1
|
Nishioka K, Hashimoto T, Mori T, Uchinami Y, Kinoshita R, Katoh N, Taguchi H, Yasuda K, Ito YM, Takao S, Tamura M, Matsuura T, Shimizu S, Shirato H, Aoyama H. A Single-Institution Prospective Study To Evaluate the Safety and Efficacy of Real- Time Image-Gated Spot-Scanning Proton Therapy (RGPT) for Prostate Cancer. Adv Radiat Oncol 2024; 9:101464. [PMID: 38560429 PMCID: PMC10981019 DOI: 10.1016/j.adro.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose In real-time image-gated spot-scanning proton therapy (RGPT), the dose distribution is distorted by gold fiducial markers placed in the prostate. Distortion can be suppressed by using small markers and more than 2 fields, but additional fields may increase the dose to organs at risk. Therefore, we conducted a prospective study to evaluate the safety and short-term clinical outcome of RGPT for prostate cancer. Methods and Materials Based on the previously reported frequency of early adverse events (AE) and the noninferiority margin of 10%, the required number of cases was calculated to be 43 using the one-sample binomial test by the Southwest Oncology Group statistical tools with the one-sided significance level of 2.5% and the power 80%. Patients with localized prostate cancer were enrolled and 3 to 4 pure gold fiducial markers of 1.5-mm diameter were inserted in the prostate. The prescribed dose was 70 Gy(relative biologic effectiveness) in 30 fractions, and treatment was performed with 3 fields from the left, right, and the back, or 4 fields from either side of slightly anterior and posterior oblique fields. The primary endpoint was the frequency of early AE (≥grade 2) and the secondary endpoint was the biochemical relapse-free survival rate and the frequency of late AE. Results Forty-five cases were enrolled between 2015 and 2017, and all patients completed the treatment protocol. The median follow-up period was 63.0 months. The frequency of early AE (≥grade 2) was observed in 4 cases (8.9%), therefore the noninferiority was verified. The overall 5-year biochemical relapse-free survival rate was 88.9%. As late AE, grade 2 rectal bleeding was observed in 8 cases (17.8%). Conclusions The RGPT for prostate cancer with 1.5-mm markers and 3- or 4- fields was as safe as conventional proton therapy in early AE, and its efficacy was comparable with previous studies.
Collapse
Affiliation(s)
- Kentaro Nishioka
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Rumiko Kinoshita
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M. Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Masaya Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Taeko Matsuura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Shirato
- Radiation Oncology Division, Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| |
Collapse
|
2
|
Yasuda K, Minatogawa H, Dekura Y, Takao S, Tamura M, Tsushima N, Suzuki T, Kano S, Mizumachi T, Mori T, Nishioka K, Shido M, Katoh N, Taguchi H, Fujima N, Onimaru R, Yokota I, Kobashi K, Shimizu S, Homma A, Shirato H, Aoyama H. Analysis of acute-phase toxicities of intensity-modulated proton therapy using a model-based approach in pharyngeal cancer patients. JOURNAL OF RADIATION RESEARCH 2021; 62:329-337. [PMID: 33372202 PMCID: PMC7948838 DOI: 10.1093/jrr/rraa130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/09/2020] [Indexed: 05/21/2023]
Abstract
Pharyngeal cancer patients treated with intensity-modulated proton therapy (IMPT) using a model-based approach were retrospectively reviewed, and acute toxicities were analyzed. From June 2016 to March 2019, 15 pharyngeal (7 naso-, 5 oro- and 3 hypo-pharyngeal) cancer patients received IMPT with robust optimization. Simulation plans for IMPT and intensity-modulated X-ray therapy (IMXT) were generated before treatment. We also reviewed 127 pharyngeal cancer patients with IMXT in the same treatment period. In the simulation planning comparison, all of the normal-tissue complication probability values for dysphagia, dysgeusia, tube-feeding dependence and xerostomia were lower for IMPT than for IMXT in the 15 patients. After completing IMPT, 13 patients completed the evaluation, and 12 of these patients had a complete response. The proportions of patients who experienced grade 2 or worse acute toxicities in the IMPT and IMXT cohorts were 21.4 and 56.5% for dysphagia (P < 0.05), 46.7 and 76.3% for dysgeusia (P < 0.05), 73.3 and 62.8% for xerostomia (P = 0.43), 73.3 and 90.6% for mucositis (P = 0.08) and 66.7 and 76.4% for dermatitis (P = 0.42), respectively. Multivariate analysis revealed that IMPT was independently associated with a lower rate of grade 2 or worse dysphagia and dysgeusia. After propensity score matching, 12 pairs of IMPT and IMXT patients were selected. Dysphagia was also statistically lower in IMPT than in IMXT (P < 0.05). IMPT using a model-based approach may have clinical benefits for acute dysphagia.
Collapse
Affiliation(s)
- Koichi Yasuda
- Corresponding author. Department of Radiation Oncology, Hokkaido University Hospital. North-15 West-7, Sapporo, 060-8638, Japan. Tel: (+81)11-706-5977; Fax: (+81)11-706-7876;
| | - Hideki Minatogawa
- Department of Radiation Oncology, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Yasuhiro Dekura
- Department of Radiation Oncology, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
- Department of Radiation Medical Science and Engineering, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Seishin Takao
- Department of Medical Physics, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
| | - Masaya Tamura
- Department of Medical Physics, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
| | - Nayuta Tsushima
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Takayoshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Takashi Mori
- Department of Oral Radiology, Graduate School of Dental Medicine, Hokkaido University, Hokkaido University, North-13 West-7, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Motoyasu Shido
- Department of Radiation Oncology, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
| | - Noriyuki Fujima
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Rikiya Onimaru
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Isao Yokota
- Department of Biostatistics, Faculty and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Keiji Kobashi
- Department of Medical Physics, Hokkaido University Hospital, North-15 West-7, Sapporo, Japan
- Department of Radiation Medical Science and Engineering, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty and Graduate School of Medicine,Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Hiroki Shirato
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty and Graduate School of Medicine, Hokkaido University, North-15 West-7, Sapporo, Japan
| |
Collapse
|
3
|
Yoshimura T, Shimizu S, Hashimoto T, Nishioka K, Katoh N, Taguchi H, Yasuda K, Matsuura T, Takao S, Tamura M, Tanaka S, Ito YM, Matsuo Y, Tamura H, Horita K, Umegaki K, Shirato H. Quantitative analysis of treatments using real-time image gated spot-scanning with synchrotron-based proton beam therapy system log data. J Appl Clin Med Phys 2020; 21:10-19. [PMID: 33151643 PMCID: PMC7769392 DOI: 10.1002/acm2.13029] [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] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023] Open
Abstract
A synchrotron-based real-time image gated spot-scanning proton beam therapy (RGPT) system with inserted fiducial markers can irradiate a moving tumor with high accuracy. As gated treatments increase the beam delivery time, this study aimed to investigate the frequency of intra-field adjustments corresponding to the baseline shift or drift and the beam delivery efficiency of a synchrotron-based RGPT system. Data from 118 patients corresponding to 127 treatment plans and 2810 sessions between October 2016 and March 2019 were collected. We quantitatively analyzed the proton beam delivery time, the difference between the ideal beam delivery time based on a simulated synchrotron magnetic excitation pattern and the actual treatment beam delivery time, frequency corresponding to the baseline shift or drift, and the gating efficiency of the synchrotron-based RGPT system according to the proton beam delivery machine log data. The mean actual beam delivery time was 7.1 min, and the simulated beam delivery time in an ideal environment with the same treatment plan was 2.9 min. The average difference between the actual and simulated beam delivery time per session was 4.3 min. The average frequency of intra-field adjustments corresponding to baseline shift or drift and beam delivery efficiency were 21.7% and 61.8%, respectively. Based on our clinical experience with a synchrotron-based RGPT system, we determined the frequency corresponding to baseline shift or drift and the beam delivery efficiency using the beam delivery machine log data. To maintain treatment accuracy within ± 2.0 mm, intra-field adjustments corresponding to baseline shift or drift were required in approximately 20% of cases. Further improvements in beam delivery efficiency may be realized by shortening the beam delivery time.
Collapse
Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Norio Katoh
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Taguchi
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Koichi Yasuda
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Taeko Matsuura
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Seishin Takao
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Masaya Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Sodai Tanaka
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Yuto Matsuo
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Tamura
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Horita
- Proton Beam Therapy Center, Hokkaido University Hospital, Sapporo, Japan
| | - Kikuo Umegaki
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan.,Department of Proton Beam Therapy, Research Center for Cooperative Projects, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
4
|
Yoshimura T, Shimizu S, Hashimoto T, Nishioka K, Katoh N, Inoue T, Taguchi H, Yasuda K, Matsuura T, Takao S, Tamura M, Ito YM, Matsuo Y, Tamura H, Horita K, Umegaki K, Shirato H. Analysis of treatment process time for real-time-image gated-spot-scanning proton-beam therapy (RGPT) system. J Appl Clin Med Phys 2019; 21:38-49. [PMID: 31886616 PMCID: PMC7020995 DOI: 10.1002/acm2.12804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/27/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
We developed a synchrotron‐based real‐time‐image gated‐spot‐scanning proton‐beam therapy (RGPT) system and utilized it to clinically operate on moving tumors in the liver, pancreas, lung, and prostate. When the spot‐scanning technique is linked to gating, the beam delivery time with gating can increase, compared to that without gating. We aim to clarify whether the total treatment process can be performed within approximately 30 min (the general time per session in several proton therapy facilities), even for gated‐spot‐scanning proton‐beam delivery with implanted fiducial markers. Data from 152 patients, corresponding to 201 treatment plans and 3577 sessions executed from October 2016 to June 2018, were included in this study. To estimate the treatment process time, we utilized data from proton beam delivery logs during the treatment for each patient. We retrieved data, such as the disease site, total target volume, field size at the isocenter, and the number of layers and spots for each field, from the treatment plans. We quantitatively analyzed the treatment process, which includes the patient load (or setup), bone matching, marker matching, beam delivery, patient unload, and equipment setup, using the data obtained from the log data. Among all the cases, 90 patients used the RGPT system (liver: n = 34; pancreas: n = 5; lung: n = 4; and prostate: n = 47). The mean and standard deviation (SD) of the total treatment process time for the RGPT system was 30.3 ± 7.4 min, while it was 25.9 ± 7.5 min for those without gating treatment, excluding craniospinal irradiation (CSI; head and neck: n = 16, pediatric: n = 31, others: n = 15); for CSI (n = 11) with two or three isocenters, the process time was 59.9 ± 13.9 min. Our results demonstrate that spot‐scanning proton therapy with a gating function can be achieved in approximately 30‐min time slots.
Collapse
Affiliation(s)
| | - Shinichi Shimizu
- Department of Radiation OncologyFaculty of MedicineHokkaido UniversitySapporoJapan
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
| | - Takayuki Hashimoto
- Department of Radiation MedicineFaculty of MedicineHokkaido UniversitySapporoJapan
| | - Kentaro Nishioka
- Department of Radiation OncologyFaculty of MedicineHokkaido UniversitySapporoJapan
| | - Norio Katoh
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Tetsuya Inoue
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Hiroshi Taguchi
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Koichi Yasuda
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | | | - Seishin Takao
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Masaya Tamura
- Department of Radiation OncologyHokkaido University HospitalSapporoJapan
| | - Yoichi M. Ito
- Department of Statistical Data ScienceThe Institute of Statistical MathematicsTokyoJapan
| | - Yuto Matsuo
- Proton Beam Therapy CenterHokkaido University HospitalSapporoJapan
| | - Hiroshi Tamura
- Proton Beam Therapy CenterHokkaido University HospitalSapporoJapan
| | - Kenji Horita
- Proton Beam Therapy CenterHokkaido University HospitalSapporoJapan
| | - Kikuo Umegaki
- Faculty of EngineeringHokkaido UniversitySapporoJapan
| | - Hiroki Shirato
- Global Station for Quantum Medical Science and EngineeringGlobal Institution for Collaborative Research and Education (GI‐CoRE)Hokkaido UniversitySapporoJapan
- Department of Radiation MedicineFaculty of MedicineHokkaido UniversitySapporoJapan
| |
Collapse
|
5
|
Nishio T, Tachibana H, Kase Y, Hotta K, Nakamura M, Tamura M, Terunuma T, Toshito T, Yamashita H, Ishikura S, Fuji H, Akimoto T, Nishimura Y. Liver phantom design and dosimetric verification in participating institutions for a proton beam therapy in patients with resectable hepatocellular carcinoma: Japan Clinical Oncology Group trial (JCOG1315C). Radiother Oncol 2019; 140:98-104. [PMID: 31265942 DOI: 10.1016/j.radonc.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE In Japan, the first domestic clinical trial of proton beam therapy for the liver was initiated as the Japan Clinical Oncology Group trial (JCOG1315C: Non-randomized controlled study comparing proton beam therapy and hepatectomy for resectable hepatocellular carcinoma). Purposes of this study were to develop a new dosimetric verification system and to carry out a credentialing for the JCOG1315C clinical trial. MATERIALS AND METHODS Accuracy and differences in doses in proton treatment planning among participating institutions were surveyed and investigated. We designed and developed a suitable water tank-type liver phantom for a dosimetric verification of proton beam therapy for liver. In a visiting survey of five institutions participating in the clinical trial, we performed the dosimetric verification using the liver phantom and an air-filled ionization chamber. RESULTS The shape of the dose distributions calculated in proton treatment planning was characteristic and dependent on the manufacturers of the proton beam therapy system, the proton treatment planning system and the setup at the participating institutions. Widths of the lateral penumbra were 5.8-12.7 mm among participating institutions. The accuracy between the calculated and the measured doses in the proton irradiation was within 3% at five measurement points including both points on the isocenter and off the isocenter. CONCLUSIONS These findings confirmed the accuracy of the delivery doses in the institutions participating in the clinical trial, and the clinical trial with integration of all institutions (five institutions) could be initiated.
Collapse
Affiliation(s)
- Teiji Nishio
- Department of Medical Physics, Graduate School of Medicine, Tokyo Women's Medical University, Japan.
| | - Hidenobu Tachibana
- Division of Radiation Oncology and Particle Therapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Yuki Kase
- Proton Therapy Division, Shizuoka Cancer Center Research Institute, Japan
| | - Kenji Hotta
- Division of Radiation Oncology and Particle Therapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Masaya Tamura
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | | | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Japan
| | - Haruo Yamashita
- Proton Therapy Division, Shizuoka Cancer Center Research Institute, Japan
| | - Satoshi Ishikura
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Hiroshi Fuji
- Department of Radiation Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuo Akimoto
- Division of Radiation Oncology and Particle Therapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| |
Collapse
|
6
|
Hashimoto T, Shimizu S, Takao S, Terasaka S, Iguchi A, Kobayashi H, Mori T, Yoshimura T, Matsuo Y, Tamura M, Matsuura T, Ito YM, Onimaru R, Shirato H. Clinical experience of craniospinal intensity-modulated spot-scanning proton therapy using large fields for central nervous system medulloblastomas and germ cell tumors in children, adolescents, and young adults. JOURNAL OF RADIATION RESEARCH 2019; 60:527-537. [PMID: 31111946 PMCID: PMC6640905 DOI: 10.1093/jrr/rrz022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/28/2019] [Indexed: 06/09/2023]
Abstract
The outcomes of intensity-modulated proton craniospinal irradiation (ipCSI) are unclear. We evaluated the clinical benefit of our newly developed ipCSI system that incorporates two gantry-mounted orthogonal online X-ray imagers with a robotic six-degrees-of-freedom patient table. Nine patients (7-19 years old) were treated with ipCSI. The prescribed dose for CSI ranged from 23.4 to 36.0 Gy (relative biological effectiveness) in 13-20 fractions. Four adolescent and young adult (AYA) patients (15 years or older) were treated with vertebral-body-sparing ipCSI (VBSipCSI). Myelosuppression following VBSipCSI was compared with that of eight AYA patients treated with photon CSI at the same institution previously. The mean homogeneity index (HI) in the nine patients was 0.056 (95% confidence interval: 0.044-0.068). The mean time from the start to the end of all beam delivery was 37 min 39 s ± 2 min 24 s (minimum to maximum: 22 min 49 s - 42 min 51 s). The nadir white blood cell, hemoglobin, and platelet levels during the 4 weeks following the end of the CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0071, 0.0453, 0.0024, respectively). The levels at 4 weeks after the end of CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0023, 0.0414, 0.0061). Image-guided ipCSI was deliverable in a reasonable time with sufficient HI. Using VBSipCSI, AYA patients experienced a lower incidence of serious acute hematological toxicity than AYA patients treated with photon CSI.
Collapse
Affiliation(s)
- Takayuki Hashimoto
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
| | - Shinichi Shimizu
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University
| | - Seishin Takao
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
- Proton Beam Therapy Center, Hokkaido University Hospital
| | - Shunsuke Terasaka
- Department of Neurosurgery, Faculty of Medicine, Hokkaido University
| | - Akihiro Iguchi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University
| | | | - Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital
| | | | - Yuto Matsuo
- Proton Beam Therapy Center, Hokkaido University Hospital
| | - Masaya Tamura
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
| | - Taeko Matsuura
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics
| | - Rikiya Onimaru
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
| | - Hiroki Shirato
- Department of Radiation Medicine, Faculty of Medicine, Hokkaido University
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University
| |
Collapse
|