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Harada M, Saito T, Ishida T, Mori Y, Sakurai H. Re-Irradiation With Proton Beam Therapy for Localized Perineural Spread Following Presacral Recurrence in Sigmoid Colon Cancer: A Case Report. Cureus 2024; 16:e56765. [PMID: 38650764 PMCID: PMC11034400 DOI: 10.7759/cureus.56765] [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: 03/17/2024] [Indexed: 04/25/2024] Open
Abstract
This report describes the effective management of localized perineural spread (PNS) to the sacral peripheral nerves following a presacral recurrence of colon cancer using proton beam therapy (PBT). The patient, a male in his 60s with a history of sigmoid colon cancer treated with laparoscopic Hartmann's procedure, presented with presacral recurrence two years post-surgery. Radical resection was deemed infeasible, leading to a combined treatment of PBT (75 Gy relative biological effectiveness (RBE) in 25 fractions) and capecitabine. However, three years post-PBT, magnetic resonance imaging revealed swelling of the left S2 nerve with abnormal fluorodeoxyglucose uptake, indicating localized PNS. Re-irradiation with PBT (75 Gy RBE in 25 fractions) was conducted, carefully considering the overlap with the previous PBT field and aiming to minimize dosage to adjacent organs. At 1.5 years post-reirradiation, the patient remained free of recurrence. This case underscores the potential efficacy of PBT and emphasizes the need for further research to assess its broader applicability in comparable situations.
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Affiliation(s)
- Masahiko Harada
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN
| | - Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN
| | - Yutaro Mori
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, JPN
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2
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Hiroshima Y, Kondo M, Sawada T, Hoshi S, Okubo R, Iizumi T, Numajiri H, Okumura T, Sakurai H. Analysis of the cost-effectiveness of proton beam therapy for unresectable pancreatic cancer in Japan. Cancer Med 2023; 12:20450-20458. [PMID: 37795771 PMCID: PMC10652344 DOI: 10.1002/cam4.6611] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/28/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Proton beam therapy (PBT) has recently been included in Japan's social health insurance benefits package. This study aimed to determine the cost-effectiveness of PBT for unresectable, locally advanced pancreatic cancer (LAPC) as a replacement for conventional photon radiotherapy (RT). METHODS We estimated the incremental cost-effectiveness ratio (ICER) of PBT as a replacement for three-dimensional conformal RT (3DCRT), a conventional photon RT, using clinical evidence in the literature and expense complemented by expert opinions. We used a decision tree and an economic and Markov model to illustrate the disease courses followed by LAPC patients. Effectiveness was estimated as quality-adjusted life years (QALY) using utility weights for the health state. Social insurance fees were calculated as the costs. The stability of the ICER against the assumptions made was appraised using sensitivity analyses. RESULTS The effectiveness of PBT and 3DCRT was 1.67610615 and 0.97181271 QALY, respectively. The ICER was estimated to be ¥5,376,915 (US$46,756) per QALY. According to the suggested threshold for anti-cancer therapy from the Japanese authority of ¥7,500,000 (US$65,217) per QALY gain, such a replacement would be considered cost-effective. The one-way and probabilistic sensitivity analyses demonstrated stability of the base-case ICER. CONCLUSION PBT, as a replacement for conventional photon radiotherapy, is cost-effective and justifiable as an efficient use of finite healthcare resources. Making it a standard treatment option and available to every patient in Japan is socially acceptable from the perspective of health economics.
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Affiliation(s)
- Yuichi Hiroshima
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
- QST hospital, National Institutes for Quantum and Radiological Sciences and TechnologyChibaChibaJapan
- Department of Radiation Oncology, Ibaraki Prefectural Central HospitalKasamaIbarakiJapan
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Takuya Sawada
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Shu‐ling Hoshi
- Department of Health Care Policy and Health Economics, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Reiko Okubo
- Department of Health Care Policy and Health Economics, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
- Department of Clinical Laboratory MedicineUniversity of Tsukuba HospitalTsukubaIbarakiJapan
- Department of Nephrology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Takashi Iizumi
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Haruko Numajiri
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Toshiyuki Okumura
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
- Department of Radiation Oncology, Ibaraki Prefectural Central HospitalKasamaIbarakiJapan
| | - Hideyuki Sakurai
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
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Lo CY, Tsai SW, Niu H, Chen FH, Hwang HC, Chao TC, Hsiao IT, Liaw JW. Gold-Nanoparticles-Enhanced Production of Reactive Oxygen Species in Cells at Spread-Out Bragg Peak under Proton Beam Radiation. ACS Omega 2023; 8:17922-17931. [PMID: 37251180 PMCID: PMC10210040 DOI: 10.1021/acsomega.3c01025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
This study investigates the radiobiological effects of gold nanoparticles (GNPs) as radiosensitizers for proton beam therapy (PBT). Specifically, we explore the enhanced production of reactive oxygen species (ROS) in GNP-loaded tumor cells irradiated by a 230 MeV proton beam in a spread-out Bragg peak (SOBP) zone obtained by a passive scattering system. Our findings indicate that the radiosensitization enhancement factor is 1.24 at 30% cell survival fraction, 8 days after 6 Gy proton beam irradiation. Since protons deposit the majority of their energy at the SOBP region and interact with GNPs to induce more ejected electrons from the high-Z GNPs, these ejected electrons then react with water molecules to produce excessive ROS that can damage cellular organelles. Laser scanning confocal microscopy reveals the excessive ROS induced inside the GNP-loaded cells immediately after proton irradiation. Furthermore, the damage to cytoskeletons and mitochondrial dysfunction in GNP-loaded cells caused by the induced ROS becomes significantly severe, 48 h after proton irradiation. Our biological evidence suggests that the cytotoxicity of GNP-enhanced ROS production has the potential to increase the tumoricidal efficacy of PBT.
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Affiliation(s)
- Chang-Yun Lo
- Department
of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Shiao-Wen Tsai
- Department
of Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan
- Department
of Periodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Huan Niu
- Accelerator
Laboratory, Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Fang-Hsin Chen
- Institute
of Nuclear Engineering and Science, National
Tsing Hua University, Hsinchu 300, Taiwan
- Department
of Radiation Oncology, Chang Gung Memorial
Hospital, Taoyuan 333, Taiwan
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiao-Chien Hwang
- Proton
and Radiation Therapy Center, Linkou Chang
Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Tsi-Chian Chao
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Ing-Tsung Hsiao
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Jiunn-Woei Liaw
- Department
of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
- Proton
and Radiation Therapy Center, Linkou Chang
Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department
of Mechanical Engineering, Ming Chi University
of Technology, New Taipei City 243, Taiwan
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4
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Takagawa Y, Suzuki M, Yamaguchi H, Seto I, Azami Y, Machida M, Takayama K, Tominaga T, Murakami M. Outcomes and Prognostic Factors for Locally Recurrent Rectal Cancer Treated With Proton Beam Therapy. Adv Radiat Oncol 2023; 8:101192. [PMID: 36896217 PMCID: PMC9991532 DOI: 10.1016/j.adro.2023.101192] [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] [Received: 07/25/2022] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose Our objective was to report the outcome and prognostic factors for patients with locally recurrent rectal cancer (LRRC) treated with proton beam therapy (PBT) at our institution. Methods and Materials The study included PBT-treated patients with LRRC between December 2008 and December 2019. Treatment response was stratified using an initial imaging test after PBT. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using the Kaplan-Meier method. Each outcome's prognostic factors were verified using the Cox proportional hazards model. Results Twenty-three patients were enrolled (median follow-up, 37.4 months). There were 11 patients with complete response (CR) or complete metabolic response (CMR), 8 with partial response or partial metabolic response, 2 with stable disease or stable metabolic response, and 2 with progressive disease or progressive metabolic disease. Three- and 5-year OS, PFS, and LC were 72.1% and 44.6%, 37.9% and 37.9%, and 55.0% and 47.2%, respectively, with 54.4 months' median survival time. The maximum standardized uptake value of fluorine-18-fluorodeoxyglucose-positron emission tomography-computed tomography (18F-FDG-PET/CT) before PBT (cutoff value, 10) showed significant differences in OS (P = .03), PFS (P = .027), and LC (P = .012). The patients who achieved CR or CMR after PBT had significantly better LC than those with non-CR or non-CMR (hazard ratio, 4.49; 95% confidence interval, 1.14-17.63; P = .021). Older patients (aged ≥65 years) had significantly higher LC and PFS rates. Patients with pain before PBT and larger tumors (≥30 mm) also had significantly lower PFS. Of 23 patients, 12 (52%) experienced further local recurrence after PBT. One patient developed grade 2 acute radiation dermatitis. Regarding late toxicity, grade 4 late gastrointestinal toxic effects were recorded in 3 patients, in 2 of whom reirradiation was associated with further local recurrence after PBT. Conclusions The results showed that PBT may have potential to be a good treatment option for LRRC. 18F-FDG-PET/CT before and after PBT may be useful for assessing tumor response and predicting outcomes.
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Affiliation(s)
- Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
- Corresponding author: Yoshiaki Takagawa, MD
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Ichiro Seto
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masanori Machida
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Takuya Tominaga
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
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Murayama S, Yamada S, Hiroshima Y, Takiyama H, Taguchi H, Kimoto T, Anzai M, Hagiwara Y, Yasui K, Mori K, Ishihara S, Ueno H, Shimizu S, Aoyama H, Tsuji H, Sakurai H. Particle beam therapy for pelvic recurrence of colorectal cancer: a registry data analysis in Japan and a systematic review. J Radiat Res 2023:rrad024. [PMID: 37117038 DOI: 10.1093/jrr/rrad024] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/25/2023] [Indexed: 06/19/2023]
Abstract
The aim of this study was to investigate the efficacy and safety of particle beam therapy (PBT) with proton or carbon ion beam for pelvic recurrence of colorectal cancer (PRCC) by comparing the clinical outcomes of a dataset of prospectively enrolled patients for PBT with those from the literature, which were collected by a systematic review of external X-ray radiotherapy (XRT) and PBT. Patients with PRCC treated at 14 domestic facilities between May 2016 and June 2019 and entered the database for prospective observational follow-up were analyzed. The registry data analyzed included 159 PRCC patients treated with PBT of whom 126 (79%) were treated with carbon ion radiation therapy (CIRT). The 3-year overall survival and local control rate were 81.8 and 76.4%, respectively. Among these PRCC patients, 5.7% had Grade 3 or higher toxicity. Systematic search of PubMed and Cochrane databases published from January 2000 to September 2020 resulted in 409 abstracts for the primary selection. Twelve studies fulfilled the inclusion criteria. With one additional publication, 13 studies were selected for qualitative analysis, including 9 on XRT and 4 on PBT. There were nine XRT studies, which included six on 3D conformal radiotherapy and three on stereotactic body radiation therapy, and four PBT studies included three on CIRT and one on proton therapy. A pilot meta-analysis using literatures with median survival time extractable over a 20-month observation period suggested that PBT, especially CIRT, may be a promising treatment option for PRCC not amenable to curative resection.
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Affiliation(s)
- Shigeyuki Murayama
- Division of Proton Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka 411-8777, Japan
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
| | - Shigeru Yamada
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan
| | - Yuichi Hiroshima
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hirotoshi Takiyama
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan
| | - Hiroshi Taguchi
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Takuya Kimoto
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo-ku, Kyoto 602-0841, Japan
| | - Makoto Anzai
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- Department of Radiology, Osaka Heavy Ion Therapy Center, 3-1-10 Otemae, Chuo-ku, Osaka-city, Osaka 540-0008, Japan
| | - Yasuhito Hagiwara
- The Japanese Society for Radiation Oncology, Particle Therapy Division, Colorectal Cancer Working Group
- Department of Radiology, Division of Radiation Oncology, Yamagata University Faculty of Medicine, 2-2-2, Iidanishi, Yamagata city, Yamagata 990-9585, Japan
| | - Kazuaki Yasui
- Division of Radiation Oncology, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka 411-8777, Japan
| | - Keita Mori
- Clinical Research Support Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka 411-8777, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
| | - Shinichi Shimizu
- Department of Carbon Ion Radiotherapy, Graduate School of Medicine, Osaka University, 3-1-10, Otemae, Chuo-ku, Osaka City, Osaka 540-0008, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba-shi, Chiba 263-8555, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Mori S, Bhattacharyya T, Furuichi W, Tohyama N, Nomoto A, Shinoto M, Takiyama H, Yamada S. Comparison of dosimetries of carbon-ion pencil beam scanning, proton pencil beam scanning and volumetric modulated arc therapy for locally recurrent rectal cancer. J Radiat Res 2023; 64:162-170. [PMID: 36403118 PMCID: PMC9855328 DOI: 10.1093/jrr/rrac074] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/18/2022] [Indexed: 06/16/2023]
Abstract
We compared the dose distributions of carbon-ion pencil beam scanning (C-PBS), proton pencil beam scanning (P-PBS) and Volumetric Modulated Arc Therapy (VMAT) for locally recurrent rectal cancer. The C-PBS treatment planning computed tomography (CT) data sets of 10 locally recurrent rectal cancer cases were randomly selected. Three treatment plans were created using identical prescribed doses. The beam angles for C-PBS and P-PBS were identical. Dosimetry, including the dose received by 95% of the planning target volume (PTV) (D95%), dose to the 2 cc receiving the maximum dose (D2cc), organ at risk (OAR) volume receiving > 15Gy (V15) and > 30Gy (V30), was evaluated. Statistical significance was assessed using the Wilcoxon signed-rank test. Mean PTV-D95% values were > 95% of the volume for P-PBS and C-PBS, whereas that for VMAT was 94.3%. However, PTV-D95% values in P-PBS and VMAT were < 95% in five and two cases, respectively, due to the OAR dose reduction. V30 and V15 to the rectum/intestine for C-PBS (V30 = 4.2 ± 3.2 cc, V15 = 13.8 ± 10.6 cc) and P-PBS (V30 = 7.3 ± 5.6 cc, V15 = 21.3 ± 13.5 cc) were significantly lower than those for VMAT (V30 = 17.1 ± 10.6 cc, V15 = 55.2 ± 28.6 cc). Bladder-V30 values with P-PBS/C-PBS (3.9 ± 4.8 Gy(RBE)/3.0 ± 4.0 Gy(RBE)) were significantly lower than those with VMAT (7.9 ± 8.1 Gy). C-PBS provided superior dose conformation and lower OAR doses compared with P-PBS and VMAT. C-PBS may be the best choice for cases in which VMAT and P-PBS cannot satisfy dose constraints. C-PBS could be another choice for cases in which VMAT and P-PBS cannot satisfy dose constraints, thereby avoiding surgical resection.
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Affiliation(s)
- Shinichiro Mori
- Corresponding author. National Institutes for Quantum and Radiological Science and Technology, Quantum Life and Medical Science Directorate, Institute for Quantum Medical Science, Inageku, Chiba 263-8555, Japan. Office: 81-43-251-2111; Fax: 81-43-284-0198; e-mail:
| | - Tapesh Bhattacharyya
- Department of Radiation Oncology, Tata Medical Center, 14, MAR(E-W), DH Block (Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Wataru Furuichi
- Accelerator Engineering Corporation, Inage-Ku, Chiba, 263-0043, Japan
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, Mihama-ku, Chiba, 261-0024m Japan
| | - Akihiro Nomoto
- National Institutes for Quantum Science and Technology, QST Hospital, Inage-ku, Chiba 263-8555, Japan
| | - Makoto Shinoto
- National Institutes for Quantum Science and Technology, QST Hospital, Inage-ku, Chiba 263-8555, Japan
| | - Hirotoshi Takiyama
- National Institutes for Quantum Science and Technology, QST Hospital, Inage-ku, Chiba 263-8555, Japan
| | - Shigeru Yamada
- National Institutes for Quantum Science and Technology, QST Hospital, Inage-ku, Chiba 263-8555, Japan
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Hiroshima Y, Ishikawa H, Iwai Y, Wakatsuki M, Utsumi T, Suzuki H, Akakura K, Harada M, Sakurai H, Ichikawa T, Tsuji H. Safety and Efficacy of Carbon-Ion Radiotherapy for Elderly Patients with High-Risk Prostate Cancer. Cancers (Basel) 2022; 14:cancers14164015. [PMID: 36011007 PMCID: PMC9406609 DOI: 10.3390/cancers14164015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 07/14/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Carbon-ion radiotherapy (CIRT) is a high-dose intensive treatment, whose safety and efficacy have been proven for prostate cancer. This study aims to evaluate the outcomes of CIRT in elderly patients with prostate cancer. Patients aged 75 years or above at the initiation of CIRT were designated as the elderly group, and younger than 75 years as the young group. The overall survival (OS), disease-specific survival (DSS), biochemical control rate (BCR), biochemical relapse-free survival (BRFS), and adverse events were compared between the elderly and young patients with high-risk prostate cancer treated with CIRT. The elderly group comprised 173 of 927 patients treated for high-risk prostate cancer between April 2000 and May 2018. The overall median age was 69 (range: 45−92) years. The median follow-up period was 91.9 (range: 12.6−232.3) months. The 10-year OS, DSS, BCR, and BRFS rates in the young and elderly groups were 86.9%/71.5%, 96.6%/96.8%, 76.8%/88.1%, and 68.6%/64.3%, respectively. The OS (p < 0.001) was longer in the younger group and the BCR was better in the elderly group (p = 0.008). The DSS and BRFS did not differ significantly between the two groups. The rates of adverse events between the two groups did not differ significantly and no patient had an adverse event of Grade 4 or higher during the study period. CIRT may be as effective and safe in elderly patients as the treatment for high-risk prostate cancer.
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Affiliation(s)
- Yuichi Hiroshima
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
- Correspondence:
| | - Yuma Iwai
- Department of Radiology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, Chiba 285-8741, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba 285-8741, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan
| | - Masaoki Harada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
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8
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Pelak MJ, Flechl B, Hug E, Galalae R, Konrath L, Góra J, Fossati P, Lütgendorf-Caucig C, Tubin S, Konstantinovic R, Mock U, Fussl C, Georg P. Normofractionated and moderately hypofractionated proton therapy: comparison of acute toxicity and early quality of life outcomes. Front Oncol 2022; 12:962697. [PMID: 36052240 PMCID: PMC9425455 DOI: 10.3389/fonc.2022.962697] [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: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
AimData on the safety of moderately hypofractionated proton beam therapy (PBT) are limited. The aim of this study is to compare the acute toxicity and early quality of life (QoL) outcomes of normofractionated (nPBT) and hypofractionated PBT (hPBT).Material and methodsWe prospectively compared acute toxicity and QoL between patients treated with nPBT (dose per fraction 1.8–2.3 Gy, n = 90) and hPBT (dose per fraction 2.5–3.1 Gy, n = 49) in following locations: head and neck (H&N, n = 85), abdomen and pelvis (A&P, n = 43), and other soft tissue (ST, n = 11). The toxicities were grouped into categories—mucosal, skin, and other sites—and evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 at baseline, treatment completion, and 3 months after PBT completion. QoL was evaluated with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 scale for all locations and additionally with EORTC QLQ-HN35 for H&N patients.ResultsOverall, the highest toxicity grades of G0, G1, G2, and G3 were observed in 7 (5%), 40 (28.8%), 78 (56.1%), and 15 (10.8%) patients, respectively. According to organ and site, no statistically significant differences were detected in the majority of toxicity comparisons (66.7%). For A&P, hPBT showed a more favorable toxicity profile as compared to nPBT with a higher frequency of G0 and G1 and a lower frequency of G2 and G3 events (p = 0.04), more patients with improvement (95.7% vs 70%, p = 0.023), and full resolution of toxicities (87% vs 50%, p = 0.008). Skin toxicity was unanimously milder for hPBT compared to nPBT in A&P and ST locations (p = 0.018 and p = 0.025, respectively). No significant differences in QoL were observed in 97% of comparisons for QLQ-C30 scale except for loss of appetite in H&N patients (+33.3 for nPBT and 0 for hPBT, p = 0.02) and role functioning for A&P patients (0 for nPBT vs +16.7 hPBT, p = 0.003). For QLQ-HN35, 97.9% of comparisons did not reveal significant differences, with pain as the only scale varying between the groups (−8.33 vs −25, p = 0.016).ConclusionHypofractionated proton therapy offers non-inferior early safety and QoL as compared to normofractionated irradiation and warrants further clinical investigation.
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Affiliation(s)
| | - Birgit Flechl
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
- *Correspondence: Birgit Flechl,
| | - Eugen Hug
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Razvan Galalae
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
- Medizinische Fakultät, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Lisa Konrath
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Joanna Góra
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Slavisa Tubin
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Ulrike Mock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Christoph Fussl
- Universitätsklinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus (LKH) Salzburg, Salzburg, Austria
| | - Petra Georg
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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Utano K, Isohata N, Nemoto D, Aizawa M, Nakajima Y, Endo S, Lefor AK, Togashi K. Rectal cancer eradication by proton beam therapy complicated by radiation proctitis: a case report. Clin J Gastroenterol 2022; 15:746-749. [DOI: 10.1007/s12328-022-01652-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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Kobeissi JM, Simone CB, Hilal L, Wu AJ, Lin H, Crane CH, Hajj C. Proton Therapy in the Management of Luminal Gastrointestinal Cancers: Esophagus, Stomach, and Anorectum. Cancers (Basel) 2022; 14:cancers14122877. [PMID: 35740544 PMCID: PMC9221464 DOI: 10.3390/cancers14122877] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/28/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Radiation treatment plays a major role in the management of luminal gastrointestinal cancers, mainly esophageal and anorectal cancers. There is a growing interest in the application of protons for gastrointestinal cancers, mainly owing to its dosimetric characteristics in decreasing dose to nearby organs at risk. We present here an up-to-date comprehensive review of the dosimetric and clinical literature on the use of proton therapy in the management of luminal gastrointestinal cancers. Abstract While the role of proton therapy in gastric cancer is marginal, its role in esophageal and anorectal cancers is expanding. In esophageal cancer, protons are superior in sparing the organs at risk, as shown by multiple dosimetric studies. Literature is conflicting regarding clinical significance, but the preponderance of evidence suggests that protons yield similar or improved oncologic outcomes to photons at a decreased toxicity cost. Similarly, protons have improved sparing of the organs at risk in anorectal cancers, but clinical data is much more limited to date, and toxicity benefits have not yet been shown clinically. Large, randomized trials are currently underway for both disease sites.
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Affiliation(s)
- Jana M. Kobeissi
- Department of Radiation Oncology, School of Medicine, American University of Beirut Medical Center, Beirut 1007, Lebanon; (J.M.K.); (L.H.)
| | - Charles B. Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY 10035, USA; (C.B.S.II); (H.L.)
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA; (A.J.W.); (C.H.C.)
| | - Lara Hilal
- Department of Radiation Oncology, School of Medicine, American University of Beirut Medical Center, Beirut 1007, Lebanon; (J.M.K.); (L.H.)
| | - Abraham J. Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA; (A.J.W.); (C.H.C.)
| | - Haibo Lin
- Department of Radiation Oncology, New York Proton Center, New York, NY 10035, USA; (C.B.S.II); (H.L.)
| | - Christopher H. Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA; (A.J.W.); (C.H.C.)
| | - Carla Hajj
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10027, USA; (A.J.W.); (C.H.C.)
- Correspondence:
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