1
|
Takagawa Y, Suzuki M, Seto I, Azami Y, Machida M, Takayama K, Sulaiman NS, Nakasato T, Kikuchi Y, Murakami M, Honda M, Teranishi Y, Kono K. Proton beam reirradiation for locally recurrent rectal cancer patients with prior pelvic irradiation. J Radiat Res 2024:rrae019. [PMID: 38604182 DOI: 10.1093/jrr/rrae019] [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: 11/09/2023] [Revised: 01/17/2024] [Indexed: 04/13/2024]
Abstract
The aim of the present study was to report the feasibility of proton beam reirradiation for patients with locally recurrent rectal cancer (LRRC) with prior pelvic irradiation. The study population included patients who were treated with proton beam therapy (PBT) for LRRC between 2008 and December 2019 in our institution. Those who had a history of distant metastases of LRRC, with or without treatment, before reirradiation, were excluded. Overall survival (OS), progression-free survival (PFS) and local control (LC) were estimated using the Kaplan-Meier method. Ten patients were included in the present study. The median follow-up period was 28.7 months, and the median total dose of prior radiotherapy (RT) was 50 Gy (range, 30 Gy-74.8 Gy). The median time from prior RT to reirradiation was 31.5 months (range, 8.1-96.6 months), and the median reirradiation dose was 72 Gy (relative biological effectiveness) (range, 56-77 Gy). The 1-year/2-year OS, PFS and LC rates were 100%/60.0%, 20.0%/10.0% and 70.0%/58.3%, respectively, with a median survival time of 26.0 months. Seven patients developed a Grade 1 acute radiation dermatitis, and no Grade ≥ 2 acute toxicity was recorded. Grade ≥ 3 late toxicity was recorded in only one patient, who had developed a colostomy due to radiation-related intestinal bleeding. Reirradiation using PBT for LRRC patients who had previously undergone pelvic irradiation was feasible. However, the indications for PBT reirradiation for LRRC patients need to be considered carefully due to the risk of severe late GI toxicity.
Collapse
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
| | - Motohisa Suzuki
- 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
| | - Nor Shazrina Sulaiman
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Tatsuhiko Nakasato
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
2
|
Sakai A, Tsuyama N, Ohira T, Sugai-Takahashi M, Ohba T, Azami Y, Matsumoto Y, Manabu I, Suzuki S, Sato M, Hosoya M, Ishikawa T, Suzuki S. No increase in translocated chromosomal aberrations, an indicator of ionizing radiation exposure, in childhood thyroid cancer in Fukushima Prefecture. Sci Rep 2023; 13:14254. [PMID: 37652956 PMCID: PMC10471584 DOI: 10.1038/s41598-023-41501-x] [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: 04/08/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
To investigate the effects of radiation exposure due to the Fukushima nuclear power plant accident, following the disaster Fukushima Prefecture launched thyroid ultrasound examinations of residents who were generally younger than 18 years at the time of the earthquake. As the rate of pediatric thyroid cancer was higher than expected, we conducted biological dose assessment based on the frequency of translocated chromosome (Tr) aberrations using peripheral blood lymphocytes. Tr formation frequency was compared among the thyroid cancer (n = 38, median age 18 years, age range 12-26 years), thyroid-related disease (n = 30, median age 21 years, age range 15-28 years), and healthy controls (n = 31, median age 22 years, age range 20-23 years) groups. Tr aberration frequency was initially significantly higher in the thyroid cancer than in the other two groups; however, differences among the groups disappeared after adjusting for history of CT scan, as 92%, 67%, and 28% of those in the thyroid cancer, thyroid-related disease, and control groups, respectively, had undergone CT previously. Therefore, the significant difference in the initial number of Tr formations is presumably due to radiation exposure from CT. Accordingly, the effects of medical exposure on the chromosomes of children and adolescents should be noted.
Collapse
Affiliation(s)
- Akira Sakai
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Naohiro Tsuyama
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Misaki Sugai-Takahashi
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takashi Ohba
- Department of Radiological Sciences, Fukushima Medical University School of Health Sciences, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku General Hospital, Sendai, Japan
| | - Yoshiko Matsumoto
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Iwadate Manabu
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Maki Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuo Ishikawa
- Department of Radiation Physics and Chemistry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Suzuki
- Department of Thyroid Treatment, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Yamaguchi H, Kato T, Ishikawa Y, Takemasa K, Narita Y, Takagawa Y, Seto I, Machida M, Dai Y, Azami Y, Tominaga T, Takayama K, Suzuki M, Kikuchi Y, Murakami M. Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases. Int J Urol 2023; 30:401-407. [PMID: 36653063 DOI: 10.1111/iju.15140] [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: 07/28/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the safety and complications of hydrogel spacer implantation. METHODS This single-center historical cohort study retrospectively analyzed cases of hydrogel spacer implantation between October 2018 and March 2022. The survey items were the rates of possible hydrogel injection implementation, the success rate of hydrogel implantation including asymmetry, higher position, rectal wall infiltration, subcapsular injection, and other adverse events, and width created by the spacer. To investigate the learning curve, 1, 2, and 3 points were assigned to adverse event grades G1, G2, and G3, respectively. Spacer effectiveness obstruction, such as asymmetry was assigned 3 points. A Mann-Whitney U test was performed to assess statistically significant differences. RESULTS The study included a total of 200 patients with a median (range) age of 70 (44-85) years. In 10 (5%) patients, hydrogel injection implementation was not possible. Of 190 patients who underwent hydrogel spacer placement, 168 (88%) received a satisfactory placement. The median (range) width of hydrogel spacers was 13.1 (4.4-18.7) mm. Spacer asymmetry, higher position, rectal wall infiltration, and prostate subcapsular infiltration occurred in 7 (3.7%), 5 (2.6%), 12 (6.3%), and 1 (0.5%) patients, respectively. G1 and G3 adverse events occurred in 13 (7%) and 4 (2%) patients, respectively. Practitioner #1 who performed the highest number of procedures had significantly (p = 0.04) lower total scores in group B. CONCLUSION Spacer implantation yielded favorable outcomes with a high percentage of appropriate spacer implantation, and few major complications.
Collapse
Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Takahiro Kato
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.,Department of Radiation Physics and Technology, Southern Tohoku General Hospital, Koriyama, Fukushima, Japan
| | - Yojiro Ishikawa
- Division of Radiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Kimihiro Takemasa
- Department of Radiation Physics and Technology, Southern Tohoku General Hospital, Koriyama, Fukushima, Japan
| | - Yuki Narita
- Department of Radiation Physics and Technology, Southern Tohoku General Hospital, Koriyama, Fukushima, Japan
| | - Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Ichiro Seto
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Masanori Machida
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yuntao Dai
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Takuya Tominaga
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Masao Murakami
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| |
Collapse
|
5
|
Azami Y, Wada H, Seto I, Azami A, Sato A, Suzuki N, Teranishi Y, Tachibana K, Ohtake T. [A Case of Emergency Radiotherapy for Intramedullary Spinal Cord Metastasis from Breast Cancer]. Gan To Kagaku Ryoho 2021; 48:705-707. [PMID: 34006719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Intramedullary spinal cord metastasis(ISCM)is rare. However, with advances in diagnostic imaging, the incidence of ISCM is increasing. We herein present a case of breast cancer metastasis in the lower thoracic spinal intramedullary area in a patient who was then successfully treated with emergency radiotherapy. A 56‒year‒old woman with breast cancer was admitted to our hospital due to rapidly progressing weakness in both legs and bladder and rectal disturbance. Spinal MRI revealed a gadolinium‒enhancing intramedullary lesion. The patient was treated with emergency radiotherapy and oral steroids. Although the prognosis of ISCM is extremely poor, emergency radiotherapy could be an effective treatment for ISCM to improve the patient's quality of life(QOL).
Collapse
Affiliation(s)
- Yusuke Azami
- Dept. of Radiotherapy, Southern Tohoku General Hospital
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Azami Y, Tsuyama N, Abe Y, Sugai-Takahashi M, Kudo KI, Ota A, Sivasundaram K, Muramatsu M, Shigemura T, Sasatani M, Hashimoto Y, Saji S, Kamiya K, Hanamura I, Ikezoe T, Onodera M, Sakai A. Chromosomal translocation t(11;14) and p53 deletion induced by the CRISPR/Cas9 system in normal B cell-derived iPS cells. Sci Rep 2021; 11:5216. [PMID: 33664418 PMCID: PMC7933289 DOI: 10.1038/s41598-021-84628-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/18/2021] [Indexed: 01/31/2023] Open
Abstract
Multiple myeloma (MM) cells are derived from mature B cells based on immunoglobulin heavy chain (IgH) gene analysis. The onset of MM is often caused by a reciprocal chromosomal translocation (cTr) between chr 14 with IgH and chr 11 with CCND1. We propose that mature B cells gain potential to transform by reprograming, and then chromosomal aberrations cause the development of abnormal B cells as a myeloma-initiating cell during B cell redifferentiation. To study myeloma-initiating cells, we have already established normal B cell-derived induced pluripotent stem cells (BiPSCs). Here we established two BiPSCs with reciprocal cTr t(11;14) using the CRISPR/Cas9 system; the cleavage site were located in the IgH Eμ region of either the VDJ rearranged allele or non-rearranged allele of IgH and the 5'-upsteam region of the CCND1 (two types of BiPSC13 with t(11;14) and MIB2-6 with t(11;14)). Furthermore, p53 was deleted using the CRISPR/Cas9 system in BiPSC13 with t(11;14). These BiPSCs differentiated into hematopoietic progenitor cells (HPCs). However, unlike cord blood, those HPCs did not differentiated into B lymphocytes by co-culture with BM stromal cell. Therefore, further ingenuity is required to differentiate those BiPSCs-derived HPCs into B lymphocytes.
Collapse
Affiliation(s)
- Yusuke Azami
- Department of Medical Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Naohiro Tsuyama
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yu Abe
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Misaki Sugai-Takahashi
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ken-Ichi Kudo
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akinobu Ota
- Department of Hematology, Aichi Medical University School of Medicine, Nagakute, 480-1195, Japan
| | - Karnan Sivasundaram
- Department of Hematology, Aichi Medical University School of Medicine, Nagakute, 480-1195, Japan
| | - Moe Muramatsu
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Tomonari Shigemura
- Department of Pediatrics, Shinshu University, Matsumoto, 390-8621, Japan
| | - Megumi Sasatani
- Department of Experimental Oncology, RIRBM, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Kenji Kamiya
- Department of Experimental Oncology, RIRBM, Hiroshima University, Hiroshima, 734-8553, Japan
| | - Ichiro Hanamura
- Department of Hematology, Aichi Medical University School of Medicine, Nagakute, 480-1195, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Masafumi Onodera
- Department of Genetics, National Research Institute for Child Health, Development, Tokyo, 157-8535, Japan
| | - Akira Sakai
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| |
Collapse
|
7
|
Hirose K, Konno A, Hiratsuka J, Yoshimoto S, Kato T, Ono K, Otsuki N, Hatazawa J, Tanaka H, Takayama K, Wada H, Suzuki M, Sato M, Yamaguchi H, Seto I, Ueki Y, Iketani S, Imai S, Nakamura T, Ono T, Endo H, Azami Y, Kikuchi Y, Murakami M, Takai Y. Boron neutron capture therapy using cyclotron-based epithermal neutron source and borofalan ( 10B) for recurrent or locally advanced head and neck cancer (JHN002): An open-label phase II trial. Radiother Oncol 2020; 155:182-187. [PMID: 33186684 DOI: 10.1016/j.radonc.2020.11.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [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: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Boron neutron capture therapy (BNCT) can be performed without reactors due to development of cyclotron-based epithermal neutron source (C-BENS), which is optimized for treatment for deeper-seated tumors. The purpose of this study was to evaluate efficacy and safety of cyclotron-based BNCT with borofalan (10B) for recurrent or locally advanced head and neck cancer. MATERIALS AND METHODS In this open-label, phase II JHN002 trial of BNCT using C-BENS with borofalan (10B), patients with recurrent squamous cell carcinoma (R-SCC) or with recurrent/locally advanced non-squamous cell carcinoma (R/LA-nSCC) of the head and neck were intravenously administered 400 mg/kg borofalan (10B), followed by neutron irradiation. The tumor dose was determined passively as the mucosal maximum dose of 12 Gy-Eq. The primary endpoint was the objective response rate (ORR). Post-trial observational JHN002 Look Up study was planned for evaluating locoregional progression-free survival (LRPFS). RESULTS Eight R-SCC and 13 R/LA-nSCC patients were enrolled. All R-SCC patients had prior radiotherapy with a median dose of 65.5 Gy (range, 59.4-76.0 Gy). The ORR for all patients was 71%, and complete response/partial response were 50%/25% in R-SCC and 8%/62% in R/LA-nSCC. The 2-year overall survival for R-SCC and R/LA-nSCC were 58% and 100%, respectively. The median LRPFS was 11.5 months for R-SCC. Frequently observed adverse events included alopecia (95%), hyperamylasemia (86%), and nausea (81%). CONCLUSION These data suggest that BNCT using C-BENS with borofalan (10B) is a promising treatment option for patients with R-SCC or R/LA-nSCC of the head and neck.
Collapse
Affiliation(s)
- Katsumi Hirose
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Japan.
| | - Akiyoshi Konno
- Department of Otorhinolaryngology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Junichi Hiratsuka
- Department of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Kato
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan; Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Japan
| | - Koji Ono
- Kansai BNCT Medical Center, Osaka Medical College, Japan
| | - Naoki Otsuki
- Department of Otolaryngology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan
| | - Hiroki Tanaka
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Mariko Sato
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yuji Ueki
- Department of Otorhinolaryngology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Susumu Iketani
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Shigeki Imai
- Department of Radiology, Southern Tohoku General Hospital, Koriyama, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Hiromasa Endo
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan; Department of Medical Oncology, School of Medicine, Fukushima Medical University, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan; Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yoshihiro Takai
- Southern Tohoku BNCT Research Center, Koriyama, Japan; Department of Radiation Oncology, Southern Tohoku General Hospital, Koriyama, Japan
| |
Collapse
|
8
|
Natori Y, Sasaki E, Soeda S, Furukawa S, Azami Y, Tokuda E, Kanbayashi T, Saji S. Risk of immunotherapy-related narcolepsy in genetically predisposed patients: a case report of narcolepsy after administration of pembrolizumab. J Immunother Cancer 2020; 8:jitc-2020-001164. [PMID: 33004543 PMCID: PMC7534705 DOI: 10.1136/jitc-2020-001164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2020] [Indexed: 01/01/2023] Open
Abstract
Background Immune-related adverse events associated with immune checkpoint therapy cause autoimmune disease-like symptoms. People who carry specific genotypes or haplotypes of human leucocyte antigen (HLA) are known to be predisposed to develop autoimmune diseases including narcolepsy. Immunotherapy could be a trigger to develop narcolepsy in predisposing HLA positive patients. Case presentation A 66-year-old woman with stage IVB endometrial carcinosarcoma experienced daytime sleepiness and temporary muscle weakness 14 days after the administration of an immune checkpoint inhibitor, pembrolizumab. These were consistent with the main symptoms of narcolepsy with cataplexy. This patient carried a highly predisposing HLA haplotype for narcolepsy; HLA-DQB1*06:02, DRB1*15:01, DQA1*01:02 and DRB5*01:01:01. A hypocretin-1/orexin-A concentration in the patient’s cerebrospinal fluid was low at 9.6 pg/mL in ELISA, and 155.5 pg/mL in radioimmunoassay that was below the normal level of 200 pg/mL. Therefore, she was diagnosed with narcolepsy tentatively according to the International Classification of Sleep Disorders, third edition diagnostic criteria for narcolepsy. The onset of narcolepsy in the 60s is very rare, and narcoleptic symptoms in our patient were likely to be caused by pembrolizumab. Conclusions This case suggests that treatment with immune checkpoint inhibitors potentially causes narcolepsy in genetically predisposed patients.
Collapse
Affiliation(s)
- Yutaka Natori
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Eisaku Sasaki
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Yusuke Azami
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Emi Tokuda
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kanbayashi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
9
|
Takayama K, Kato T, Nakamura T, Azami Y, Ono T, Suzuki M, Takada A, Yamaguchi H, Seto I, Nakasato T, Wada H, Kikuchi Y, Mitsudo K, Fuwa N, Murakami M. Proton Beam Therapy Combined with Intra-Arterial Infusion Chemotherapy for Stage IV Adenoid Cystic Carcinoma of the Base of the Tongue. Cancers (Basel) 2019; 11:cancers11101413. [PMID: 31546728 PMCID: PMC6826952 DOI: 10.3390/cancers11101413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a very rare epithelial tumor of the salivary glands. Surgical resection is considered to be a standard therapy. However, the optimal treatment strategy for managing advanced cases has not yet been established. This study evaluated the efficacy and toxicity of proton beam therapy (PBT) combined with selective intra-arterial infusion chemotherapy (IAIC) using weekly cisplatin for locally advanced ACC of the base of the tongue. Between March 2009 and February 2018, 15 patients were treated. The median follow-up duration was 56 (range: 15–116) months. The 5-year local control and overall survival rates were 89% and 76%, respectively. With regard to late toxicities, grade 2 osteoradionecrosis was found in one patient and grade 5 pharyngeal necrosis was observed in one patient. Considering most cases were significantly advanced and inoperable, this therapy was effective in controlling the primary tumor, preserving function and maintaining the quality of life. Although improvements are needed to reduce adverse events, PBT in combination with IAIC can be a treatment option for locally advanced ACC of the base of the tongue.
Collapse
Affiliation(s)
- Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Takahiro Kato
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Akinori Takada
- Department of Radiation Oncology, Mie University Hospital, 2-174, Edobashi Tsu, Mie 514-8507, Japan.
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Tatsuhiko Nakasato
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Nobukazu Fuwa
- Department of Radiation Oncology, Ise red cross hospital, 1-471-2, Funae, Ise, Mie 516-8512, Japan.
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| |
Collapse
|
10
|
Ono T, Nakamura T, Azami Y, Suzuki M, Wada H, Kikuchi Y, Murakami M, Nemoto K. Proton beam therapy is a safe and feasible treatment for patients with second primary lung cancer after lung resection. Thorac Cancer 2018; 10:289-295. [PMID: 30585704 PMCID: PMC6360225 DOI: 10.1111/1759-7714.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/10/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The purpose of the present study was to retrospectively evaluate the safety and efficacy of proton beam therapy (PBT) in patients with second primary lung cancer after lung resection. METHODS Patients who were diagnosed with second primary lung cancer after lung resection and underwent PBT between January 2009 and February 2015 were retrospectively recruited. Toxicities were evaluated using Common Terminology Criteria for Adverse Events version 4.0. RESULTS Nineteen patients were eligible for inclusion in this study. All of the patients completed the treatment. The median age was 75 (range: 63-82) years, and the median follow-up time of living patients was 60 months. The median dose of PBT was 76.8 Gy relative biological effectiveness (range: 66.0-80.0 Gy). The three-year overall survival rate was 63.2% and the three-year local control rate was 84.2%. No grade 4 or 5 toxicities were observed after PBT. CONCLUSIONS Our results suggest that PBT is a safe and feasible treatment for second primary lung cancer compared to surgery or X-ray radiotherapy. PBT may become a treatment choice for patients with second primary lung cancer after lung resection.
Collapse
Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan.,Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| |
Collapse
|
11
|
Azami A, Azami Y, Ohtake T, Tachibana K, Tomura N, Seto I, Todate Y, Waragai M, Suzuki N, Sato A, Takano Y, Abe T, Teranishi Y. [Indication for Radiotherapy for Breast Cancer Metastasis to the Skull Base Accompanied by Cranial Nerve Palsies]. Gan To Kagaku Ryoho 2018; 45:1806-1808. [PMID: 30692360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Distant metastasis to the skull base region frequently manifests various cranial nerve symptoms and reduces patients' quality of life(QOL). We report a 62-year-old woman with skull base metastasis of breast cancer, whose condition clinically improved following palliative radiotherapy. The patient presented to our hospital with hoarseness. CT screening revealed a tumor in the right breast, axial lymph node swelling, and osteoblastic change at multiple sites. A core needle biopsy of the breast tumor revealed invasive lobular carcinoma. She also had nausea, anorexia, vertigo, lower left angle of the mouth, apraxia of lid closing, and dysphagia owing to several cranial nerve palsies. MRI T1- and T2-weighted images showed a diffuse low-signal intensity of the skull base region, and the patient was diagnosed as having breast cancer with symptomatic skull base metastases. Her cranial nerve symptoms improved after 1 week of palliative irradiation to the skull base. We conclude that, even among terminal-stage patients, palliative radiotherapy to the skull base region is an effective treatment option to improve patients' QOL.
Collapse
Affiliation(s)
- Ayaka Azami
- Dept. of Surgery, Southern Tohoku General Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Azami A, Suzuki N, Azami Y, Seto I, Sato A, Takano Y, Abe T, Teranishi Y, Tachibana K, Ohtake T. Abscopal effect following radiation monotherapy in breast cancer: A case report. Mol Clin Oncol 2018; 9:283-286. [PMID: 30155251 DOI: 10.3892/mco.2018.1677] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/14/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022] Open
Abstract
Radiotherapy has been found to be valuable for the control and eradication of local foci in various malignant tumors. The abscopal effect is determined as a systemic antitumor response at a distance from the irradiation site invoked by local irradiation. We herein present an extremely rare case of breast cancer in a 64-year-old woman, in whom the abscopal effect was observed after radiotherapy induced an antitumor response in all metastatic lesions, without any combination therapy. The patient was admitted to our hospital complaining of a breast mass and pain at the left hip, and was diagnosed with breast cancer with multiple bone, lung and lymph node metastases. She received treatment with local radiotherapy delivered to the breast tumor and some of the bone metastases but did not receive chemotherapy due to her poor performance status. However, 10 months after radiotherapy, spontaneous regression was observed, not only within the irradiated field, but also in the non-irradiated areas. All signs of cancer throughout the body disappeared, and the patient's performance status drastically improved. To the best of our knowledge, there have been no reports of advanced breast cancer cases in which the abscopal effect was observed after radiation monotherapy; therefore, this case report is extremely rare and highly valuable.
Collapse
Affiliation(s)
- Ayaka Azami
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Nobuyasu Suzuki
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Yusuke Azami
- Department of Radiation Therapy, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Ichiro Seto
- Department of Radiation Therapy, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Atai Sato
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Tsuyoshi Abe
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, Fukushima 963-8563, Japan
| | - Kazunoshin Tachibana
- Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan
| | - Tohru Ohtake
- Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, Fukushima 960-1295, Japan
| |
Collapse
|
13
|
Ono T, Nakamura T, Yamaguchi H, Azami Y, Takayama K, Suzuki M, Wada H, Kikuchi Y, Murakami M, Nemoto K. Clinical results of proton beam therapy for elderly patients with non-small cell lung cancer. Radiat Oncol 2018; 13:19. [PMID: 29402290 PMCID: PMC5799978 DOI: 10.1186/s13014-018-0967-4] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/31/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The purpose of the present study was to evaluate retrospectively the efficacy and safety of proton beam therapy for elderly patients (≥80 years of age) with non-small cell lung cancer. METHODS Patients diagnosed with T1-4 N0 M0 non-small cell lung cancer and treated with proton beam therapy between January 2009 and 2015 were recruited from our database retrospectively. Toxicity was evaluated using The Common Terminology Criteria for Adverse Events version 4.0. RESULTS Thirty-five patients, including 25 (71%) with clinically inoperable lung cancer, were administered proton beam therapy. The median age was 82 years (range: 80-87 years), and the median follow-up time was 34 months (range: 10-72 months). The median dose of proton beam therapy was 80.0 Gy relative biological effectiveness (RBE) (range: 60.0-80.0 Gy [RBE]), and all patients completed the treatments. All patients were followed for at least 23 months or until their death. The 3-year overall survival rate was 67.2% (90.0% in patients with operable lung cancer, and 58.2% in those with inoperable lung cancer). The 3-year local control rate was 86.5%. Two patients presented with grade 2 pneumonitis. The occurrence rate of grade 2 pneumonitis was significantly correlated with a high lung V20 (p = 0.030), and a high mean lung dose (p = 0.030), and a low ratio of lung volume spared from 0.05 Gy (RBE) dose (total lung volume minus lung volume irradiated at least 0.05 Gy [RBE]) (p = 0.030). However, there were no cases of grade 3 or higher radiation pneumonitis. CONCLUSIONS This study suggests that the proton beam therapy was feasible for elderly patients with non-small cell lung cancer and can be considered as one of the treatment choices for elderly patients with lung cancer.
Collapse
Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan.
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata, Japan
| |
Collapse
|
14
|
Kimura K, Nakamura T, Ono T, Azami Y, Suzuki M, Wada H, Takayama K, Endo H, Takeyama T, Hirose K, Takai Y, Kikuchi Y. Clinical results of proton beam therapy for hepatocellular carcinoma over 5 cm. Hepatol Res 2017; 47:1368-1374. [PMID: 28198132 DOI: 10.1111/hepr.12874] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/26/2017] [Accepted: 02/10/2017] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to evaluate the safety and efficacy of proton beam therapy for large hepatocellular carcinoma (HCC). METHODS Twenty-four patients with a HCC larger than 5.0 cm were treated with proton beam therapy at our institution between 2008 and 2015. RESULTS The clinical stage was I in 2 patients, II in 9 patients, and IIIB in 13 patients. Ten of the 24 patients were not surgical candidates because of advanced HCC or old age. Median tumor size was 90 mm (range, 50-180 mm). Median total dose delivered was 72.6 Gray-equivalents (GyE) in 22 fractions (range, 60.8-85.8 GyE). Median follow-up period was 17.5 months (range, 3-70 months). Local control rate at 2 years was 87.0%. The 2-year overall survival rate was 52.4%. The predominant tumor progression pattern was new hepatic tumor development outside the irradiated field. No acute or late treatment-related toxicity of grade 3 or higher, other than dermatitis, was observed. CONCLUSIONS These results show that proton beam therapy offers an effective and safe method for treating patients with large HCC. Proton beam therapy represents a promising method for treatment of large-volume HCC.
Collapse
Affiliation(s)
- Kanako Kimura
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Hiromasa Endo
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Teruhito Takeyama
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| | - Katsumi Hirose
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Japan
| | - Yoshihiro Takai
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Beam Therapy Center, Koriyama, Japan
| |
Collapse
|
15
|
Ono T, Yabuuchi T, Nakamura T, Kimura K, Azami Y, Hirose K, Suzuki M, Wada H, Kikuchi Y, Nemoto K. High Dose Hypofractionated Proton Beam Therapy is a Safe and Feasible Treatment for Central Lung Cancer. Radiol Oncol 2017; 51:324-330. [PMID: 28959169 PMCID: PMC5611997 DOI: 10.1515/raon-2017-0023] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/14/2017] [Indexed: 12/25/2022] Open
Abstract
Background There have been few reports about high total dose hypofractionated proton beam therapy for central lung cancer. The aim of this study was to examine retrospectively the safety and efficacy of high total dose hypofractionated proton beam therapy for central lung cancer. Patients and methods Patients treated by proton beam therapy for central lung cancer located less than 2 cm from the trachea, mainstem bronchus, or lobe bronchus were included in this study. All patients received 80 Gy of relative biological dose effectiveness (RBE) in 25 fractions with proton beam therapy over 5 weeks between January 2009 and February 2015. The toxicities were evaluated using the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer criteria. Results Twenty patients, including 14 clinically inoperable patients (70%), received proton beam therapy for central lung cancer. The median patient age was 75 years (range: 63–90 years), the median follow up time was 27.5 months (range: 12–72 months), and the median tumor diameter was 39.5 mm (range: 24–81 mm). All patients were followed for at least 20 months or until death. The 2-year overall survival rate was 73.8% (100% in operable patients, and 62.5% in inoperable patients), and the 2-year local control rate was 78.5%. There was no Grade 3 or higher toxicities, including bronchial stricture, obstruction, and fistula. Conclusions The present study suggests that a high total dose hypofractionated proton beam therapy for central lung cancer was safe and feasible.
Collapse
Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Tomonori Yabuuchi
- Department of Radiation Oncology, Ninohe Hospital, 38 - 2, Okawarage, Aza, Horino, Ninohe, Iwate, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Kanako Kimura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Katsumi Hirose
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, 2-2-2, Iida-Nishi, Yamagata, Japan
| |
Collapse
|
16
|
Ishikawa Y, Nakamura T, Kato T, Kadoya N, Suzuki M, Azami Y, Hareyama M, Kikuchi Y, Jingu K. Dosemetric Parameters Predictive of Rib Fractures after Proton Beam Therapy for Early-Stage Lung Cancer. TOHOKU J EXP MED 2017; 238:339-45. [PMID: 27087118 DOI: 10.1620/tjem.238.339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Proton beam therapy (PBT) is the preferred modality for early-stage lung cancer. Compared with X-ray therapy, PBT offers good dose concentration as revealed by the characteristics of the Bragg peak. Rib fractures (RFs) after PBT lead to decreased quality of life for patients. However, the incidence of and the risk factors for RFs after PBT have not yet been clarified. We therefore explored the relationship between irradiated rib volume and RFs after PBT for early-stage lung cancer. The purpose of this study was to investigate the incidence and the risk factors for RFs following PBT for early-stage lung cancer. We investigated 52 early-stage lung cancer patients and analyzed a total of 215 irradiated ribs after PBT. Grade 2 RFs occurred in 12 patients (20 ribs); these RFs were symptomatic without displacement. No patient experienced more severe RFs. The median time to grade 2 RFs development was 17 months (range: 9-29 months). The three-year incidence of grade 2 RFs was 30.2%. According to the analysis comparing radiation dose and rib volume using receiver operating characteristic curves, we demonstrated that the volume of ribs receiving more than 120 Gy3 (relative biological effectiveness (RBE)) was more than 3.7 cm(3) at an area under the curve of 0.81, which increased the incidence of RFs after PBT (P < 0.001). In this study, RFs were frequently observed following PBT for early-stage lung cancer. We demonstrated that the volume of ribs receiving more than 120 Gy3 (RBE) was the most significant parameter for predicting RFs.
Collapse
Affiliation(s)
- Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hatayama Y, Nakamura T, Suzuki M, Azami Y, Ono T, Yabuuchi T, Hayashi Y, Kimura K, Hirose K, Wada H, Hareyama M, Kikuchi Y, Takai Y. Clinical Outcomes and Prognostic Factors of High-Dose Proton Beam Therapy for Peripheral Stage I Non-Small-Cell Lung Cancer. Clin Lung Cancer 2016; 17:427-432. [DOI: 10.1016/j.cllc.2015.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 12/25/2022]
|
18
|
Hayashi Y, Nakamura T, Mitsudo K, Kimura K, Yamaguchi H, Ono T, Azami Y, Takayama K, Hirose K, Yabuuchi T, Suzuki M, Hatayama Y, Kikuchi Y, Wada H, Fuwa N, Hareyama M, Tohnai I. Re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy for recurrent oral cancer. Asia Pac J Clin Oncol 2016; 13:e394-e401. [DOI: 10.1111/ajco.12502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/18/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery; Yokohama City University Graduate School of Medicine; Yokohama Japan
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Kanako Kimura
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Takashi Ono
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Yusuke Azami
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Kanako Takayama
- Department of Oral and Maxillofacial Surgery; Yokohama City University Graduate School of Medicine; Yokohama Japan
| | - Katsumi Hirose
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Tomonori Yabuuchi
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Yoshiomi Hatayama
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Hitoshi Wada
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Nobukazu Fuwa
- Department of Radiology; Ise Red Cross Hospital; Ise Japan
| | - Masato Hareyama
- Department of Radiation Oncology; Southern Tohoku Proton Therapy Center; Koriyama Japan
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery; Yokohama City University Graduate School of Medicine; Yokohama Japan
| |
Collapse
|
19
|
Hayashi Y, Nakamura T, Mitsudo K, Yamaguchi H, Ono T, Azami Y, Takayama K, Suzuki M, Hatayama Y, Tsukiyama I, Hareyama M, Kikuchi Y, Fuwa N, Tohnai I. Retrograde intra-arterial chemotherapy and daily concurrent proton beam therapy for recurrent oral cavity squamous cell carcinoma: Analysis of therapeutic results in 46 cases. Head Neck 2016; 38:1145-51. [PMID: 27018982 DOI: 10.1002/hed.24421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/18/2015] [Revised: 10/07/2015] [Accepted: 12/30/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy and toxicities of proton beam therapy combined with intra-arterial infusion chemotherapy via superficial temporal and occipital arteries for recurrent oral cavity squamous cell carcinoma (SCC). METHODS Between October 2009 and June 2013, 46 patients with recurrent oral cavity SCC were treated by proton beam therapy combined with intra-arterial infusion chemotherapy of cisplatin (CDDP) and docetaxel. Treatment consisted of proton beam therapy (28.6-74.8 GyE in 13-34 fractions) and intra-arterial infusion chemotherapy (CDDP, 30-50 mg/body/week; docetaxel, 5-25 mg/body/week). RESULTS One-year and 2-year overall survival (OS) rates were 65% and 46%, respectively. One-year and 2-year local control rates were 81% and 70%, respectively. CONCLUSION These findings suggest that proton beam therapy combined with intra-arterial infusion chemotherapy could be applied effectively and safely for patients with recurrent oral cavity SCC. © 2016 Wiley Periodicals, Inc. Head Neck 38:1145-1151, 2016.
Collapse
Affiliation(s)
- Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Kanako Takayama
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yoshiomi Hatayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Iwao Tsukiyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Masato Hareyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Nobukazu Fuwa
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
20
|
Takada A, Nakamura T, Takayama K, Makita C, Suzuki M, Azami Y, Kato T, Tsukiyama I, Hareyama M, Kikuchi Y, Daimon T, Toyomasu Y, Ii N, Nomoto Y, Sakuma H, Fuwa N. Preliminary treatment results of proton beam therapy with chemoradiotherapy for stage I-III esophageal cancer. Cancer Med 2016; 5:506-15. [PMID: 26806272 PMCID: PMC4799947 DOI: 10.1002/cam4.607] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/22/2015] [Accepted: 11/17/2015] [Indexed: 12/20/2022] Open
Abstract
The effect of proton beam therapy (PBT) on various cancers is controversial. We aimed to evaluate the efficacy and safety of PBT with alternating chemoradiotherapy (ACRT) for patients with stage I–III esophageal cancer. Two cycles of systemic chemotherapy with a continuous infusion of 5‐fluorouracil (5‐FU) on days 1–5 and a 5h infusion of nedaplatin (NDP) on day 6 were accompanied by thoracic irradiation using X‐ray therapy and PBT. During the first half of the treatment, X‐rays were delivered to the prophylactic area. During the second half of the treatment, proton beams were used to irradiate the involved field. To reduce the dose of cardiac irradiation, proton beams were delivered with posterior and posterior oblique angles. Between January 2009 and December 2012, 47 patients were enrolled in this study. The median follow‐up duration was 29 months for all patients and 40 months for survivors. The 3 year overall survival rate, progression‐free survival rate, and local control rate were 59.2%, 56.3%, and 69.8%, respectively. With respect to grade 3–4 late toxicities, there were no pleural or pericardial effusions, but two patients (4.3%) had esophageal stenosis, one patient (2.1%) had fistula, and two patients (4.3%) developed radiation pneumonitis. PBT with ACRT might have the potential to reduce the risk of cardiac damage and might become one of the primary methods of esophageal cancer treatment.
Collapse
Affiliation(s)
- Akinori Takada
- Department of Radiation Oncology, Mie University Hospital, Tsu, Mie, Japan
| | - Tatsuya Nakamura
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Kanako Takayama
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan.,Department of Dentistry/oral surgery, Graduate School of Medicine, Yokohama City University, Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Chiyoko Makita
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusaku, Nagoya, Japan
| | - Motohisa Suzuki
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yusuke Azami
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Takahiro Kato
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Iwao Tsukiyama
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Masato Hareyama
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Takashi Daimon
- Division of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yutaka Toyomasu
- Department of Radiation Oncology, Mie University Hospital, Tsu, Mie, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Mie University Hospital, Tsu, Mie, Japan
| | - Yoshihito Nomoto
- Department of Radiation Oncology, Mie University Hospital, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiation Oncology, Mie University Hospital, Tsu, Mie, Japan
| | - Nobukazu Fuwa
- Hyogo Ion Beam Medical Center, Shingu, Tatsuno, Hyogo, Japan
| |
Collapse
|
21
|
Ono T, Nakamura T, Azami Y, Yamaguchi H, Hayashi Y, Suzuki M, Hatayama Y, Tsukiyama I, Hareyama M, Kikuchi Y, Nemoto K. Clinical results of proton beam therapy for twenty older patients with esophageal cancer. Radiol Oncol 2015; 49:371-8. [PMID: 26834524 PMCID: PMC4722928 DOI: 10.1515/raon-2015-0034] [Citation(s) in RCA: 9] [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: 03/15/2015] [Accepted: 06/20/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In an aging society, increasing number of older patients are diagnosed with esophageal cancer. The purpose of this study was to assess the clinical efficacy and safety of proton beam therapy for older patients with esophageal cancer. PATIENTS AND METHODS Older patients (age: ≥ 65 years) newly diagnosed with esophageal cancer between January 2009 and June 2013 were enrolled in this study. All patients underwent either proton beam therapy alone or proton beam therapy with initial X-ray irradiation. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. RESULTS Twenty patients were eligible for this study and all completed the treatment. The median age was 78 years (range: 65-89 years) and the median follow-up time was 26.5 months (range: 6-62 months). Seven patients had lymph node metastases and 10 had stage II/III cancer. The median dose of proton beam therapy was 72.6 Gy relative biological dose effectiveness (RBE) (range: 66-74.8 Gy [RBE]) for proton beam therapy alone and 33 Gy (RBE) (range: 30.8-39.6 Gy [RBE]; total dose range: 66.8-75.6 Gy [RBE]) for proton beam therapy with initial X-ray irradiation. The 2-year overall survival rate was 81.8% (95% confidence interval [CI]: 62.4%-100%), and the 2-year local control rate was 89.4% (95% CI: 75.5%-100%). Grade 2 or 3 toxicities occurred in some cases; however, no grade 4 or 5 toxicity was observed. CONCLUSIONS High-dose (66-75.6 Gy [RBE]) proton beam therapy without chemotherapy was an efficacious and safe treatment for older patients with esophageal cancer.
Collapse
Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yuichiro Hayashi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yoshiomi Hatayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Iwao Tsukiyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Masato Hareyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| |
Collapse
|
22
|
Nakamura T, Azami Y, Ono T, Yamaguchi H, Hayashi Y, Suzuki M, Hatayama Y, Tsukiyama I, Hareyama M, Kikuchi Y, Takayama K, Fuwa N. Preliminary results of proton beam therapy combined with weekly cisplatin intra-arterial infusion via a superficial temporal artery for treatment of maxillary sinus carcinoma. Jpn J Clin Oncol 2015; 46:46-50. [DOI: 10.1093/jjco/hyv160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
|
23
|
Hatayama Y, Nakamura T, Suzuki M, Azami Y, Ono T, Yamaguchi H, Hayashi Y, Tsukiyama I, Hareyama M, Kikuchi Y, Takai Y. Preliminary results of proton-beam therapy for stage III non-small-cell lung cancer. Curr Oncol 2015; 22:e370-5. [PMID: 26628878 PMCID: PMC4608411 DOI: 10.3747/co.22.2523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We conducted a preliminary retrospective evaluation of the efficacy and toxicity of proton-beam therapy (pbt) for stage iii non-small-cell lung cancer. METHODS Between January 2009 and August 2013, 27 patients (26 men, 1 woman) with stage iii non-small-cell lung cancer underwent pbt. The relative biologic effectiveness value of the proton beam was defined as 1.1. The beam energy and spread-out Bragg peak were fine-tuned such that the 90% isodose volume of the prescribed dose encompassed the planning target volume. Of the 27 patients, 11 underwent neoadjuvant chemotherapy. Cumulative survival curves were calculated using the Kaplan-Meier method. Treatment toxicities were evaluated using version 4 of the Common Terminology Criteria for Adverse Events. RESULTS Median age of the patients was 72 years (range: 57-91 years), and median follow-up was 15.4 months (range: 7.8-36.9 months). Clinical stage was iiia in 14 patients (52%) and iiib in 13 (48%). The median dose of pbt was 77 GyE (range: 66-86.4 GyE). The overall survival rate in the cohort was 92.3% at 1 year and 51.1% at 2 years. Locoregional failure occurred in 7 patients, and distant metastasis, in 10. In 2 patients, initial failure was both locoregional and distant. The 1-year and 2-year rates of local control were 68.1% and 36.4% respectively. The 1-year and 2-year rates of progression-free survival were 39.9% and 21.4% respectively. Two patients experienced grade 3 pneumonitis. CONCLUSIONS For patients with stage iii non-small-cell lung cancer, pbt can be an effective and safe treatment option.
Collapse
Affiliation(s)
- Y. Hatayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - T. Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - M. Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - T. Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - H. Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Hayashi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - I. Tsukiyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - M. Hareyama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Y. Takai
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
24
|
Makita C, Nakamura T, Takada A, Takayama K, Suzuki M, Azami Y, Kato T, Tsukiyama I, Hareyama M, Kikuchi Y, Daimon T, Hata M, Inoue T, Fuwa N. High-dose proton beam therapy for stage I non-small cell lung cancer: Clinical outcomes and prognostic factors. Acta Oncol 2015; 54:307-14. [PMID: 25291076 DOI: 10.3109/0284186x.2014.948060] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence has suggested that radiation therapy with a lower dose per fraction may be a reasonable option for the treatment of centrally located non-small cell lung cancer (NSCLC). The aim of this study was to evaluate the safety and efficacy of two proton beam therapy (PBT) protocols for stage I NSCLC and to determine prognostic factors. MATERIAL AND METHODS This study included patients clinically diagnosed with stage I NSCLC. Based on the location of the tumor, one of the two PBT protocols was administered. Patients with peripherally located tumors were given 66 Gy relative biological dose effectiveness (RBE) over 10 fractions (Protocol A) while patients with centrally located tumors were given 80 Gy (RBE) over 25 fractions (Protocol B). RESULTS Between January 2009 and May 2012, 56 eligible patients were enrolled (protocol A: 32 patients; protocol B: 24 patients). The three-year overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 81.3% [95% confidence interval (CI) 75.9-86.7%], 73.4% (95% CI 67.2-79.6%), and 96.0% (95% CI 93.2-98.8%), respectively. There were no significant differences in outcomes between the two protocols. Late grade 2 and 3 pulmonary toxicities were observed in nine patients (13.4%) and one patient (1.5%), respectively; no grade 4 or 5 toxicities were observed. Sex, age, performance status, T-stage, operability, and tumor pathology were not associated with OS and PFS. Only maximum standardized uptake value (SUVmax; <5 vs. ≥5) was identified as a significant prognostic factor for OS and PFS. CONCLUSION Both high-dose PBT protocols achieved high LC rates with tolerable toxicities in stage I NSCLC patients, and SUVmax was a significant prognostic factor.
Collapse
Affiliation(s)
- Chiyoko Makita
- Department of Radiation Oncology, Aichi Cancer Center Hospital , Chikusaku, Nagoya , Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Makita C, Nakamura T, Takada A, Takayama K, Suzuki M, Ishikawa Y, Azami Y, Kato T, Tsukiyama I, Kikuchi Y, Hareyama M, Murakami M, Fuwa N, Hata M, Inoue T. Clinical outcomes and toxicity of proton beam therapy for advanced cholangiocarcinoma. Radiat Oncol 2014; 9:26. [PMID: 24422711 PMCID: PMC3904195 DOI: 10.1186/1748-717x-9-26] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 03/18/2013] [Accepted: 01/09/2014] [Indexed: 12/25/2022] Open
Abstract
Background We examined the efficacy and toxicity of proton beam therapy (PBT) for treating advanced cholangiocarcinoma. Methods The clinical data and outcomes of 28 cholangiocarcinoma patients treated with PBT between January 2009 and August 2011 were retrospectively examined. The Kaplan–Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and local control (LC) rates, and the log-rank test to analyze the effects of different clinical and treatment variables on survival. Acute and late toxicities were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Results The median age of the 17 male and 11 female patients was 71 years (range, 41 to 84 years; intrahepatic/peripheral cholangiocarcinoma, n = 6; hilar cholangiocarcinoma/Klatskin tumor, n = 6; distal extrahepatic cholangiocarcinoma, n = 3; gallbladder cancer, n = 3; local or lymph node recurrence, n = 10; size, 20–175 mm; median 52 mm). The median radiation dose was 68.2 Gy (relative biological effectiveness [RBE]) (range, 50.6 to 80 Gy (RBE)), with delivery of fractions of 2.0 to 3.2 Gy (RBE) daily. The median follow-up duration was 12 months (range, 3 to 29 months). Fifteen patients underwent chemotherapy and 8 patients, palliative biliary stent placement prior to PBT. OS, PFS, and LC rates at 1 year were 49.0%, 29.5%, and 67.7%, respectively. LC was achieved in 6 patients, and was better in patients administered a biologically equivalent dose of 10 (BED10) > 70 Gy compared to those administered < 70 Gy (83.1% vs. 22.2%, respectively, at 1 year). The variables of tumor size and performance status were associated with survival. Late gastrointestinal toxicities grade 2 or greater were observed in 7 patients <12 months after PBT. Cholangitis was observed in 11 patients and 3 patients required stent replacement. Conclusions Relatively high LC rates after PBT for advanced cholangiocarcinoma can be achieved by delivery of a BED10 > 70 Gy. Gastrointestinal toxicities, especially those of the duodenum, are dose-limiting toxicities associated with PBT, and early metastatic progression remains a treatment obstacle.
Collapse
Affiliation(s)
- Chiyoko Makita
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, 963-8052 Koriyama, Fukushima, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Takayama K, Nakamura T, Takada A, Makita C, Suzuki M, Ishikawa Y, Azami Y, Kikuchi Y, Tsukiyama I, Kato T, Tohnai I, Fuwa N. Proton beam therapy combined with selective intra-arterial infusion chemotherapy for locally advanced tongue cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6086] [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: 11/20/2022] Open
Abstract
6086 Background: The standard treatment for locally advanced tongue cancer is surgery. However, the patient’s quality of life is lost. As a newly non-operative treatment, we report the efficacy and toxicity of proton beam therapy combined with selective intra-arterial infusion chemotherapy (PBT-IACT) for locally advanced tongue cancer. Methods: Between February 2009 and August 2012, 45 cases of stage III-IV(M0) squamous cell carcinoma of the tongue (28 men and 17 women) were treated by PBT-IACT at Southern TOHOKU Proton Therapy Center. Median age was 58 years (range:24-83 years), and clinical stage III/IVA/IVB were 11/32/2 respectively. In case of surgery, the patients required subtotal or total resection of the tongue. Initially, 2 courses of systemic chemotherapy and prophyractic whole neck irradiation (36Gy/20fr.) were performed. Subsequently, for gross tumor targets, PBT (33Gy/15fr.) and IACT were administered via the superficial temporal artery by continuous infusion of cisplatin with sodium thiosulphate. For PBT, 1 or 2 portals of 210 MeV proton beam were arranged in optimal angles to avoid overdosing the risk organ. Systemic chemotherapy was performed only for age of 70 years or younger. Results: The median follow-up was 27 months (range:8-48 months). Over all survival (OS), disease-free survival (DFS), and local control (LC) rates at 2 years were 88%,78%, 80%, respectively. LC of cervical lymph node metastases at 2 years was 86%. As the early toxic event, grade 3 mucositis (32/45) and blood/bone marrow toxicity (22/45) were observed. Within 6 months after this therapy, mandibular osteomyelitis occurred in 1 case. Conclusions: PBT-IACT appeared to be safe and has a good LC rate for locally advanced tongue cancer. Furthermore, it is not inferior to surgery and can be one of the new effective treatment options for locally advanced tongue cancer.
Collapse
Affiliation(s)
- Kanako Takayama
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Tatsuya Nakamura
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Akinori Takada
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Chiyoko Makita
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Motohisa Suzuki
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Youjirou Ishikawa
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Yusuke Azami
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Yasuhiro Kikuchi
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Iwao Tsukiyama
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Takahiro Kato
- Southern TOHOKU Proton Therapy Center, Koriyama-city, Fukushima-pref, Japan
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nobukazu Fuwa
- Southern TOHOKU Proton Therapy Cente, Koriyama-city, Fukushima-pref, Japan
| |
Collapse
|
27
|
Hattori M, Azami Y. Searching for preventive measures of cardiovascular events in aged Japanese taxi drivers--the daily rhythm of cardiovascular risk factors during a night duty day. J Hum Ergol (Tokyo) 2001; 30:321-6. [PMID: 14564902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Previous studies have shown that Japanese taxi drivers are exposed to more risk factors and have a higher mortality rate due to cardiovascular disease than other occupational groups. We investigated the effect of night taxi driving with a view to preventing acute events of cardiovascular disease among aged taxi drivers. Twenty-nine taxi drivers (41-67 years old) were examined for urine normetanephrine/creatinine, von Willebrand factor, anti-thrombin III, t-plasminogen activator-plasminogen activator inhibitor 1-complex, hematocrit, blood glucose and blood pressure in the morning and at midnight during a duty day and in the following morning. At the same time, the blood pressure and blood glucose of 46 taxi drivers (43-67 years old) in the morning after a night duty with little sleep and in the morning after daytime work and subsequent night sleep were compared. The results obtained indicate that the aggravation of sympathetic nervous system functions with disturbed circadian rhythms, increased blood coagulation and blood concentration, endothelial injury and the elevation of blood glucose at midnight or the next morning were induced by their night work. These conditions are supposed to favour acute vascular events in aged taxi drivers. Preventive measures considered include social support for anticoagulant food and water intake, short exercise and walking as well as taking a rest and a nap during night work.
Collapse
|
28
|
Abstract
We observed two patients with diabetes who were suffering from nausea, vomiting and epigastralgia after meals. These symptoms subsided when lying on their left side. Since the 2 patients had autonomic neuropathy, at first, the symptoms seemed to be attributable to diabetic gastroparesis. However, they were diagnosed as having superior mesenteric artery syndrome by hypotonic duodenography. These finding suggest that in diabetic patients who have a history of excessive weight loss superior mesenteric artery syndrome should be ruled out even though they have autonomic neuropathy.
Collapse
Affiliation(s)
- Y Azami
- Department of Internal Medicine, Johoku Hospital, Kanazawa
| |
Collapse
|
29
|
Azami Y. Paralytic ileus accompanied by pneumatosis cystoides intestinalis after acarbose treatment in an elderly diabetic patient with a history of heavy intake of maltitol. Intern Med 2000; 39:826-9. [PMID: 11030208 DOI: 10.2169/internalmedicine.39.826] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 87-year-old woman, diagnosed with diabetes mellitus at age 73, exhibited abdominal distention and appetite loss in March 1998. She had received acarbose as well as 5 mg per day of glibenclamide and had habitually used about 100 g of maltitol daily from 1997. She was diagnosed as having paralytic ileus accompanied by pneumatosis cystoides intestinalis (PCI). This condition subsided quickly with discontinuation of diet or cessation of acarbose and maltitol usage. The patient's condition appears to be attributable to increased gas levels produced by fermentation of disaccharides and maltitol. Decreased intestinal motility may be a result of pre-existing diabetic autonomic neuropathy and hypothyroidism. The patient's clinical course suggests that paralytic ileus and PCI should be listed as rare side effects of alpha-glucosidase inhibitors and that the drug should be used with great caution for those who consume non-digestive sugar substitutes.
Collapse
Affiliation(s)
- Y Azami
- Department of Internal Medicine, Johoku Hospital, Kanazawa
| |
Collapse
|