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Kang Y, Ishikawa H, Inaniwa T, Iwai Y, Matsufuji N, Kasuya G, Okonogi N, Liu Y, Chao Y, Wakatsuki M, Tsujii H, Tsuji H. The clinical relative biological effectiveness and prostate-specific antigen kinetics of carbon-ion radiotherapy in low-risk prostate cancer. Cancer Med 2022; 12:1540-1551. [PMID: 35852142 PMCID: PMC9883571 DOI: 10.1002/cam4.5045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To evaluate the clinical relative biological effectiveness (RBE) of carbon-ion radiotherapy (C-ion RT) for prostate cancer. METHODS The records of 262 patients with low-risk prostate cancer (median age, 65 [47-80] years) treated with C-ion RT at QST Hospital, National Institutes for Quantum Science and Technology in Japan during 2000-2018 were reviewed retrospectively. Four different protocol outcomes and prostate-specific antigen (PSA) responses were evaluated. The median follow-up was 8.4 years. The Kaplan-Meier method was used to estimate the biochemical or clinical failure-free rate (BCFFR). Clinical RBE was calculated using the tumor control probability model. RESULTS The 5-, 7-, and 10-year BCFFRs were 91.7%, 83.8%, and 73.2%, respectively. The 10-year BCFFRs of patients who received C-ion RT at 66 Gy (RBE) in 20 fractions, 63 Gy (RBE) in 20 fractions, and 57.6 Gy (RBE) in 16 fractions were 81.4%, 70.9%, and 68.9%, respectively. The PSA level and density during follow-up were better in the patients treated with the lower fraction size. A higher PSA nadir and shorter time to PSA nadir were risk factors for biochemical or clinical failure by multivariate Cox regression. The tumor control probability analysis showed that the estimated clinical RBE values to achieve an 80% BCFFR at 10 years for 20, 16, and 12 fractions were 2.19 (2.18-2.24), 2.16 (2.14-2.23), and 2.12 (2.09-2.21), respectively. CONCLUSIONS Using clinical data from low-risk prostate cancer patients, we showed the clinical RBE of C-ion RT decreased with increasing dose per fraction.
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Affiliation(s)
- Yu‐Mei Kang
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan,Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan,Faculty of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
| | - Taku Inaniwa
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan,Department of Accelerator and Medical PhysicsNational Institutes for Quantum Science and TechnologyChibaJapan
| | - Yuma Iwai
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
| | - Naruhiro Matsufuji
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan,Department of Accelerator and Medical PhysicsNational Institutes for Quantum Science and TechnologyChibaJapan
| | - Goro Kasuya
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
| | - Noriyuki Okonogi
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
| | - Yu‐Ming Liu
- Division of Radiation Oncology, Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan,Faculty of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yee Chao
- Faculty of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of OncologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
| | - Hirohiko Tsujii
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and TechnologyChibaJapan
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Sato H, Kasuya G, Ishikawa H, Nomoto A, Ono T, Nakajima M, Isozaki Y, Yamamoto N, Iwai Y, Nemoto K, Ichikawa T, Tsuji H. Long-term clinical outcomes after 12-fractionated carbon-ion radiotherapy for localized prostate cancer. Cancer Sci 2021; 112:3598-3606. [PMID: 34107139 PMCID: PMC8409298 DOI: 10.1111/cas.15019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
There are no clinical reports of long-term follow-up after carbon-ion radiotherapy (CIRT) using a dose of 51.6 Gy (relative biological effectiveness [RBE]) in 12 fractions for localized prostate cancer, or of a comparison of clinical outcomes between passive and scanning beam irradiation. A total of 256 patients with localized prostate cancer who received CIRT at a dose of 51.6 Gy (RBE) in 12 fractions using two different beam delivery techniques (passive [n = 45] and scanning [n = 211]), and who were followed for more than 1 year, were analyzed. The biochemical relapse-free (bRF) rate was defined by the Phoenix definition, and the actuarial toxicity rates were evaluated using the Kaplan-Meier method. Of the 256 patients, 41 (16.0%), 111 (43.4%), and 104 (40.6%) were classified as low, intermediate, and high risk, respectively, after a median follow-up of 7.0 (range 1.1-10.4) years. Androgen deprivation therapy was performed in 212 patients (82.8%). The 5-year bRF rates of the low-, intermediate-, and high-risk patients were 95.1%, 90.9%, and 91.1%, respectively. The 5-year rates of grade 2 late gastrointestinal and genitourinary toxicities in all patients were 0.4% and 6.3%, respectively. No grade ≥3 toxicities were observed. There were no significant differences in the rates of bRF or grade 2 toxicities in patients who received passive irradiation versus scanning irradiation. Our long-term follow-up results showed that a CIRT regimen of 51.6 Gy (RBE) in 12 fractions for localized prostate cancer yielded a good therapeutic outcome and low toxicity rates irrespective of the beam delivery technique.
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Affiliation(s)
- Hiraku Sato
- Department of Radiation OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Goro Kasuya
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Hitoshi Ishikawa
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Akihiro Nomoto
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Takashi Ono
- Department of Radiation OncologyFaculty of MedicineYamagata UniversityYamagataJapan
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Mio Nakajima
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Yuka Isozaki
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Naoyoshi Yamamoto
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
| | - Yuma Iwai
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
- Department of RadiologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Kenji Nemoto
- Department of Radiation OncologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Tomohiko Ichikawa
- Department of UrologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Hiroshi Tsuji
- Quantum Medical Science DirectorateNational Institutes for Quantum and Radiological Science and Technology (formerly the National Institute of Radiological Science Hospital)QST HospitalChibaJapan
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Ono T, Yamamoto N, Nomoto A, Nakajima M, Isozaki Y, Kasuya G, Ishikawa H, Nemoto K, Tsuji H. Long Term Results of Single-Fraction Carbon-Ion Radiotherapy for Non-small Cell Lung Cancer. Cancers (Basel) 2020; 13:cancers13010112. [PMID: 33396455 PMCID: PMC7795673 DOI: 10.3390/cancers13010112] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 12/25/2022] Open
Abstract
Simple Summary There were no reports on long-term results of single-fraction passive carbon-ion radiotherapy in patients with early-stage non-small cell lung cancer. We showed that this treatment was not inferior compared to stereotactic body radiotherapy or proton beam therapy with no ≥grade 2 pneumonitis. This study suggests that single-fraction passive carbon-ion radiotherapy can serve as an alternate treatment for patients with early-stage non-small cell lung cancer, especially in medically inoperable patients. Abstract Background: The purpose of the present study was to evaluate the efficacy and safety of single-fraction carbon-ion radiotherapy (CIRT) in patients with non-small cell lung cancer. Methods: Patients with histologically confirmed non-small cell lung cancer, stage T1-2N0M0, and treated with single-fraction CIRT (50Gy (relative biological effectiveness)) between June 2011 and April 2016 were identified in our database and retrospectively analyzed. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events version 4.0. Results: The study included 57 patients, 22 (38.6%) of whom had inoperable cancer. The median age was 75 years (range: 42–94 years), and the median follow-up time was 61 months (range: 6–97 months). The 3- and 5-year overall survival rates were 91.2% and 81.7%, respectively. All survivors were followed up for more than three years. The 3- and 5-year local control rates were 96.4% and 91.8%, respectively. No case of ≥ grade 2 pneumonitis was recorded. Conclusions: This study suggests that single-fraction CIRT for T1-2N0M0 non-small cell lung cancer patients is feasible and can be considered as one of the treatment choices, especially in medically inoperable patients.
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Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, 2-2-2, Iida-Nishi, Yamagata 990-9585, Japan;
- Correspondence: ; Tel.: +81-43-206-3181; Fax: +81-43-206-3188
| | - Naoyoshi Yamamoto
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Akihiro Nomoto
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Mio Nakajima
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Yuka Isozaki
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Goro Kasuya
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, 2-2-2, Iida-Nishi, Yamagata 990-9585, Japan;
| | - Hiroshi Tsuji
- Department of Radiation Oncology, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan; (N.Y.); (A.N.); (M.N.); (Y.I.); (G.K.); (H.I.); (H.T.)
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Sato H, Kasuya G, Tsuji H, Nemoto K. Five-Year Clinical Outcomes Of 51.6Gy (RBE) In 12-Fractionated Carbon-Ion Radiotherapy For Localized Prostate Cancer: Two Prospective Analyses. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makishima H, Yasuda S, Kato H, Kaneko T, Sato H, Chang T, Kasuya G, Yamada S, Tsuji H. PO-1077: Carbon-ion radiotherapy for hepatocellular carcinoma with vascular invasion. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sato H, Kasuya G, Chang T, Makishima H, Nemoto K, Tsuji H. PH-0115: Five-year outcomes of 51.6 Gy (RBE) in 12-fractionated carbon-ion RT for localized prostate cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yamazaki K, Nishii R, Maeda T, Makishima H, Kasuya G, Chang T, Tamura K, Wakatsuki M, Tsuji H, Murakami K, Higashi T. Assessment of SPECT-CT fusion images and semi-quantitative evaluation using SUV in 123I-IMP SPECT in patients with choroidal melanoma. Ann Nucl Med 2020; 34:864-872. [PMID: 32902695 DOI: 10.1007/s12149-020-01517-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic ability of N-isopropyl-p-[I-123] iodoamphetamine (IMP) SPECT semi-quantitative evaluation based on the standardized uptake value (SUV) in patients with choroidal melanoma. The secondary aim was to investigate the 6-h IMP SPECT imaging in comparison with 24-h imaging. METHODS Twenty-five patients (14 males and 11 females, mean age of 59.2-year-old) were analyzed in this retrospective study. Patients underwent 24-h IMP SPECT imaging with a gamma camera after intravenous injection of IMP. Twelve of 25 patients underwent 6-h SPECT imaging in addition to the 24-h imaging. All acquired SPECT images were fused with CT images using an image-analysis software. To assess the utility of semi-quantitative evaluation method, we introduced an image evaluation method using SUVmax comparing with conventional count-based uptake index (UI) evaluation of the lesion. Volumes-of-interest (VOIs) for SUVmax and regions-of-interest (ROIs) for UI were drawn referring to the SPECT-CT fusion image. Then the relationship between the 6- and 24-h images was examined both in SUV and UI evaluation. Furthermore, the relationship between the size category classification (SCC) by UICC/AJCC: 1-4 scales and each semi-quantitative value using SUVmax and UI was also assessed. RESULTS SUVmax of the tumor was significantly higher than that of the normal side; 2.37 ± 0.88 and 1.77 ± 0.39 (P < 0.05) on 6-h image, 4.17 ± 1.73 and 2.04 ± 0.45 (P < 0.001) on 24-h image, respectively. UI of the tumor was also significantly higher than that of the normal side; 2.24 ± 0.67 and 1.53 ± 0.35 (P < 0.01) on 6-h image, 3.79 ± 1.24 and 1.67 ± 0.44 (P < 0.001) on 24-h image, respectively. There was a strong significant linear relationship in the evaluation with SUVmax between 6- and 24-h on the tumor side (R2 = 0.88, P < 0.0001), compared to that with Tumor-UI (R2 = 0.35, P < 0.05). In addition, SUVmax of the tumor clearly differentiated the SCC of the tumor category 4 from that of category 1, where SUVmax of the tumor for categories 1‒4 were 2.56 ± 0.59, 4.33 ± 1.92, 4.63 ± 1.45, and 5.73 ± 1.69, respectively (P < 0.05, for categories 1 and 4). CONCLUSIONS The semi-quantitative evaluation by SUV of 123I-IMP SPECT images fused with CT images is useful for detecting choroidal melanoma. Moreover, 6-h imaging with SUV-based evaluation of 123I-IMP SPECT is promising compared to the conventional count-based UI evaluation method. Trial registration This study is registered in UMIN Clinical Trials Registry (UMIN-CTR) as UMIN study ID: UMIN000038174.
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Affiliation(s)
- Kana Yamazaki
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryuichi Nishii
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan.
| | - Takamasa Maeda
- Radiological Technology Section, QST Hospital, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Hirokazu Makishima
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS) and QST Hospital, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Goro Kasuya
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS) and QST Hospital, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Tachen Chang
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS) and QST Hospital, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Kentaro Tamura
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Masaru Wakatsuki
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS) and QST Hospital, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Hiroshi Tsuji
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences (NIRS) and QST Hospital, National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Koji Murakami
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
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Isozaki Y, Takiyama H, Bhattacharyya T, Ebner D, Kasuya G, Makishima H, Tsuji H, Kamada T, Yamada S. Heavy charged particles for gastrointestinal cancers. J Gastrointest Oncol 2020; 11:203-211. [PMID: 32175123 DOI: 10.21037/jgo.2019.03.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Carbon ion beams constitute the primary delivery method of heavy ion radiotherapy. It offers improved dose distribution, and enables concentration of dose within target volumes with minimal extraneous exposure of normal tissue, while delivering superior biological effect in comparison with photon and proton technologies. Here, we review the application of this technology to various gastrointestinal cancers.
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Affiliation(s)
- Yuka Isozaki
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hirotoshi Takiyama
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tapesh Bhattacharyya
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Daniel Ebner
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Goro Kasuya
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tadashi Kamada
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shigeru Yamada
- Department of Radiation Oncology, Hospital of the National Institute of Radiological Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Yasuda S, Kato H, Imada H, Isozaki Y, Kasuya G, Makishima H, Tsuji H, Ebner DK, Yamada S, Kamada T, Tsujii H, Kato N, Miyazaki M. Long-Term Results of High-Dose 2-Fraction Carbon Ion Radiation Therapy for Hepatocellular Carcinoma. Adv Radiat Oncol 2019; 5:196-203. [PMID: 32280819 PMCID: PMC7136623 DOI: 10.1016/j.adro.2019.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/24/2019] [Accepted: 09/18/2019] [Indexed: 02/08/2023] Open
Abstract
Purpose Carbon ion beams have several physical and biological advantages compared with conventional radiation for cancer therapy. The objective of this study is to evaluate the safety and effectiveness of 2-fraction carbon ion radiation therapy (CIRT) in patients with hepatocellular carcinoma (HCC). Methods and Materials Between December 2008 and March 2013, 57 patients with localized HCC were treated with CIRT at a total dose of 45 Gy (relative biological effectiveness) in 2 fractions and retrospectively analyzed after long-term observation. The main endpoints of this study were treatment-related toxicity and local tumor control. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Changes in the Child-Pugh score from before to after CIRT were also examined to evaluate hepatic toxicity. Local control was defined as no progression of the irradiated lesion according to the modified Response Evaluation Criteria in Solid Tumors. Results The median age of the patients was 75 years (range, 49-89 years). Of these patients, 41 had a newly diagnosed lesion, and 16 had residual or recurrent lesions after previous treatments. The median follow-up duration was 54 months (range, 7-103 months). All surviving patients were followed for more than 51 months. Two patients experienced grade 3 acute skin reactions, but no other grade 3 or higher toxicities were observed in any organ. No patient exhibited an increase in the Child-Pugh score of 2 or more points after CIRT. The local tumor control rates at 1, 3, and 5 years were 98%, 91%, and 91% after CIRT, respectively. All lesions that failed to respond to previous treatments were successfully controlled by CIRT. The 1-, 3-, and 5-year overall survival rates were 97%, 67%, and 45%, respectively. Conclusions Two-fraction CIRT was a well-tolerated and effective treatment for patients with HCC.
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Affiliation(s)
- Shigeo Yasuda
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Department of Radiology, Chiba Rosai Hospital, Chiba, Japan
| | | | - Hiroshi Imada
- Department of Internal Medicine, Shirogane Orthopedic Hospital, Chiba, Japan
| | - Yuka Isozaki
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Goro Kasuya
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hirokazu Makishima
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Daniel K Ebner
- Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Shigeru Yamada
- 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.,Ion-beam Radiation Oncology Center in Kanagawa, Kanagawa Cancer Center, Yokohama, Japan
| | - Hirohiko Tsujii
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaru Miyazaki
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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Ikoma Y, Kishimoto R, Tachibana Y, Omatsu T, Kasuya G, Makishima H, Higashi T, Obata T, Tsuji H. Reference region extraction by clustering for the pharmacokinetic analysis of dynamic contrast-enhanced MRI in prostate cancer. Magn Reson Imaging 2019; 66:185-192. [PMID: 31487532 DOI: 10.1016/j.mri.2019.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/13/2019] [Accepted: 08/31/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures changes in the concentration of an administered contrast agent to quantitatively evaluate blood circulation in a tumor or normal tissues. This method uses a pharmacokinetic analysis based on the time course of a reference region, such as muscle, rather than arterial input function. However, it is difficult to manually define a homogeneous reference region. In the present study, we developed a method for automatic extraction of the reference region using a clustering algorithm based on a time course pattern for DCE-MRI studies of patients with prostate cancer. METHODS Two feature values related to the shape of the time course were extracted from the time course of all voxels in the DCE-MRI images. Each voxel value of T1-weighted images acquired before administration were also added as anatomical data. Using this three-dimensional feature vector, all voxels were segmented into five clusters by the Gaussian mixture model, and one of these clusters that included the gluteus muscle was selected as the reference region. RESULTS Each region of arterial vessel, muscle, and fat was segmented as a different cluster from the tumor and normal tissues in the prostate. In the extracted reference region, other tissue elements including scattered fat and blood vessels were removed from the muscle region. CONCLUSIONS Our proposed method can automatically extract the reference region using the clustering algorithm with three types of features based on the time course pattern and anatomical data. This method may be useful for evaluating tumor circulatory function in DCE-MRI studies.
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Affiliation(s)
- Yoko Ikoma
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Riwa Kishimoto
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yasuhiko Tachibana
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Tokuhiko Omatsu
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Goro Kasuya
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hirokazu Makishima
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Takayuki Obata
- Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan.
| | - Hiroshi Tsuji
- Department of Charged Particle Therapy Research, National Institute of Radiological Sciences, QST, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
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11
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Bhattacharyya T, Koto M, Ikawa H, Hayashi K, Hagiwara Y, Makishima H, Kasuya G, Yamamoto N, Kamada T, Tsuji H. First prospective feasibility study of carbon-ion radiotherapy using compact superconducting rotating gantry. Br J Radiol 2019; 92:20190370. [PMID: 31317764 PMCID: PMC6849685 DOI: 10.1259/bjr.20190370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective: We had developed compact rotating gantry for carbon ion using superconducting magnets in 2015 which became clinically operational in 2017. The objective of this study was to assess the clinical feasibility and safety of using compact rotating gantry with three-dimensional active scanning in delivery of carbon-ion radiotherapy (C-ion RT) for relatively stationary tumours. Methods: A prospective feasibility study was conducted with 10 patients who had been treated with C-ion RT using compact rotating gantry between April 2017 and April 2018 at Hospital of the National Institute of Radiological Sciences (NIRS) for head and neck and prostate cancers. The primary end point was evaluation of acute toxicities within 3 months of starting C-ion RT. Results: Out of 10 cases 8 were of head and neck cancers and 2 were of prostate cancers. All of those eight head and neck cases were of locally advanced stages. Both of the prostate cancer patients belong to intermediate risk categories. None of the patients developed even Grade 2 or more severe skin reactions. Six out of eight cases with head and neck cancers experienced Grade 2 mucosal reactions; however, nobody developed Grade 3 or more severe mucosal reactions. There was no gastrointestinal reaction observed in prostate cancer patients. One patient developed Grade 2 genitourinary reaction. Conclusion: C-ion RT using compact rotating gantry and three-dimensional active scanning is a safe and feasible treatment for relatively less mobile tumours. Advances in knowledge: This study will be the first step to establish the use of superconducting rotating gantry in C-ionRT in clinical setting paving the way for treating large number of patients and make it a standard of practice in the future.
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Affiliation(s)
- Tapesh Bhattacharyya
- 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
| | - Hiroaki Ikawa
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Kazuhiko Hayashi
- 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
| | - Hirokazu Makishima
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Goro Kasuya
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Naoyoshi Yamamoto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Tadashi Kamada
- 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
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12
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Kasuya G, Terashima K, Shibuya K, Toyama S, Ebner DK, Tsuji H, Okimoto T, Ohno T, Shioyama Y, Nakano T, Kamada T. Carbon-ion radiotherapy for cholangiocarcinoma: a multi-institutional study by and the Japan carbon-ion radiation oncology study group (J-CROS). Oncotarget 2019; 10:4369-4379. [PMID: 31320991 PMCID: PMC6633891 DOI: 10.18632/oncotarget.27028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022] Open
Abstract
To evaluate the safety and efficacy of carbon-ion radiotherapy (CIRT) for cholangiocarcinoma via a multicenter retrospective study. Clinical data were collected from patients with cholangiocarcinoma who had received CIRT at one of four treating institutions in Japan. Of 56 eligible patients, none received surgery for cholangiocarcinoma before or after CIRT. The primary endpoint was overall survival (OS). Based on the tumor site, the 56 cases were categorized as intrahepatic cholangiocarcinoma (IHC) (n=27) or perihilar cholangiocarcinoma (PHC) (n=29). In all patients, the median tumor size was 37 (range, 15‒110) mm, and the most commonly prescribed dose was 76 Gy (relative biological effectiveness) in 20 fractions. The median survival was 14.8 (range, 2.1-129.2) months, and the 1- and 2-year OS rates were 69.7% and 40.9%, respectively. The median survival times of the patients with IHC and those with PHC were 23.8 and 12.6 months, respectively. Both univariate and multivariate analyses revealed that cholangitis pre-CIRT and Child‒Pugh class B were significant prognostic factors for an unfavorable OS. Of four patients who died of liver failure, one with IHC was suspected to have radiation-induced liver disease because of newly developed ascites, and died at 4.3 months post-CIRT. Grade 3 CIRT-related bile duct stenosis was observed in one IHC case. No other CIRT-related severe adverse events, including gastrointestinal events, were observed. These results suggest that CIRT yields relatively favorable treatment outcomes, especially for patients with IHC, and acceptable toxicities were observed in patients with cholangiocarcinoma who did not receive surgery.
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Affiliation(s)
- Goro Kasuya
- QST Hospital (Former Hospital of the National Institute of Radiological Sciences), National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Kei Shibuya
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Shingo Toyama
- Ion Beam Therapy Center, SAGA-HIMAT Foundation, Tosu, Japan
| | - Daniel K Ebner
- QST Hospital (Former Hospital of the National Institute of Radiological Sciences), National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Hiroshi Tsuji
- QST Hospital (Former Hospital of the National Institute of Radiological Sciences), National Institutes for Quantum and Radiological Science 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
| | | | - Takashi Nakano
- QST Hospital (Former Hospital of the National Institute of Radiological Sciences), National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tadashi Kamada
- QST Hospital (Former Hospital of the National Institute of Radiological Sciences), National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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13
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Kasuya G, Tsuji H, Nomiya T, Makishima H, Haruyama Y, Kobashi G, Hayashi K, Ebner DK, Omatsu T, Kishimoto R, Yasuda S, Igarashi T, Oya M, Akakura K, Suzuki H, Ichikawa T, Shimazaki J, Kamada T. Prospective clinical trial of 12-fraction carbon-ion radiotherapy for primary renal cell carcinoma. Oncotarget 2019; 10:76-81. [PMID: 30713604 PMCID: PMC6343760 DOI: 10.18632/oncotarget.26539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/20/2018] [Indexed: 12/20/2022] Open
Abstract
The aims of this study were to clarify the safety and efficacy of 12-fraction carbon-ion radiotherapy (CIRT) for primary renal cell carcinoma (RCC) and to confirm the recommended dose in a prospective clinical trial. This clinical trial was planned as a non-randomized, open-label, single-center phase I/II study of CIRT monotherapy. The incidence of acute adverse events was the primary endpoint. Dose-limiting toxicities (DLTs) were defined as grade ≥3 skin, gastrointestinal tract, or urologic adverse events. Based on the eligibility criteria, 8 patients with primary RCC, including 3 medically inoperable patients and 5 patients with tumors >4 cm, were enrolled. Of the 8 patients, 5 were treated with 66 Gy (relative biological effectiveness [RBE]), and subsequently, the dose was escalated to 72 Gy (RBE) for the remaining 3 patients. The median follow-up time was 43.1 months. No DLTs were observed at any dose level though the end of follow-up. Although 1 patient died of pneumonia 3 months after CIRT, which was determined to be unrelated to CIRT, no grade 3 or higher adverse events were observed, and both local control and cancer-specific survival rates were 100%. In conclusion, the safety and efficacy of CIRT hypofractionation using 12-fractions for the treatment of eligible RCC patients, including those with inoperable or tumor size >4 cm, were confirmed in this prospective trial, and a recommended dose of 72 Gy (RBE) was established.
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Affiliation(s)
- Goro Kasuya
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Takuma Nomiya
- Department of Radiology, Joban Hospital, Iwaki, Japan
| | - Hirokazu Makishima
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | | | - Daniel K Ebner
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Tokuhiko Omatsu
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Riwa Kishimoto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shigeo Yasuda
- Department of Radiation Oncology, Chiba Rosai Hospital, Chiba, Japan
| | - Tatsuo Igarashi
- Department of Urology, Seirei Sakura Citizen Hospital, Chiba, Japan.,Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo, Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Shimazaki
- Department of Urology, Graduate School of Medicine, Chiba University, 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Kasuya G, Tsuji H, Nomiya T, Makishima H, Haruyama Y, Kobashi G, Ebner DK, Hayashi K, Omatsu T, Kishimoto R, Yasuda S, Igarashi T, Oya M, Akakura K, Suzuki H, Ichikawa T, Shimazaki J, Kamada T. Updated long-term outcomes after carbon-ion radiotherapy for primary renal cell carcinoma. Cancer Sci 2018; 109:2873-2880. [PMID: 29981249 PMCID: PMC6125442 DOI: 10.1111/cas.13727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/03/2018] [Indexed: 12/31/2022] Open
Abstract
Long‐term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon‐ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16‐fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease‐free, cancer‐specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7‐16.5) years; 9 of these patients were inoperable because of comorbidities or advanced‐stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre‐CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non‐renal adverse events. Local control rate, and disease‐free, cancer‐specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long‐term follow‐up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre‐CIRT, and yield favorable treatment outcomes, even in inoperable cases.
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Affiliation(s)
- Goro Kasuya
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Takuma Nomiya
- Department of Radiology, Joban Hospital, Iwaki, Japan
| | - Hirokazu Makishima
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Daniel K Ebner
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Brown University Alpert Medical School, Providence, Rhode Island
| | - Kazuhiko Hayashi
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tokuhiko Omatsu
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Riwa Kishimoto
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shigeo Yasuda
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Chiba Rosai Hospital, Chiba, Japan
| | - Tatsuo Igarashi
- Department of Urology, Seirei Sakura Citizen Hospital, Chiba, Japan.,Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo, Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | | | - Jun Shimazaki
- Department of Urology, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Tadashi Kamada
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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16
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Kasuya G, Ishikawa H, Tsuji H, Haruyama Y, Kobashi G, Ebner DK, Akakura K, Suzuki H, Ichikawa T, Shimazaki J, Makishima H, Nomiya T, Kamada T, Tsujii H. Cancer-specific mortality of high-risk prostate cancer after carbon-ion radiotherapy plus long-term androgen deprivation therapy. Cancer Sci 2017; 108:2422-2429. [PMID: 28921785 PMCID: PMC5715357 DOI: 10.1111/cas.13402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
The treatment outcomes of patients with high‐risk localized prostate cancer (PC) after carbon‐ion radiotherapy (CIRT) combined with long‐term androgen deprivation therapy (LTADT) were analyzed, and compared with those of other treatment modalities, focusing on PC‐specific mortality (PCSM). A total of 1247 patients were enrolled in three phase II clinical trials of fixed‐dose CIRT between 2000 and 2013. Excluding patients with T4 disease, 608 patients with high‐risk or very‐high‐risk PC, according to the National Comprehensive Cancer Network classification system, who received CIRT with LTADT were evaluated. The median follow‐up time was 88.4 months, and the 5‐/10‐year PCSM rates were 1.5%/4.3%, respectively. T3b disease, Gleason score of 9–10 and percentage of positive biopsy cores >75% were associated with significantly higher PCSM on univariate and multivariate analyses. The 10‐year PCSM rates of patients having all three (n = 16), two (n = 74) or one of these risk factors (n = 217) were 27.1, 11.6 and 5.7%, respectively. Of the 301 patients with none of these factors, only 1 PCSM occurred over the 10‐year follow‐up (10‐year PCSM rate, 0.3%), and significant differences were observed among the four stratified groups (P <0.001). CIRT combined with LTADT yielded relatively favorable treatment outcomes in patients with high‐risk PC and very favorable results in patients without any of the three abovementioned factors for PCSM. Because a significant difference in PCSM among the high‐risk PC patient groups was observed, new categorization and treatment intensity adjustment may be required for high‐risk PC patients treated with CIRT.
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Affiliation(s)
- Goro Kasuya
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, Graduate School of Medicine, Tsukuba University, Ibaraki, Japan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Daniel K Ebner
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Brown University Alpert Medical School, Providence, RI, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo, Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Shimazaki
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirokazu Makishima
- 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
| | - Hirohiko Tsujii
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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17
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Kasuya G, Kato H, Yasuda S, Tsuji H, Yamada S, Haruyama Y, Kobashi G, Ebner DK, Okada NN, Makishima H, Miyazaki M, Kamada T, Tsujii H. Progressive hypofractionated carbon-ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials. Cancer 2017; 123:3955-3965. [PMID: 28662297 PMCID: PMC5655922 DOI: 10.1002/cncr.30816] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/29/2017] [Accepted: 05/05/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the safety and efficacy of carbon-ion radiotherapy (CIRT) in patients with hepatocellular carcinoma (HCC) with stepwise dose escalation and hypofractionation in 2 combined prospective trials. METHODS Sequential phase 1/2 (protocol 9603) and phase 2 (protocol 0004) trials were conducted for patients with histologically proven HCC. The phase 1 component of protocol 9603 was a dose-escalation study; CIRT was delivered in 12, 8, or 4 fractions. After determination of the recommended dose, 2 phase 2 trials were performed in an expanded cohort, and the data were pooled to analyze toxicity, local control, and overall survival. RESULTS In the phase 1 component of protocol 9603, 69.6, 58.0, and 52.8 Gy (relative biological effectiveness [RBE]) in 12, 8, and 4 fractions, respectively, constituted the maximum tolerated doses, and 52.8 Gy (RBE) in 4 fractions was established as the recommended dose regimen for the 2 phase 2 studies. In 124 patients with a total of 133 lesions, few severe adverse effects occurred, and local-control and overall survival rates at 1, 3, and 5 years were 94.7% and 90.3%, 91.4% and 50.0%, and 90.0% and 25.0%, respectively; this included 1-, 3-, and 5-year local-control rates of 97.8%, 95.5%, and 91.6%, respectively, in the phase 2 study. In a multivariate analysis, Child-Pugh class B and the presence of a tumor thrombus were significant factors for mortality. CONCLUSIONS The safety and efficacy of CIRT in 12, 8, and 4 fractions were confirmed, with 52.8 Gy (RBE) in 4 fractions established as the recommended treatment course for eligible HCC patients. Cancer 2017;123:3955-65. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Goro Kasuya
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
| | | | - Shigeo Yasuda
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
- Chiba Rosai HospitalChibaJapan
| | - Hiroshi Tsuji
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
| | - Shigeru Yamada
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
| | - Yasuo Haruyama
- Department of Public HealthDokkyo Medical UniversityTochigiJapan
| | - Gen Kobashi
- Department of Public HealthDokkyo Medical UniversityTochigiJapan
| | - Daniel K. Ebner
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
- Brown University Alpert Medical SchoolProvidenceRhode Island
| | - Naomi Nagatake Okada
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
| | - Hirokazu Makishima
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
| | - Masaru Miyazaki
- International University of Health and WelfareMita HospitalTokyoJapan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
| | - Hirohiko Tsujii
- Hospital of the National Institute of Radiological SciencesNational Institutes for Quantum and Radiological Science and TechnologyChibaJapan
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Kasuya G, Ishikawa H, Tsuji H, Nomiya T, Makishima H, Kamada T, Akakura K, Suzuki H, Shimazaki J, Haruyama Y, Kobashi G, Tsujii H. Significant impact of biochemical recurrence on overall mortality in patients with high-risk prostate cancer after carbon-ion radiotherapy combined with androgen deprivation therapy. Cancer 2016; 122:3225-3231. [PMID: 27351298 PMCID: PMC5094521 DOI: 10.1002/cncr.30050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/18/2016] [Accepted: 04/04/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whether biochemical recurrence (BR) is a significant predictive factor of mortality after definitive radiation therapy for prostate cancer remains unknown. The aim of the current study was to investigate the relation between BR and overall mortality (OAM) in high‐risk prostate cancer patients who were treated with carbon‐ion radiotherapy (CIRT) and had long‐term follow‐up in 2 prospective trials. METHODS In the 2 phase 2 clinical trials, which involved 466 prostate cancer patients who received 63.0 to 66.0 Gy of CIRT (relative biological effect) in 20 fractions between 2000 and 2007, 324 patients who were deemed to be at high risk on the basis of the modified D'Amico classification criteria and received CIRT along with androgen‐deprivation therapy (ADT) were examined. The OAM rate was adjusted for the ADT duration, and multivariate analyses using a Cox proportional hazards model were performed for OAM with BR as a time‐dependent covariate. RESULTS The median follow‐up period was 107.4 months, and the 5‐ and 10‐year OAM rates after adjustments for the ADT duration were 7.0% (95% confidence interval [CI], 4.0%‐9.4%) and 23.9% (95% CI, 16.4%‐26.2%), respectively. A multivariate analysis revealed that the presence of BR (hazard ratio, 2.82; 95% Cl, 1.57‐5.08; P = .001) was one of the predictive factors for OAM. On the other hand, the duration of ADT had no impact on OAM. CONCLUSIONS BR after CIRT combined with ADT is an independent predictive factor for OAM in high‐risk prostate cancer patients. The results of this study could be applied to other high‐dose radiation therapies. Cancer 2016;122:3225–31. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. Two prospective phase 2 studies involving 324 high‐risk prostate cancer patients treated with carbon‐ion radiotherapy have revealed that the presence of biochemical recurrence is an independent predictive factor for overall mortality (hazard ratio, 2.82; 95% confidence interval, 1.57‐5.08; P = .001) in patients with high‐risk prostate cancer after carbon‐ion radiotherapy according to a multivariate analysis.
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Affiliation(s)
- Goro Kasuya
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Graduate School of Medicine, Tsukuba University Faculty of Medicine, Ibaraki, Japan
| | - Hiroshi Tsuji
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
| | | | - Hirokazu Makishima
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Tadashi Kamada
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Jun Shimazaki
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hirohiko Tsujii
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
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Kasuya G, Tsuji H. [Carbon ion radiotherapy]. Nihon Rinsho 2016; 74 Suppl 3:546-551. [PMID: 27344791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Toita T, Ariga T, Kasuya G, Hashimoto S, Maemoto H, Heianna J, Kakinohana Y, Murayama S. [Current Status and Perspective of Chemoradiotherapy for Uterine Cervical Cancer]. Gan To Kagaku Ryoho 2015; 42:1156-1161. [PMID: 26489545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Fifteen years has passed since the NCI announced the clinical importance of concurrent chemoradiotherapy (CCRT) in radiotherapy for patients with locoregionally advanced uterine cervical cancer. Numerous clinical trials have been performed to further improve the outcomes of CCRT. In addition to investigations of chemotherapeutic regimens and schedules, adaptation of novel radiotherapy methods such as image-guided brachytherapy (IGBT) and intensity-modulated radiotherapy (IMRT) is encouraged in CCRT for cervical cancer.
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Affiliation(s)
- Takafumi Toita
- Dept. of Radiology, Graduate School of Medical Science, University of the Ryukyus
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Heianna J, Toita T, Endo W, Kasuya G, Ariga T, Hashimoto S, Maemoto H, Terui K, Miura N, Togashi A, Miyauchi T, Murayama S. Concurrent use of strontium-89 with external beam radiotherapy for multiple bone metastases: early experience. Ann Nucl Med 2015; 29:848-53. [PMID: 26266885 DOI: 10.1007/s12149-015-1010-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to consider the safety and efficacy of concurrent use of strontium-89 (Sr-89) with external beam radiotherapy (EBRT) for multiple bone metastases, including lesions that require urgent therapy. METHODS A retrospective review was performed of a consecutive series of patients who received Sr-89 for multiple bone metastases. Forty-five patients with multiple bone metastases received Sr-89 injection. Since 17 of the 45 patients had osteolytic bone lesions requiring emergent EBRT, they underwent concurrent use of Sr-89 with EBRT (concurrent group). The remaining 28 patients, none of whom had osteolytic lesions requiring urgent EBRT, were given Sr-89 injection only (singularity group). The injection of Sr-89 was to be given during EBRT, or on the day before the first day of EBRT. The dose of EBRT was 30 Gy in 10 fractions or 40 Gy in 20 fractions. Adverse events were evaluated according to hematological toxicity as measured by the Common Terminology Criteria for Adverse Events (V4.0). To assess efficacy, we checked changes in the pain scale and analgesic drug dosages, and the presence or absence of serious complications from bone metastases. RESULTS Fifteen of 17 patients (88.2%) in the concurrent group and 17 of 28 patients (60.7%) in the singularity group reported bone pain relief. A statistically significant difference was found between the two groups, and severe complications (spinal cord compression and pathological fracture) from bone metastases could be prevented in all patients in the concurrent group. Severe hematological toxicity (grade 3 or higher) was not observed in the two groups. There was no statistical difference between the two groups. No one required additional intervention. The adverse events were tolerable. CONCLUSIONS The results of our study suggest that concurrent use of Sr-89 with EBRT for multiple bone metastases can be performed safely if it is carried out with care, and that it may be an effective therapy in cases requiring emergency treatment.
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Affiliation(s)
- Joichi Heianna
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Takafumi Toita
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Wataru Endo
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Goro Kasuya
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Takuro Ariga
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Seiji Hashimoto
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hitoshi Maemoto
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Kazuyuki Terui
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Naoki Miura
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Aki Togashi
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Takaharu Miyauchi
- Department of Radiation Oncology, Akita Red Cross Hospital, 222-1, Kamikitate, Saruta, Akita City, 010-1406, Japan
| | - Sadayuki Murayama
- Department of Radiology, Ryukyus University of Medicine, 207, Uehara, Nishihara, Okinawa, 903-0215, Japan
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Kakinohana Y, Toita T, Kasuya G, Ariga T, Heianna J, Murayama S. SU-E-T-123: Dosimetric Comparison Between Portrait and Landscape Orientations in Radiochromic Film Dosimetry. Med Phys 2014. [DOI: 10.1118/1.4888453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Toita T, Kusada T, Kasuya G, Ariga T, Shiina H, Hashimoto S, Maemoto H, Kakinohana Y, Murayama S. EP-1910: Predictive factors for high D2cc of the organs at risk in image-guided brachytherapy for cervical cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)32028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wakayama A, Inamine M, Kudaka W, Nagai Y, Nakamoto T, Ooyama T, Ariga T, Kasuya G, Toita T, Aoki Y. Concurrent chemoradiotherapy for non-bulky stage IB/II cervical cancer without pelvic node enlargement. Anticancer Res 2013; 33:5123-5126. [PMID: 24222159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) has not been extensively studied in patients with small cervical cancer tumors with no pelvic node enlargement. PATIENTS AND METHODS We retrospectively analyzed 55 patients with stage IB1-IIB cervical cancer and tumors of ≤40 mm with no pelvic node enlargement treated with radiotherapy (RT)-alone. RESULTS Cancer recurred in seven patients. Patient age (≤63 years) was identified as an independent factor for better disease-free survival (DFS) (p=0.027), and tumor size (≥25 mm) had a tendency to correlate with reduced locoregional DFS (p=0.089) by the Cox hazard model. Among patients aged 63 years or less, cancer recurred in five out of 18 patients with tumors of ≥25 mm, but in only one of 10 patients with tumors of ≤24 mm. CONCLUSION In patients with stage IB1-IIB cervical cancer and small tumors with no node enlargement, CCRT may provide a better disease control for the group aged 63 years or less and with tumor size of 25 mm or more.
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Affiliation(s)
- Akihiko Wakayama
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, Japan.
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Kasuya G, Toita T, Ariga T, Kakinohana Y, Murayama S. Geometric Factors Predicting High D2 cc Values in Organs at Risk in Patients With Cervical Cancer Treated With Image Guided Brachytherapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ariga T, Toita T, Kasuya G, Nagai Y, Inamine M, Kudaka W, Kakinohana Y, Aoki Y, Murayama S. External beam boost irradiation for clinically positive pelvic nodes in patients with uterine cervical cancer. J Radiat Res 2013; 54:690-696. [PMID: 23365264 PMCID: PMC3709666 DOI: 10.1093/jrr/rrs138] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/21/2012] [Accepted: 12/24/2012] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to retrospectively analyze the treatment results of boost external beam radiotherapy (EBRT) to clinically positive pelvic nodes in patients with uterine cervical cancer. The study population comprised 174 patients with FIGO stages 1B1-4A cervical cancer who were treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT). Patients with positive para-aortic or common iliac nodes (≥10 mm in the shortest diameter, as evaluated by CT/MRI) were ineligible for the study. Fifty-seven patients (33%) had clinically positive pelvic nodes. The median maximum diameter of the nodes was 15 mm (range, 10-60 mm) and the median number of positive lymph nodes was two (range, one to four). Fifty-two of 57 patients (91%) with positive nodes were treated with boost EBRT (6-10 Gy in three to five fractions). The median prescribed dose of EBRT for nodes was 56 Gy. The median follow-up time for all patients was 66 months (range, 3-142 months). The 5-year overall survival rate, disease-free survival rate and pelvic control rate for patients with positive and negative nodes were 73% and 92% (P = 0.001), 58% and 84% (P < 0.001), and 83% and 92% (P = 0.082), respectively. Five of 57 node-positive patients (9%) developed pelvic node recurrences. All five patients with nodal failure had concomitant cervical failure and/or distant metastases. No significant difference was observed with respect to the incidence or severity of late complications by application of boost EBRT. The current retrospective study demonstrated that boost EBRT to positive pelvic nodes achieves favorable nodal control without increasing late complications.
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Affiliation(s)
- Takuro Ariga
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Takafumi Toita
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Goro Kasuya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Yutaka Nagai
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Morihiko Inamine
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Yasumasa Kakinohana
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Youichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
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Kasuya G, Toita T, Furutani K, Kodaira T, Ohno T, Kaneyasu Y, Yoshimura R, Uno T, Yogi A, Ishikura S, Hiraoka M. Distribution patterns of metastatic pelvic lymph nodes assessed by CT/MRI in patients with uterine cervical cancer. Radiat Oncol 2013; 8:139. [PMID: 23758698 PMCID: PMC3682904 DOI: 10.1186/1748-717x-8-139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/01/2013] [Indexed: 11/14/2022] Open
Abstract
Background To investigate the three-dimensional (3D) distribution patterns of clinically metastatic (positive) lymph nodes on pretreatment computed tomography (CT)/magnetic resonance imaging (MRI) images of patients with locally advanced cervical cancer. Methods We enrolled 114 patients with uterine cervical cancer with positive nodes by CT/MRI (≥10 mm in the shortest diameter). Pretreatment CT/MRI data were collected at 6 institutions. The FIGO stage was IB1 in 2 patients (2%), IB2 in 6 (5%), IIA in 3 (3%), IIB in 49 (43%), IIIB in 50 (44%), and IVA in 4 (4%) patients. The median cervical tumor diameter assessed by T2-weighted MRI was 55 mm (range, 10–87 mm). The anatomical distribution of the positive nodes was evaluated on CT/MRI images by two radiation oncologists and one diagnostic radiologist. Results In these patients, 273 enlarged nodes were assessed as positive. The incidence of positive nodes was 104/114 (91%) for the obturator region, 31/114 (27%) for the external iliac region, 16/114 (14%) for the internal iliac region, 22/114 (19%) for the common iliac region, and 6/114 (5%) for the presacral region. The external iliac region was subdivided into four sub-regions: lateral, intermediate, medial, and caudal. The obturator region was subdivided into two sub-regions: cranial and caudal. The majority of patients had positive nodes in the cranial obturator and/or the medial external iliac region (111/114). In contrast, few had positive nodes in the lateral external iliac, caudal external iliac, caudal obturator, internal iliac and presacral regions. All cases with positive nodes in those low-risk regions also had positive nodes in other pelvic nodal regions concomitantly. The incidence of positive nodes in the low-risk regions/sub-regions was significantly related to FIGO stage (p=0.017) and number of positive nodes (p<0.001). Conclusions We demonstrated the 3D distribution patterns of clinical metastatic pelvic lymph nodes on pretreatment CT/MRI images of patients with locally advanced cervical cancer. These findings might contribute to future individualization of the clinical target volume of the pelvic nodes in patients with cervical cancer.
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Affiliation(s)
- Goro Kasuya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.
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Kakinohana Y, Toita T, Ariga T, Kasuya G. SU-E-T-698: Fractal Analysis for Assessing IMRT Modulation Complexity. Med Phys 2013. [DOI: 10.1118/1.4815125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kasuya G, Ogawa K, Iraha S, Nagai Y, Hirakawa M, Toita T, Kakinohana Y, Kudaka W, Inamine M, Ariga T, Aoki Y, Murayama S. Postoperative radiotherapy for uterine cervical cancer: impact of lymph node and histological type on survival. Anticancer Res 2013; 33:2199-2204. [PMID: 23645776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To retrospectively analyze the treatment results of postoperative radiotherapy (PORT) in patients with early-stage uterine cervical cancer. PATIENTS AND METHODS Records of 141 patients with stage IB-IIB uterine cervical cancer treated with PORT from 1985 to 2004 were retrospectively reviewed. The majority of patients received whole-pelvic radiotherapy with antero-posterior fields, and the total radiation doses ranged from 10.8-60 Gy (median: 50.4 Gy). The median follow-up of all 141 patients was 106 months (range: 0.8-273.7 months). RESULTS Multivariate analysis revealed that positive lymph node status (p=0.001) and histological type (p=0.015) were independent prognostic factors for overall survival. The group with three or more involved lymph nodes was significantly more likely to have extra-pelvic recurrence when compared with the groups with no (p=0.006) and up to two lymph nodes (p=0.024), respectively. CONCLUSION PORT yielded excellent pelvic control rates for early-stage uterine cervical cancer. Lymph node status and histological type were significant prognostic factors for overall survival of patients with these tumors.
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Affiliation(s)
- Goro Kasuya
- Department of Radiology, Graduate School of Medical Science University of the Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
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Kasuya G, Ogawa K, Nagai Y, Inamine M, Kudaka W, Toita T, Kakinohana Y, Ariga T, Aoki Y, Murayama S. Outcomes of Postoperative Radiation Therapy for Early-stage Uterine Cervical Cancer. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ariga T, Ogawa K, Shimoji H, Karimata H, Toita T, Kakinohana Y, Kasuya G, Nishimaki T, Yoshimi N, Murayama S. Radical radiotherapy for superficial esophageal cancer: impact of clinical N stage on survival. Anticancer Res 2012; 32:3371-3376. [PMID: 22843917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To retrospectively analyze the results of radical radiotherapy for patients with superficial esophageal cancer (SEC). PATIENTS AND METHODS Forty-eight patients with SEC were reviewed. The median dose of external beam radiotherapy was 66 Gy (range, 30 to 70 Gy). Intraluminal brachytherapy was used in 10 patients, and 15 patients (31%) underwent chemotherapy. The median follow-up period was 28 months (range, 4 to 116 months). RESULTS Sixteen patients had recurrence (11 patients: in-field local recurrence; 3 patients: regional lymph node recurrence; 2 patients: distant metastasis), and the 5-year local control (LC) rate was 74.2%. The 5-year overall survival and disease-free survival (DFS) rates were 44.5% and 48.6%, respectively. Patients with clinical N1 disease (5-year DFS: 0%) had significantly poorer DFS than patients with clinical N0 disease (5-year DFS: 51%, p=0.019). CONCLUSION Radical radiotherapy yielded relatively favorable LC rates in patients with SEC, and clinical N stage was a significant prognostic factor for DFS.
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Affiliation(s)
- Takuro Ariga
- Department of Radiology, University of the Ryukyus, Okinawa, Japan
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Kasuya G, Ogawa K, Iraha S, Nagai Y, Shiraishi M, Hirakawa M, Samura H, Toita T, Kakinohana Y, Kudaka W, Inamine M, Ariga T, Nishimaki T, Aoki Y, Murayama S. Severe late complications in patients with uterine cancer treated with postoperative radiotherapy. Anticancer Res 2011; 31:3527-3533. [PMID: 21965774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Severe late complications, particularly radiation enterocolitis and leg edema, remain major problems in patients with uterine cancer, who have undergone hysterectomy and postoperative external beam radiotherapy (EBRT). We carried out this retrospective analysis to identify the incidence of risk factors for such complications. PATIENTS AND METHODS The records of 228 patients, who underwent radical hysterectomy and postoperative EBRT (uterine cervix: 149 patients; uterine corpus: 79 patients) were reviewed retrospectively. The majority of the patients (90.8%) were treated with 50 to 50.4 Gy EBRT in conventional fractionations with anteroposterior fields. Intracavitary brachytherapy (ICBT) was administered to 9 patients (3.9%), and 35 patients (15.2%) received chemotherapy. The median follow-up for all 228 patients was 81.7 months (range, 1-273 months). RESULTS Nineteen patients (8.3%) developed severe radiation enterocolitis with a median latency of 12.6 months, and the ileum was the most frequently affected site. On multivariate analysis, smoking was an independent predictor of severe radiation enterocolitis. Nineteen patients (8.3%) developed severe leg edema with a median latency of 32.7 months. The degree of leg edema did not improve in any of the 19 patients despite intensive treatment. On multivariate analysis, addition of ICBT was an independent predictor of severe leg edema. CONCLUSION Severe radiation enterocolitis and severe leg edema were each observed in approximately 8% of patients with uterine cancer, who underwent postoperative radiotherapy. Severe radiation enterocolitis correlated strongly with smoking, and severe leg edema correlated strongly with addition of ICBT. These factors should be considered before administering postoperative radiotherapy to uterine cancer patients.
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Affiliation(s)
- Goro Kasuya
- Department of Radiology, University of the Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan
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Ogawa K, Ishiuchi S, Inoue O, Yoshii Y, Saito A, Watanabe T, Iraha S, Toita T, Kakinohana Y, Ariga T, Kasuya G, Murayama S. Phase II trial of radiotherapy after hyperbaric oxygenation with multiagent chemotherapy (procarbazine, nimustine, and vincristine) for high-grade gliomas: long-term results. Int J Radiat Oncol Biol Phys 2011; 82:732-8. [PMID: 21420247 DOI: 10.1016/j.ijrobp.2010.12.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/17/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the long-term results of a Phase II trial of radiotherapy given immediately after hyperbaric oxygenation (HBO) with multiagent chemotherapy in adults with high-grade gliomas. METHODS AND MATERIALS Patients with histologically confirmed high-grade gliomas were administered radiotherapy in daily 2 Gy fractions for 5 consecutive days per week up to a total dose of 60 Gy. Each fraction was administered immediately after HBO, with the time interval from completion of decompression to start of irradiation being less than 15 minutes. Chemotherapy consisting of procarbazine, nimustine, and vincristine and was administered during and after radiotherapy. RESULTS A total of 57 patients (39 patients with glioblastoma and 18 patients with Grade 3 gliomas) were enrolled from 2000 to 2006, and the median follow-up of 12 surviving patients was 62.0 months (range, 43.2-119.1 months). All 57 patients were able to complete a total radiotherapy dose of 60 Gy immediately after HBO with one course of concurrent chemotherapy. The median overall survival times in all 57 patients, 39 patients with glioblastoma and 18 patients with Grade 3 gliomas, were 20.2 months, 17.2 months, and 113.4 months, respectively. On multivariate analysis, histologic grade alone was a significant prognostic factor for overall survival (p < 0.001). During treatments, no patients had neutropenic fever or intracranial hemorrhage, and no serious nonhematologic or late toxicities were seen in any of the 57 patients. CONCLUSIONS Radiotherapy delivered immediately after HBO with multiagent chemotherapy was safe, with virtually no late toxicities, and seemed to be effective in patients with high-grade gliomas.
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Affiliation(s)
- Kazuhiko Ogawa
- Department of Radiology, University of the Ryukyus, Okinawa, Japan.
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Kasuya G, Ogawa K, Nagai Y, Shiraishi M, Hirakawa M, Toita T, Kakinohana Y, Nishimaki T, Aoki Y, Murayama S. Risk Factors of Severe Late Complications in Patients with Uterine Cancer Treated with Postoperative Radiotherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Toita T, Ohno T, Kaneyasu Y, Uno T, Yoshimura R, Kodaira T, Furutani K, Kasuya G, Ishikura S, Kamura T, Hiraoka M. A Consensus-based Guideline Defining the Clinical Target Volume for Pelvic Lymph Nodes in External Beam Radiotherapy for Uterine Cervical Cancer. Jpn J Clin Oncol 2010; 40:456-63. [DOI: 10.1093/jjco/hyp191] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tanaka T, Araki T, Kasuya G, Fujino T, Makita K. [A malignant lymphoma (non-hodgkin lymphoma, follicular type) patient who achieved complete remission by radiochemotherapy]. Gan To Kagaku Ryoho 2009; 36:1931-1934. [PMID: 19920404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 54-year-old female patient visited our hospital as an outpatient in August 2008 for her growing mass thigh, without pain, redness or fever. She had suffered discomfort from that swelling since she had been diagnosed with erysipelas by a dermatologist she had visited 6 months before and received some medication. Suspicious of a subcutaneous soft tissue tumor, we performed a biopsy, and histological examination of the lesion indicated malignant lymphoma (follicular lymphoma grade 2). PET-CT (as of September, 2008) showed abnormal migration at the right inguinocrural and right external iliac lymph nodes. In view of her age and the that rapid exacerbation, we considered chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisolone: R-CHOP) and involved field radiotherapy (IFRT) better to perform than 'watchful wait'. PET-CT (as of November, 2008) after 3 courses of R-CHOP therapy showed abnormal migration had been significantly improved (complete remission on PET-CT) and completely disappeared in the right external iliac lymph nodes. For long-term prognosis and prophylaxis of recurrence, we then added 2 courses of chemotherapy (rituximab alone) and IFRT (30 Gy/20 Fr) as radical therapy. She is now doing well and visits our hospital once a month for follow-up after achieving CR with RECIST guideline.
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Affiliation(s)
- Tohru Tanaka
- Dept. of Internal Medicine/Center for Chemotherapy, Nozaki Tokushukai Hospital
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Kasuya G, Ogawa K, Shimoji H, Tamaki W, Karimata H, Toita T, Kakinohana Y, Ariga T, Nishimaki T, Murayama S. Development of gastro-lymphatic fistula during chemoradiotherapy for advanced esophageal cancer: a case report. Anticancer Res 2009; 29:525-527. [PMID: 19331198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This is a case report of a gastro-lymphatic fistula which appeared during chemoradiotherapy for advanced esophageal cancer. A 60-year-old male was referred to the University of the Ryukyus Hospital because of a 10 kg monthly weight loss and dysphagia. Computed tomography (CT) scans indicated thickened esophageal wall at the lower thoracic esophagus and a swollen lymph node attached to the lesser curvature of the stomach. Histological analysis of the biopsy specimen revealed poorly differentiated squamous cell carcinoma and the diagnosis was of advanced esophageal cancer. A combination of chemotherapy (nedaplatin and 5-fluorouracil) and radiotherapy was initiated. After radiotherapy (20 Gy), CT scans revealed that the swollen lymph node penetrated the gastric wall resulting in a gastro-lymphatic fistula. Although gastrostomy and intestinal fistula repair were performed for gastric decompression and tube feeding, respectively, the patient's general status did not improve and he died two months after interruption of his chemoradiotherapy. The results indicate that there may be some risks of gastro-lymphatic fistula in patients treated with concurrent chemoradiotherapy for advanced esophageal cancer when there are possible signs of involvement by CT scans.
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Affiliation(s)
- Goro Kasuya
- Department of Radiology, University of the Ryukyus, Nishihara-cho, Okinawa, Japan
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