg curves are consistent, a fact that confirms the validity of reported parameters for analytical proton dosimetry inside considered media. Furthermore, derived analytical parameters for these media are different from those of water. Listed parameters can be reliably utilized for analytical proton dosimetry inside muscle, bone, and PMMA. Furthermore, accurate proton dosimetry inside each medium demands dedicated analytical parameters and one is not allowed to use the water coefficients for non-water media.
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Affiliation(s)
- Behzad Aminafshar
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran
| | - Hamid Reza Baghani
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran.
| | - Ali Asghar Mowlavi
- Physics Department, Hakim Sabzevari University, Daneshgah Blvd, P.O. 9617976487, Sabzevar, Iran
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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Okimoto T, Ogino T, Suzuki M, Murayama S. The Japanese nationwide cohort data of proton beam therapy for liver oligometastasis in breast cancer patients. JOURNAL OF RADIATION RESEARCH 2024; 65:231-237. [PMID: 38321606 PMCID: PMC10959435 DOI: 10.1093/jrr/rrad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/17/2023] [Indexed: 02/08/2024]
Abstract
A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology in Japan in May 2016. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis in breast cancers. Cases in which PBT was performed at all Japanese proton therapy facilities between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: the primary cancer was controlled, liver recurrence without extrahepatic tumors and no more than three liver lesions. Fourteen females, with a median age of 57 years (range, 44-73) and 22 lesions, were included. The median lesion size, fraction (fr) size and biological effective dose were 44 (20-130) mm, 6.6 (2-8) gray (Gy) (relative biological effectiveness)/fr and 109.6 (52.7-115.2) Gy, respectively. The median follow-up period was 22.8 (4-54) months. The 1-, 2- and 3-year local control (LC) rates of liver metastasis from breast cancer were 100% for all. The 1-, 2- and 3-year overall survival rates were 85.7, 62.5 and 62.5%, respectively. The 1-, 2- and 3-year progression-free survival (PFS) rates were 50.0%, 33.3%, and 16.7%, respectively. The median PFS time was 16 months. Only one patient did not complete PBT due to current disease progression. One patient had Grade 3 radiation-induced dermatitis. None of the patients experienced radiation-induced liver failure during the acute or late phase. Owing to the low incidence of adverse events and the high LC rate, PBT appears to be a feasible option for liver oligometastasis in breast cancers.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Takashi Ogino
- Medipolis Proton Therapy and Research Center, 4423 Higashikata, Ibusuki, Kagoshima 891-0304, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Shigeyuki Murayama
- Division of Proton Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka 411-8777, Japan
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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Katoh N, Okimoto T, Suzuki M, Sakurai H. The Japanese nationwide cohort data of proton beam therapy for liver oligometastasis in esophagogastric cancer patients. JOURNAL OF RADIATION RESEARCH 2023; 64:926-932. [PMID: 37697668 PMCID: PMC10665303 DOI: 10.1093/jrr/rrad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/03/2023] [Indexed: 09/13/2023]
Abstract
A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology in Japan in May 2016. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis of esophagogastric cancers. Cases in which PBT was performed at all PBT facilities in Japan between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: controlled primary cancer, liver recurrence without extrahepatic tumors and no more than three liver lesions. Twenty-two males and two females with a median age of 69 (range, 52-80) years and 35 lesions were included. This study included 6 patients with esophageal and 18 patients with gastric cancer. The median lesion size, fraction size and biological effective dose (BED)10 were 32 (7-104) mm, 3.8 gray (relative biological effect)/fractions (Gy (RBE)/fr) (2-8 Gy (RBE)/fr) and 96.9 (88.8-115.2) Gy, respectively. The median follow-up period was 18 (4-47) months. The 1-, 2- and 3-year overall survival (OS) rates were 75, 51.8 and 45.3%, respectively, and the median OS was 25.3 months. The 1-, 2- and 3-year cumulative local recurrence (LR) rates were 3, 6 and 6%, respectively. Patients' age (P < 0.01), performance status (P = 0.017) and tumor size (P = 0.024) were significant OS-related factors. No Grade 3 or higher adverse events (AEs) were observed. Owing to the low incidence of AEs and the low LR cumulative incidence, PBT is a feasible option for liver oligometastasis of esophagogastric cancers.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
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Yamaguchi H, Kato T, Honda M, Hamada K, Seto I, Tominaga T, Takagawa Y, Takayama K, Suzuki M, Kikuchi Y, Teranishi Y, Murakami M. Effectiveness of proton beam therapy for liver oligometastatic recurrence in patients with postoperative esophagus cancer. JOURNAL OF RADIATION RESEARCH 2023; 64:582-589. [PMID: 36913708 DOI: 10.1093/jrr/rrad009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Indexed: 05/27/2023]
Abstract
There are several reports of hepatic resection for postoperative hepatic metastatic recurrence of esophageal cancer. However, it is unclear whether surgery is the best local treatment for liver metastases. Thus, this study aimed to retrospectively analyze proton beam therapy (PBT) for postoperative liver metastatic recurrence of esophageal cancer without extrahepatic lesions and examine outcomes and adverse events. This single-center historical cohort study selected patients who underwent PBT at our proton therapy center between 2012 and 2018. The patients were selected based on the following criteria: primary esophagus carcinoma was resection and metachronous liver oligometastasis recurrence without extrahepatic tumors and no more than three liver metastases. This study included seven males with a median age of 66 (range, 58-78) years, and 15 lesions were included in the study. The median tumor size was 22.6 (7-55.3) mm. The most frequent dose was 72.6 Gy relative biological effect (RBE)/22 fractions (fr) for four lesions and 64 Gy (RBE)/8 fr for four lesions. The median survival time was 35.5 (13.2-119.4) months. The 1-, 2- and 3-year overall survival (OS) rates were 100%, 57.1% and 42.9%, respectively. The median progression-free survival (PFS) time was 8.7 (1.2-44.1) months. The 1-, 2- and 3-year PFS rates were 28.6%. The 1-, 2- and 3-year local control (LC) rates were 100%. No grade ≥4 radiation-induced adverse events (AEs) were observed. We conclude that PBT can be considered an alternative to hepatic resection for recurrent liver metastases postoperative esophageal cancer.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Takahiro Kato
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima 963-8563, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Gastroenterology, Southern Tohoku General Hospital, Koriyama City, Fukushima 963-8563, Japan
| | - Ichiro Seto
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Takuya Tominaga
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Kanako Takayama
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Yasuhiro Kikuchi
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima 963-8563, Japan
| | - Masao Murakami
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima 963-8052, Japan
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Clinical outcomes and factors involved in the local control of proton beam therapy for oligometastatic liver tumors in patients with colorectal cancer. Strahlenther Onkol 2023; 199:304-312. [PMID: 36446925 DOI: 10.1007/s00066-022-02023-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE There are no existing reports on proton beam therapy (PBT) for local control (LC) of liver metastasis of colorectal cancer (LMCRC). We calculated the LC rate of PBT for LMCRC and explored the influence of each factor on the LC rate. MATERIALS AND METHODS Cases in which PBT was performed at our center between 2009 and 2018 were retrospectively selected from the database. Patients with LMCRC without extrahepatic lesions and no more than three liver metastases were included. Effectiveness was assessed based on LC, overall survival (OS), and progression-free survival (PFS) rates. Adverse events (AEs) are described. Factors that may be related to LC were also investigated. RESULTS This study included 23 men and 18 women, with a median age of 66 (range 24-87) years. A total of 63 lesions were included in the study. The most frequent dose was 72.6 Gy (relative biological effectiveness)/22 fractions. The median follow-up period was 27.6 months. The 3‑year LC, OS, and PFS rates were 54.9%, 61.6%, and 16.7%, respectively. Our multivariate analysis identified the distance between the tumor and the gastrointestinal (GI) tract as a factor associated with LC (P = 0.02). No grade ≥ 3 AEs were observed. None of the patients experienced liver failure during the acute or late phase. CONCLUSION Care must be taken with tumors that have reduced planning target volume coverage owing to organs at risk restrictions, especially in tumors near the GI tract.
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Kim K, Yu JI, Park HC, Yoo GS, Lim DH, Noh JM, Jeong WK. A phase II trial of hypofractionated high-dose proton beam therapy for unresectable liver metastases. Radiother Oncol 2022; 176:9-16. [PMID: 36113779 DOI: 10.1016/j.radonc.2022.09.003] [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: 08/03/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Proton beam therapy (PBT) is an effective treatment option for primary malignant liver disease. However, evidence regarding liver metastasis is insufficient. We aimed to investigate the efficacy and safety of hypofractionated high-dose PBT in the treatment of metastatic liver disease. MATERIALS AND METHODS From January 2019 to January 2021, patients with unresectable liver metastases were enrolled. For PBT, the dose schemes of 60 Gy relative biological effectiveness (GyRBE) in 5 fractions (fx) (biologically effective dose [BED] 132 GyE) or 70 GyRBE in 10 fx (BED 119 GyE) were used. Either a passive scattered beam or pencil beam scanning (PBS)-based intensity-modulated proton therapy (IMPT) was performed with proper respiratory management. The primary endpoint of the study was 6-month freedom from local progression (FFLP) rate; and the Kaplan-Meier method was used to calculate the FFLP and survival rates. RESULTS Of the 49 liver metastases in 46 patients, the colorectum accounted for 60% of the primary cancer sites, followed by the gastrointestinal organs and pancreas/biliary tract. Forty patients presented only 1 liver metastasis, while the other 6 patients had 2 to 4 metastases. The Six-month FFLP rate was 95.2%. The 1-year FFLP rate in patients with <3 cm liver metastasis was 87.4%, while that was 74.1% in patients with > 3 cm group (p = 0.087). With regard to systemic treatment, the 1-year FFLP rate after PBT was better (94.1%) than that without systemic treatment (75.8%; p = 0.051). Regarding PBT-related toxicity, one patient developed a grade 2 gastric ulcer, while none of the patients developed grade ≥3 toxicities. CONCLUSIONS Hypofractionated PBT with a BED > 100 GyRBE for liver metastasis is safe and effective, given the high rate of 6-month FFLP without grade ≥3 treatment-related toxicities. However, further improvements are required for larger tumors and/or those without prior systemic therapy.
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Affiliation(s)
- Kangpyo Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Mohamad I, Barry A, Dawson L, Hosni A. Stereotactic body radiation therapy for colorectal liver metastases. Int J Hyperthermia 2022; 39:611-619. [DOI: 10.1080/02656736.2021.1923836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Aisling Barry
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Laura Dawson
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Ali Hosni
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Taunk NK, Burgdorf B, Dong L, Ben-Josef E. Simultaneous Multiple Liver Metastasis Treated with Pencil Beam Proton Stereotactic Body Radiotherapy (SBRT). Int J Part Ther 2021; 8:89-94. [PMID: 34722815 PMCID: PMC8489493 DOI: 10.14338/ijpt-20-00085.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
Compared with photon stereotactic body radiotherapy (SBRT) plans that may have to use many more penetrating x-ray beams for each isocenter, proton SBRT with ultrahypofractionated doses use fewer beam angles and offer significantly reduced low-dose radiation bath to normal liver tissue. We demonstrate techniques to deliver safe and effective proton SBRT, where planning and organ motion complexity further increased with multiple liver lesions. For treatment planning, we recommend robust and logical beam angles, avoiding devices and encouraging entry perpendicular to the dominant motion, as well as volumetric repainting to mitigate the interplay effect to clinically acceptable levels. This report highlights the significant technical challenges with ultrahypofractionated proton pencil beam scanning liver therapy, how they are managed, and the effectiveness of this treatment.
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Affiliation(s)
- Neil K Taunk
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brendan Burgdorf
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lei Dong
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Tanaka M, Komatsu S, Kido M, Toyama H, Tominaga M, Uchida Y, Terashima K, Demizu Y, Okimoto T, Fukumoto T. Salvage hepatectomy for local recurrence after particle therapy using proton and carbon ion beams for liver cancer. Ann Gastroenterol Surg 2021; 5:711-719. [PMID: 34585055 PMCID: PMC8452475 DOI: 10.1002/ags3.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
AIM With the increased use of particle therapy for liver cancer, local recurrence after particle therapy increased. Salvage hepatectomy is an acceptable treatment option for local recurrence following particle therapy; however, its safety and effectiveness remain unclear. Therefore, this multi-center study aimed to verify the feasibility and efficacy of salvage hepatectomy and assess clinical issues associated with its application. METHODS We retrospectively assessed the perioperative outcomes, prognosis, and pathological characteristics of 15 patients who underwent salvage hepatectomy for local recurrence after particle therapy between 2006 and 2019. RESULTS Hepatocellular carcinoma and metastatic liver tumors were noted in eight and seven patients, respectively. The mean total dose and number of fractions were 66.5 Gy and 12, respectively, and the mean interval between particle therapy and surgery was 30.1 months. Major hepatectomy was performed in seven cases. Moreover, the mortality rate was 0%, and surgical complications of Clavien-Dindo grade IIIa or higher were observed in four cases (27%)-two bile leakages, one pleural effusion, and one refractory skin fistula. The median overall survival time and 5-year overall survival rate after salvage hepatectomy were 29.9 months and 43.1%, respectively. Histological examination of the irradiated liver tissue surrounding the tumor showed sinusoidal dilatation, loss of hepatocyte, and fibrosis in most cases. CONCLUSION Salvage hepatectomy after particle therapy is a feasible therapy; however, the risk of refractory complications associated with particle therapy is relatively high. Therefore, the first-line treatment for resectable liver cancer should be carefully determined considering second-line treatment after local recurrence.
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Affiliation(s)
- Motofumi Tanaka
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Shohei Komatsu
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Masahiro Kido
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hirochika Toyama
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Masahiro Tominaga
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Yoichiro Uchida
- Department of Gastroenterological Surgery and OncologyThe Tazuke Kofukai Medical Research InstituteKitano HospitalOsakaJapan
| | - Kazuki Terashima
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
| | - Yusuke Demizu
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
- Department of Radiation OncologyHyogo Ion Beam Medical Center Kobe Proton CenterKobeJapan
| | - Tomoaki Okimoto
- Department of RadiologyHyogo Ion Beam Medical CenterTatsunoJapan
| | - Takumi Fukumoto
- Division of Hepato‐Biliary‐Pancreatic SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
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Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon 2021; 7:e06454. [PMID: 33748501 PMCID: PMC7966996 DOI: 10.1016/j.heliyon.2021.e06454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.
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Affiliation(s)
- Pooya Afaghi
- Department of Chemistry, University of Guelph, ON, Canada
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Chuong M, Kaiser A, Molitoris J, Mendez Romero A, Apisarnthanarax S. Proton beam therapy for liver cancers. J Gastrointest Oncol 2020; 11:157-165. [PMID: 32175119 DOI: 10.21037/jgo.2019.04.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Proton beam therapy (PBT) delivers less dose to nearby normal organs compared to X-ray therapy (XRT), which is particularly relevant for treating liver cancers given that both mean and low liver dose are among the most significant predictors of radiation induced liver disease (RILD). High-dose PBT has been shown to achieve excellent long-term tumor control with minimal toxicity in hepatocellular carcinoma (HCC) patients. Increasing data support ablative PBT for patients with unresectable cholangiocarcinoma or liver metastases, especially those with larger tumors not suitable for XRT.
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Affiliation(s)
- Michael Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, University of Maryland and Maryland Proton Treatment Center, Baltimore, MD, USA
| | - Jason Molitoris
- Department of Radiation Oncology, University of Maryland and Maryland Proton Treatment Center, Baltimore, MD, USA
| | - Alejandra Mendez Romero
- Department of Radiation Oncology, Erasmus Medical Center and Holland Proton Therapy Center, Rotterdam, The Netherlands
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Siddiqui O, Pollock A, Samanta S, Kaiser A, Molitoris JK. Proton Beam Therapy in Liver Malignancies. Curr Oncol Rep 2020; 22:30. [PMID: 32108284 DOI: 10.1007/s11912-020-0889-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Proton beam therapy (PBT) allows for improved sparing of surrounding normal tissues compared with X-ray-based radiation therapy. This is especially important in the setting of liver malignancies, where an increase in integral dose leads to a higher risk of radiation-induced liver disease (RILD) as well as close proximity to vital gastrointestinal (GI) organs. RECENT FINDINGS We have data from multiple centers demonstrating that PBT can safely deliver high, ablative doses of radiation therapy conferring excellent local control with good tolerance of treatment. PBT is an effective treatment with longstanding evidence of efficacy that is increasing in availability.
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Affiliation(s)
- Osman Siddiqui
- Department of Radiation Oncology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Ariel Pollock
- Department of Radiation Oncology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Santanu Samanta
- Department of Radiation Oncology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
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Shimizu S, Okumura T, Oshiro Y, Fukumitsu N, Fukuda K, Ishige K, Hasegawa N, Numajiri H, Murofushi K, Ohnishi K, Mizumoto M, Nonaka T, Ishikawa H, Sakurai H. Clinical outcomes of previously untreated patients with unresectable intrahepatic cholangiocarcinoma following proton beam therapy. Radiat Oncol 2019; 14:241. [PMID: 31881895 PMCID: PMC6935160 DOI: 10.1186/s13014-019-1451-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The effectiveness of proton beam therapy (PBT) as initial treatment for patients with unresectable intrahepatic cholangiocarcinoma (ICC) is unclear, particularly as related to ICC histological subtypes. We performed this study to address this gap in knowledge. METHODS Thirty-seven patients with unresectable ICC who underwent PBT as their initial treatment were evaluated. Twenty-seven patients had Child-Pugh class A liver function, 11 exhibited jaundice, and 10 had multiple tumors. Nineteen, 7, and 11 tumors were classified as mass forming (MF), periductal infiltrating (PI), and intraductal growth (IG) types, respectively, based on gross appearance in imaging studies. Patients were classified into the curative group (n = 25) and palliative group (n = 12) depending on whether the planning target volume covered all the macroscopic tumors. RESULTS The 1- and 2-year overall survival rates were 60.3, and 41.4%, respectively; the median survival time (MST) was 15 months for all patients. The MSTs for curative and palliative groups were 25 and 7 months, respectively. Curative treatment and adjuvant chemotherapy significantly improved overall survival, while the presence of periductal infiltrating type tumors was a negative prognostic factor. In the curative group, the 1- and 2-year local control rates were 100 and 71.5%, respectively, while the 1-, and 2-year progression-free survival rates were 58.5, and 37.6%, respectively. No severe acute toxicities were observed. Three patients experienced grade 3 biliary tract infection, although it was unclear whether this was radiotherapy-related. CONCLUSION PBT may yield to improve survival and local tumor control among patients with unresectable ICC.
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Affiliation(s)
- Shosei Shimizu
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kuniaki Fukuda
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazunori Ishige
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Naoyuki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Keiko Murofushi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuo Nonaka
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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14
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Makishima H, Yasuda S, Isozaki Y, Kasuya G, Okada N, Miyazaki M, Mohamad O, Matsufuji N, Yamada S, Tsuji H, Kamada T. Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study. Cancer Sci 2018; 110:303-309. [PMID: 30417485 PMCID: PMC6317930 DOI: 10.1111/cas.13872] [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: 08/24/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022] Open
Abstract
Prognosis is usually grim for those with liver metastasis from colorectal cancer (CRC) who cannot receive resection. Radiation therapy can be an option for those unsuitable for resection, with carbon ion radiotherapy (CIRT) being more effective and less toxic than X-ray due to its physio-biological characteristics. The objective of this study is to identify the optimal dose of single fraction CIRT for colorectal cancer liver metastasis. Thirty-one patients with liver metastasis from CRC were enrolled in the present study. Twenty-nine patients received a single-fraction CIRT, escalating the dose from 36 Gy (RBE) in 5% to 10% increments until unacceptable incidence of dose-limiting toxicity was observed. Dose-limiting toxicity was defined as grade ≥3 acute toxicity attributed to radiotherapy. The prescribed doses were as follows: 36 Gy (RBE) (3 cases), 40 Gy (2 cases), 44 Gy (4 cases), 46 Gy (6 cases), 48 Gy (3 cases), 53 Gy (8 cases) and 58 Gy (3 cases). Dose-limiting toxicity was not observed, but late grade 3 liver toxicity due to biliary obstruction was observed in 2 patients at 53 Gy (RBE). Both cases had lesions close to the hepatic portal region, and, therefore, the dose was escalated to 58 Gy (RBE), limited to peripheral lesions. The 3-year actuarial overall survival rate of all 29 patients was 78%, and the median survival time was 65 months. Local control improved significantly at ≥53 Gy (RBE), with a 3-year actuarial local control rate of 82%, compared to 28% in lower doses. Treatment for CRC liver metastasis with single-fraction CIRT appeared to be safe up to 58 Gy (RBE) as long as the central hepatic portal region was avoided.
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Affiliation(s)
- Hirokazu Makishima
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Shigeo Yasuda
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yuka Isozaki
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Goro Kasuya
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Naomi Okada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Masaru Miyazaki
- Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Osama Mohamad
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan.,University of Texas Southwestern Medical center, Dallas, Texas
| | - Naruhiro Matsufuji
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Shigeru Yamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tadashi Kamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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Badiyan SN, Hallemeier CL, Lin SH, Hall MD, Chuong MD. Proton beam therapy for gastrointestinal cancers: past, present, and future. J Gastrointest Oncol 2018; 9:962-971. [PMID: 30505599 DOI: 10.21037/jgo.2017.11.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite the conformality of modern X-ray therapy limiting high dose received by normal tissues the physical properties of X-rays make it impossible to avoid dose being delivered distal to the target. This "exit dose" is likely clinically significant especially for patients with gastrointestinal (GI) cancers when considering that even low dose received by the heart, lungs, bowel, and other radiosensitive structures can lead to morbidity and even may affect long-term tumor control. In contrast, proton beam therapy (PBT) delivers no "exit dose" and a growing body of literature suggests that this may improve clinical outcomes by reducing toxicity and even allowing for safe dose intensification to enhance tumor control. While there are not yet robust prospective data demonstrating the role of PBT for GI cancers, emerging retrospective data provide a strong rationale for continued study of how PBT may improve the therapeutic ratio for these patients. Here we review these data as well as discuss ongoing clinical trials of PBT for GI cancers.
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Affiliation(s)
- Shahed N Badiyan
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | | | - Steven H Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
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16
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Nakamura M, Fukumitsu N, Kamizawa S, Numajiri H, Nemoto Murofushi K, Ohnishi K, Aihara T, Ishikawa H, Okumura T, Tsuboi K, Sakurai H. A validated proton beam therapy patch-field protocol for effective treatment of large hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2018; 59:632-638. [PMID: 30085200 PMCID: PMC6151630 DOI: 10.1093/jrr/rry056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/14/2018] [Indexed: 05/21/2023]
Abstract
Development of a curative local treatment for large hepatocellular carcinoma (HCC) is an important issue. Here, we investigated the dose homogeneity, safety and antitumor effectiveness of proton beam therapy (PBT) using a patch-field technique for large HCC. Data from nine patients (aged 52-79 years) with large HCC treated with patch-field PBT were investigated. The cranial-caudal diameters of the clinical target volumes (CTVs) were 15.0-18.6 cm (median 15.9). The CTV was divided cranially and caudally while both isocenters were aligned along the cranial-caudal axis and overlap of the cranial and caudal irradiation fields was set at 0-0.5 mm. Multileaf collimators were used to eliminate hot or cold spots. Total irradiation doses were 60-76.4 Gy equivalents. Irradiation doses as a percentage of the prescription dose (from the treatment planning system) around the junction were a minimum of 93-105%, a mean of 99-112%, and a maximum of 105-120%. Quality assurance (QA) was assessed in the cranial and caudal irradiation fields using imaging plates. Acute adverse effects of Grade 3 were observed in one patient (hypoalbuminemia), and a late adverse effect of Grade 3 was observed in one patient (liver abscess). Child-Pugh class elevations were observed in four patients (A to B: 3; B to C: 1). Overall survival rates at 1 and 2 years were 55 and 14%, respectively, with a median overall survival of 13.6 months. No patients showed local recurrence. Patch-field PBT supported by substantial QA therefore is one of the treatment options for large HCC.
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Affiliation(s)
- Masatoshi Nakamura
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
- Corresponding author. Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305–8575, Japan. Tel: +81-29-853-7100, Fax: +81-29-853-7102,
| | - Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Satoshi Kamizawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Keiko Nemoto Murofushi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, Tsukuba, 1-1-1 Tennoudai, Tsukuba, Japan
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17
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Yoo GS, Yu JI, Park HC. Proton therapy for hepatocellular carcinoma: Current knowledges and future perspectives. World J Gastroenterol 2018; 24:3090-3100. [PMID: 30065555 PMCID: PMC6064962 DOI: 10.3748/wjg.v24.i28.3090] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death, as few patients can be treated with currently available curative local modalities. In patients with HCC where curative modalities are not feasible, radiation therapy (RT) has emerged as an alternative or combination therapy. With the development of various technologies, RT has been increasingly used for the management of HCC. Among these advances, proton beam therapy (PBT) has several unique physical properties that give it a finite range in a distal direction, and thus no exit dose along the beam path. Therefore, PBT has dosimetric advantages compared with X-ray therapy for the treatment of HCC. Indeed, various reports in the literature have described the favorable clinical outcomes and improved safety of PBT for HCC patients compared with X-ray therapy. However, there are some technical issues regarding the use of PBT in HCC, including uncertainty of organ motion and inaccuracy during calculation of tissue density and beam range, all of which may reduce the robustness of a PBT treatment plan. In this review, we discuss the physical properties, current clinical data, technical issues, and future perspectives on PBT for the treatment of HCC.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, South Korea
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18
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Fukumitsu N, Takahashi S, Okumura T, Ishida T, Murofushi KN, Ohnishi K, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Normal liver tissue change after proton beam therapy. Jpn J Radiol 2018; 36:559-565. [PMID: 29980916 DOI: 10.1007/s11604-018-0757-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan.
| | - Shinsei Takahashi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Toshiki Ishida
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Keiko Nemoto Murofushi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
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19
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Fukumitsu N, Okumura T, Numajiri H, Takizawa D, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Follow-up study of liver metastasis from breast cancer treated by proton beam therapy. Mol Clin Oncol 2017; 7:56-60. [PMID: 28685076 DOI: 10.3892/mco.2017.1283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/17/2017] [Indexed: 02/07/2023] Open
Abstract
Liver metastasis from breast cancer (LMBC) is an incurable, fatal disease with a very poor prognosis. Although various local treatments have been applied, their clinical utility has not been established. The purpose of this study was to investigate the safety and effectiveness of proton beam therapy (PBT) for the treatment of patients with LMGC. A total of 8 female patients (aged 38-63 years) with LMBC who received PBT between 2002 and 2012 were retrospectively reviewed. Patients who had tumors confined to the liver were investigated, whereas patients with extrahepatic tumors were excluded. A total of 5 patients had solitary tumors and 3 had multiple tumors. The total irradiation dose was 66-72.6 Gray equivalent [Gy relative biological effectiveness (RBE)] and 2 patients received concurrent chemotherapy or hormone therapy. The overall and progression-free survival (OS and PFS) rates, local control (LC) rate and adverse effects were investigated. All the patients completed treatment without interruption and late adverse effects of grade >3 were not observed. The OS rate was 88/73/58%, the PFS rate was 50/25/0% and the LC rate was 86/86/86% at 1/3/5 years, respectively. Thus, PBT is a safe treatment and the OS and PFS rates are comparable to those with other local treatments. PBT may be considered as an effective local treatment option for the treatment of LMBC patients.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Daichi Takizawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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20
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Fukumitsu N, Okumura T, Takizawa D, Numajiri H, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Proton beam therapy for liver metastases from gastric cancer. JOURNAL OF RADIATION RESEARCH 2017; 58:357-362. [PMID: 27974509 PMCID: PMC5440857 DOI: 10.1093/jrr/rrw102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/28/2016] [Indexed: 05/31/2023]
Abstract
Liver metastases from gastric cancer (LMGC) is a non-curable, fatal disease with a 5-year survival rate of <10%. Although various local treatments have been applied, their clinical utility has not been established. The purpose of this study was to investigate the safety and effectiveness of proton beam therapy (PBT) for the treatment of patients with LMGC. A total of nine patients (seven men, two women; aged 56-78 years) with LMGC who received PBT between 2002 and 2012 were retrospectively reviewed. Patients who had tumors confined to the liver were investigated, and patients who had extrahepatic tumors were excluded. Six of the patients had solitary tumors, and three patients had multiple tumors. The total irradiation dose was 64-77 Gy relative biological effectiveness (RBE), and three patients received concurrent chemotherapy. The overall and progression-free survival (OS and PFS) rates, local control (LC) rate, and adverse effects were investigated. All patients completed treatment without interruption, and late adverse effects of higher than Grade 3 were not observed. The OS rates at 1, 3 and 5 years were 100%, 78% and 56%, respectively (median, 5.5 years); the PFS rates were 67%, 40% and 40% (median, 2.6 years); and the LC rates were 89%, 71% and 71%. PBT was demonstrated to be a safe treatment, and the OS and PFS rates were not inferior to those for other types of local treatment. Therefore, PBT should be considered as an effective local treatment option for patients with LMGC.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Daichi Takizawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
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21
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Comparative study of the calculated risk of radiation-induced cancer after photon- and proton-beam based radiosurgery of liver metastases. Phys Med 2017; 42:263-270. [PMID: 28366554 DOI: 10.1016/j.ejmp.2017.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/21/2017] [Accepted: 03/21/2017] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The potential of proton therapy to improve the sparing of the healthy tissue has been demonstrated in several studies. However, even small doses delivered to the organs at risk (OAR) may induce long-term detriments after radiotherapy. In this study, we investigated the possibility to reduce the risk of radiation-induced secondary cancers with intensity modulated proton therapy (IMPT), when used for radiosurgery of liver metastases. MATERIAL AND METHODS Ten patients, previously treated for liver metastases with photon-beam based stereotactic body radiation therapy (SBRT) were retrospectively planned for radiosurgery with IMPT. A treatment plan comparison was then performed in terms of calculated risk of radiation-induced secondary cancer. The risks were estimated using two distinct models (Dasu et al., 2005; Schneider et al., 2005, 2009). The plans were compared pairwise with a two-sided Wilcoxon signed-rank test with a significance level of 0.05. RESULTS Reduced risks for induction of fatal and other types of cancers were estimated for the IMPT plans (p<0.05) with the Dasu et al. MODEL Using the Schneider et al. model, lower risks for carcinoma-induction with IMPT were estimated for the skin, lungs, healthy part of the liver, esophagus and the remaining part of the body (p<0.05). The risk of observing sarcomas in the bone was also reduced with IMPT (p<0.05). CONCLUSION The findings of this study indicate that the risks of radiation-induced secondary cancers after radiosurgery of liver metastases may be reduced, if IMPT is used instead of photon-beam based SBRT.
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