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1.
Anticancer Res ; 40(1): 379-386, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892590

RESUMO

BACKGROUND/AIM: We evaluated the efficacy and safety of carbon-ion radiotherapy (CIRT) alone for Stage III non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Data of 65 patients (median age=73 years) with Stage III NSCLC who underwent CIRT alone in the QST Hospital, Chiba, Japan, between 1997 and 2015 were retrospectively analysed. The median dose was 72.0 Gy (relative biological effectiveness). RESULTS: The median follow-up was 27.6 months (range=1.6-207.7 months). Two-year local control, progression-free survival (PFS), and overall survival (OS) rates were 73.9%, 38.6%, and 54.9%, respectively. Overall, 1 (2%), 4 (6%), and 1 (2%) patient developed Grade 4 (mediastinal haemorrhage), Grade 3 (radiation pneumonitis), and Grade 3 (bronchial fistula) toxicities, respectively. On univariate analysis, clinical T and N stage and CIRT timing were significant predictors of PFS and OS; clinical target volume was a significant predictor of PFS. CONCLUSION: CIRT alone is effective with acceptable toxicity for Stage III NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Radioterapia com Íons Pesados/efeitos adversos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Resultado do Tratamento
2.
Br J Radiol ; 92(1103): 20190370, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31317764

RESUMO

OBJECTIVE: We had developed compact rotating gantry for carbon ion using superconducting magnets in 2015 which became clinically operational in 2017. The objective of this study was to assess the clinical feasibility and safety of using compact rotating gantry with three-dimensional active scanning in delivery of carbon-ion radiotherapy (C-ion RT) for relatively stationary tumours. METHODS: A prospective feasibility study was conducted with 10 patients who had been treated with C-ion RT using compact rotating gantry between April 2017 and April 2018 at Hospital of the National Institute of Radiological Sciences (NIRS) for head and neck and prostate cancers. The primary end point was evaluation of acute toxicities within 3 months of starting C-ion RT. RESULTS: Out of 10 cases 8 were of head and neck cancers and 2 were of prostate cancers. All of those eight head and neck cases were of locally advanced stages. Both of the prostate cancer patients belong to intermediate risk categories. None of the patients developed even Grade 2 or more severe skin reactions. Six out of eight cases with head and neck cancers experienced Grade 2 mucosal reactions; however, nobody developed Grade 3 or more severe mucosal reactions. There was no gastrointestinal reaction observed in prostate cancer patients. One patient developed Grade 2 genitourinary reaction. CONCLUSION: C-ion RT using compact rotating gantry and three-dimensional active scanning is a safe and feasible treatment for relatively less mobile tumours. ADVANCES IN KNOWLEDGE: This study will be the first step to establish the use of superconducting rotating gantry in C-ionRT in clinical setting paving the way for treating large number of patients and make it a standard of practice in the future.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia com Íons Pesados/métodos , Neoplasias da Próstata/radioterapia , Adulto , Idoso , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Radioterapia com Íons Pesados/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
3.
Int J Clin Oncol ; 24(9): 1143-1150, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30968270

RESUMO

BACKGROUND: The efficacy of carbon-ion radiotherapy (C-ion RT) for lymph node (LN) oligo-recurrence has only been evaluated in limited single-center studies. We aimed to investigate the benefit of C-ion RT for LN oligo-recurrence in a large multi-center study. METHODS: Patients who received C-ion RT between December 1996 and December 2015 at 4 participating facilities and who met the following eligibility criteria were included: (i) histological or clinical diagnosis of LN recurrence; (ii) controlled primary lesion; (iii) no recurrence other than LN; (iv) LN recurrence involved in a single lymphatic site; and (v) age ≥ 20 years. RESULTS: A total of 323 patients were enrolled. Median follow-up period was 34 months for surviving patients. The most common dose fractionation of C-ion RT was 48.0 Gy (relative biological effectiveness) in 12 fractions. Forty-seven patients had a history of RT at the recurrent site. The 2-year local control (LC) and overall survival (OS) rates after C-ion RT were 85% and 63%, respectively. Only 1 patient developed grade-3 toxicity. Factors such as LN diameter, histology, and history of previous RT did not correlate with LC. Smaller diameters (< 30 mm) and numbers (≤ 3) of LN metastases as well as longer disease-free intervals post-primary therapy (≥ 16 months) were associated with significantly better OS. CONCLUSIONS: C-ion RT for LN oligo-recurrence appeared to be effective and safe. C-ion RT may provide a survival benefit to patients with LN oligo-recurrence, particularly to those with few LN metastases, smaller LN diameters, and longer disease-free intervals.


Assuntos
Radioterapia com Íons Pesados , Metástase Linfática/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
4.
Cancer Sci ; 110(2): 734-741, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30467928

RESUMO

The efficacy and safety of carbon-ion radiotherapy (CIRT) for locally advanced non-small-cell lung cancer (LA-NSCLC) remain unclear. We reported the clinical outcomes of CIRT for LA-NSCLC. Data for 141 eligible patients who received CIRT between 1995 and 2015 were retrospectively analyzed. Local control (LC), locoregional control (LRC), progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. The median age was 75.0 years. Overall, 21 (14.9%), 57 (40.4%), 43 (30.5%) and 20 (14.2%) patients had T1, T2, T3 and T4 disease, respectively. Moreover, 51 (36.2%), 45 (31.9%), 40 (28.4%) and 5 (3.5%) patients had N0, N1, N2 and N3 disease, respectively. Furthermore, 34 (24.1%), 42 (29.8%), 45 (31.9%) and 20 (14.2%) patients had stages IIA, IIB, IIIA and ΙΙΙB disease, respectively. Overall, 62 (44.0%), 60 (42.6%), 8 (5.7%) and 11 (7.8%) patients had adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and others, respectively. The median dose was 72.0 Gy (relative biological effectiveness). No patient received concurrent chemotherapy. Median follow-up periods were 29.3 (1.6-207.7) and 40.0 (10.7-207.7) months for all patients and survivors, respectively. Two-year LC, PFS and OS rates were 80.3%, 40.2% and 58.7%, respectively. Overall, 1 (0.7%), 5 (3.5%) and 1 (0.7%) patient developed Grades 4 (mediastinal hemorrhage), 3 (radiation pneumonitis) and 3 (bronchial fistula) toxicities, respectively. Multivariate analysis showed adenocarcinoma and N2/3 classification as significant poor prognosticators of PFS. CIRT is an effective treatment with acceptable toxicity for LA-NSCLC, especially for elderly patients or patients with severe comorbidities who cannot be treated with surgery or chemoradiotherapy.


Assuntos
Carbono/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia/métodos , Feminino , Radioterapia com Íons Pesados/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
5.
Int J Radiat Oncol Biol Phys ; 102(5): 1551-1559, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30076985

RESUMO

PURPOSE: To investigate the suitability of the linear-quadratic (LQ) and universal survival curve (USC) models in describing the 3-year tumor control probability data of patients with stage I non-small cell lung cancer treated with carbon-ion radiation therapy. Carbon-ion radiation therapy was given at a total dose of 59.4 to 95.4 Gy (relative biological effectiveness [RBE]) in 18 fractions, at 72 Gy[RBE] in 9 fractions, at 52.8 to 60 Gy[RBE] in 4 fractions, and at 28 to 50 Gy[RBE] in a single fraction. METHODS AND MATERIALS: A meta-analysis of published clinical data from 394 patients presenting with early-stage non-small cell lung cancer was conducted. Tumor control probability modeling based on the LQ and USC models was performed by simultaneously fitting the clinical data obtained from the different fractionation schedules while considering several spread-out Bragg peak (SOBP) sizes. Radiobiological parameters were derived from the fit. On the basis of the results, a novel SOBP was created for the single-fraction regimen that was optimized with respect to the USC model and aimed at achieving a 95% local control. RESULTS: The USC model gave a better fit to the 3-year local control data than the LQ model did. The fit using various SOBP sizes yielded transition doses between 5.6 and 7.0 Gy. The results also revealed α/ß ratios between 7.4 and 9.1 Gy for the LQ model and between 7.4 and 9.4 Gy for the USC model. CONCLUSIONS: The USC model provided a better estimate of the local control rate for the single-fraction course. For the schemes with a greater number of fractions, the local control rate estimates from the LQ and USC models were comparable. A USC-based SOBP design was then created for the single-fraction schedule. The updated design resulted in a flatter RBE profile compared with the conventional SOBP design. It also gave a better clinical dose prediction to optimize the tumor control rate.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Fracionamento da Dose de Radiação , Radioterapia com Íons Pesados , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Humanos , Método de Monte Carlo , Estadiamento de Neoplasias , Probabilidade , Resultado do Tratamento
6.
Phys Med ; 52: 18-26, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30139605

RESUMO

INTRODUCTION: In the 7 years since our facility opened, we have treated >2000 patients with pencil-beam scanned carbon-ion beam therapy. METHODS: To summarize treatment workflow, we evaluated the following five metrics: i) total number of treated patients; ii) treatment planning time, not including contouring procedure; iii) quality assurance (QA) time (daily and patient-specific); iv) treatment room occupancy time, including patient setup, preparation time, and beam irradiation time; and v) daily treatment hours. These were derived from the oncology information system and patient handling system log files. RESULTS: The annual number of treated patients reached 594, 7 years from the facility startup, using two treatment rooms. Mean treatment planning time was 6.0 h (minimum: 3.4 h for prostate, maximum: 9.3 h for esophagus). Mean time devoted to daily QA and patient-specific QA were 22 min and 13.5 min per port, respectively, for the irradiation beam system. Room occupancy time was 14.5 min without gating for the first year, improving to 9.2 min (8.2 min without gating and 12.8 min with gating) in the second. At full capacity, the system ran for 7.5 h per day. CONCLUSIONS: We are now capable of treating approximately 600 patients per year in two treatment rooms. Accounting for the staff working time, this performance appears reasonable compared to the other facilities.


Assuntos
Radioterapia com Íons Pesados , Ensaios Clínicos como Assunto , Radioterapia com Íons Pesados/métodos , Humanos , Manutenção , Neoplasias/radioterapia , Garantia da Qualidade dos Cuidados de Saúde , Planejamento da Radioterapia Assistida por Computador , Fatores de Tempo , Fluxo de Trabalho
7.
Cancer Sci ; 109(5): 1562-1569, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29498145

RESUMO

Intrathoracic recurrence after carbon-ion radiotherapy for primary or metastatic lung tumors remains a major cause of cancer-related deaths. However, treatment options are limited. Herein, we report on the toxicity and efficacy of re-irradiation with carbon-ion radiotherapy for locoregionally recurrent, metastatic, or secondary lung tumors. Data of 95 patients with prior intrathoracic carbon-ion radiotherapy who were treated with re-irradiation with carbon-ion radiotherapy at our institution between 2006 and 2016 were retrospectively analyzed. Seventy-three patients (76.8%) had primary lung tumors and 22 patients (23.2%) had metastatic lung tumors. The median dose of initial carbon-ion radiotherapy was 52.8 Gy (relative biological effectiveness) and the median dose of re-irradiation was 66.0 Gy (relative biological effectiveness). None of the patients received concurrent chemotherapy. The median follow-up period after re-irradiation was 18 months. In terms of grade ≥3 toxicities, one patient experienced each of the following: grade 5 bronchopleural fistula, grade 4 radiation pneumonitis, grade 3 chest pain, and grade 3 radiation pneumonitis. The 2-year local control and overall survival rates were 54.0% and 61.9%, respectively. In conclusion, re-irradiation with carbon-ion radiotherapy was associated with relatively low toxicity and moderate efficacy. Re-irradiation with carbon-ion radiotherapy might be an effective treatment option for patients with locoregionally recurrent, metastatic, or secondary lung tumors.


Assuntos
Radioterapia com Íons Pesados , Neoplasias Pulmonares/radioterapia , Recidiva Local de Neoplasia/radioterapia , Segunda Neoplasia Primária/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico
8.
Oncotarget ; 9(19): 14849-14861, 2018 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-29599911

RESUMO

Malignant mesothelioma (MM) is extremely aggressive and a typical refractory cancer. In this study we investigated how effective on killing MM cells by carbon ion beam alone or in combination with cisplatin (CDDP) in vitro. Carbon ion beam (at the center of SOBP with 50 keV/µm of average LET) dose-independently suppressed MM cells MESO-1 and H226 cell viability and in combination with CDDP (25 µM) significantly enhanced its action. Relative biological effectiveness (RBE) values at 73 keV/µm and 13 keV/µm portion of carbon ion beam was estimated as 2.82-2.93 and 1.19-1.22 at D10 level relative to X-ray, respectively by using colony formation assay. Quantitative real time PCR analysis showed that expression of apoptosis-related BAX and autophagy-related Beclin1 and ATG7 was significantly enhanced by carbon ion beam alone or in combination with CDDP. Apoptosis analysis showed that caspase 3/7 activity and the percentage of apoptotic cells was dose-dependently increased after carbon ion beam and it was further increased when combined with CDDP. Spheroid formation ability of cancer stem like CD44+/CD26+ cells was significantly inhibited by carbon ion beam combined with CDDP. Besides, carbon ion beam combined with cisplatin significantly inhibited cell cycle progression (sub-G1 arrest) and induced more large number of γH2AX foci. In conclusion, carbon ion beam combined with CDDP has superior potential to kill MM cells including CSCs with enhanced apoptosis.

9.
J Radiat Res ; 58(5): 761-764, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28992088

RESUMO

Carbon-ion radiation therapy (CIRT) for advanced non-small-cell lung cancer (NSCLC) has not been well studied to date. This paper aimed to analyze a retrospective multicenter survey for detecting problems with the use of CIRT for Stage II and III NSCLC (7th UICC TNM Staging System). Inclusion was restricted to patients with Stage II and III NSCLC who received CIRT from November 2003 to December 2014. We gathered the data from three CIRT operating centers on July 2015. Patients with radiotherapy history, patients with cancers other than lung cancer, and those receiving palliative therapies were excluded. The patient characteristics, prescribed dose/fraction, survival rates, and adverse effects were analyzed. The total number of patients was 64 (male: 49, female: 15). Of these, 53 patients were medically inoperable. The median age was 76 years (range 46-91), and the median follow-up period was 18.5 months (range 3.2-121.5). The clinical staging consisted of 10 Stage IIA, 30 Stage IIB, 23 Stage IIIA and 1 Stage IIIB. The median prescribed dose was 72.0 Gy (RBE) (range 52.8-72.0) in 16 fractions (range 4-16). The 2-year overall survival, progression-free survival, and local control rates were 62.2% [confidence interval (CI): 47.5-76.9], 42.3% (CI: 28.8-55.8) and 81.8% (CI: 69.9-94.0), respectively. There were no higher than Grade 2 adverse effects observed. CIRT for inoperable Stage II and III NSCLC could be implemented without severe adverse effects, but the clinical staging (including lymph node status) was inhomogeneous. In addition, the prescribed dose and fractionation were not standardized. Further data accumulation and a multiple centers prospective trial for evaluating clinical stage-based results are required.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Radioterapia com Íons Pesados , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/radioterapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
10.
Radiat Oncol ; 12(1): 144, 2017 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-28865463

RESUMO

BACKGROUND: Lung cancer is frequently complicated by interstitial lung disease (ILD). Treatment protocols for lung cancer patients with ILD have not been established; surgery, chemotherapy, and radiotherapy can all cause acute exacerbation of ILD. This study evaluated the toxicity and efficacy of carbon ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC) and ILD. METHODS: Between June 2004 and November 2014, 29 patients diagnosed with NSCLC and ILD were treated with CIRT. No patient was eligible for curative surgery or conventional radiotherapy secondary to ILD. Owing to prior symptomology, radiation pneumonitis (RP) and symptom progression pre- and post-treatment were evaluated. The relationships between RP and clinical factors were investigated. RESULTS: Twenty-eight men and one woman, aged 62 to 90 years old, were followed for 2.7-77.1 months (median: 22.8 months). Single-grade symptomatic progression (grade 2-3) was observed in 4 patients, while 1 patient experiencedtwo-grade progression. Two patients experienced radiation-induced acute exacerbation. Local control at 3 years was 63.3% (72.2% for stage I disease); survival at 3 years was 46.3% (57.2% for stage I disease). Eighteen patients had died by the time of this writing, 10 of lung cancer progression. Radiation pneumonitis post-treatment progression correlated with dosimetric factors of the lungs (V5, V10) and a low pre-treatment serum surfactant protein-D. CONCLUSIONS: We found that CIRT may be useful as a low-risk, curative option for NSCLC patients with ILD, a population that is typically ineligible for conventional therapy. The DVH analysis showed that minimizing the low-dose region is important for reducing the risk of severe RP. TRIAL REGISTRATION: NIRS-9404 . Registered 1 March 1994.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Radioterapia com Íons Pesados/métodos , Doenças Pulmonares Intersticiais/complicações , Neoplasias Pulmonares/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Pneumonite por Radiação/epidemiologia , Estudos Retrospectivos
11.
Radiother Oncol ; 125(1): 31-35, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28784437

RESUMO

PURPOSE: To investigate carbon-ion radiotherapy (CIRT) for in-field recurrence of stage I non-small cell lung cancer (NSCLC) initially treated with CIRT. MATERIALS AND METHODS: From January 2007 to March 2014, patients initially treated for stage I NSCLC with CIRT and relapsed in-field were candidates. Overall survival (OS) rate, local control (LC) rate, progressive free survival (PFS) rate, dose to the lungs and skin, and adverse effects were analyzed. RESULTS: Twenty-nine patients were eligible. Median age at re-irradiation was 74years (range 53-90). Median observation period from the first day of re-irradiation was 29months (4-88months). Median prescribed dose was 46.0Gy (RBE) as initial treatment and 66.0Gy (RBE) in 12 fractions as re-irradiation. Two-year OS, LC, and PFS rates after re-irradiation were 69.0% (95% CI: 50.3-83.0), 66.9% (95% CI: 47.5-81.9), and 51.7% (95% CI: 34.1-68.9). Median skin maximum dose was 53.8Gy (RBE) (range 4.4-103.1) and median of mean lung dose was 7.3Gy (RBE) (range 2.6-14.0). There were no severer than grade 2 adverse effects except one (3.4%) grade 3 bacterial pneumonia, which was not considered radiation-induced. CONCLUSION: CIRT for stage I NSCLC local recurrence is an acceptable definitive re-treatment.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Radioterapia com Íons Pesados , Neoplasias Pulmonares/radioterapia , Recidiva Local de Neoplasia/radioterapia , Reirradiação , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
12.
Radiat Oncol ; 12(1): 91, 2017 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-28558766

RESUMO

BACKGROUND: Carbon-ion radiotherapy (CIRT) is a promising treatment for locally advanced non-small-cell lung cancer, especially for patients with inoperable lung cancer. Although the incidence of CIRT-induced radiation pneumonitis (RP) ≥ grade 2 ranges from 2.5 to 9.9%, the association between CIRT-induced RP and dosimetric parameters is not clear. Herein, we identified prognostic factors associated with symptomatic RP after CIRT for patients with non-small-cell lung cancer. METHODS: Clinical results of 65 patients treated with CIRT between 2000 and 2015 at the National Institute of Radiological Sciences were retrospectively analyzed. Clinical stage II B disease (TNM classification) was the most common stage among the patients (45%). The median radiation dose was 72 Gy (68-76) relative biological effectiveness (RBE) in 16 fractions. In cases involving metastatic lymph nodes, prophylactic irradiation of mediastinal lymph nodes was performed at a median dose of 49.5 Gy (RBE). The median follow-up was 22 months. RESULTS: Grade 2 and grade 3 RP occurred in 6 and 3 patients (9 and 5%), respectively. No patients developed grade 4 or 5 RP. Using univariate analysis, vital capacity as a percentage of predicted (%VC), forced expiratory volume in 1 s (FEV1), mean lung dose (MLD), volume of lung receiving ≥5 Gy (RBE) (V5), V10, V20 and V30 were determined to be the significant predictive factors for ≥ grade 2 RP. The receiver operating characteristic (ROC) analysis revealed the cutoff values for %VC, FEV1, MLD, V5, V10, V20 and V30 for ≥ grade 2 RP, which were 86.9%, 1.16 L, 12.5 Gy (RBE), 28.8, 29.9, 20.1 and 15.0%, respectively. In addition, the multivariate analysis revealed that %VC <86.9% (odds ratio = 13.7; p = 0.0041) and V30 ≥ 15% (odds ratio = 6.1; p = 0.0221) were significant risk factors. CONCLUSIONS: Our study demonstrated the risk factors for ≥ grade 2 RP after carbon-ion radiotherapy for patients with locally advanced lung cancer.


Assuntos
Adenocarcinoma/radioterapia , Carcinoma de Células Grandes/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Escamosas/radioterapia , Radioterapia com Íons Pesados/efeitos adversos , Neoplasias Pulmonares/radioterapia , Pneumonite por Radiação/etiologia , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Grandes/patologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Pneumonite por Radiação/diagnóstico , Dosagem Radioterapêutica , Estudos Retrospectivos
13.
Br J Radiol ; 90(1074): 20160936, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28466645

RESUMO

OBJECTIVE: To explore the trade-off between dose assessment and imaging dose in respiratory gating with radiographic fluoroscopic imaging, we evaluated the relationship between dose assessment and fluoroscopic imaging dose in various gating windows, retrospectively. METHODS: Four-dimensional (4D) CT images acquired for 10 patients with lung and liver tumours were used for 4D treatment planning for scanned carbon ion beam. Imaging dose from two oblique directions was calculated by the number of images multiplied by the air kerma per image. Necessary beam-on time was calculated from the treatment log file. Accumulated dose distribution was calculated. The gating window was defined as tumour position not respiratory phase and changed from 0-100% duty cycle on 4DCT. These metrics were individually evaluated for every case. RESULTS: For lung cases, sufficient dose conformation was achieved in respective gating windows [D95-clinical target volume (CTV) > 99%]. V20-lung values for 50%- and 30%-duty cycles were 2.5% and 6.0% of that for 100%-duty cycle. Maximum doses (cord/oesophagus) for 30%-duty cycle decreased 6.8%/7.4% to those for 100%-duty cycle. For liver cases, V10-liver values for 50%- and 30%-duty cycles were 9.4% and 12.8% of those for 100%-duty cycle, respectively. Maximum doses (cord/oesophagus) for 50%- and 30%-duty cycles also decreased 17.2%/19.3% and 24.6%/29.8% to those for 100%-duty cycle, respectively. Total imaging doses increased 43.5% and 115.8% for 50%- and 30%-duty cycles to that for the 100%-duty cycle. CONCLUSION: When normal tissue doses are below the tolerance level, the gating window should be expanded to minimize imaging dose and treatment time. Advances in knowledge: The skin dose from imaging might not be counterbalanced to the OAR dose; however, imaging dose is a particularly important factor.


Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Doses de Radiação , Dosagem Radioterapêutica , Idoso , Carbono , Feminino , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Íons , Masculino , Técnicas de Imagem de Sincronização Respiratória , Estudos Retrospectivos
14.
Jpn J Clin Oncol ; 47(1): 80-83, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27677663

RESUMO

Phase-controlled rescanning of the carbon-ion beam offers fast and precise dose application with decreased irradiation of normal tissue. However, organ movement with respiration remains a unique challenge. Technological development has enabled the simultaneous application of beam-energy-modulated markerless phase-controlled rescanning with respiration gating, allowing scanning treatment of respiration-mobile tumors with carbon. A total of 10 patients with tumors in the liver or lung were treated in a feasibility study at our facility using this combination. At a median of 10.5 months, follow-up examination including computed tomography/magnetic resonance imaging revealed no grade 2+ acute adverse effects with this new therapy. Two patients with complex disease experienced local recurrence, which may be improved with increased dose delivery. One patient died of unrelated causes. All other patients are alive with good control at the time of writing. Though long-term observation is pending, these are promising initial results for use of the carbon-beam phase-controlled rescanning method in respiration-mobile disease.


Assuntos
Radioterapia com Íons Pesados , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/radioterapia , Estudos de Viabilidade , Feminino , Seguimentos , Tomografia Computadorizada Quadridimensional , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , Respiração , Dermatopatias/etiologia , Taxa de Sobrevida
15.
J Thorac Oncol ; 12(4): 673-680, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28007628

RESUMO

OBJECTIVES: Our objective was to report initial results of a dose escalation trial of single-fraction carbon ion radiotherapy for peripheral stage I NSCLC. METHODS: Between April 2003 and February 2012, a total of 218 patients were treated. The total dose was raised from 28 to 50 Gy (relative biological effectiveness [RBE]). There were 157 male and 61 female patients, with a median age of 75 years. Of the tumors, 123 were stage T1 and 95 were stage T2. A total of 134 patients (61.5%) were medically inoperable. By histological type, there were 146 adenocarcinomas, 68 squamous cell carcinomas, three large cell carcinomas, and one mucoepidermoid carcinoma. RESULTS: The median follow-up was 57.8 months (range 1.6-160.7). The overall survival rate at 5 years was 49.4%. The local control (LC) rate was 72.7%. A statistically significant difference in LC rate (p = 0.0001, log-rank test) was seen between patients receiving 36 Gy (RBE) or more and those receiving less than 36 Gy (RBE). In 20 patients irradiated with 48 to 50 Gy (RBE), the LC rate at 5 years was 95.0%, the overall survival rate was 69.2%, and the progression-free survival rate was 60.0% (median follow-up was 58.6 months). With dose escalation, LC tended to improve. As for adverse lung and skin reactions, there were no patients with grade 3 or higher reactions, and less than 2% had a grade 2 reaction. Regarding chest wall pain, only one patient had grade 3 late toxicity. CONCLUSIONS: We have reported the outcome of a dose escalation study of single-fraction carbon ion radiotherapy for stage I NSCLC, showing the feasibility of obtaining excellent results comparable to those with previous fractionated regimens.


Assuntos
Adenocarcinoma/radioterapia , Carcinoma de Células Grandes/radioterapia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma de Células Escamosas/radioterapia , Radioterapia com Íons Pesados , Neoplasias Pulmonares/radioterapia , Recidiva Local de Neoplasia/radioterapia , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Grandes/patologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Dosagem Radioterapêutica , Radioterapia Conformacional , Taxa de Sobrevida
16.
J Radiat Res ; 57(5): 576-581, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27380799

RESUMO

Carbon-ion beam scanning has not previously been used for moving tumor treatments. We have commenced respiratory-gated carbon-ion radiotherapy (CIRT) in the thoracic and abdominal regions under free-breathing conditions as a clinical trial. This study aimed to investigate this treatment in the lungs in comparison with passive scattering CIRT. Five patients had thoracic tumors treated with carbon-ion scanned beams using respiratory gating. We analyzed the actual treatments and calculated passive scattering treatment plans based on the same planning CT. We evaluated tumor size until 3 months post treatment and each treatment plan regarding dose delivered to 95% of the clinical target volume (CTV-D95), mean lung dose, percentage of lung receiving at least 5 Gy (RBE) (Lung-V5), Lung-V10, Lung-V20, heart maximum dose (Dmax), esophagus Dmax, cord Dmax and skin Dmax. Obvious tumor deterioration was not observed up to 3 months post treatment. The dose evaluation metrics were similar item by item between respiratory-gated scanned CIRT and passive scattering CIRT. In conclusion, scanned beam CIRT provided treatments equivalent to passive scattering CIRT for thoracic tumors. Increased sample numbers and longer-term observation are needed.


Assuntos
Radioterapia com Íons Pesados , Tórax/efeitos da radiação , Idoso , Feminino , Tomografia Computadorizada Quadridimensional , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica
18.
Phys Med ; 32(6): 787-94, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27184551

RESUMO

INTRODUCTION: We evaluated the impact of 4DCT artifacts on carbon-ion pencil beam scanning dose distributions in lung and liver treatment. METHODS & MATERIALS: 4DCT was performed in 20 liver and lung patients using area-detector CT (original 4DCT). 4DCT acquisition by multi-detector row CT was simulated using original 4DCT by selecting other phases randomly (plus/minus 20% phases). Since tumor position can move over the respiratory range in original 4DCT, mid-exhalation was set as reference phase. Total prescribed dose of 60Gy (RBE) was delivered to the clinical target volume (CTV). Reference dose distribution was calculated with the original CT, and actual dose distributions were calculated with treatment planning parameters optimized using the simulated CT (simulated dose). Dose distribution was calculated by substituting these parameters into the original CT. RESULTS: For liver cases, CTV-D95 and CTV-Dmin values for the reference dose were 97.6±0.5% and 89.8±0.6% of prescribed dose, respectively. Values for the simulated dose were significantly degraded, to 88.6±14.0% and 46.3±26.7%, respectively. Dose assessment results for lung cases were 84.8±12.8% and 58.0±24.5% for the simulated dose, showing significant degradation over the reference dose of 95.1±1.5% and 87.0±2.2%, respectively. CONCLUSIONS: 4DCT image quality should be closely checked to minimize degradation of dose conformation due to 4DCT artifacts. Medical staff should pay particular attention to checking the quality of 4DCT images as a function of respiratory phase, because it is difficult to recognize 4DCT artifact on a single phase in some cases.


Assuntos
Artefatos , Tomografia Computadorizada Quadridimensional , Radioterapia com Íons Pesados/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
19.
Int J Radiat Oncol Biol Phys ; 95(1): 258-66, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-26960747

RESUMO

PURPOSE: Having implemented amplitude-based respiratory gating for scanned carbon-ion beam therapy, we sought to evaluate its effect on positional accuracy and throughput. METHODS AND MATERIALS: A total of 10 patients with tumors of the lung and liver participated in the first clinical trials at our center. Treatment planning was conducted with 4-dimensional computed tomography (4DCT) under free-breathing conditions. The planning target volume (PTV) was calculated by adding a 2- to 3-mm setup margin outside the clinical target volume (CTV) within the gating window. The treatment beam was on when the CTV was within the PTV. Tumor position was detected in real time with a markerless tumor tracking system using paired x-ray fluoroscopic imaging units. RESULTS: The patient setup error (mean ± SD) was 1.1 ± 1.2 mm/0.6 ± 0.4°. The mean internal gating accuracy (95% confidence interval [CI]) was 0.5 mm. If external gating had been applied to this treatment, the mean gating accuracy (95% CI) would have been 4.1 mm. The fluoroscopic radiation doses (mean ± SD) were 23.7 ± 21.8 mGy per beam and less than 487.5 mGy total throughout the treatment course. The setup, preparation, and irradiation times (mean ± SD) were 8.9 ± 8.2 min, 9.5 ± 4.6 min, and 4.0 ± 2.4 min, respectively. The treatment room occupation time was 36.7 ± 67.5 min. CONCLUSIONS: Internal gating had a much higher accuracy than external gating. By the addition of a setup margin of 2 to 3 mm, internal gating positional error was less than 2.2 mm at 95% CI.


Assuntos
Radioterapia com Íons Pesados/métodos , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/radioterapia , Movimento , Planejamento da Radioterapia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Carbono/uso terapêutico , Intervalos de Confiança , Desenho de Equipamento , Feminino , Tomografia Computadorizada Quadridimensional , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Erros de Configuração em Radioterapia/prevenção & controle , Erros de Configuração em Radioterapia/estatística & dados numéricos , Respiração , Fatores de Tempo
20.
Int J Radiat Oncol Biol Phys ; 95(1): 542-8, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-26797538

RESUMO

PURPOSE: In an aging society, many senior citizens want less invasive treatment because of potential medical complications. The National Institute of Radiological Sciences has started to treat stage I lung cancer with single-fraction carbon-ion radiation therapy (CIRT) as a dose escalation prospective phase 1/2 trial. We evaluated the efficacy and safety of CIRT for patients 80 years of age and older, undergoing single-fraction CIRT. METHODS AND MATERIALS: Peripheral non-small cell lung cancer patients who were treated with single-fraction CIRT were prospectively followed. We analyzed the data from among these patients 80 years of age and older. RESULTS: There were 70 patients. Median age was 83 years (range: 80-89) and median follow-up period was 42.7 months (range: 12-128 months). Three-year local control, cause-specific survival, and overall survival rates were 88.0%, 81.6%, and 72.4%, respectively. Five-year local control, cause-specific survival, and overall survival rates were 85.8%, 64.9%, and 39.7%, respectively. There were no adverse effects higher than grade 2 either in the acute or late phase in terms of skin and lung. Analgesic agents were necessary for only 5 patients (7.1%), to relieve muscular or rib fracture pain caused by irradiation. CONCLUSIONS: Single-fraction CIRT was low-risk and effective, even for the elderly.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Radioterapia com Íons Pesados/métodos , Neoplasias Pulmonares/radioterapia , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Causas de Morte , Estudos de Viabilidade , Feminino , Seguimentos , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Estudos Prospectivos , Lesões por Radiação/patologia , Dosagem Radioterapêutica , Testes de Função Respiratória , Taxa de Sobrevida , Fatores de Tempo , Carga Tumoral
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