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Mizumoto M, Oshiro Y, Sakurai H. Challenges for breast radiotherapy with SIB: the IMPORT HIGH trial. Lancet 2024; 403:1749-1750. [PMID: 38704167 DOI: 10.1016/s0140-6736(24)00358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/20/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan.
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan; Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
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Niitsu H, Fukumitsu N, Tanaka K, Mizumoto M, Nakai K, Matsuda M, Ishikawa E, Hatano K, Hashimoto T, Kamizawa S, Sakurai H. Methyl- 11C-L-methionine positron emission tomography for radiotherapy planning for recurrent malignant glioma. Ann Nucl Med 2024; 38:305-314. [PMID: 38356008 PMCID: PMC10954960 DOI: 10.1007/s12149-024-01901-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To investigate differences in uptake regions between methyl-11C-L-methionine positron emission tomography (11C-MET PET) and gadolinium (Gd)-enhanced magnetic resonance imaging (MRI), and their impact on dose distribution, including changing of the threshold for tumor boundaries. METHODS Twenty consecutive patients with grade 3 or 4 glioma who had recurrence after postoperative radiotherapy (RT) between April 2016 and October 2017 were examined. The study was performed using simulation with the assumption that all patients received RT. The clinical target volume (CTV) was contoured using the Gd-enhanced region (CTV(Gd)), the tumor/normal tissue (T/N) ratios of 11C-MET PET of 1.3 and 2.0 (CTV (T/N 1.3), CTV (T/N 2.0)), and the PET-edge method (CTV(P-E)) for stereotactic RT planning. Differences among CTVs were evaluated. The brain dose at each CTV and the dose at each CTV defined by 11C-MET PET using MRI as the reference were evaluated. RESULTS The Jaccard index (JI) for concordance of CTV (Gd) with CTVs using 11C-MET PET was highest for CTV (T/N 2.0), with a value of 0.7. In a comparison of pixel values of MRI and PET, the correlation coefficient for cases with higher JI was significantly greater than that for lower JI cases (0.37 vs. 0.20, P = 0.007). D50% of the brain in RT planning using each CTV differed significantly (P = 0.03) and that using CTV (T/N 1.3) were higher than with use of CTV (Gd). V90% and V95% for each CTV differed in a simulation study for actual treatment using CTV (Gd) (P = 1.0 × 10-7 and 3.0 × 10-9, respectively) and those using CTV (T/N 1.3) and CTV (P-E) were lower than with CTV (Gd). CONCLUSIONS The region of 11C-MET accumulation is not necessarily consistent with and larger than the Gd-enhanced region. A change of the tumor boundary using 11C-MET PET can cause significant changes in doses to the brain and the CTV.
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Affiliation(s)
- Hikaru Niitsu
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatoshima-Minamimachi, Kobe, 650-0047, Japan
| | - Keiichi Tanaka
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kentaro Hatano
- Department of Applied Molecular Imaging, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsuyoshi Hashimoto
- Department of Radiology, AIC Imaging Center, 2-1-16 Amakubo, Tsukuba, Ibaraki, 305-0005, Japan
| | - Satoshi Kamizawa
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
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Nitta H, Mizumoto M, Li Y, Oshiro Y, Fukushima H, Suzuki R, Hosaka S, Saito T, Numajiri H, Kawano C, Kamizawa S, Maruo K, Sakurai H. An analysis of muscle growth after proton beam therapy for pediatric cancer. J Radiat Res 2024; 65:251-255. [PMID: 38265112 PMCID: PMC10959433 DOI: 10.1093/jrr/rrad105] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/20/2023] [Indexed: 01/25/2024]
Abstract
Retardation of growth and development is a well-known late effect after radiotherapy for pediatric patients. The goal of the study was to examine the effect of proton beam therapy (PBT) on the growth of muscles included in the irradiated area. The subjects were 17 pediatric patients (age ≤ 5 years) who received PBT with a treatment field including a muscle on only one side out of a pair of symmetrical bilateral muscles and had imaging evaluations for at least 1 year after PBT. The thicknesses of the irradiated and non-irradiated (contralateral) muscles were measured retrospectively on CT or MRI axial images collected before and after PBT. The change of thickness divided by the period (years) for each muscle was compared between the irradiated and contralateral sides. Correlations of muscle growth with irradiation dose and age at the start of treatment were also evaluated. The median observation period was 39.2 months. The measurement sites included the erector spinae (n = 9), gluteus maximus (n = 5) and rhomboids + trapezius (n = 3) muscles. The average changes in muscle thickness were 0.24 mm/year on the irradiated side and 1.19 mm/year on the contralateral side, showing significantly reduced growth on the irradiated side (P = 0.001). Younger patients had greater muscle growth. Irradiation dose was not significant, but muscle growth tended to decrease as the dose increased, and muscles irradiated at >50 Gy (RBE) showed little growth. These results show that muscle growth is affected by PBT and that long-term follow-up is needed to evaluate muscle growth retardation.
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Affiliation(s)
- Hazuki Nitta
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yinuo Li
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
- Department of Child Health, Institute of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Ryoko Suzuki
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
- Department of Child Health, Institute of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Chie Kawano
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Satoshi Kamizawa
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
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Nakamura M, Mizumoto M, Saito T, Shimizu S, Li Y, Oshiro Y, Inaba M, Hosaka S, Fukushima H, Suzuki R, Iizumi T, Nakai K, Maruo K, Sakurai H. A systematic review and meta-analysis of radiotherapy and particle beam therapy for skull base chondrosarcoma: TRP-chondrosarcoma 2024. Front Oncol 2024; 14:1380716. [PMID: 38567162 PMCID: PMC10985235 DOI: 10.3389/fonc.2024.1380716] [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: 02/02/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Chondrosarcoma is a rare malignant bone tumor. Particle beam therapy (PT) can concentrate doses to targets while reducing adverse events. A meta-analysis based on a literature review was performed to examine the efficacy of PT and photon radiotherapy for skull base chondrosarcoma. Methods The meta-analysis was conducted using 21 articles published from 1990 to 2022. Results After PT, the 3- and 5-year overall survival (OS) rates were 94.1% (95% confidence interval [CI]: 91.0-96.2%) and 93.9% (95% CI: 90.6-96.1%), respectively, and the 3- and 5-year local control rates were 95.4% (95% CI: 92.0-97.4%) and 90.1% (95% CI: 76.8-96.0%), respectively. Meta-regression analysis revealed a significant association of PT with a superior 5-year OS rate compared to three-dimensional conformal radiotherapy (p < 0.001). In the studies used in the meta-analysis, the major adverse event of grade 2 or higher was temporal lobe necrosis (incidence 1-18%, median 7%). Conclusion PT for skull base chondrosarcoma had a good outcome and may be a valuable option among radiotherapy modalities. However, high-dose postoperative irradiation of skull base chondrosarcoma can cause adverse events such as temporal lobe necrosis.
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Affiliation(s)
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Shosei Shimizu
- Department of Pediatric Radiation Therapy Center/Pediatric Proton Beam Therapy Center, Hebei Yizhou Cancer Hospital, Zhuozhou, China
| | - Yinuo Li
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masako Inaba
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hiroko Fukushima
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryoko Suzuki
- Department of Child Health, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
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Mizumoto M, Ogino H, Okumura T, Terashima K, Murakami M, Ogino T, Tamamura H, Akimoto T, Waki T, Katoh N, Araya M, Onoe T, Takagi M, Iwata H, Numajiri H, Okimoto T, Uchinami Y, Maruo K, Shibuya K, Sakurai H. Proton Beam Therapy for Hepatocellular Carcinoma: Multicenter Prospective Registry Study in Japan. Int J Radiat Oncol Biol Phys 2024; 118:725-733. [PMID: 37778422 DOI: 10.1016/j.ijrobp.2023.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE A prospective multicenter registry study was started May 2016 in Japan to evaluate the efficacy and safety of proton beam therapy (PBT) for hepatocellular carcinoma (HCC). METHODS AND MATERIALS Patients who received PBT for HCC from May 2016 to June 2018 were registered in the database of the Particle Beam Therapy Committee and Subcommittee of the Japanese Society for Radiation Oncology. Overall survival (OS), progression-free survival (PFS), and local recurrence were evaluated. RESULTS Of the 755 registered patients, 576 with initial PBT and no duplicate cancer were evaluated. At final follow-up, 322 patients were alive and 254 had died. The median follow-up period for survivors was 39 months (0-58 months). The median OS time of the 576 patients was 48.8 months (95% CI, 42.0-55.6 months) and the 1-, 2-, 3-, and 4-year OS rates were 83.8% (95% CI, 80.5%-86.6%), 68.5% (64.5%-72.2%), 58.2% (53.9%-62.2%), and 50.1% (44.9%-55.0%), respectively. Recurrence was observed in 332 patients, including local recurrence in 45 patients. The median PFS time was 14.7 months (95% CI, 12.4-17.0 months) and the 1-, 2-, 3-, and 4-year PFS rates were 55.2% (95% CI, 51.0%-59.2%), 37.5% (33.5%-41.5%), 30.2% (26.3%-34.2%), and 22.8% (18.5%-27.4%), respectively. The 1-, 2-, 3-, and 4-year OS rates were significantly higher for tumor size <5 versus 5 to 10 cm (P < .001) and <5 versus ≥10 cm (P < .001); Child-Pugh score A/B versus C (P < .001); and distance of the tumor from the gastrointestinal tract <1 versus 1 to 2 cm (P < .008) and <1 versus >2 cm (P < .001). At final follow-up, 27 patients (4.7%) had late adverse events of grade 3 or higher, with liver failure (n = 7), and dermatitis (n = 7) being most common. CONCLUSIONS This multicenter prospective data registry indicated that PBT for HCC gives good therapeutic effects (3-year local control rate of 90%) with a low risk of severe late adverse events.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, 462-8508, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, 679-5165, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, 963-8052, Japan
| | - Takashi Ogino
- Medipolis Proton Therapy and Research Center, 4423 Higashikata, Ibusuki, Kagoshima, 891-0304, Japan
| | - Hiroyasu Tamamura
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, Fukui, 910-8526, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, 277-8577, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, Tsuyama, Okayama, 708-0841, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Institute of Medicine, Hokkaido, 060-8648, Japan
| | - Masayuki Araya
- Proton Therapy Center, Aizawa Hospital, Matsumoto, Nagano, 390-8510, Japan
| | - Tsuyoshi Onoe
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Masaru Takagi
- Department of Radiation Oncology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, 065-0033, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, 462-8508, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, 679-5165, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Institute of Medicine, Hokkaido, 060-8648, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan
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Oshiro Y, Mizumoto M, Kato Y, Tsuchida Y, Tsuboi K, Sakae T, Sakurai H. Single isocenter dynamic conformal arcs-based radiosurgery for brain metastases: Dosimetric comparison with Cyberknife and clinical investigation. Tech Innov Patient Support Radiat Oncol 2024; 29:100235. [PMID: 38299171 PMCID: PMC10827586 DOI: 10.1016/j.tipsro.2024.100235] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/14/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Purpose To compare the dosimetric quality of automatic multiple brain metastases planning (MBM) with that of Cyberknife (CK) based on the clinical tumor condition, such as the tumor number, size, and location. Methods 76 treatment plans for 46 patients treated with CK were recalculated with the MBM treatment planning system. Conformity index (CI), homogeneity index (HI), gradient index (GI), lesion underdosage volume factor (LUF), healthy tissue overdose volume factor (HTOF), geometric conformity index (g) and mean dose to normal organs were compared between CK and MBM for tumor number, size, shape and distance from the brainstem or chiasm. Results The results showed that the mean brain dose was significantly smaller in MBM than CK. CI did not differ between MBM and CK; however, HI was significantly more ideal in CK (p = 0.000), and GI was significantly smaller in MBM (P = 0.000). LUF was larger in CK (p = 0.000) and HTOF and g was larger in MBM (p = 0.003, and 0.012). For single metastases, CK had significantly better HTOF (p = 0.000) and g (p = 0.002), but there were no differences for multiple tumors. Brain dose in MBM was significantly lower and CI was higher for tumors < 30 mm (p = 0.000 and 0.000), whereas HTOF and g for tumors < 10 mm were significantly smaller in CK (p = 0.041 and p = 0.016). Among oval tumors, brain dose, GI and LUF were smaller in MBM, but HTOF and g were smaller in CK. There were no particular trends for tumors close to the brainstem, but HTOF tended to be smaller in CK (0.03 vs. 0.29, p = 0.068) for tumors inside the brainstem. Conclusions MBM can reduce the brain dose while achieving a dose distribution quality equivalent to that with CK.
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Affiliation(s)
- Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
| | - Masashi Mizumoto
- Department of Neurosurgery, Tsukuba Central Hospital, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
- Department of Radiation Therapy, University of Tsukuba, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
| | - Yuichi Kato
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
| | - Yukihiro Tsuchida
- Department of Neurosurgery, Tsukuba Central Hospital, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
| | - Koji Tsuboi
- Department of Neurosurgery, Tsukuba Central Hospital, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
| | - Takeji Sakae
- Department of Radiation Therapy, University of Tsukuba, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
| | - Hideyuki Sakurai
- Department of Radiation Therapy, University of Tsukuba, Amakubo 1-3-1, Tsukuba, Ibaraki, 305-8558, Japan
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Niitsu H, Mizumoto M, Li Y, Nakamura M, Ishida T, Iizumi T, Saito T, Numajiri H, Makishima H, Nakai K, Oshiro Y, Maruo K, Sakurai H. Tumor Response on Diagnostic Imaging after Proton Beam Therapy for Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:357. [PMID: 38254846 PMCID: PMC10814092 DOI: 10.3390/cancers16020357] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Follow-up after treatment for hepatocellular carcinoma (HCC) can be mostly performed using dynamic CT or MRI, but there is no common evaluation method after radiation therapy. The purpose of this study is to examine factors involved in tumor reduction and local recurrence in patients with HCC treated with proton beam therapy (PBT) and to evaluate HCC shrinkage after PBT. METHODS Cases with only one irradiated lesion or those with two lesions irradiated simultaneously were included in this study. Pre- and post-treatment lesions were evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) by measuring the largest diameter. RESULTS The 6-, 12-, and 24-month CR + PR rates after PBT were 33.1%, 57.5%, and 76.9%, respectively, and the reduction rates were 25.1% in the first 6 months, 23.3% at 6-12 months, and 14.5% at 13-24 months. Cases that reached CR/PR at 6 and 12 months had improved OS compared to non-CR/non-PR cases. CONCLUSIONS It is possible that a lesion that reached SD may subsequently transition to PR; it is reasonable to monitor progress with periodic imaging evaluations even after 1 year of treatment.
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Affiliation(s)
- Hikaru Niitsu
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Masashi Mizumoto
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Yinuo Li
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Masatoshi Nakamura
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Toshiki Ishida
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Takashi Iizumi
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Takashi Saito
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Haruko Numajiri
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Hirokazu Makishima
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Kei Nakai
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Yoshiko Oshiro
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan;
| | - Hideyuki Sakurai
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
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8
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Nakamura M, Ohnishi K, Nakazawa K, Shimizu K, Miyauchi D, Mizumoto M, Nakai K, Okumura T, Sakurai H. Long-term follow-up of unresectable adenoid cystic carcinoma of the trachea and bronchus treated with high-dose proton beam therapy: A report of two cases. Thorac Cancer 2024; 15:201-205. [PMID: 37984929 PMCID: PMC10788470 DOI: 10.1111/1759-7714.15158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) of the trachea is a rare disease that is slow growing and has a risk of distant metastasis. The standard treatment for ACC of the trachea is surgery, but this tumor is often unresectable. In definitive radiotherapy using photons for unresectable ACC of the trachea, it is sometimes difficult to deliver a sufficient dose to the target without exceeding the tolerable dose to the surrounding normal tissues. Here, we report two cases of ACC of the trachea that received a high dose (74 Gy [relative biological effectiveness]) of proton beam therapy and achieved long-term survival.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
- Department of Radiology, School of MedicineInternational University of Health and WelfareChibaJapan
| | - Kensuke Nakazawa
- Department of Respiratory Medicine, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kei Shimizu
- Department of Respiratory MedicineHitachi General HospitalIbarakiJapan
| | - Daigo Miyauchi
- Department of Health ScreeningSakuragawa Regional Medical CenterIbarakiJapan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Kei Nakai
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
- Department of Radiation OncologyIbaraki Prefectural Central HospitalIbarakiJapan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of MedicineUniversity of TsukubaIbarakiJapan
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9
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Takizawa D, Okumura T, Mizumoto M, Nakai K, Sakurai H. A Case of Circumscribed Choroidal Hemangioma Treated With Proton Beam Therapy and Followed Up for 15 Years. Cureus 2024; 16:e52389. [PMID: 38361666 PMCID: PMC10868711 DOI: 10.7759/cureus.52389] [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] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Circumscribed choroidal hemangiomas are rare and benign tumors but often have a progressive course and are complicated by retinal detachment and glaucoma. The effectiveness of external radiation for large tumors that are difficult to treat with photodynamic therapy was recently reported; however, few studies have conducted long-term follow-ups. We encountered a case of localized choroidal hemangioma that was treated with proton beam therapy and followed up for 15 years. A 37-year-old man was diagnosed with a 10 × 4 mm circumscribed choroidal hemangioma involving the macular area with retinal detachment. Proton beam therapy was performed at 26.4 Gy relative biological effectiveness (RBE) in 8 fractions. The choroidal hemangioma gradually shrank over three years, and the retinal detachment also improved. A cataract developed on the affected side 11 years after irradiation, and eye coordination issues developed 15 years after irradiation. Glaucoma was not observed during the follow-up period; however, visual acuity did not recover, and the patient developed light perception. Although vision was not preserved, proton beam therapy effectively shrank the tumor and maintained quality of life.
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Affiliation(s)
| | - Toshiyuki Okumura
- Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, JPN
- Radiation Oncology, University of Tsukuba, Tsukuba, JPN
| | | | - Kei Nakai
- Radiation Oncology, University of Tsukuba, Tsukuba, JPN
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10
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Watanabe N, Mizumoto M, Amano T, Hosoo H, Yamano A, Zaboronok A, Matsuda M, Takano S, Matsumaru Y, Ishikawa E. Early Response to Radiation Therapy without Surgical Intervention in a Giant Cavernous Sinus Hemangioma with Hydrocephalus: A Case Report. NMC Case Rep J 2023; 10:337-342. [PMID: 38125931 PMCID: PMC10730386 DOI: 10.2176/jns-nmc.2023-0094] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023] Open
Abstract
Cavernous sinus hemangioma (CSH) is a rare vascular malformation, arising from the cavernous sinus. Because of its anatomically complex location, a large lesion can cause a variety of symptoms due to cranial nerve compression. A 69-year-old woman with an unsteady gait was admitted to our hospital, and magnetic resonance imaging revealed an extra-axial giant tumor in the cavernous sinus and enlarged ventricles. A radiographic diagnosis of CSH was made. As the risk of surgical removal was considered high, the patient underwent intensity-modulated radiation therapy of 50.4 Gy in 28 fractions. The size of the tumor decreased markedly over time, and the symptoms improved soon after treatment. A 61.8% reduction in tumor size was confirmed immediately after irradiation, and a 75.9% reduction was revealed at a follow-up visit one year later. We reported a case of a giant CSH with hydrocephalus, where tumor shrinkage was confirmed immediately after radiation therapy, and the symptoms of hydrocephalus improved without surgical intervention.
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Affiliation(s)
- Noriyuki Watanabe
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Taishi Amano
- Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hisayuki Hosoo
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akinari Yamano
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Alexander Zaboronok
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shingo Takano
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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11
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Oshiro Y, Mizumoto M, Hisanaga T, Tanaka K, Komine M, Takahashi M, Kikuchi K, Sakurai H. Abscopal effect with fever of unknown cause during radiotherapy: Two case reports and review of the literature. Exp Ther Med 2023; 26:510. [PMID: 37840568 PMCID: PMC10570764 DOI: 10.3892/etm.2023.12209] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/08/2023] [Indexed: 10/17/2023] Open
Abstract
The abscopal effect is a rare phenomenon that is defined as regression of tumor lesions distant from irradiation targets. At our department, two cases with an abscopal effect with fever of unknown cause (FUC) and an inflammatory response during radiotherapy were encountered. Radiotherapy is a local treatment; therefore, it rarely causes systemic side effects during radiotherapy, and if a patient develops a fever during radiotherapy, it is frequently considered tumor fever. We experienced 2 cases of FUC during irradiation followed by abscopal effect. The obvious relationship between the abscopal effect and the fever remains to be clarified. However, FUC during radiotherapy may be a hint to the abscopal effect, considering that immune response and cytokines are closely related to the abscopal effect.
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Affiliation(s)
- Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan
| | - Ken Tanaka
- Department of Urology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan
| | - Manabu Komine
- Department of Urology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan
| | - Mizuki Takahashi
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Koji Kikuchi
- Department of Urology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki 305-8558, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
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12
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Makishima H, Iizumi T, Saito T, Numajiri H, Nakai K, Mizumoto M, Okumura T, Sakurai H. Proton Beam Therapy for HCC Exceeding up-to-Seven Criteria. Int J Radiat Oncol Biol Phys 2023; 117:e322-e323. [PMID: 37785150 DOI: 10.1016/j.ijrobp.2023.06.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Whilst standard treatment for intermediate-stage hepatocellular carcinoma (HCC) is transcatheter arterial chemoembolization (TACE), those exceeding "up-to-seven" criteria don't respond as such as those within, and systemic therapy is suggested to be more beneficial. This is sought to be both because of the limited efficacy of TACE and its hepatic toxicity. Proton beam therapy (PBT) offers high local control and low toxicity rates, and we hypothesize that the same can be said in this patient group also. We here present the outcome of PBT for primary HCC exceeding "up-to-seven" criteria. MATERIALS/METHODS Primary HCC treated with PBT between 2010 and 2018 were extracted from an all-in treatment database and retrospectively reviewed. (Maximum diameter of the largest tumor in centimeters) + (tumor count) > 7 was considered as exceeding "up-to-seven" criteria. Local recurrence was defined as tumor re-enlargement or the appearance of arterial phase hyperenhancement. Adverse events were evaluated by CTCAE v5.0. Overall survival and recurrence-free survival were determined by the Kaplan-Meier method, and local recurrence was analyzed as cumulative incidence with death as a competing risk. All statistical analyses were done using R. RESULTS Out of 202 primary cases, 79 exceeded the "up-to-seven" criteria. The median tumor diameter was 8.0 cm (range 3.1 - 20 cm) and macroscopic vascular invasion (MVI) was observed in 26 cases. For tumor count, 36 were solitary, 28 were between 2 - 3, and 15 had 4 or more. According to the modified ALBI grade, 38 were grade 1, 18 were grade 2a and 23 were 2b. The prescribed dose was 66 Gy / 10 Fr for 6, 72.6 Gy / 22 Fr for 60, 74 Gy / 37 Fr for 12 and 60 Gy / 15 Fr for one case after relative biological effect weighting of 1.1. With a median follow-up period of 33 months (IQR 15 - 57 months), 2-year overall survival was 62% (95% C.I. 50 - 72%) and median survival time was 37 months (95% C.I. 30 - 52 months). 2-year recurrence-free survival and local recurrence rate were 42% (95% C.I. 30 - 53%) and 8% (95% C.I. 3 - 15%) respectively. Cox regression analysis revealed modified ALBI grade as the only significant risk factor for survival (hazard ratio 1.80, 95% C.I. 1.27 - 2.55, p = 0.0010) among age, sex, alpha-fetoprotein level, MVI, tumor count, and size. Other than one case of early death (2 weeks after treatment) with an unknown causal relationship, there were no adverse events of grade 4 or higher observed. CONCLUSION PBT for primary HCC exceeding "up-to-seven" criteria appears to be safe and effective. Local control of intrahepatic lesions may be beneficial even in intermediate-stage cases, while results of this study suggests that suppression of out-of-field recurrence is required for further survival prolongment.
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Affiliation(s)
- H Makishima
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Saito
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - K Nakai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - M Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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13
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Niitsu H, Makishima H, Iizumi T, Saito T, Numajiri H, Nakai K, Mizumoto M, Okumura T, Sakurai H. Outcome of Proton Beam Therapy for Primary Hepatocellular Carcinoma with "Unfavorable" Macroscopic Classification. Int J Radiat Oncol Biol Phys 2023; 117:e328-e329. [PMID: 37785162 DOI: 10.1016/j.ijrobp.2023.06.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Transcatheter arterial chemoembolization (TACE) is the standard treatment for early to intermediate-stage hepatocellular carcinoma (HCC) unfit for hepatectomy or radiofrequency/microwave ablation (RFA/MWA). Putting aside its hepatic toxicity, local control of TACE is far from satisfactory, especially with non- "simple nodular type" appearances, to an extent where systemic therapy is suggested to be more beneficial. We here analyzed the outcome of proton beam therapy (PBT) for primary HCC by macroscopic classification. MATERIALS/METHODS Primary HCC treated with PBT between 2010 and 2018 were extracted from an all-in treatment database. The macroscopic classification was defined by CT or MRI prior to PBT. Local recurrence was defined as tumor re-enlargement or the appearance of arterial phase hyperenhancement. Adverse events were evaluated by CTCAE v5.0. Overall survival, local control, intrahepatic recurrence-free survival, and extrahepatic recurrence-free survival were determined by the Kaplan-Meier method, and the association with treatment factors was analyzed by log-rank and cox regression model. RESULTS A total of 202 primary HCC cases were extracted, all not a candidate for hepatectomy nor RFA/MWA. Out of them, 75 cases were simple nodular type, 79 were simple nodular type with extranodular growth, 38 were confluent multinodular type, and 10 were infiltrative type. 26 cases were HBV positive, and 84 cases were HCV positive. 35 cases had macroscopic vascular invasion (MVI). With a median follow-up period of 3.72 years (IQR: 1.79-5.85years), the 3-year overall survival rate was 68.1% (95% CI 61.0 - 74.3%), the 3-year local control rate was 89.6% (95% CI 83.4-93.5), the 3-year intrahepatic recurrence-free survival rate was 53.7% (95% CI 45.9-60.8%), and the 3-year extrahepatic recurrence-free survival rate was 87.4% (95% CI: 81.5-91.6%). Simple nodular type had better overall survival (73.2% vs 65.2% p = 0.012) and extrahepatic recurrence free survival (96.9% vs 81.9% p<0.01), but there was no statistically significant difference in local control (92.7% vs 87.6% p = 0.06) and intrahepatic recurrence-free survival (62.0% vs 48.5% p = 0.114). Multivariate analysis of risk factors against OS, including age, sex, AFP, MVI, and macroscopic classification, revealed age and macroscopic classification as independent risk factors. Adverse events of grade 3 included 2 cases of gastrointestinal bleeding, 7 cases of liver function disorder, 1 cases of biliary hemorrhage, and 1 case of pleural effusion. Other than one case of early death (2 weeks after treatment) with an unknown causal relationship, there were no adverse events of grade 4 or severe. CONCLUSION PBT for non- "simple nodular type" primary HCC appears to be safe and effective, whilst suppression of out-of-field recurrence is needed for further survival prolongment.
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Affiliation(s)
- H Niitsu
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Makishima
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Saito
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - K Nakai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - M Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - T Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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14
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Saito T, Mizumoto M, Oshiro Y, Miyamoto T, Kamizawa S, Nakamura M, Ishida T, Makishima H, Numajiri H, Nakai K, Sakae T, Sakurai H. Synchronization of light flash with the irradiation pulse in proton beam therapy: A case report. Tech Innov Patient Support Radiat Oncol 2023; 27:100218. [PMID: 37485049 PMCID: PMC10362298 DOI: 10.1016/j.tipsro.2023.100218] [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: 04/13/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
The correlation between sensory light flash and proton beam delivery was evaluated by measuring the timing of pulse beam delivery and light flash sensing using an event recorder in an 83-year-old patient receiving proton beam therapy (PBT) for nasopharyngeal adenoid cystic carcinoma. The treatment dose was 65 Gy (RBE) in 26 fractions with 2 ports, and both beams included the visual pathway (retina, optic nerve, chiasma). Measurements were obtained in 13 of the 26 fractions. The patient sensed a light flash in all 13 fractions and pressed the recorder button for 426 of the 430 pulsed beam deliveries, giving a sensing rate of 99.1%. The median duration of button-pressing of 0.3 s was almost the same as that of the beam pulse of 0.2 s, with a reaction time lag of 0.35 s. These results suggest a consistency between light flash during PBT and the timing of irradiation.
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Affiliation(s)
- Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Toshio Miyamoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Kamizawa
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | | | - Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | | | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Takeji Sakae
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
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15
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Oshiro Y, Mizumoto M, Miyamoto T, Sumiya T, Fujioka D, Shirataki H, Nakamura M, Ishida T, Iizumi T, Saito T, Numajiri H, Makishima H, Nakai K, Maruo K, Sakae T, Sakurai H. Retrospective Analysis of the Areas Responsible for Light Flash and Odor During Proton Beam Therapy and Photon Therapy. Cureus 2023; 15:e44790. [PMID: 37809274 PMCID: PMC10558275 DOI: 10.7759/cureus.44790] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/10/2023] Open
Abstract
Background Abnormal sensations were frequently experienced by patients who received irradiation of the brain or head and neck region. We have previously suggested correlations with irradiation of the nasal cavity and retina. Purpose We performed a retrospective dose-volume histogram analysis focused on the brain and head and neck tumor to examine the relationship between these abnormal sensations and the details of irradiation. Methods Multivariate logistic regression models were applied for the presence or absence of light flash and odor. Gender, age, radiotherapy method (proton beam therapy vs. photon radiotherapy), dose of retina, optic nerve, chiasmatic gland, pituitary, nasal cavity, oral cavity, frontal lobe, parietal lobe, occipital lobe, temporal lobe, amygdala, and hippocampus were set as candidates of explanatory variables. Results Light flash and odor during radiotherapy have been suggested to be associated with younger age and retina and nasal cavity irradiation. Multivariate analyses including dose-volume histograms indicated that light flash was related to age, chiasmatic gland irradiation, and pituitary dose, and odor was related to age and nasal cavity irradiation. Conclusion Our results indicate that light flash during radiotherapy is caused by irradiation of the visual pathway and that odor is caused by irradiation of the nasal cavity or olfactory bulb.
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Affiliation(s)
- Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, JPN
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Toshio Miyamoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Taisuke Sumiya
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Den Fujioka
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Haruka Shirataki
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Masatoshi Nakamura
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Takashi Iizumi
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
- Department of Radiation Oncology, Ibaraki Prefectual Central Hospital, Tsukuba, JPN
| | - Haruko Numajiri
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | | | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Takeji Sakae
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN
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16
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Sekino Y, Tateishi R, Fukumitsu N, Okumura T, Maruo K, Iizumi T, Numajiri H, Mizumoto M, Minami T, Nakagomi R, Sato M, Asaoka Y, Nakagawa H, Hayata Y, Fujiwara N, Shiina S, Koike K, Sakurai H. Proton Beam Therapy versus Radiofrequency Ablation for Patients with Treatment-Naïve Single Hepatocellular Carcinoma: A Propensity Score Analysis. Liver Cancer 2023; 12:297-308. [PMID: 37817755 PMCID: PMC10561322 DOI: 10.1159/000528537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 11/28/2022] [Indexed: 10/12/2023] Open
Abstract
Introduction Proton beam therapy (PBT) is known to be an effective locoregional treatment for hepatocellular carcinoma (HCC). However, few comparative studies in treatment-naïve cases have been reported. The aim of this study was to compare the survival outcomes of PBT with those of radiofrequency ablation (RFA) in patients with treatment-naïve solitary HCC. Methods Ninety-five consecutive patients with treatment-naïve HCC, a single nodule measuring ≤5 cm in diameter, and a Child-Pugh score of ≤8 who were treated with PBT at the University of Tsukuba Hospital between 2001 and 2013 were enrolled in the study. In addition, 836 patients with treatment-naïve HCC treated by RFA at the University of Tokyo Hospital during the same period were analyzed as controls. Recurrence-free survival (RFS) and overall survival (OS) were compared in 83 patient pairs after propensity score matching. Results The 1-year, 3-year, and 5-year RFS rates were 86.6%, 49.5%, and 35.5%, respectively, in the PBT group and 59.5%, 34.0%, and 20.9% in the RFA group (p = 0.058); the respective OS rates were 97.6%, 77.8%, and 57.1% in the PBT group and 95.1%, 81.7%, and 67.7% in the RFA group (p = 0.16). Regarding adverse effects, no grade 3 or higher adverse events were noted in the PBT; however, two grade 3 adverse events occurred within 30 days of RFA in the RFA group: one hemoperitoneum and one hemothorax. Discussion After propensity score matching, PBT showed no significant difference in RFS and OS compared to RFA. PBT can be an alternative for patients with solitary treatment-naïve HCC.
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Affiliation(s)
- Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshinari Asaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Hayata
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoto Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterological Imaging and Interventional Oncology, Juntendo University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Iizumi T, Okumura T, Hasegawa N, Ishige K, Fukuda K, Seo E, Makishima H, Niitsu H, Takahashi M, Sekino Y, Takahashi H, Takizawa D, Oshiro Y, Baba K, Murakami M, Saito T, Numajiri H, Mizumoto M, Nakai K, Sakurai H. Proton beam therapy for hepatocellular carcinoma with bile duct invasion. BMC Gastroenterol 2023; 23:267. [PMID: 37537527 PMCID: PMC10401805 DOI: 10.1186/s12876-023-02897-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023] Open
Abstract
AIM Hepatocellular carcinoma (HCC) with bile duct invasion (BDI) (BDIHCC) has a poor prognosis. Moreover, due to the paucity of reports, there is no consensus regarding optimal management of this clinical condition yet. The aim of this study was to clarify the efficacy and safety of proton beam therapy (PBT) for BDIHCC. METHODS Between 2009 and 2018, 15 patients with BDIHCC underwent PBT at our institution. The overall survival (OS), local control (LC), and progression-free survival (PFS) curves were constructed using the Kaplan-Meier method. Toxicities were assessed using the Common Terminology Criteria of Adverse Events version 4.0. RESULTS The median follow-up time was 23.4 months (range, 7.9-54.3). The median age was 71 years (range, 58-90 years). Many patients were Child A (n = 8, 53.3%) and most had solitary tumors (n = 11, 73.3%). Additionally, most patients had central type BDI (n = 11, 73%). The median tumor size was 4.0 cm (range, 1.5-8.0 cm). The 1-, 2-, and 3-year OS rates were 80.0%, 58.7% and 40.2%, respectively, and the corresponding LC and PFS rates were 93.3%, 93.3%, and 74.7% and 72.7%, 9.7%, and 0.0%, respectively. Acute grade 1/2 dermatitis (n = 7, 46.7%), and grades 2 (n = 1, 6.7%) and 3 (n = 1, 6.7%) cholangitis were observed. Late toxicities such as grade 3 gastric hemorrhage and pleural effusion were observed. No toxicities of grade 4 or higher were observed. CONCLUSIONS PBT was feasible with tolerable toxicities for the treatment of BDIHCC.
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Affiliation(s)
- Takashi Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan.
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Naoyuki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazunori Ishige
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Gastroenterology, Kasumigaura Medical Center, Ibaraki, Japan
| | - Kuniaki Fukuda
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Gastroenterology, Kasumigaura Medical Center, Ibaraki, Japan
| | - Emiko Seo
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Hikaru Niitsu
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Mizuki Takahashi
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | | | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Takashi Saito
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan
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Shimomura O, Endo M, Makishima H, Yamada T, Hashimoto S, Numajiri H, Miyazaki Y, Doi M, Furuya K, Takahashi K, Moriwaki T, Hasegawa N, Yamamoto Y, Niisato Y, Kobayashi M, Mizumoto M, Nakai K, Saito T, Hoshiai S, Saida T, Mathis BJ, Mori K, Nakajima T, Tsuchiya K, Sakurai H, Oda T. Triple modal treatment comprising with proton beam radiation, hyperthermia, and gemcitabine/nab-paclitaxel for locally advanced pancreatic cancer: a phase I/II study protocol (TT-LAP trial). BMC Cancer 2023; 23:624. [PMID: 37403011 DOI: 10.1186/s12885-023-11110-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Locally advanced pancreatic ductal adenocarcinoma (PDAC), accounting for about 30% of PDAC patients, is difficult to cure by radical resection or systemic chemotherapy alone. A multidisciplinary strategy is required and our TT-LAP trial aims to evaluate whether triple-modal treatment with proton beam therapy (PBT), hyperthermia, and gemcitabine plus nab-paclitaxel is a safe and synergistically effective treatment for patients with locally advanced PDAC. METHODS This trial is an interventional, open-label, non-randomized, single-center, single-arm phase I/II clinical trial organized and sponsored by the University of Tsukuba. Eligible patients who are diagnosed with locally advanced pancreatic cancer, including both borderline resectable (BR) and unresectable locally advanced (UR-LA) patients, and selected according to the inclusion and exclusion criteria will receive triple-modal treatment consisting of chemotherapy, hyperthermia, and proton beam radiation. Treatment induction will include 2 cycles of chemotherapy (gemcitabine plus nab-paclitaxel), proton beam therapy, and 6 total sessions of hyperthermia therapy. The initial 5 patients will move to phase II after adverse events are verified by a monitoring committee and safety is ensured. The primary endpoint is 2-year survival rate while secondary endpoints include adverse event rate, treatment completion rate, response rate, progression-free survival, overall survival, resection rate, pathologic response rate, and R0 (no pathologic cancer remnants) rate. The target sample size is set at 30 cases. DISCUSSION The TT-LAP trial is the first to evaluate the safety and effectiveness (phases1/2) of triple-modal treatment comprised of proton beam therapy, hyperthermia, and gemcitabine/nab-paclitaxel for locally advanced pancreatic cancer. ETHICS AND DISSEMINATION This protocol was approved by the Tsukuba University Clinical Research Review Board (reference number TCRB22-007). Results will be analyzed after study recruitment and follow-up are completed. Results will be presented at international meetings of interest in pancreatic cancer plus gastrointestinal, hepatobiliary, and pancreatic surgeries and published in peer-reviewed journals. TRIAL REGISTRATION Japan Registry of Clinical Trials, jRCTs031220160. Registered 24 th June 2022, https://jrct.niph.go.jp/en-latest-detail/jRCTs031220160 .
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Affiliation(s)
- Osamu Shimomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masato Endo
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | | | - Takeshi Yamada
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Shinji Hashimoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Haruko Numajiri
- Department of Radiation oncology, University of Tsukuba, Ibaraki, Japan
| | - Yoshihiro Miyazaki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Manami Doi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Kazuhiro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | | | - Naoyuki Hasegawa
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | | | - Yusuke Niisato
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Mariko Kobayashi
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation oncology, University of Tsukuba, Ibaraki, Japan
| | - Kei Nakai
- Department of Radiation oncology, University of Tsukuba, Ibaraki, Japan
| | - Takashi Saito
- Department of Radiation oncology, University of Tsukuba, Ibaraki, Japan
| | - Sodai Hoshiai
- Department of Radiology, University of Tsukuba, Ibaraki, Japan
| | - Tsukasa Saida
- Department of Radiology, University of Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kensaku Mori
- Department of Radiology, University of Tsukuba, Ibaraki, Japan
| | | | - Kiichiro Tsuchiya
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation oncology, University of Tsukuba, Ibaraki, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
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Saito T, Nakayama M, Ohnishi K, Tanaka S, Nakamura M, Murakami M, Matsumoto S, Baba K, Fujii K, Mizumoto M, Tabuchi K, Sakurai H. Proton beam therapy in multimodal treatment for locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinus. Radiat Oncol 2023; 18:106. [PMID: 37386495 DOI: 10.1186/s13014-023-02296-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND To evaluate proton beam therapy (PBT) in multimodal treatment for locally advanced squamous cell carcinoma of the nasal cavity and paranasal sinus (NPSCC). METHODS The cases in this study included T3 and T4 NPSCC without distant metastases that were treated at our center using PBT between July 2003 and December 2020. These cases were classified into 3 groups based on resectability and treatment strategy: surgery followed by postoperative PBT (group A); those indicated to be resectable, but the patient refused surgery and received radical PBT (group B); and those declared unresectable based on the extent of the tumor and treated with radical PBT (group C). RESULTS The study included 37 cases, with 10, 9 and 18 in groups A, B and C, respectively. The median follow-up period in surviving patients was 4.4 years (range 1.0-12.3 years). The 4-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 58%, 43% and 58% for all patients; 90%, 70% and 80% in group A, 89%, 78% and 89% in group B; and 24%, 11% and 24% in group C. There were significant differences in OS (p = 0.0028) and PFS (p = 0.009) between groups A and C; and in OS (p = 0.0027), PFS (p = 0.0045) and LC (p = 0.0075) between groups B and C. CONCLUSIONS PBT gave favorable outcomes in multimodal treatment for resectable locally advanced NPSCC, including surgery followed by postoperative PBT and radical PBT with concurrent chemotherapy. The prognosis for unresectable NPSCC was extremely poor, and reconsideration of treatment strategies, such as more active use of induction chemotherapy, may improve outcomes.
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Affiliation(s)
- Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan.
| | - Masahiro Nakayama
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kayoko Ohnishi
- Department of Radiology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shuho Tanaka
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Motohiro Murakami
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Shin Matsumoto
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Keitaro Fujii
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
| | - Keiji Tabuchi
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan
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Mizumoto M, Fukushima H, Miyamoto T, Oshiro Y, Sumiya T, Iizumi T, Saito T, Makishima H, Numajiri H, Hosaka S, Nagatomo K, Yamaki Y, Nakai K, Sakurai H. Analysis of person-hours required for proton beam therapy for pediatric tumors. J Radiat Res 2023; 64:599-601. [PMID: 37134315 PMCID: PMC10214988 DOI: 10.1093/jrr/rrad022] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/22/2023] [Accepted: 03/25/2023] [Indexed: 05/05/2023]
Abstract
Proton beam therapy (PBT) is effective for pediatric tumors, but patients may require sedation and other preparations, which extend the treatment time. Pediatric patients were classified into sedation and non-sedation cases. Adult patients were classified into three groups based on irradiation from two directions without or with respiratory synchronization and patch irradiation. Treatment person-hours were calculated as follows: (time from entering to leaving the treatment room) × (number of required personnel). A detailed analysis showed that the person-hours required for the treatment of pediatric patients are about 1.4-3.5 times greater than those required for adult patients. With the inclusion of additional time for the preparation of pediatric patients, PBT for pediatric cases is two to four times more labor-intensive than for typical adult cases.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroko Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshio Miyamoto
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kumie Nagatomo
- Department of Pediatrics, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yuni Yamaki
- Department of Pediatrics, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
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Fukushima H, Suzuki R, Yamaki Y, Hosaka S, Inaba M, Masumoto K, Muroi A, Tsurubuchi T, Okubo R, Hidaka K, Mizumoto M, Sakurai H, Takada H. Longitudinal health-related quality of life analysis in childhood cancer survivors after proton beam therapy. Int J Clin Oncol 2023:10.1007/s10147-023-02353-7. [PMID: 37209157 DOI: 10.1007/s10147-023-02353-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Whilst proton beam therapy (PBT) for children with cancer is expected to reduce their comorbidities, to date only a limited number of studies have been published. To analyze the long-term comorbidity and health-related quality of life (HRQoL) of childhood cancer survivors (CCSs) after PBT, we conducted a questionnaire-based study. METHODS Questionnaires were sent to CCSs who underwent PBT at the University of Tsukuba Hospital during the period from 1984 to 2020. Scores from 41 CCSs who did not undergo PBT (noPBT-CCSs) and from the general population were used for comparison. RESULTS In total, 110 individuals who underwent PBT participated in the study. Among them, 40 individuals were longitudinally analyzed. The range of change in the scores was significantly greater in the CCSs whose initial scores were low. Although the comorbidity levels were more severe, HRQoL tended to be better in the PBT-CCSs than in the noPBT-CCSs with central nervous system (CNS) or solid tumors, respectively. When compared with the general population, the psychosocial health summary scores and its components were not different in the noPBT-CNS-CCSs. On the other hand, the psychosocial health summary scores and/or at least one of the scores of emotional, social, and school functioning were significantly higher in the other CCSs groups. CONCLUSIONS The HRQoL scores of CCSs with low initial scores can be greatly changed over time. Appropriate psychosocial support for this population is warranted. PBT may avoid reduction in HRQoL in terms of the psychosocial functioning of CCSs with CNS tumors.
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Affiliation(s)
- Hiroko Fukushima
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan.
- Department of Child Health, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ryoko Suzuki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuni Yamaki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masako Inaba
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ai Muroi
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takao Tsurubuchi
- Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Reiko Okubo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kyoko Hidaka
- Department of Clinical Psychology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Hiroshima Y, Ishikawa H, Sumiya T, Murakami M, Nakamura M, Ishida T, Ogawa K, Hisakura K, Mizumoto M, Oda T, Okumura T, Sakurai H. Clinical Impact of Proton Beam Therapy for Postoperative Lymph Node Oligorecurrence of Esophageal Cancer. In Vivo 2023; 37:1253-1259. [PMID: 37103111 DOI: 10.21873/invivo.13202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/11/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM Radiotherapy is a salvage therapy type for postoperative recurrence of esophageal cancer. Compared to conventional photon-based radiotherapy, proton beam therapy can reduce the irradiated dose to the surrounding organs, facilitating the management of patients who are unfit for radiotherapy. In this study, the outcomes and toxicity of proton beam therapy for postoperative lymph node oligorecurrence of esophageal cancer were investigated. PATIENTS AND METHODS We retrospectively evaluated the clinical outcomes and toxicity of 13 sites in 11 patients treated with proton beam therapy for postoperative lymph node oligorecurrence of esophageal cancer. In total, eight men and three women with a median age of 68 years (range=46-83 years) were included. RESULTS The median follow-up period was 20.2 months. During the follow-up period, four patients died of esophageal cancer. Eight of the 11 patients developed recurrence; of these, seven patients had recurrence outside the irradiated field, and one had recurrence inside and outside the irradiated field. The 2-year overall survival, progression-free survival, and local control rates were 48.0%, 27.3%, and 84.6%, respectively. The median survival time was 22.4 months. There were no severe acute or late adverse events. CONCLUSION Proton beam therapy could be a safe and effective treatment method for postoperative lymph node oligorecurrence of esophageal cancer. It may be beneficial even in cases where conventional photon-based radiotherapy is difficult to administer in combination with increased doses or with chemotherapy.
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Affiliation(s)
- Yuichi Hiroshima
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan;
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
- QST hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Toshiki Ishida
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Katsuji Hisakura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan
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Nakamura M, Ishikawa H, Ohnishi K, Baba K, Sumiya T, Murakami M, Hiroshima Y, Mizumoto M, Okumura T, Sakurai H. Long-term Outcomes After Moderate Hypofractionated Proton Therapy for Centrally Located Non-small Cell Lung Cancer. Anticancer Res 2023; 43:2003-2013. [PMID: 37097674 DOI: 10.21873/anticanres.16361] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/AIM To investigate the outcomes of patients with centrally located non-small-cell lung cancer (NSCLC) treated with proton beam therapy (PBT) using moderate hypofractionation. PATIENTS AND METHODS Between 2006 and 2019, 34 patients with centrally located T1-T4N0M0 NSCLC who received moderate hypofractionated PBT were retrospectively reviewed. RESULTS The median follow-up was 50.8 months (range=5.8-100.4 months). The 3-year overall survival, progression-free survival (PFS), and local control rates were 70.4%, 55.5% and 80.5%, respectively. Grade 2 or 3 lung adverse events (AEs) after PBT were observed in five (14.7%) patients; however, grade 3 radiation pneumonitis was observed in one (2.9%) patient. Notably, no grade 4 or higher AEs were observed. Regarding the correlation between the lung dose and proximal bronchial tree maximum dose and grade 2 or higher lung AEs, a weak correlation was observed between the mean lung dose and AEs (p=0.035). Although the clinical target volume (CTV) was a risk factor for poor PFS, no significant correlation was found between the CTV and lung AEs after PBT. CONCLUSION Moderate hypofractionated PBT may be a useful radiotherapy method for centrally located cT1-T4N0M0 NSCLC.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan;
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Radiology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Fukushima H, Mizumoto M, Suzuki R, Yamaki Y, Hosaka S, Inaba M, Tagawa M, Watanabe A, Okunushi T, Masumoto K, Muroi A, Sakurai H, Takada H. Gastrointestinal bleeding/ulcer among paediatric cancer patients after proton beam therapy. Jpn J Clin Oncol 2023:7087169. [PMID: 36974697 DOI: 10.1093/jjco/hyad024] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The details of gastrointestinal bleeding/ulcer in paediatric cancer patients treated with proton beam therapy have not been reported previously. METHODS Patients aged 15 years or younger at the time of proton beam therapy and whose gastrointestinal tract was included in the irradiated field participated. RESULTS A total of 124 patients participated in the study; their median age at irradiation was 5.4 years. Concurrent chemotherapies were vincristine-cyclophosphamide (16 patients), irinotecan-based treatment (16 patients), vincristine-cyclophosphamide-ifosfamide-etoposide (14 patients), other chemotherapy (27 patients) and no chemotherapy (51 patients). Gastrointestinal bleeding/ulcer occurred in four patients (3.2%), with no death due to the bleeding/ulcer. The sites of the gastrointestinal bleeding/ulcer were the stomach (two patients) and the duodenum (two patients). The ages of the four patients at PBT were 5.3, 13.8, 14.2 and 14.8 years, which were significantly older than those of patients without GI bleeding/ulcer (p = 0.017). The maximum irradiated doses to the GI tract in the four patients were 43.2, 45, 50.4 and 50.4 gray equivalent, respectively. The concomitant chemotherapy was vincristine-cyclophosphamide-ifosfamide-etoposide 3 and vincristine-cyclophosphamide 1. Weeks from proton beam therapy to bleeding/ulcer were 15, 20, 22 and 264. DISCUSSION AND CONCLUSIONS Patients who developed gastrointestinal bleeding/ulcer were treated concurrently with vincristine-cyclophosphamide-ifosfamide-etoposide or vincristine-cyclophosphamide, and their ages were older than those of patients without gastrointestinal bleeding/ulcer. Bleeding occurred in the upper gastrointestinal tract in all the cases, and most cases occurred early and during chemotherapy. Upper gastrointestinal irradiation in older children undergoing intensive chemotherapy may increase the risk of developing gastrointestinal complications.
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Affiliation(s)
- Hiroko Fukushima
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ryoko Suzuki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuni Yamaki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masako Inaba
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Manabu Tagawa
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsuko Watanabe
- Department of Pediatric Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama
| | - Tomoko Okunushi
- Department of Pediatrics, Chiba University Hospital, Chiba, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ai Muroi
- Department of Neurosurgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Matsuda M, Mizumoto M, Kohzuki H, Sugii N, Sakurai H, Ishikawa E. High-dose proton beam therapy versus conventional fractionated radiation therapy for newly diagnosed glioblastoma: a propensity score matching analysis. Radiat Oncol 2023; 18:38. [PMID: 36823671 PMCID: PMC9948305 DOI: 10.1186/s13014-023-02236-1] [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: 01/04/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND High-dose proton beam therapy (PBT) uses excellent dose concentricity based on the unique characteristic termed the Bragg peak. PBT is a highly feasible treatment option that improves survival in select patients with newly diagnosed glioblastoma (GBM). However, selection bias remains an issue in prior studies that evaluated the efficacy of PBT. The aim of the present study was to compare the survival outcomes and toxicities of high-dose PBT and conventional radiation therapy (CRT) using propensity score-matched treatment cohorts. METHODS The analysis included patients with newly diagnosed GBM treated with high-dose PBT of 96.6 Gy (RBE) or CRT of 60 Gy from 2010 to 2020. Propensity score generation and 1:1 matching of patients were performed based on the following covariates: age, sex, tumor location, extent of resection, chemotherapy, immunotherapy, and pre-radiation Karnofsky performance scale score. RESULTS From a total of 235 patients, 26 were selected in each group by propensity score matching. The median overall survival (OS) of the PBT group was 28.3 months, while the median OS of the CRT group was 21.2 months. Although acute radiation-related toxicities were equivalent between the PBT and CRT groups, radiation necrosis as a late radiation-related toxicity was observed significantly more frequently in the PBT group. CONCLUSIONS High-dose PBT provided significant survival benefits for patients with newly diagnosed GBM compared to CRT as shown by propensity score matching analysis. Radiation necrosis remains an issue in high-dose PBT; thus, the establishment of an effective treatment strategy centered on bevacizumab would be essential.
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Affiliation(s)
- Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Masashi Mizumoto
- grid.20515.330000 0001 2369 4728Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Hidehiro Kohzuki
- grid.20515.330000 0001 2369 4728Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Narushi Sugii
- grid.20515.330000 0001 2369 4728Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Hideyuki Sakurai
- grid.20515.330000 0001 2369 4728Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Eiichi Ishikawa
- grid.20515.330000 0001 2369 4728Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
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Li Y, Mizumoto M, Oshiro Y, Nitta H, Saito T, Iizumi T, Kawano C, Yamaki Y, Fukushima H, Hosaka S, Maruo K, Kamizawa S, Sakurai H. A Retrospective Study of Renal Growth Changes after Proton Beam Therapy for Pediatric Malignant Tumor. Curr Oncol 2023; 30:1560-1570. [PMID: 36826081 PMCID: PMC9955816 DOI: 10.3390/curroncol30020120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
The purpose of this study was to analyze renal late effects after proton beam therapy (PBT) for pediatric malignant tumors. A retrospective study was performed in 11 patients under 8 years of age who received PBT between 2013 and 2018. The kidney was exposed in irradiation of the primary lesion in all cases. Kidney volume and contour were measured on CT or MRI. Dose volume was calculated with a treatment-planning system. The median follow-up was 24 months (range, 11-57 months). In irradiated kidneys and control contralateral kidneys, the median volume changes were -5.63 (-20.54 to 7.20) and 5.23 (-2.01 to 16.73) mL/year; and the median % volume changes at 1 year were -8.55% (-47.52 to 15.51%) and 9.53% (-2.13 to 38.78%), respectively. The median relative volume change for irradiated kidneys at 1 year was -16.42% (-52.21 to -4.53%) relative to control kidneys. Kidneys irradiated with doses of 10, 20, 30, 40, and 50 GyE had volume reductions of 0.16%, 0.90%, 1.24%, 2.34%, and 8.2% per irradiated volume, respectively. The larger the irradiated volume, the greater the kidney volume was lost. Volume reduction was much greater in patients aged 4-7 years than in those aged 2-3 years. The results suggest that kidneys exposed to PBT in treatment of pediatric malignant tumor show continuous atrophy in follow-up. The degree of atrophy is increased with a higher radiation dose, greater irradiated volume, and older age. However, with growth and maturation, the contralateral kidney becomes progressively larger and is less affected by radiation.
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Affiliation(s)
- Yinuo Li
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
- Correspondence: ; Tel.: +81-29-853-7100; Fax: +81-29-853-7102
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hazuki Nitta
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Chie Kawano
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Yuni Yamaki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Satoshi Kamizawa
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
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Muacevic A, Adler JR, Li Y, Mizumoto M, Kumada H, Ishikawa E, Yamamoto T, Matsumura A, Sakurai H. Boron Neutron Capture Therapy for Recurrent Glioblastoma Multiforme: Imaging Evaluation of a Case With Long-Term Local Control and Survival. Cureus 2023; 15:e33898. [PMID: 36819302 PMCID: PMC9937644 DOI: 10.7759/cureus.33898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Glioblastoma (GBM) is difficult to cure with conventional multimodal treatment and has an extremely poor prognosis. Boron neutron capture therapy (BNCT) is a new particle therapy for malignant tumors in the brain and head and neck region. This radiotherapy utilizes a nuclear reaction between neutrons and a nonradioactive isotope, boron-10. In this method, a boron compound is administered transvenously into the body. The boron compound has the property of being selectively taken up only by the cells of malignant tumors, and the subsequent irradiation with neutrons can destroy malignant tumor cells without damaging normal cells. Since the irradiation dose to normal tissues is reduced in BNCT, it may be possible to re-irradiate malignant tumors that recur after radiotherapy. Clinical trials have reported prolonged survival and safety of BNCT in a small number of patients with refractory malignancies, including GBM, but these reports do not address quality of life or activities of daily living (ADL) after treatment, and there is no information on the assessment of local control by imaging. Here, we report a case of GBM that recurred after surgery, 60 Gy of conventional radiotherapy and standard treatment with temozolomide. The patient achieved long-term local control and survival over five years after BNCT and was able to maintain ADL at home without any specialist care. We describe the case with evaluation using longitudinal magnetic resonance imaging (MRI).
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Tsurubuchi T, Hara K, Takano S, Muroi A, Fukushima H, Mizumoto M, Sakamoto N, Matsuda M, Akutsu H, Sakurai H, Ishikawa E. Factors Influencing Craniospinal Relapse of Intracranial Germinoma After Complete Remission. World Neurosurg 2022; 166:e325-e336. [PMID: 35842173 DOI: 10.1016/j.wneu.2022.07.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the pathomechanism of the recurrence of intracranial germinoma after complete response and to confirm the association of the initial magnetic resonance imaging and therapeutic factors with recurrence. METHODS This study included patients who were followed up for ≥5 years and who were treated in our hospital from 1980 to 2021. Those with germinoma and germinoma with syncytiotrophoblastic giant cells were diagnosed pathologically. Data were categorizedbased on "gender," "single region," "intraventricular dissemination at the initial diagnosis," "hydrocephalus," "types of radiation therapy (RT)," and "chemotherapy." Fisher's exact probability test was used to assess differences between the no recurrence and recurrence groups. RESULTS Among 43 patients, 34 had no recurrence, 5 had delayed recurrence (≥60 months), and 4 had early recurrence (<60 months). Follow-up periods were 143.5 (60-380), 198 (88-222), and 132.5 (75-291) months for the no recurrence, delayed recurrence, and early recurrence groups, respectively. Five patients with delayed recurrence showed 3 intracranial lesions and 2 spinal lesions. Four patients with early recurrence showed 3 intracranial lesions and 1 spinal lesion. Differences in delayed recurrences (focal RT vs. RT including whole-ventricle system; P = 0.0491) were significant in Fisher's exact test. CONCLUSIONS RT including the whole-ventricle system reduces delayed craniospinal relapses including dissemination, local, and distant recurrences even ≥5 years after complete response in patients with primary central nervous system germinoma.
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Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Kei Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shingo Takano
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Neurosurgery, Dokkyo Medical University, Shimotsuga, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Mizumoto M, Oshiro Y, Miyamoto T, Sumiya T, Shimizu S, Iizumi T, Saito T, Makishima H, Numajiri H, Nakai K, Okumura T, Sakae T, Maruo K, Sakurai H. Abnormal sensation during total body irradiation: a prospective observational study. J Radiat Res 2022; 63:792-795. [PMID: 35818297 PMCID: PMC9494512 DOI: 10.1093/jrr/rrac042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Indexed: 06/05/2023]
Abstract
Light flash and odor during radiotherapy are well-known phenomena. Two prospective observational studies have indicated that 55% of patients observed a light flash during irradiation of the retina and 27% of patients sensed an odor during radiotherapy for the nasal cavity. A prospective observational study was performed in all patients at our hospital who received total body irradiation (TBI) between January 2019 to October 2021. Light flash and odor during TBI were examined using the same method as that used in previous studies. A total of 32 patients received TBI during the study period. The patients had a median age of 41 (18-60) years, and included 20 males and 12 females. A survey checklist showed that 14 patients (44%) sensed light and 14 patients (44%) sensed odor during TBI,. The color of the light during irradiation was yellow in six cases, white in four cases, and blue in four cases. The intensity of the light was 2-5 (median 3, 1 is very weak, 5 is very strong) and the time over which the light flash was felt was 4-60 s (median 10 s). Two patients each sensed smells of plastic, ozone and bleach, and others sensed one smell each. The intensity of the odor was 1-4 (median 3, 1 is very weak, 5 is very strong) and the time over which the odor was sensed was 1-25 s (median 3 s). We conclude that light flashes and odors are each sensed by 44% of patients during TBI. Various types of light flashes and odors were reported in this study.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Yoshiko Oshiro
- Corresponding author. Department of Radiation Oncology, University of Tsukuba, 11-1 Tennoudai, Tsukuba, Ibaraki, 305-8575 Japan. Tel: +81-29-853-7100; Fax: +81-29-853-7102; E-mail:
| | - Toshio Miyamoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Takeji Sakae
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
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Mizumoto M, Oshiro Y, Miyamoto T, Sumiya T, Baba K, Murakami M, Shimizu S, Iizumi T, Saito T, Makishima H, Numajiri H, Nakai K, Okumura T, Maruo K, Sakae T, Sakurai H. Light flash and odor during proton beam therapy for pediatric patients: a prospective observational study. Front Oncol 2022; 12:863260. [PMID: 35978807 PMCID: PMC9376462 DOI: 10.3389/fonc.2022.863260] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 01/27/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Light flash and odor during radiation therapy are well-known phenomena, but the details are poorly understood, particularly in pediatric patients. Therefore, we conducted a prospective observational study of these events in pediatric patients (age ≤20 years old) who received radiotherapy at our center from January 2019 to November 2021. Light flash and odor were evaluated using a patient-reported checklist including the presence, strength, and duration of the phenomenon, and color of light or type of odor. 53 patients who received proton therapy (n=47) and photon radiotherapy (n=6) were enrolled in this study. The median age of the patients was 10, ranged from 5 to 20. The patients who was able to see the light flash was 4, and all of them received retina irradiation. This was equivalent to 57% of the patients who received radiotherapy to retina (n=7). The light was bright and colored mainly blue and purple, which seemed to be consistent with Cherenkov light. Odor was sensed by 9 (17%) patients, and seven patients of the 9 received nasal cavity irradiation. This was equivalent to 41% of the patients who received nasal cavity irradiation (n=17). Other 2 patients received proton therapy to brain tumor. The odors were mainly described as plastic, burnt and disinfectant, which may be caused by ozone generated during irradiation. These data suggest that pediatric patients with retinal and nasal cavity irradiation frequently sense light flashes or odor. So adequate care is necessary so that these patients are not worried about this phenomenon.
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Li Y, Shimizu S, Mizumoto M, Iizumi T, Numajiri H, Makishima H, Li G, Sakurai H. Proton Beam Therapy for Multifocal Hepatocellular Carcinoma (HCC) Showing Complete Response in Pathological Anatomy After Liver Transplantation. Cureus 2022; 14:e25744. [PMID: 35812555 PMCID: PMC9264287 DOI: 10.7759/cureus.25744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
We describe a patient with multifocal recurrent hepatocellular carcinoma (HCC) who received proton beam therapy (PBT) and then underwent donation after brain dead (DBD) liver transplantation. The anatomy of the explanted diseased liver was examined pathologically post-transplantation. The patient was a 52-year-old male with hepatitis B virus infection and liver cirrhosis of Child-Pugh class B. Right lobe and caudate lobectomy were performed for primary HCC. However, three recurrent tumors appeared in the remnant liver in segments S2 (two sites) and S4, of sizes 23 mm, 10 mm, and 32 mm, respectively. Liver transplantation was required due to these multiple HCCs and liver cirrhosis, but the patient was ineligible for living donor liver transplantation (LDLT) based on Milan criteria. He was registered as a candidate on the waiting list for DBD transplantation. In consideration of the long waiting time for a deceased donor transplant for more than one year, the progression of multiple recurrent HCCs, and the risk of death, the patient had limited treatment options other than PBT for poor liver function and multifocal HCC and eventually received 65 GyE/18 fractions of PBT. Eleven months after the start of PBT, the tumors remained progression-free and liver function did not deteriorate, allowing the patient to wait for liver transplantation. After transplantation, the histopathology of the explanted liver showed that the left lobe of the liver treated by PBT showed no evidence of solid tumors and tumor cells in visual and microscopic examinations. There was also no significant damage to normal liver tissue. This case demonstrates that PBT is a prospective option for patients with HCC with poor liver function, multiple tumors, and no other treatment options. PBT can achieve control or even complete response of HCC while maintaining liver function and may be an effective pre-transplant method for tumor downstaging and prolonging survival. PBT may enable more people to wait for a donor liver or to become eligible for liver transplantation.
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Nakamura M, Ishikawa H, Ohnishi K, Baba K, Saito T, Sumiya T, Murakami M, Hiroshima Y, Nakai K, Mizumoto M, Okumura T, Sakurai H. Proton Beam Therapy in Elderly Patients With cT1-3N0M0 Non-small Cell Lung Cancer. Anticancer Res 2022; 42:2953-2960. [PMID: 35641259 DOI: 10.21873/anticanres.15778] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To investigate the outcomes of elderly patients with cT1-3N0M0 non-small cell lung cancer (NSCLC) undergoing proton beam therapy (PBT). PATIENTS AND METHODS Between 2009 and 2019, 110 patients receiving hypofractionated PBT for cT1-3N0M0 NSCLC were retrospectively reviewed. RESULTS The median follow-up was 36.5 months (range=4.9-131.0 months). In the elderly group (80 years or older), the 3-year overall survival and progression-free survival rates were 79.8% and 73.9%, respectively, and the corresponding rates in the younger group were 80.5% and 61.2%, respectively. Grade 3 radiation pneumonitis (RP) was observed in 4.4% patients in the young group, whereas no grade 3 RP was observed in the elderly group. Age was not a risk factor for symptomatic RP. There were no significant differences in the survival and adverse events between the elderly and younger groups. CONCLUSION PBT may be a reasonable approach for treating lung cancer in elderly patients with T1-3N0M0 NSCLC.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; .,QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Radiology, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Saito
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kei Nakai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Mizumoto M, Oshiro Y, Sumiya T, Miyamoto T, Baba K, Murakami M, Shimizu S, Iizumi T, Saito T, Makishima H, Numajiri H, Nakai K, Okumura T, Maruo K, Sakae T, Sakurai H. Olfactory Sensations During Proton and Photon Radiotherapy: A Multicenter Prospective Observational Study. Cureus 2022; 14:e22964. [PMID: 35411284 PMCID: PMC8989623 DOI: 10.7759/cureus.22964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose: Patients often report a sense of smell during radiation therapy (RT), but the details of these events are not well understood. The purpose of the study was to evaluate events of smell during photon RT and proton beam therapy (PBT). Methods and materials: The subjects were all adult patients (≥20 years old) treated with photon RT or PBT at two centers from January 2019 to August 2020, with the exclusion of those with communication difficulties or olfactory abnormality. The presence of smell, odor type, intensity (five levels), and time period was examined prospectively using a weekly checklist. Results: A total of 649 courses were examined in 620 patients who received photon RT (n=415) or PBT (n=205). A smell during the procedure was sensed by 51 patients (8.2%). In multivariate logistic regression analysis, nasal cavity dose (p=0.002), age (p<0.001), and photon RT (p=0.018) were identified as significant factors associated with a sense of smell. Smell occurred in only 23/515 patients (4.5%) in whom the nasal cavity was not irradiated, but in 4/19 (21.1%) and 24/86 (27.9%) with nasal cavity maximum isodose lines of 10%-50% and 60%-100%, respectively. Patients who received photon RT sensed a smell (43/415; 10.4%) more frequently than those treated with PBT (8/205; 3.9%). Of the 51 patients who sensed a smell, 32 (63%) reported a burnt smell, eight (16%) a chemical smell, two (4%) a sour smell, and nine another smell (copier machine, sweet, garbage, etc.). Conclusions: The sense of a smell appears to be common during RT and this sensation is significantly associated with the nasal cavity dose, younger age, and photon RT.
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Affiliation(s)
- Masashi Mizumoto
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yoshiko Oshiro
- Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, JPN
| | - Taisuke Sumiya
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Toshio Miyamoto
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Keiichiro Baba
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | | | - Shosei Shimizu
- Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Takashi Iizumi
- Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Takashi Saito
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | | | - Haruko Numajiri
- Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Kei Nakai
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Toshiyuki Okumura
- Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Kazushi Maruo
- Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN
| | - Takeji Sakae
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Hideyuki Sakurai
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
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Ishida T, Ohno T, Saito T, Hiroshima Y, Akito S, Tatsuo I, Yoshida A, Mizumoto M, Sakurai H, Tamaki Y. A Recurrent Solitary Fibrous Tumor With an Exceptional Response to Low-Dose Radiotherapy: A Case Report and Literature Review. Cureus 2022; 14:e21199. [PMID: 35186518 PMCID: PMC8844230 DOI: 10.7759/cureus.21199] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Solitary fibrous tumor (SFT) is a soft tissue tumor derived from mesenchymal cells. We report a case of a giant SFT with insulin-like growth factor 2 (IGF-2) production in the pelvis of an 85-year-old male. SFT was diagnosed in surgery for a complaint of left lower abdominal distension. Subsequent tumor recurrence and progression caused rectal passage obstruction and hypoglycemia. Low-dose radiotherapy of 15 Gy in five fractions was started five years and four months after surgery, initially for a huge tumor around the rectum to improve rectal passage obstruction. The tumor volume shrank from 1054 cc before irradiation to 449 cc at one month and 396 cc at 10 months after irradiation. He had reached 90 years old at that time. Two months after the initial irradiation, similar radiotherapy of 15 Gy in five fractions was performed for a huge tumor in the right abdominal cavity. This tumor decreased from 1874 cc before irradiation to 615 cc at two months and 556 cc at seven months after irradiation. Dexamethasone (2.5 mg) was used for paraneoplastic syndrome at the time of initial radiation but was then reduced and became unnecessary two months after the second irradiation. Acute and late adverse events were mild. The patient is alive 60 months after the first irradiation. This case suggests that low-dose radiotherapy is beneficial as palliative therapy for symptom relief in patients with SFT.
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Affiliation(s)
- Toshiki Ishida
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, JPN
| | - Toshiki Ohno
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, JPN
| | - Takashi Saito
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, JPN
| | - Yuichi Hiroshima
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, JPN
| | - Shikama Akito
- Department of Endocrinology and Metabolism, Ibaraki Prefectural Central Hospital, Kasama, JPN
| | - Iijima Tatsuo
- Department of Pathology, Ibaraki Prefectural Central Hospital, Kasama, JPN
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, JPN
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yoshio Tamaki
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, JPN
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Mizumoto M, Oshiro Y, Miyamoto T, Sumiya T, Murakami M, Baba K, Shimizu S, Iizumi T, Numajiri H, Nakai K, Okumura T, Maruo K, Sakae T, Sakurai H. Light flashes during proton and photon radiotherapy: A multicenter prospective observational study. Tech Innov Patient Support Radiat Oncol 2021; 20:41-45. [PMID: 34901476 PMCID: PMC8637639 DOI: 10.1016/j.tipsro.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/06/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
A total of 88 patients experienced light flashes among 416 who received photon radiotherapy and 205 who received proton beam therapy in our prospective study. The frequency of light flashes during radiotherapy was associated with the retina dose and younger age, and were commonly blue or white light for brain or head and neck irradiation. Light flashes were seen by only 35/524 patients (6.7%) without retinal irradiation, but by 13/33 (39.4%) and 41/64 (64.1%) with retinal maximum isodose lines of 10–50% and 60–100%, respectively. Totals of 52, 15, 15, 9, 16 and 8 patients sensed light of blue, purple, yellow, red, white and other colors, respectively.
Background Patients who receive radiation therapy sometimes complain of a light flash during irradiation. The details of the characteristics of this light have not been described. Purpose To evaluate light flashes during photon and proton radiotherapy. Methods and Materials A prospective observational study was performed in all adult patients (≥20 years old) who received photon and proton therapy at two centers between January 2019 and August 2020, except for patients who could not communicate and those with visual abnormality. Evaluations were obtained for the presence or absence of light flashes, light darkness (7 levels), light intensity (5 levels), frequency, light movement, light flashing, and time seeing the light, using a weekly checklist. Results A total of 650 courses were examined for 621 patients, of whom 416 received photon radiotherapy and 205 received proton beam therapy. The checklist indicated that 88 patients (16.1%) sensed light during photon or proton radiotherapy. In multivariate logistic regression analysis, the factors that were significantly associated with a light flash were a higher retina dose and younger age (p < 0.001). Light flashes were seen by only 35/524 patients (6.7%) for whom the retina was not irradiated, but by 13/33 (39.4%) and 41/64 (64.1%) with maximum isodose lines for the retina of 10–50% and 60–100%, respectively. The numbers of patients who sensed blue, purple, yellow, red, white and other colors were 52, 15, 15, 9, 16 and 8, respectively (multiple selections possible). Light movement was observed by 52 patients (59%). The location of the light was defined as near, far, and middle by 70, 13, and 5 patients, respectively. The median time the light was seen was 10 s. Conclusions Many patients sense light flashes during radiotherapy. The retina dose and a younger age were significantly associated with the frequency of light flashes.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
- Corresponding author at: Departments of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575 Japan.
| | - Toshio Miyamoto
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takeji Sakae
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Matsuda M, Mizumoto M, Kohzuki H, Sugii N, Ishikawa E. RT-4 Treatment outcome of proton beam therapy for glioblastoma. Neurooncol Adv 2021. [PMCID: PMC8664621 DOI: 10.1093/noajnl/vdab159.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction: Proton beam therapy enables high dose irradiation for tumors while reducing the dose to surrounding normal tissue due to the sharp energy peak called the Bragg peak. We retrospectively analyzed the efficacy of the high dose radiotherapeutic strategy using proton beam for glioblastoma (GBM) in our institution. Methods: Twenty-nine patients with newly diagnosed GBM who underwent high dose proton beam therapy concomitant with temozolomide were investigated. All patients received hyperfractionated concomitant radiotherapy consisting of X-ray radiotherapy (50.4Gy in 28 fractions) and proton beam therapy (46.2Gy [RBE] in 28 fractions). The survival outcome and adverse events were analyzed. Results: The median overall survival time and progression free survival time for all 29 patients were 31.0 months (95%CI, 25.9–36.1) and 11.0 months (95%CI, 7.8–14.2), respectively. No significant survival difference according to the MGMT methylation status was shown. Failure patterns after proton beam therapy included 17 cases of local recurrence, 3 cases of distant recurrence, and 5 cases of dissemination. Although there was no significant difference in time to recurrence according to the failure pattern, there was a tendency of longer survival in the local recurrence group. Regarding adverse events, radiation necrosis was observed in 8 cases (including 2 asymptomatic cases). The median time to onset of necrosis after radiation was 18.2 months (95%CI, 10.3–26.2). There were 5 cases of long survivor over 5 years out of 29 cases (17.2%). Of these, 4 cases developed radiation necrosis. Conclusions: Our results indicate that high dose proton beam therapy of 96.6Gy (RBE) prolonged survival in selected GBM patients. Particularly in long survivors, special attention and effective treatment to radiation necrosis is a remaining problem.
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Affiliation(s)
- Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba
| | - Hidehiro Kohzuki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Narushi Sugii
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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Saito T, Ohnishi K, Ishikawa H, Nakamura M, Hoshiai S, Numajiri H, Murofushi KN, Mizumoto M, Okumura T, Sakurai H. Hypofractionated Proton Beam Therapy for cT1-2N0M0 Non-small Cell Lung Cancer Patients With Interstitial Lung Disease. Anticancer Res 2021; 41:5635-5642. [PMID: 34732436 DOI: 10.21873/anticanres.15379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate the outcomes of proton beam therapy (PBT) for early-stage non-small cell lung cancer (NSCLC) in patients with interstitial lung disease (ILD). PATIENTS AND METHODS Between 2002 and 2017, 110 patients receiving hypofractionated PBT for cT1-2N0M0 NSCLC were reviewed. RESULTS Of the 110 patients, 17 were diagnosed with ILD. The median follow-up period was 37.8 months. No significant difference in the 1-year cumulative rate of grade ≥2 pneumonitis was observed between patients with and those without ILD (17.6% vs. 14.1%, p=0.708). The lung doses were significantly lower in patients with than in those without ILD among patients without grade ≥2 pneumonitis. There were no significant differences in overall survival or local recurrence-free rates according to the presence of ILD. CONCLUSION PBT appears to be a feasible and effective treatment for cT1-2N0M0 NSCLC in patients with ILD, but the lung dose should be strictly reduced.
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Affiliation(s)
- Takashi Saito
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; .,Department of Radiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Sodai Hoshiai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keiko Nemoto Murofushi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Iizumi T, Ishikawa H, Sekino Y, Tanaka K, Takizawa D, Makishima H, Numajiri H, Mizumoto M, Nakai K, Okumura T, Sakurai H. Acute toxicity and patient-reported symptom score after conventional versus moderately hypofractionated proton therapy for prostate cancer. J Med Radiat Sci 2021; 69:198-207. [PMID: 34664410 PMCID: PMC9163454 DOI: 10.1002/jmrs.551] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/08/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION To confirm the feasibility of hypofractionated proton beam therapy (PBT), we compared the acute adverse event rates and International Prostate Symptom Score (IPSS) in prostate cancer patients treated with hypofractionated versus conventionally fractionated (2.0 Gy relative biological effectiveness (RBE)/fraction) PBT. METHODS We reviewed 289 patients with prostate cancer, of whom 73, 100, and 116 patients were treated with 2.0, 2.5, and 3.0 Gy (RBE)/fraction, respectively. The endpoints were acute genitourinary and gastrointestinal toxicities and the IPSS, evaluated up to 6 months after PBT initiation. RESULTS No significant differences were found in acute toxicity rates or the IPSS among the fractionation schedules. Diabetes mellitus, age, and androgen deprivation therapy were not identified as factors associated with the IPSS. CONCLUSION There were no significant differences in adverse events or quality of life among the three fractionation schedules early after PBT.
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Affiliation(s)
- Takashi Iizumi
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan.,Department of Radiation Oncology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Keiichi Tanaka
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan.,Department of Radiation Oncology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Daichi Takizawa
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan.,Department of Radiation Oncology, Hitachi General Hospital, Hitachi Ltd., Hitachi, Japan
| | - Hirokazu Makishima
- QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
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Sumiya T, Ishikawa H, Hiroshima Y, Nakamura M, Murakami M, Mizumoto M, Okumura T, Sakurai H. The impact of lymphopenia during chemoradiotherapy using photons or protons on the clinical outcomes of esophageal cancer patients. J Radiat Res 2021:rrab094. [PMID: 34632514 DOI: 10.1093/jrr/rrab094] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Indexed: 06/13/2023]
Abstract
We assessed the development of lymphopenia during concurrent chemoradiotherapy (CRT) using X-ray versus proton beams and the impact on survival in patients with esophageal cancer. Among patients with esophageal cancer who were administered concurrent CRT with a curative intent at our institute from 2014 to 2018, 69 (15 receiving X-ray radiotherapy (XRT) and 54 receiving proton beam therapy [PBT]) who underwent weekly blood testing during treatment were enrolled. The absolute lymphocyte counts (ALC) at 1, 5 and 6 weeks were significantly higher in the patients who received PBT than in those who received XRT (p = 0.002, p = 0.006 and p = 0.009, respectively), and a similar trend in the neutrophil-to-lymphocyte ratio (NLR) was observed (p = 0.003 at 5 weeks). The 2-year overall survival (OS) and progression-free survival (PFS) rates tended to be higher in the patients who maintained an ALC ≥200 compared with those who did not (p = 0.083 and p = 0.053, respectively), and similar trends were observed in the NLR (p = 0.061 and p = 0.038, respectively). Dose-volume analysis revealed significant correlations between volumes of the thoracic bones irradiated by 5-50 Gy and minimum ALCs and maximum NLR. These findings suggested that PBT prevented the development of lymphopenia during CRT by reducing the irradiated volume of the thoracic bone, and the maintained lymphocyte count is possibly one of the early predictors for survival in patients with esophageal cancer.
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Affiliation(s)
- Taisuke Sumiya
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
- National Institutes for Quantum and Radiological Science and Technology, QST Hospital, Chiba, Chiba 263-8555, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki 305-8575, Japan
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Mizumoto M, Liang HK, Oshiro Y, Matsuda M, Kohzuki H, Iizumi T, Numajiri H, Nakai K, Okumura T, Ishikawa E, Sakurai H. Radiation Therapy for Grade 3 Gliomas: Correlation of MRI Findings With Prognosis. Cureus 2021; 13:e16887. [PMID: 34513462 PMCID: PMC8416380 DOI: 10.7759/cureus.16887] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Postoperative radiotherapy is usually indicated for both grade 3 glioma and grade 4 glioblastoma. However, the treatment results and tumor features of grade 3 glioma clearly differ from those of glioblastoma. There is limited information on outcomes and tumor progression for grade 3 glioma. In this study, we evaluate the result of postoperative radiotherapy for grade 3 glioma and focus on the correlation of MRI findings with prognosis. Methods In this study, 99 of 110 patients with grade 3 glioma who received postoperative radiotherapy and were followed up for more than one year were retrospectively analyzed. The total irradiation dose was 60.0 Gy in 30 fractions, and daily temozolomide or two cycles of nimustine (ACNU) was concurrently administered during radiotherapy. The median follow-up period was 46 months (range: 2-151 months). Results In multivariate analysis, pathology [anaplastic oligodendroglioma (AO) vs. anaplastic astrocytoma (AA)], the status of surgical resection (biopsy vs. partial resection or more), and contrast enhancement (enhanced by MRI image or not) were significant factors for overall survival (OS). The five-year OS for AO vs. AA cases were 76.8% vs. 46.1%, total to partial resection vs. biopsy cases were 72.7% vs. 21.0%, and non-enhanced vs. enhanced cases were 82.5% vs. 45.6%, respectively. In multivariate analysis, the status of surgical resection and longer extension of preoperative edema (PE) were significant factors for progression-free survival (PFS). The five-year PFS for the total to partial resection vs. biopsy cases were 52.9% vs. 10.7%, and non-extensive PE vs. extensive PE (EPE) cases were 62.2% vs. 19.1%, respectively. Conclusion Our results suggest that a contrast-enhanced tumor on MRI and a longer PE may also be significantly associated with OS and PFS among grade 3 glioma patients.
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Affiliation(s)
- Masashi Mizumoto
- Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Hsiang-Kuang Liang
- Department of Biomedical Engineering, National Taiwan University, Taipei, TWN.,Division of Radiation Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, TWN.,Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, TWN
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, JPN
| | | | | | - Takashi Iizumi
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Haruko Numajiri
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
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Iizumi T, Okumura T, Maruo K, Baba K, Murakami M, Shimizu S, Saito T, Nakajima M, Makishima H, Numajiri H, Mizumoto M, Nakai K, Sakurai H. 943P Long-term outcome of the oldest-old patients (85 years or older) underwent proton beam therapy for hepatocellular carcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.163] [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: 11/29/2022] Open
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42
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Liang HKT, Mizumoto M, Ishikawa E, Matsuda M, Tanaka K, Kohzuki H, Numajiri H, Oshiro Y, Okumura T, Matsumura A, Sakurai H. Peritumoral edema status of glioblastoma identifies patients reaching long-term disease control with specific progression patterns after tumor resection and high-dose proton boost. J Cancer Res Clin Oncol 2021; 147:3503-3516. [PMID: 34459971 PMCID: PMC8557163 DOI: 10.1007/s00432-021-03765-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/27/2021] [Accepted: 08/13/2021] [Indexed: 01/22/2023]
Abstract
Background Glioblastoma peritumoral edema (PE) extent is associated with survival and progression pattern after tumor resection and radiotherapy (RT). To increase tumor control, proton beam was adopted to give high-dose boost (> 90 Gy). However, the correlation between PE extent and prognosis of glioblastoma after postoperative high-dose proton boost (HDPB) therapy stays unknown. We intend to utilize the PE status to classify the survival and progression patterns. Methods Patients receiving HDPB (96.6 GyE) were retrospectively evaluated. Limited peritumoral edema (LPE) was defined as PE extent < 3 cm with a ratio of PE extent to tumor maximum diameter of < 0.75. Extended progressive disease (EPD) was defined as progression of tumors extending > 1 cm from the tumor bed edge. Results After long-term follow-up (median 88.7, range 63.6–113.8 months) for surviving patients with (n = 13) and without (n = 32) LPE, the median overall survival (OS) and progression-free survival (PFS) were 77.2 vs. 16.7 months (p = 0.004) and 13.6 vs. 8.6 months (p = 0.02), respectively. In multivariate analyses combined with factors of performance, age, tumor maximum diameter, and tumor resection extent, LPE remained a significant factor for favorable OS and PFS. The rates of 5-year complete response, EPD, and distant metastasis with and without LPE were 38.5% vs. 3.2% (p = 0.005), 7.7% vs. 40.6% (p = 0.04), and 0% vs. 34.4% (p = 0.02), respectively. Conclusions The LPE status effectively identified patients with relative long-term control and specific progression patterns after postoperative HDPB for glioblastoma. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03765-6.
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Affiliation(s)
- Hsiang-Kuang Tony Liang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Radiation Oncology, National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan
- Division of Radiation Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keiichi Tanaka
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hidehiro Kohzuki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Ishikawa E, Sugii N, Matsuda M, Kohzuki H, Tsurubuchi T, Akutsu H, Takano S, Mizumoto M, Sakurai H, Matsumura A. Maximum resection and immunotherapy improve glioblastoma patient survival: a retrospective single-institution prognostic analysis. BMC Neurol 2021; 21:282. [PMID: 34281518 PMCID: PMC8287820 DOI: 10.1186/s12883-021-02318-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/19/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Glioblastoma (GBM) is a refractory disease with a poor prognosis and various methods, including maximum resection and immunotherapy, have been tested to improve outcomes. In this retrospective study we analyzed the prognostic factors of 277 newly diagnosed GBM patients over 11 years of consecutive cases at our institution to evaluate the effect of these methods on prognosis. Various data, including the extent of removal (EOR) and type of adjuvant therapy, were examined and prognostic relationships were analyzed. The median overall survival (OS) of the entire 277-case cohort, 200 non-biopsy cases, and 77 biopsy cases was 16.6 months, 19.7 months, and 9.7 months, respectively. Gross total removal (GTR; 100% of EOR) was achieved in 32.9% of the cases. Univariate analysis revealed younger age, right side, higher Karnofsky performance status, GTR, intraoperative magnetic resonance imaging (MRI) use for removal, proton therapy, combination immunotherapy, and discharge to home as good prognostic factors. Intraoperative MRI use and EOR were closely related. In the multivariate analysis, GTR, proton therapy, and a combination of immunotherapies, including autologous formalin-fixed tumor vaccine, were the significant prognostic factors. A multivariate analysis of 91 GTR cases showed that immunotherapy contributed to prognostic improvements. The median OS and 5-year OS % values were 36.9 months and 43.3% in GTR cases receiving immunotherapy. In conclusion, GTR, proton therapy, and immunotherapy were good prognostic factors in single-center GBM cases. Tumor vaccine therapy for GTR cases achieved a notably high median survival time and long-term survival ratio, indicating its usefulness in GTR cases.
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Affiliation(s)
- Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Narushi Sugii
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hidehiro Kohzuki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shingo Takano
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Iizumi T, Okumura T, Sekino Y, Takahashi H, Tsai YL, Takizawa D, Ishida T, Hiroshima Y, Nakamura M, Shimizu S, Saito T, Numajiri H, Mizumoto M, Nakai K, Sakurai H. Long-term clinical outcomes of patients receiving proton beam therapy for caudate lobe hepatocellular carcinoma. J Radiat Res 2021; 62:682-687. [PMID: 34036362 PMCID: PMC8273797 DOI: 10.1093/jrr/rrab040] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/27/2021] [Indexed: 05/09/2023]
Abstract
Hepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scarce. Therefore, the present study aimed to investigate the outcomes of this group of patients. Thirty patients with caudate HCC who underwent definitive PBT between February 2002 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose. The median follow-up period was 37.5 (range, 3.0-152.0) months. The overall survival (OS) rates at one, three and five years were 86.6%, 62.8% and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02) and a low serum alpha-fetoprotein level (AFP; P < 0.01) were significant factors predicting longer survival. The local control (LC) rates at one, three and five years were 100%, 85.9% and 85.9%, respectively, while the corresponding progression-free survival (PFS) rates were 65%, 27.5% and 22%, respectively. No grade 3 or worse adverse events were observed. PBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.
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Affiliation(s)
- Takashi Iizumi
- Corresponding author. Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan. TEL: +81-29-853-7100; FAX: +81-29-853-7102; E-mail:
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Yuta Sekino
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Yu-Lun Tsai
- Department of Radiation Oncology, Cathay General Hospital, Taipei, 106, Taiwan
| | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Ibaraki, 317-0077, Japan
| | - Toshiki Ishida
- Department of Radiation Therapy, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Ibaraki, 309-1793, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Takashi Saito
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Kei Nakai
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Centre, University of Tsukuba, Ibaraki 305-8576, Japan
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Hiroshima Y, Ishikawa H, Murakami M, Nakamura M, Shimizu S, Enomoto T, Oda T, Mizumoto M, Nakai K, Okumura T, Sakurai H. Proton Beam Therapy for Local Recurrence of Rectal Cancer. Anticancer Res 2021; 41:3589-3595. [PMID: 34230155 DOI: 10.21873/anticanres.15147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Curing local recurrence of rectal cancer (LRRC) is difficult with conventional photon radiotherapy. Proton beam therapy (PBT) on the other hand, has unique physical characteristics that permit higher doses to LRRC while minimizing side effects on surrounding organs. However, the efficacy of PBT on controlling rectal cancer recurrence has not yet been reported. This study aimed to evaluate clinical outcomes and toxicities of PBT for LRRC. PATIENTS AND METHODS Clinical outcomes were retrospectively evaluated for 12 patients with 13 total lesions that had received PBT for LRRC at our institute. RESULTS The median follow-up period from the initiation of PBT was 35.6 months. The 3-year local control, progression-free survival and overall survival rates were 80.2%, 10.4% and 73.8%, respectively. Median survival time was 67.1 months. There were no severe acute or late adverse events. CONCLUSION PBT could be a safe and effective treatment method for LRRC.
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Affiliation(s)
- Yuichi Hiroshima
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan;
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan.,QST hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tsuyoshi Enomoto
- Department of GI & HBP Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tatsuya Oda
- Department of GI & HBP Surgery, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kei Nakai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Japan
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Oshiro Y, Mizumoto M, Sekino Y, Maruo K, Ishida T, Sumiya T, Nakamura M, Ohkawa A, Takizawa D, Okumura T, Tamaki Y, Sakurai H. Risk factor of pneumonitis on dose-volume relationship for chemoradiotherapy with durvalumab: Multi-institutional research in Japan. Clin Transl Radiat Oncol 2021; 29:54-59. [PMID: 34151033 PMCID: PMC8190008 DOI: 10.1016/j.ctro.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/19/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To estimate appropriate dose-volume parameters for avoidance of pneumonitis in use of chemoradiotherapy and durvalumab for treatment of lung cancer. Materials and methods Patients with non-small cell lung cancer treated with concurrent chemoradiotherapy followed by durvalumab at 9 centers were enrolled in the study. Three-dimensional radiotherapy, intensity modulated radiotherapy, and proton beam therapy were used. The frequency and severity of pneumonitis and the dose-volume relationship for normal lung were evaluated. Univariable and multivariable analyses were conducted to identify risk factors. A covariate adjusted hazard ratio was then estimated for the percentages of normal lung volume irradiated at ≥ X Gy (Vx) (X = 5-40) and lung volume non-irradiated at ≥ X Gy (X = 5-40), with the covariates selected in the variable selection. Cumulative incidence functions and covariate adjusted hazard ratios were also estimated for dichotomized variables, with estimated cut-off points. Results A total of 91 patients were enrolled in the study. The median time from the start of radiotherapy to development of pneumonitis was 4.1 months. Pneumonitis was observed in 80 patients (88%), including grade 2 or severe pneumonitis in 31 (34%) and ≥ grade 3 pneumonitis in 11 (12%). Pneumonitis was inside the irradiation field in 73 of the 80 patients (91%). The selected factors for ≥ grade 2 pneumonitis were V20, and primary site (upper lobe) in multivariable analysis. The cut off value of V20 was 18.99%, and there was a significant difference between V20 of < 18.77 and ≥ 18.77. Conclusion Though there are some limitation of this study, the basic concept of concurrent chemoradiotherapy with an emphasis on V20 remains unchanged in use of durvalumab. However, we recommend reduction of V20 to as small a value as possible in use of this therapy.
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Affiliation(s)
- Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Ibaraki, Japan.,Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibarakihigashi National Hospital, Ibaraki Japan
| | - Yuta Sekino
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki, Japan
| | - Taisuke Sumiya
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Mito Kyodo General Hospital, Ibaraki, Japan
| | | | - Ayako Ohkawa
- Department of Radiation Oncology, Mito Medical Center Hospital, Ibaraki, Japan
| | - Daichi Takizawa
- Department of Radiation Oncology, Hitachi General Hospital, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibaraki Seinan Medical Center Hospital, Ibaraki, Japan
| | - Yoshio Tamaki
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan.,Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
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Sato H, Mizumoto M, Okumura T, Sakurai H, Sakamoto N, Akutsu H, Ishikawa E, Tsuboi K. Long-term outcomes of patients with unresectable benign meningioma treated with proton beam therapy. J Radiat Res 2021; 62:427-437. [PMID: 33855438 PMCID: PMC8127652 DOI: 10.1093/jrr/rrab017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Indexed: 05/07/2023]
Abstract
This study aimed to evaluate the long-term efficacy of proton beam therapy (PBT) for unresectable benign meningiomas at the University of Tsukuba, Japan. From 1986-1998, 10 patients were treated at the Particle Radiation Medical Science Center (PRMSC) with a relative biological effectiveness (RBE) value of 1.0 using an accelerator built for physics experiments. The total dose was compensated with an X-ray in three patients. Following that, from 2002-2017, 17 patients were treated with a RBE value of 1.1 at the Proton Medical Research Center (PMRC) which was built for medical use. At the PRMSC, the total dose ranged from 50.4-66 Gy (median: 54 Gy). During the follow-up, which lasted between 3.8 and 31.6 years (median: 25.1 years), the 5-, 10-, 15-, 20- and 30-year local control rates were 100%, and the 5-, 10-, 15-, 20- and 30-year survival rates were 90, 80, 70, 70 and 36%, respectively. One patient died of brainstem radiation necrosis 5.1 years after PBT. At PMRC, the total dose ranged from 45.0-61.2 GyE, with a median of 50.4 GyE. During the follow-up, which lasted between 3 and 17 years with a median of 10.5 years, the 5-, 10- and 15-year local control rates were 94.1%, and the 5-, 10- and 15-year survival rates were 100, 100 and 88.9%, respectively. Neither malignant transformation nor secondary malignancy was observed, indicating that fractionated PBT may be effective and safely control benign unresectable meningioma even for the lifelong period of time.
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Affiliation(s)
- Hiroshige Sato
- Biomedical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Beam Therapy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Beam Therapy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Beam Therapy Center, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Noriaki Sakamoto
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Koji Tsuboi
- Tumor Therapy Center, Tsukuba Central Hospital, 1589-3 Kashiwada, Ushiku, Ibaraki 300-1211, Japan
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Mizumoto M, Oshiro Y, Tsujino K, Shimizu S, Iizumi T, Numajiri H, Nakai K, Okumura T, Soejima T, Sakurai H. Photon or Proton Therapy for Adolescent and Young Adult Tumors Focused on Long-Term Survivors. Cureus 2021; 13:e14627. [PMID: 34055504 PMCID: PMC8144073 DOI: 10.7759/cureus.14627] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background This study was conducted to evaluate late toxicities in adolescent and young adult (AYA) patients who received photon or proton therapy. Methodology A total of 106 AYA patients who received proton and photon therapy and were followed-up for more than two years were retrospectively evaluated. The median age of patients was 22 years (range, 15-29 years). A total of 47 patients were male and 59 were female. A total of 35 and 71 patients received photon and proton therapy, respectively. All but one patient received radiotherapy with curative intent. The target disease was benign and malignant in 28 and 78 patients, respectively. Results The median follow-up period in all patients was 62 months (range: 24-293 months). Grade 3 or higher toxicity was observed in 20 patients. There was one case of grade 5 toxicity (myelodysplastic syndrome), which was probably due to chemotherapy. No other secondary cancers were observed. Regarding life events, 15 and 88 patients were married and unmarried at the start of radiotherapy, respectively. Of the 88 unmarried patients, five were married after radiotherapy. Occupation and education were evaluated in 71 patients. Of the 71 patients, 33 were students, 21 were employed, and 16 were unemployed. Of the 33 students, eight were employed and 11 were at a higher educational grade after radiotherapy. Of the 21 employed patients, 17 had the same jobs and four had lost their jobs after radiotherapy. For the 16 unemployed patients, all remained unemployed. Conclusions This study is one of the largest studies to focus on life after radiation therapy among AYAs and suggests that cancer treatment has an influence on life events.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, JPN
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, JPN
| | - Shosei Shimizu
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Takashi Iizumi
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Haruko Numajiri
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, JPN
| | | | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN
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Mizumoto M, Fuji H, Miyachi M, Soejima T, Yamamoto T, Aibe N, Demizu Y, Iwata H, Hashimoto T, Motegi A, Kawamura A, Terashima K, Fukushima T, Nakao T, Takada A, Sumi M, Oshima J, Moriwaki K, Nozaki M, Ishida Y, Kosaka Y, Ae K, Hosono A, Harada H, Ogo E, Akimoto T, Saito T, Fukushima H, Suzuki R, Takahashi M, Matsuo T, Matsumura A, Masaki H, Hosoi H, Shigematsu N, Sakurai H. Proton beam therapy for children and adolescents and young adults (AYAs): JASTRO and JSPHO Guidelines. Cancer Treat Rev 2021; 98:102209. [PMID: 33984606 DOI: 10.1016/j.ctrv.2021.102209] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 09/23/2020] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022]
Abstract
Children and adolescents and young adults (AYAs) with cancer are often treated with a multidisciplinary approach. This includes use of radiotherapy, which is important for local control, but may also cause adverse events in the long term, including second cancer. The risks for limited growth and development, endocrine dysfunction, reduced fertility and second cancer in children and AYAs are reduced by proton beam therapy (PBT), which has a dose distribution that decreases irradiation of normal organs while still targeting the tumor. To define the outcomes and characteristics of PBT in cancer treatment in pediatric and AYA patients, this document was developed by the Japanese Society for Radiation Oncology (JASTRO) and the Japanese Society of Pediatric Hematology/Oncology (JSPHO).
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Affiliation(s)
- Masashi Mizumoto
- Departments of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroshi Fuji
- Department of Radiology and National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Toshinori Soejima
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Kobe, Hyogo, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Aichi, Japan
| | - Takayuki Hashimoto
- Department of Radiation Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Atsufumi Kawamura
- Department of Neurosurgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Keita Terashima
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Fukushima
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomohei Nakao
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Akinori Takada
- Department of Radiology, Mie University Hospital, Tsu-shi, Mie, Japan
| | - Minako Sumi
- Department of Radiation Oncology and Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Radiation Oncology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | | | - Kensuke Moriwaki
- Department of Medical Statistics, Kobe Pharmaceutical University, Kobe, Hyogo, Japan
| | - Miwako Nozaki
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yuji Ishida
- Department of Pediatrics, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Keisuke Ae
- Department of Orthopaedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ako Hosono
- Department of Pediatric Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Takashi Saito
- Departments of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroko Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryoko Suzuki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mitsuru Takahashi
- Department of Orthopaedic Oncology, Shizuoka Cancer Center Hospital, Nagaizumi, Shizuoka, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Akira Matsumura
- Departments of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hidekazu Masaki
- Proton Therapy Center, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Sakurai
- Departments of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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50
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Sawada T, Mizumoto M, Oshiro Y, Numajiri H, Shimizu S, Hiroshima Y, Nakamura M, Iizumi T, Okumura T, Sakurai H. Long-term follow up of a patient with a recurrent desmoid tumor that was successfully treated with proton beam therapy: A case report and literature review. Clin Transl Radiat Oncol 2021; 27:32-35. [PMID: 33392400 PMCID: PMC7773558 DOI: 10.1016/j.ctro.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/30/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Desmoid tumors are benign, but may have a locally invasive tendency that commonly results in local recurrence. Most occur on the body trunk or extremities, whereas a head and neck desmoid tumor is relatively rare. The efficacy of radiotherapy has been suggested and 50-60 Gy is used for unresectable or recurrent desmoid tumors, but there are few reports of use of particle beam therapy. However, since this tumor occurs more often in younger patients compared to malignant tumors and the prognosis is favorable, there may be an advantage of this therapy. We treated a male patient with a head and neck recurrent desmoid tumor with proton beam therapy (PBT) at a dose of 60 Gy (RBE). This patient underwent surgical resection as initial treatment, but the tumor recurred only six months after surgery, and resection was performed again. After PBT, the tumor gradually shrank and complete remission has been achieved for 10 years without any severe late toxicity. Here, we report the details of this case, with a review of the literature. We suggest that PBT may reduce the incidence of second malignant tumors by reducing the dose exposure around the planning target volume.
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Affiliation(s)
- Takuya Sawada
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Masatoshi Nakamura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Takashi Iizumi
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
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