Kyushu University Academic Staff Educational and Research Activities Database
List of Papers
Yoshiyuki Shioyama Last modified date:2019.06.13

Professor / Faculty of Medical Sciences


Papers
1. Makoto Shinoto, Shigeru Yamada, Masahiko Okamoto, Yoshiyuki Shioyama, Tatsuya Ohno, Takashi Nakano, Kenji Nemoto, Yuka Isozaki, Shohei Kawashiro, Hiroshi Tsuji, Tadashi Kamada, Carbon-ion radiotherapy for locally recurrent rectal cancer
Japan Carbon-ion Radiation Oncology Study Group (J-CROS) Study 1404 Rectum, Radiotherapy and Oncology, 10.1016/j.radonc.2018.10.007, 132, 236-240, 2019.03, Purpose: We investigated the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for locally recurrent rectal cancer (LRRC). Patients and methods: Data from patients with LRRC treated with C-ion RT from November 2003 to December 2014 at three institutions were retrospectively analyzed. The endpoints of this clinical trial were overall survival (OS), local control (LC), and acute/late toxicity. Results: A total of 224 patients' data were collected. The prescribed dose was 70.4 Gy (relative biological effectiveness [RBE]-weighted absorbed dose) or 73.6 Gy (RBE) in 16 fractions. The median follow-up period from the initiation of C-ion RT was 62 months (range 6–169 months). The OS rates were 73% (95% confidence interval [CI], 67%–79%) at 3 years and 51% (95%CI 44%–58%) at 5 years. The LC rates were 93% (95%CI 88%–96%) at 3 years, and 88% (95%CI 82%–93%) at 5 years. Grade 3 acute toxicity was observed in three patients: gastrointestinal toxicity (n = 1) and pelvic infection (n = 2). Grade 3 late toxicity was observed in 12 patients: skin reaction (n = 2), gastrointestinal toxicity (n = 2), neuropathy (n = 1), and pelvic infection (n = 7). There was no grade 4 or 5 acute or late toxicity. Conclusions: This first multi-institutional analysis of C-ion RT for LRRC indicated relatively favorable outcomes with limited toxicities..
2. Kazuhiko Hayashi, Masashi Koto, Yusuke Demizu, Jun ichi Saitoh, Hiroaki Suefuji, Tomoaki Okimoto, Tatsuya Ohno, Yoshiyuki Shioyama, Ryo Takagi, Hiroaki Ikawa, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, A retrospective multicenter study of carbon-ion radiotherapy for external auditory canal and middle ear carcinomas, Cancer Medicine, 10.1002/cam4.1830, 8, 1, 51-57, 2019.01, Background: We conducted a retrospective multicenter study to assess the clinical outcomes of carbon-ion radiotherapy (CIRT) for head and neck malignancies (Japan Carbon-Ion Radiation Oncology Study Group [J-CROS] study: 1402 HN). We aimed to evaluate the safety and efficacy of CIRT in patients with external auditory canal (EAC) and middle ear (ME) carcinomas. Methods: Thirty-one patients treated with CIRT at four Japanese institutions were analyzed. Fourteen patients (45.2%) had squamous cell carcinomas, 13 (41.9%) had adenoid cystic carcinomas, and four (12.9%) had other types. Nineteen (61.3%), six (19.4%), three (9.7%), and three (9.7%) patients had T4, T3, T2, and T1 disease, respectively. All patients had N0M0 status. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 33.3 mL. Results: The median follow-up period was 18.4 months (range, 5.1-85.6). The 1- and 3-year local control and overall survival rates were 75.0% and 55.0% and 79.3% and 58.7%, respectively. Regarding grade 3 or higher toxicities, three patients (9.7%) had grade 3 dermatitis, one (3.2%) had grade 3 mucositis, and two (6.5%) had grade 3 central nervous necrosis (ie, radiation-induced brain necrosis). No grade 4 or worse reactions were observed. Conclusion: CIRT was effective for EAC and ME carcinomas..
3. Satoshi Baba, Yoshihiro Matsumoto, Kenichi Kawaguchi, Keiichiro Iida, Hirokazu Saiwai, Seiji Okada, Akira Matsunobu, Yoshiyuki Shioyama, Yasuharu Nakashima, Post-carbon-ion radiotherapy vertebral pathological fractures in upper cervical primary malignant spinal tumors treated by occipito-cervical fusion, Archives of Orthopaedic and Trauma Surgery, 10.1007/s00402-019-03183-x, 2019.01, Purpose: To describe the characteristic features of post-carbon-ion radiotherapy (CIRT) vertebral pathological fractures (VPFs) in upper cervical primary malignant spinal tumors (PMSTs) treated by occipito-cervical (OC) fusion. Methods: OC fusion was performed for three consecutive patients with post-CIRT VPFs. The clinical results and imaging findings, including bone single-photon emission computed tomography (SPECT)/CT were prospectively collected. Results: No surgery-related wound complication and surgical site infection were noted. One patient experienced re-fracture and displacement of dens with the loosening of occipital screws and was treated by posterior revision surgery. At the final follow-up, all patients were alive without evidence of disease, and the solid OC fusion was confirmed. Bone SPECT/CT clearly revealed the effect of CIRT on bone turnover in the irradiated field. Conclusion: The OC fusion with autologous bone grafts was a reliable option for the treatment of post-CIRT VPCs in the patients with upper cervical PMSTs. In addition, evaluation of the bone turnover at the irradiated field by bone SPECT/CT would help surgeons select an effective plan of care, such as fusion level and postoperative care..
4. Takanori Abe, Tatsuya Ohno, Masashi Koto, Yusuke Demizu, Hiroaki Suefuji, Hiroshi Tsuji, Tomoaki Okimoto, Yoshiyuki Shioyama, Jun ichi Saitoh, Katsuyuki Shirai, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, Hiroyuki Katoh, A multi-institutional retrospective study of carbon-ion radiotherapy for non-squamous cell malignant tumors of the nasopharynx
Subanalysis of Japan Carbon-Ion Radiation Oncology Study Group study 1402 HN, Cancer Medicine, 10.1002/cam4.1884, 7, 12, 6077-6083, 2018.12, Background: This multi-institutional retrospective study focused on the clinical outcome of carbon-ion radiotherapy (C-ion RT) for non-squamous cell malignant tumors of the nasopharynx. Methods: The Japan Carbon-ion Radiation Oncology Study Group collected and analyzed data for 43 patients with non-squamous cell malignant tumors of the nasopharynx treated with C-ion RT at four institutions in Japan. Results: Twenty-nine patients had adenoid cystic carcinomas, seven had malignant melanomas, three had adenocarcinomas, two had mucoepidermoid carcinomas, and two had other pathologies. Twenty-six of the 43 patients (61%) had T4 tumors. The most common dose-fractionation schedule was 64 Gy (relative biological effectiveness) in 16 fractions. The median follow-up period was 30 months. The 2-year local control (LC) and overall survival (OS) rates were 88% and 84%, respectively. For late toxicity, one patient developed grade 4 optic nerve disorder and two developed grade 5 pharyngeal hemorrhage. Actual incidence of grade 3 or higher late adverse events was 19%, and included cranial nerve dysfunction, jaw bone necrosis, central nervous system necrosis, and ear inflammation. Conclusions: C-ion RT provided good LC and OS rates with acceptable toxicity for treatment of non-squamous cell malignant tumors of the nasopharynx..
5. Rikiya Onimaru, Hiroshi Onishi, Gakuto Ogawa, Masahiro Hiraoka, Satoshi Ishikura, Katsuyuki Karasawa, Yukinori Matsuo, Masaki Kokubo, Yoshiyuki Shioyama, Haruo Matsushita, Yoshinori Ito, Hiroki Shirato, Final report of survival and late toxicities in the Phase i study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702), Japanese journal of clinical oncology, 10.1093/jjco/hyy141, 48, 12, 1076-1082, 2018.12, Purpose A dose escalation study to determine the recommended dose with stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinomas (JCOG0702) was conducted. The purpose of this paper is to report the survival and the late toxicities of JCOG0702. Materials and methods The continual reassessment method was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose. The starting dose was 40 Gy in four fractions at D 95 of PTV. Results Twenty-eight patients were enrolled. Ten patients were treated with 40 Gy at D 95 of PTV, four patients with 45 Gy, eight patients with 50 Gy, one patient with 55 Gy and five patients with 60 Gy. Ten patients were alive at the last follow-up. Overall survival (OS) for all patients was 67.9% (95% CI 47.3-81.8%) at 3 years and 40.8% (95% CI 22.4-58.5%) at 5 years. No Grade 3 or higher toxicity was observed after 181 days from the beginning of the SBRT. Compared to the toxicities up to 180 days, chest wall related toxicities were more frequent after 181 days. Conclusions The 5-year OS of 40.8% indicates the possibility that SBRT for peripheral T2N0M0 non-small cell lung cancer is superior to conventional radiotherapy. The effect of the SBRT dose escalation on OS is unclear and further studies are warranted..
6. Kei Shibuya, Tatsuya Ohno, Kazuki Terashima, Shingo Toyama, Shigeo Yasuda, Hiroshi Tsuji, Tomoaki Okimoto, Yoshiyuki Shioyama, Kenji Nemoto, Tadashi Kamada, Takashi Nakano, Short-course carbon-ion radiotherapy for hepatocellular carcinoma
A multi-institutional retrospective study, Liver International, 10.1111/liv.13969, 38, 12, 2239-2247, 2018.12, Background & Aims: Carbon-ion radiation therapy has shown encouraging results in hepatocellular carcinoma patients in single-centre studies. We evaluated the effectiveness and safety of short-course carbon-ion radiation therapy for hepatocellular carcinoma in a multicentre study conducted by the Japan Carbon Ion Radiation Oncology Study Group. Methods: Consecutive hepatocellular carcinoma patients who were treated with carbon-ion radiation therapy in four or fewer fractions at four Japanese institutions between April 2005 and November 2014 were analysed retrospectively. The primary outcome was overall survival; secondary outcomes were local control rate, treatment-related toxicity and radiation-induced liver disease. Results: A total of 174 patients were included in this study. Prescribed carbon-ion radiation therapy doses were (relative biological effectiveness): 48.0 Gy in two fractions (n = 46), and 52.8 Gy (n = 108) and 60.0 Gy (n = 20) in four fractions. The median follow-up period was 20.3 (range, 2.9-103.5) months. The overall survival and local control rates at 1, 2 and 3 years were 95.4%, 82.5% and 73.3%; and 94.6%, 87.7% and 81.0% respectively. Multivariate analysis revealed that Eastern Cooperative Oncology Group performance status 1-2, Child-Pugh class B, maximum tumour diameter ≥3 cm, multiple tumours and serum alpha foetoprotein level >50 ng/mL were significant prognostic factors of overall survival. No treatment-related death occurred during the follow-up period. Grades 3 or 4 treatment-related toxicities were observed in 10 patients (5.7%); radiation-induced liver disease was observed in three patients (1.7%). Conclusions: Short-course carbon-ion radiation therapy is a safe, effective and potentially curative therapy for hepatocellular carcinoma..
7. Makoto Shinoto, Kotaro Terashima, Hiroaki Suefuji, Akira Matsunobu, Shingo Toyama, Kaori Fukunishi, Yoshiyuki Shioyama, A single institutional experience of combined carbon-ion radiotherapy and chemotherapy for unresectable locally advanced pancreatic cancer, Radiotherapy and Oncology, 10.1016/j.radonc.2018.08.026, 129, 2, 333-339, 2018.11, Purpose: The aim of this study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for unresectable locally advanced pancreatic cancer (LAPC). Methods and materials: Patients with LAPC treated with definitive C-ion RT between April 2014 and July 2017 were analyzed retrospectively. The prescribed dose was 55.2 Gy (relative biological effectiveness [RBE] weighted absorbed dose) in 12 fractions. Overall survival (OS), local control (LC), progression free survival (PFS), and toxicity were evaluated. Results: Sixty-four patients were enrolled. All patients completed planned course of C-ion RT. The median follow-up time for survivors from the initiation of C-ion RT was 24.4 months (range, 5.1–46.1 months). Median survival time was 25.1 months. Two-year OS, LC, and PFS were 53% (95% confidence interval [CI], 39%–66%), 82% (95% CI, 66%–91%), and 23% (95% CI, 14%–36%), respectively. Four patients experienced acute grade 3 toxicities including 3 gastrointestinal (GI) toxicities. There was no grade 3 or more late toxicity. Conclusions: The clinical results of C-ion RT for LAPC at our institution were comparable to those of a recent multi-institutional analysis..
8. Masashi Koto, Yusuke Demizu, Jun ichi Saitoh, Hiroaki Suefuji, Hiroshi Tsuji, Tomoaki Okimoto, Tatsuya Ohno, Yoshiyuki Shioyama, Hiroaki Ikawa, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, Definitive Carbon-Ion Radiation Therapy for Locally Advanced Sinonasal Malignant Tumors
Subgroup Analysis of a Multicenter Study by the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS), International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2018.05.074, 102, 2, 353-361, 2018.10, Purpose: To evaluate the safety and efficacy of carbon-ion radiation therapy (C-ion RT) for locally advanced sinonasal malignant tumors in a multicenter retrospective study (J-CROS 1402 HN). Methods and Materials: Clinical data were collected for patients who had sinonasal malignant tumors of stage N0-1M0 and received C-ion RT at 4 institutions in Japan between November 2003 and December 2014. Of the 458 patients, 393 had naïve tumors and 65 had recurrent tumors. The tumors were located in the nasal cavity (n = 263), maxillary sinus (n = 109), ethmoid sinus (n = 71), and other locations (n = 15). The histologic types were mucosal melanoma (n = 221, 48%), adenoid cystic carcinoma (n = 122, 27%), squamous cell carcinoma (n = 31, 7%), olfactory neuroblastoma (n = 30, 7%), adenocarcinoma (n = 21, 5%), and other types (n = 33, 7%). Of the 458 patients, 300 (66%) had T4 tumors. All patients received definitive C-ion RT. Results: The median follow-up period was 25.2 months for all patients (range, 1.4-132.3 months). The 2-year overall survival and local control rates were 79.6% and 84.1%, respectively. As analyzed according to histology, the 2-year overall survival rate was 68.0% for mucosal melanoma, 96.8% for adenoid cystic carcinoma, 70.0% for squamous cell carcinoma, 96.7% for olfactory neuroblastoma, and 89.7% for adenocarcinoma. Regarding late toxicities, 17% of patients developed grade 3 and 4 toxicities, of which visual impairment was the most common. Conclusion: The results of our multicenter study have demonstrated that C-ion RT can provide excellent clinical outcomes with acceptable late toxicities in patients who have locally advanced sinonasal malignant tumors..
9. Onishi H, Yamashita H, Shioyama Y, Matsumoto Y, Takayama K, Matsuo Y, Miyakawa A, Matsushita H, Aoki M, Nihei K, Kimura T, Ishiyama H, Murakami N, Nakata K, Takeda A, Uno T, Nomiya T, Takanaka T, Seo Y, Komiyama T, Marino K, Aoki S, Saito R, Araya M, Maehata Y, Tominaga L, Kuriyama K, Stereotactic body radiation therapy for patients with pulmonary interstitial change: high incidence of fatal radiation pneumonitis in a retrospective multi-institutional study, Cancers (Basel) , 10.3390/cancers10080257, 10, 8, pii: E257, 2018.08.
10. Kaori Asai, Tomonari Sasaki, Yoshiyuki Shioyama, III. Current Treatment Strategy for Locally Advanced Non-Small-Cell Lung Cancer - From the Point of View of Radiation Oncologists, Gan to kagaku ryoho. Cancer & chemotherapy, 45, 8, 1155-1158, 2018.08.
11. Shohei Kawashiro, Shigeru Yamada, Masahiko Okamoto, Tatsuya Ohno, Takashi Nakano, Makoto Shinoto, Yoshiyuki Shioyama, Kenji Nemoto, Yuka Isozaki, Hiroshi Tsuji, Tadashi Kamada, Multi-institutional Study of Carbon-ion Radiotherapy for Locally Advanced Pancreatic Cancer
Japan Carbon-ion Radiation Oncology Study Group (J-CROS) Study 1403 Pancreas, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2018.04.057, 101, 5, 1212-1221, 2018.08, Purpose: The aim of this multi-institutional study was to evaluate the efficacy and safety of carbon-ion radiotherapy (C-ion RT) for locally advanced pancreatic cancer (LAPC). Methods and Materials: Patients with LAPC treated with C-ion RT from April 2012 to December 2014 at 3 institutions were retrospectively analyzed. Patients with pathologically-confirmed invasive ductal adenocarcinoma of the pancreas were eligible. The prescribed dose was 52.8 Gy (relative biological effectiveness weighted absorbed dose; RBE) or 55.2 Gy (RBE) in 12 fractions. Overall survival (OS), distant metastasis-free survival (DMFS), local recurrence (LR), and toxicity were evaluated. Results: In total, 72 patients were included in this study. Tumors in the head of the pancreas were seen in 30 patients (42%), while those in the body or tail of the pancreas were seen in 42 patients (58%). Fifty-six patients (78%) received concurrent chemotherapy. The OS rates were 73% (95% confidence interval [CI], 62%-84%) at 1 year, and 46% (95% CI, 31%-61%) at 2 years with a median OS of 21.5 months (95% CI, 11.8-31.2 months). The 1- and 2-year DMFS rates were 41% (95% CI, 29%-52%) and 28% (95% CI, 16%-40%), respectively. The 1- and 2-year cumulative incidences of LR were 16% (95% CI, 9%-26%) and 24% (95% CI, 14%-36%), respectively. Nineteen patients (26%) experienced acute grade 3 or 4 hematological toxicities. Two patients (3%) had grade 3 anorexia. Late gastrointestinal (GI) grade 3 toxicity was observed in 1 patient (1%). No patients developed late grade 4 or 5 toxicity. Conclusions: The first multi-institutional analysis of C-ion RT for LAPC indicated relatively favorable outcomes with limited toxicities, especially for tumors not in close proximity to GI tract..
12. Tetsuya Inoue, Norio Katoh, Yoichi M. Ito, Tomoki Kimura, Yasushi Nagata, Kengo Kuriyama, Hiroshi Onishi, Tadamasa Yoshitake, Yoshiyuki Shioyama, Yusuke Iizuka, Koji Inaba, Koji Konishi, Masaki Kokubo, Katsuyuki Karasawa, Takuyo Kozuka, Kensuke Tanaka, Jun Sakakibara-Konishi, Ichiro Kinoshita, Hiroki Shirato, Stereotactic body radiotherapy to treat small lung lesions clinically diagnosed as primary lung cancer by radiological examination
A prospective observational study, Lung Cancer, 10.1016/j.lungcan.2018.05.025, 122, 107-112, 2018.08, Objectives: Even with advanced image guidance, biopsies occasionally fail to diagnose small lung lesions, which are highly suggestive of primary lung cancer by radiological examination. The aim of this study was to evaluate the outcome of stereotactic body radiotherapy (SBRT) to treat small lung lesions clinically diagnosed as primary lung cancer. Materials and methods: This is a prospective, multi-institutional observation study. Strict inclusion and exclusion criteria were determined in a nation-wide consensus meeting and used to include patients who were clinically diagnosed with primary lung cancer using precise imaging modalities, for whom further surgical intervention was not feasible, who refused watchful waiting, and who were highly tolerable of SBRT with informed consent. SBRT was performed with 48 Gy in 4 fractions at the tumor isocenter. Results: From August 2009 to August 2014, 62 patients from 11 institutions were enrolled. Their median age was 80 years. The tumors ranged in size from 9 to 30 mm in diameter (median, 18 mm). The median follow-up interval was 55 months. The 3-year overall survival rate was 83.3% (95% confidence interval (CI) 71.1–90.7%) for all the patients and 94.7% (95% CI 68.1–99.2%) for the patients younger than 75 years. Local failure, regional lymph node metastases and distant metastases occurred in 4 (6.4%), 3 (4.8%) and 11 (17.7%) patients, respectively. Grades 3 and 4 toxicities were observed in 8 (12.9%) patients and 1 (1.6%) patient, respectively. No grade 5 toxicities were observed. Conclusions: SBRT is safe and effective for patients with small lung lesions clinically diagnosed as primary lung cancer that satisfied the proposed strict indication criteria as previously reported. A prospective interventional study is required to ascertain if SBRT is an alternative strategy for these patients..
13. Kaori Asai, Tomonari Sasaki, Yoshiyuki Shioyama, Thorax/lung and mediastinum, pleura
cancer current organ topics, Japanese Journal of Cancer and Chemotherapy, 45, 8, 1155-1158, 2018.08.
14. Kazuhiko Hayashi, Masashi Koto, Yusuke Demizu, Jun Ichi Saitoh, Hiroaki Suefuji, Tomoaki Okimoto, Tatsuya Ohno, Yoshiyuki Shioyama, Ryo Takagi, Hiroaki Ikawa, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, A retrospective multicenter study of carbon-ion radiotherapy for major salivary gland carcinomas
Subanalysis of J-CROS 1402 HN, Cancer Science, 10.1111/cas.13558, 109, 5, 1576-1582, 2018.05, A retrospective multicenter study was carried out to assess the clinical outcomes of carbon-ion radiotherapy for head and neck malignancies (Japan Carbon-Ion Radiation Oncology Study Group [J-CROS] study: 1402 HN). We evaluated the safety and efficacy of carbon-ion radiotherapy in patients with major salivary gland carcinoma. Sixty-nine patients treated with carbon-ion radiotherapy at four Japanese institutions were analyzed. Thirty-three patients (48%) had adenoid cystic carcinomas, 10 (14%) had mucoepidermoid carcinomas, and 26 (38%) had other disease types. Three patients (4%) had T1 disease, 8 (12%) had T2, 25 (36%) had T3, and 33 (48%) had T4. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 27 mL. The median follow-up period was 32.7 months. The 3-year local control rate and overall survival rate were 81% and 94%, respectively. Regarding acute toxicities, seven patients had grade 3 mucositis and seven had grade 3 dermatitis. Regarding late toxicities, one patient had grade 3 dysphagia and one had a grade 3 brain abscess. No grade 4 or worse late reactions were observed. In conclusion, definitive carbon-ion radiotherapy was effective with acceptable toxicity for major salivary gland carcinomas..
15. Sulaiman NS, Demizu Y, Koto M, Saitoh JI, Suefuji H, Tsuji H, Ohno T, Shioyama Y, Okimoto T, Daimon T, Nemoto K, Nakano T, Kamada T; Japan Carbon-Ion Radiation Oncology Study Group , Multicenter study of carbon-ion radiation therapy for adenoid cystic carcinoma of the head and neck: subanalysis of the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) study (1402 HN), Int J Radiat Oncol Biol Phys , 100(3):639-646, 2018, 2018.03.
16. Hiroaki Suefuji, Masashi Koto, Yusuke Demizu, Jun Ichi Saitoh, Yoshiyuki Shioyama, Hiroshi Tsuji, Tomoaki Okimoto, Tatsuya Ohno, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, A retrospective multicenter study of carbon ion radiotherapy for locally advanced olfactory neuroblastomas, Anticancer research, 10.21873/anticanres.12399, 38, 3, 1665-1670, 2018.03, The purpose was to evaluate efficacy and safety of carbon ion radiotherapy (C-ion RT) in patients with locally advanced olfactory neuroblastomas (ONBs). This study was a sub-analysis of the Japan Carbon-Ion Radiation Oncology Study Group Study (1402 HN, UMIN000024473). Clinical data of T4 ONBs treated with C-ion RT at four Institutions between November 2003 and December 2014 were retrospectively reviewed. Twenty-one patients underwent C-ion RT. Seven patients had T4a and 14 had T4b tumours without cervical node metastases. The median follow-up period was 39 (range=5-111) months. The 3-year overall survival and local control rates were 88.4% and 83.0%, respectively. Grade 4 late toxicity was observed in three patients, including ipsilateral optic nerve disorder (n=2) and ipsilateral retinopathy (n=1). C-Ion RT is effective and can be a curative modality for T4 ONBs. Prospective multicenter studies are warranted to confirm these findings..
17. Nor Shazrina Sulaiman, Yusuke Demizu, Masashi Koto, Jun ichi Saitoh, Hiroaki Suefuji, Hiroshi Tsuji, Tatsuya Ohno, Yoshiyuki Shioyama, Tomoaki Okimoto, Takashi Daimon, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, Multicenter Study of Carbon-Ion Radiation Therapy for Adenoid Cystic Carcinoma of the Head and Neck
Subanalysis of the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) Study (1402 HN), International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2017.11.010, 100, 3, 639-646, 2018.03, Purpose: To retrospectively analyze the treatment outcomes of carbon-ion radiation therapy for adenoid cystic carcinoma (ACC) of the head and neck at 4 active carbon-ion facilities in Japan. Methods and Materials: A total of 289 patients who underwent carbon-ion radiation therapy for histology-proven ACC of the head and neck at 4 institutions in Japan between November 2003 and December 2014 were included in this study. Results: Median patient age was 58 years (range, 12-83 years). Tumor sites included the nasal cavity and paranasal sinuses (42%), nasopharynx and oropharynx (19%), oral cavity (12%), major salivary glands (12%), and others (15%). Tumor classifications were T4 in 200 (69%) patients, T3 in 45 (16%), T2 in 22 (8%), T1 in 15 (5%), and unclassified in 7 (2%). The median total dose was 64 Gy (relative biological effectiveness [RBE]; range, 55.2-70.4 Gy [RBE]) in 16 fractions (range, 12-32 fractions). Median follow-up time was 30 months (range, 2-118 months). The 2-year overall survival, progression-free survival, and local control rates were 94%, 68%, and 88%, respectively. Estimated 5-year overall survival, progression-free survival, and local control rates were 74%, 44%, and 68%, respectively. In all, 43 patients (15%) experienced grade ≥3 late toxicity, of which osteonecrosis of the jaw bone was the most common. Two patients treated for nasopharyngeal ACC died from a bleeding ulcer at the tumor site (grade 5 toxicity). Conclusions: Carbon-ion radiation therapy seems to be a promising treatment for ACC of the head and neck..
18. Onishi H, Marino K, Yamashita H, Terahara A, Onimaru R, Kokubo M, Shioyama Y, Kozuka T, Matsuo Y, Aruga T, Hiraoka M, Case series of 23 patients who developed fatal radiation pneumonitis after stereotactic body radiotherapy for lung cancer, Technol Cancer Res Treat , 10.1177/1533033818801323, 17:1533033818801323, 2018.01.
19. Shioyama Y, Onishi H, Takayama K, Matsuo Y, Takeda A, Yamashita H, Miyakawa A, Murakami N, Aoki M, Matsushita H, Matsumoto Y, Shibamoto Y; Japanese Radiological Society Multi-Institutional SBRT Study Group (JRS-SBRTSG) , Clinical outcomes of stereotactic body radiotherapy for patients with stage I small-cell lung cancer: analysis of a subset of the Japanese Radiological Society Multi-Institutional SBRT Study Group database, Technol Cancer Res Treat , 10.1177/1533033818783904, 17:1533033818783904, 2018, 2018.01.
20. Jun ichi Saitoh, Masashi Koto, Yusuke Demizu, Hiroaki Suefuji, Tatsuya Ohno, Hiroshi Tsuji, Tomoaki Okimoto, Yoshiyuki Shioyama, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, A Multicenter Study of Carbon-Ion Radiation Therapy for Head and Neck Adenocarcinoma, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2017.04.032, 99, 2, 442-449, 2017.10, Purpose Head and neck (HN) adenocarcinoma is rare, and to date, there have been no reports of prospective studies. We retrospectively evaluated the efficacy and safety of carbon-ion radiation therapy (C-ion RT) for HN adenocarcinoma in institutions in Japan. Methods and Materials HN adenocarcinoma patients with N0M0 or N1M0 disease who were treated with C-ion RT at institutions in Japan between November 2003 and December 2014 were analyzed retrospectively. We enrolled 47 patients (30 male and 17 female patients; median age, 60 years) with HN adenocarcinoma. Results Primary sites included the nasal and paranasal sinus in 21 patients, orbit in 11, salivary grand in 7, oral cavity and pharynx in 6, and acoustic organ in 2. Thirty-two patients had T4 tumors, 6 had T3, and 6 had T2. Forty-five patients received a diagnosis of N0 disease, whereas 2 had N1 disease. The median total dose of C-ion RT and the number of fractions were 64.0 Gy (relative biological effectiveness) and 16 fractions, respectively. The median follow-up period was 51 months (range, 6-118 months). The 2- and 5-year overall survival rates were 87.9% and 60.4%, respectively, and the 2- and 5-year local control rates were 83.3% and 79.3%, respectively. Multivariate analysis showed that operability (patients with operable tumors) (P=.045) and fractionation (16 fractions) (P=.010) were significant independent prognostic factors for better overall survival. No grade 5 late morbidities were observed. Grade 4 late morbidities were observed in 4 patients, and all of these grade 4 morbidities were visual impairments. All 4 patients with grade 4 visual impairment had T4 tumors in the nasopharynx or paranasal sinuses, which implied inoperable tumors with orbital or brain invasion. Conclusions C-ion RT resulted in excellent local control. C-ion RT could become a curative treatment option for HN adenocarcinoma with acceptable toxicities..
21. Yoshiyuki Shioyama, Hiroaki Suefuji, Makoto Shinoto, Kotarou Terashima, Shingo Toyama, Carbon-ion radiotherapy for lung cancer
Current status and future directions, Japanese Journal of Lung Cancer, 10.2482/haigan.57.723, 57, 6, 723-732, 2017.10, Recent advances in high-precision photon radiotherapy represented by stereotactic body radiotherapy (SBRT) and intensity-modulated radiotherapy (IMRT) have helped improve the treatment outcomes of lung cancers, both in disease control and side effect reduction, for normal tissues, including lung and heart, compared with conventional radiotherapy. However, photon radiotherapy is inherently limited by the physical properties of the photon beam, which result in unavoidable low to moderate irradiation to normal tissues, even at substantial distances from the tumor. The unavoidable spread of radiation sometimes leads to acute or late side effects. Efforts have been made to develop charged particle radiotherapy as an effective and less-invasive new radiation modality. Charged particle radiotherapy has the physical advantage of the dose being focused on the tumor with only minimal exposure of the surrounding normal tissues. This physical advantage of improved dose localization helps to reduce the toxicity of normal tissue, such as lung and heart, even further. Carbon ion, which is categorized as a heavy ion, not only has favorable physical properties but also a biologic advantage compared with photons and protons. Carbon ion has a strong cell-killing effect, and this effect is not markedly influenced by the oxygen concentration or the cell cycle. These physical and biological advantages of carbon-ion radiotherapy have been confirmed by a number of clinical studies, although many of these are single-institutional studies. Many multi-institutional studies for carbon-ion radiotherapy are now being vigorously conducted, including studies in lung cancer patients. The clinical superiority of carbon-ion radiotherapy to conventional techniques is expected to become clearer in the near future..
22. Yasuo Kawata, Hidetaka Arimura, Koujirou Ikushima, Ze Jin, Kento Morita, Chiaki Tokunaga, Hidetake Yabuuchi, Yoshiyuki Shioyama, Tomonari Sasaki, Hiroshi Honda, Masayuki Sasaki, Impact of pixel-based machine-learning techniques on automated frameworks for delineation of gross tumor volume regions for stereotactic body radiation therapy, Physica Medica, 10.1016/j.ejmp.2017.08.012, 42, 141-149, 2017.10, The aim of this study was to investigate the impact of pixel-based machine learning (ML) techniques, i.e., fuzzy-c-means clustering method (FCM), and the artificial neural network (ANN) and support vector machine (SVM), on an automated framework for delineation of gross tumor volume (GTV) regions of lung cancer for stereotactic body radiation therapy. The morphological and metabolic features for GTV regions, which were determined based on the knowledge of radiation oncologists, were fed on a pixel-by-pixel basis into the respective FCM, ANN, and SVM ML techniques. Then, the ML techniques were incorporated into the automated delineation framework of GTVs followed by an optimum contour selection (OCS) method, which we proposed in a previous study. The three-ML-based frameworks were evaluated for 16 lung cancer cases (six solid, four ground glass opacity (GGO), six part-solid GGO) with the datasets of planning computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT images using the three-dimensional Dice similarity coefficient (DSC). DSC denotes the degree of region similarity between the GTVs contoured by radiation oncologists and those estimated using the automated framework. The FCM-based framework achieved the highest DSCs of 0.79 ± 0.06, whereas DSCs of the ANN-based and SVM-based frameworks were 0.76 ± 0.14 and 0.73 ± 0.14, respectively. The FCM-based framework provided the highest segmentation accuracy and precision without a learning process (lowest calculation cost). Therefore, the FCM-based framework can be useful for delineation of tumor regions in practical treatment planning..
23. Tomoki Kimura, Yasushi Nagata, Hideyuki Harada, Shinya Hayashi, Yukinori Matsuo, Tsuyoshi Takanaka, Masaki Kokubo, Kenji Takayama, Hiroshi Onishi, Koichi Hirakawa, Yoshiyuki Shioyama, Takeshi Ehara, Phase I study of stereotactic body radiation therapy for centrally located stage IA non-small cell lung cancer (JROSG10-1), International Journal of Clinical Oncology, 10.1007/s10147-017-1125-y, 22, 5, 849-856, 2017.10, Background: To investigate the maximum tolerated dose (MTD) and recommended dose (RD) of stereotactic body radiation therapy (SBRT) for centrally located stage IA non-small cell lung cancer (NSCLC). Methods: Five dose levels, ranging from of 52 to 68 Gy in eight fractions, were determined; the treatment protocol began at 60 Gy (level 3). Each dose level included 10 patients. Levels 1–2 were indicated if more than four patients exhibited dose-limiting toxicity (DLT), which was defined as an occurrence of a grade 3 (or worse) adverse effect within 12 months after SBRT initiation. MTD was defined as the lowest dose level at which more than four patients exhibited DLT. Results: Ten patients were enrolled in the level 3 study. One patient was considered unsuitable because of severe emphysema. Therefore, nine patients were evaluated and no patient exhibited DLT. The level 3 results indicated that we should proceed to level 4 (64 Gy). However, due to the difficulty involved in meeting the dose constraints, further dose escalation was not feasible and the MTD was found to be 60 Gy. Conclusions: The RD of SBRT for centrally located stage IA NSCLC was 60 Gy in eight fractions..
24. Masataka Karube, Naoyoshi Yamamoto, Yoshiyuki Shioyama, Junichi Saito, Akira Matsunobu, Tamaki Okimoto, Tatsuya Ohno, Hiroshi Tsuji, Takashi Nakano, Tadashi Kamada, Carbon-ion radiotherapy for patients with advanced stage non-small-cell lung cancer at multicenters, Journal of radiation research, 10.1093/jrr/rrx037, 58, 5, 761-764, 2017.09, 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..
25. Katsuyuki Shirai, Masashi Koto, Yusuke Demizu, Hiroaki Suefuji, Tatsuya Ohno, Hiroshi Tsuji, Tomoaki Okimoto, Yoshiyuki Shioyama, Jun Ichi Saitoh, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, Multi-institutional retrospective study of mucoepidermoid carcinoma treated with carbon-ion radiotherapy, Cancer Science, 10.1111/cas.13270, 108, 7, 1447-1451, 2017.07, This study aimed to evaluate the clinical outcomes of patients with mucoepidermoid carcinomas in the head and neck treated with carbon-ion radiotherapy. Data from 26 patients who underwent carbon-ion radiotherapy in four facilities were analyzed in this multi-institutional retrospective study: the Japan Carbon-ion Radiation Oncology Study Group. The median follow-up time was 34 months. One patient experienced local recurrence, and the 3-year local control rate was 95%. One patient developed lymph node recurrence and five developed distant metastases. The 3-year progression-free survival rate was 73%. Five patients died, two of mucoepidermoid carcinoma and three of intercurrent disease. The 3-year overall survival rate was 89%. Acute mucositis and dermatitis of grade 3 or higher were experienced by 19% and 8% of patients, respectively; these improved with conservative therapy. Late mucositis and osteonecrosis of jaw were observed in 12% and 23% of patients, respectively. The 3-year cumulative rate of any late adverse event of grade 3 or higher was 14%. None of the patients died of the acute or late adverse events. Carbon-ion radiotherapy was efficacious and safe for treating mucoepidermoid carcinoma in this multi-institutional retrospective study (registration no. UMIN000024473). We are currently undertaking a prospective multicenter study..
26. Masashi Koto, Yusuke Demizu, Jun ichi Saitoh, Hiroaki Suefuji, Hiroshi Tsuji, Tomoaki Okimoto, Tatsuya Ohno, Yoshiyuki Shioyama, Ryo Takagi, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, Multicenter Study of Carbon-Ion Radiation Therapy for Mucosal Melanoma of the Head and Neck
Subanalysis of the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) Study (1402 HN), International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2016.12.028, 97, 5, 1054-1060, 2017.04, Purpose To evaluate the efficacy and safety of carbon-ion radiation therapy (RT) for mucosal melanoma of the head and neck (MMHN) in the Japan Carbon-Ion Radiation Oncology Study Group study. Methods and Materials Patients with MMHN with N0-1M0 status who were treated with carbon-ion RT at 4 institutions in Japan between November 2003 and December 2014 were analyzed retrospectively. Two hundred sixty patients (male, 111; female, 149; median age, 68 years) with histologically proven MMHN were enrolled. Results Primary sites included the nasal cavity in 178 patients, paranasal sinuses in 43, oral cavity in 27, and pharynx in 12. Eighty-six patients had T3 tumors, 147 had T4a tumors, and 27 had T4b tumors. Two hundred fifty-one patients were diagnosed with N0 disease, and 9 with N1 disease. The median total dose and number of fractions were 57.6 Gy RBE (relative biological effectiveness) and 16, respectively. Chemotherapy including dimethyl traizeno imidazole carboxamide was used concurrently in 129 patients. The median follow-up duration was 22 months (range, 1-132 months). The 2-year overall survival and local control rates were 69.4% and 83.9%, respectively. Multivariate analysis showed that gross tumor volume and concurrent chemotherapy were significant prognostic factors for overall survival. Grade 3 and grade 4 late morbidities were observed in 27 and 7 patients (5 developed ipsilateral blindness, 1 mucosal ulcer, and 1 second malignant disease in the irradiated volume), respectively. No patients developed grade 5 late morbidities. Conclusion Carbon-ion RT is a promising treatment option for MMHN..
27. Rikiya Onimaru, Hiroshi Onishi, Taro Shibata, Masahiro Hiraoka, Satoshi Ishikura, Katsuyuki Karasawa, Yukinori Matsuo, Masaki Kokubo, Yoshiyuki Shioyama, Haruo Matsushita, Yoshinori Ito, Hiroki Shirato, Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702)
Results for the group with PTV ⩾ 100 cc, Radiotherapy and Oncology, 10.1016/j.radonc.2016.11.022, 122, 2, 281-285, 2017.02, Purpose A dose escalation study to determine the recommended dose (RD) with stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinomas (NSCLC) was conducted. The results of the group with PTV ⩾ 100 cc are reported in this paper. Materials and methods The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose (MTD). Dose limiting toxicity (DLT) was Grade 3 or higher radiation pneumonitis (RP), and Grade 2 or higher RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D
95
of the PTV. Results Thirteen patients were accrued. More patients should have been enrolled but we decided not to prolong the study period. No patients experienced Grade 3 RP. Two patients experienced Grade 2 RP at 50 Gy in 4 fractions. The predicted MTD was 50.2 Gy. The posterior probability of the Grade 2 RP frequency over 40% was 5.3% for the dose level of 50 Gy. The RD was determined to be 50 Gy. Conclusions The RD was determined to be 50 Gy in 4 fractions in this population..
28. Masashi Koto, Yusuke Demizu, Jun Ichi Saitoh, Hiroaki Suefuji, Hiroshi Tsuji, Tomoaki Okimoto, Tatsuya Ohno, Yoshiyuki Shioyama, Hiroaki Ikawa, Kenji Nemoto, Takashi Nakano, Tadashi Kamada, A retrospective multicenter study of carbon-ion radiotherapy for the head and neck cancer except sarcoma (J-CROS1402 HN), Japanese Journal of Head and Neck Cancer, 10.5981/jjhnc.43.362, 43, 3, 362-366, 2017.01, A retrospective multicenter study was conducted to assess the clinical outcomes of carbon-ion radiotherapy for head and neck malignancies(Japan Carbon-Ion Radiation Oncology Study Group[J-CROS] study: 1402 HN). Patients with head and neck malignancies with N0-1M0 status who were treated with carbon-ion RT at four institutions in Japan between November 2003 and December 2014 were analyzed retrospectively. Nine hundred and eight patients were enrolled. Primary sites included the sinonasal cavity in 458 patients(50.4%), choroid in 119(13.1%), oral cavity in 83(9.1%), major salivary gland in 69(7.6%), orbit in 48(5.3%), nasopharynx in 46 (5.1%), and the others in 85(9.4%). Twenty-eight patients(3.1%) had T1 tumors, 59(6.5%) had T2 tumors, 295(32.5%) had T3 tumors, 509(56.1%) had T4 tumors, and 17(1.8%) had unclassified tumors. The disease histologic type was as follows: 387 patients (42.6%) had malignant melanoma, 289 (31.8%) had adenoid cystic carcinoma, 63 (6.9%) had squamous cell carcinoma, 47 (5.2%) had adenocarcinoma, and 122 (13.4%) had others. The median follow-up duration was 28 months. The 3-year and 5-year local control rates were 81% and 74%, respectively. The 3-year and 5-year overall survival rates were 76% and 64%, respectively. Late toxicities of grade 4 or more were observed in 4.4% of the patients. Carbon-ion radiotherapy is one of the promising treatment options for locally advanced head and neck malignancies, particularly radio-resistant tumors such as non-squamous cell carcinomas..
29. Koujiro Ikushima, Hidetaka Arimura, Ze Jin, Hidetake Yabuuchi, Jumpei Kuwazuru, Yoshiyuki Shioyama, Tomonari Sasaki, Hiroshi Honda, Masayuki Sasaki, Computer-assisted framework for machine-learning-based delineation of GTV regions on datasets of planning CT and PET/CT images, Journal of radiation research, 10.1093/jrr/rrw082, 58, 1, 123-134, 2017.01, We have proposed a computer-assisted framework for machine-learning-based delineation of gross tumor volumes (GTVs) following an optimum contour selection (OCS) method. The key idea of the proposed framework was to feed image features around GTV contours (determined based on the knowledge of radiation oncologists) into a machine-learning classifier during the training step, after which the classifier produces the 'degree of GTV' for each voxel in the testing step. Initial GTV regions were extracted using a support vector machine (SVM) that learned the image features inside and outside each tumor region (determined by radiation oncologists). The leave-one-out-by-patient test was employed for training and testing the steps of the proposed framework. The final GTV regions were determined using the OCS method that can be used to select a global optimum object contour based on multiple active delineations with a LSM around the GTV. The efficacy of the proposed framework was evaluated in 14 lung cancer cases [solid: 6, ground-glass opacity (GGO): 4, mixed GGO: 4] using the 3D Dice similarity coefficient (DSC), which denotes the degree of region similarity between the GTVs contoured by radiation oncologists and those determined using the proposed framework. The proposed framework achieved an average DSC of 0.777 for 14 cases, whereas the OCS-based framework produced an average DSC of 0.507. The average DSCs for GGO and mixed GGO were 0.763 and 0.701, respectively, obtained by the proposed framework. The proposed framework can be employed as a tool to assist radiation oncologists in delineating various GTV regions..
30. Yoshihiro Matsumoto, Makoto Shinoto, Makoto Endo, Nokitaka Setsu, Keiichiro Iida, Jun-Ichi Fukushi, Kenichi Kawaguchi, Seiji Okada, Hirofumi Bekki, Reiko Imai, Tadashi Kamada, Yoshiyuki Shioyama, Yasuharu Nakashima, Evaluation of risk factors for vertebral compression fracture after carbon-ion radiotherapy for primary spinal and paraspinal sarcoma, BioMed Research International, 10.1155/2017/9467402, 2017, 2017.01, Background and Purpose. Carbon-ion radiotherapy (C-ion RT) was effective therapy for inoperable spinal and paraspinal sarcomas. However, a significant adverse event following radiotherapies is vertebral compression fractures (VCFs). In this study, we investigated the incidence of and risk factors for post-C-ion RT VCFs in patients with spinal or paraspinal sarcomas. Material and Methods. Thirty consecutive patients with spinal or paraspinal sarcomas treated with C-ion RT were retrospectively reviewed. Various clinical parameters and the Spinal Instability Neoplastic Score (SINS) were used to evaluate the risk factors for post-C-ion RT VCFs. Results. The overall incidence of VCFs was 23% (median time: 7 months). Patients with VCFs showed a markedly higher SINS score (median value, 9 points) than those without VCF (5 points). The area under the receiver operating characteristic curve for the SINS score was 0.88, and the optimum SINS cut-off score was 8 points. The cumulative incidence of VCFs at 1 year was 9% for patients with a SINS score under 8 points, versus 80% for those with a SINS score of 8 points or higher (p<0.0001). Conclusions. In patients with a SINS score of 8 points or higher, referral to a spine surgeon for stabilization and multidisciplinary discussion is appropriate..
31. Katsumasa Nakamura, Kenta Konishi, Tetsuya Komatsu, Yoshiyuki Shioyama, Keiji Matsumoto, The advantages and disadvantages of IMRT and particle therapy for prostate cancer, Japanese Journal of Cancer and Chemotherapy, 44, 1, 37-40, 2017.01.
32. Takuma Nomiya, Hiroshi Tsuji, Hidemasa Kawamura, Tatsuya Ohno, Shingo Toyama, Yoshiyuki Shioyama, Yuko Nakayama, Kenji Nemoto, Hirohiko Tsujii, Tadashi Kamada, A multi-institutional analysis of prospective studies of carbon ion radiotherapy for prostate cancer
A report from the Japan Carbon ion Radiation Oncology Study Group (J-CROS), Radiotherapy and Oncology, 10.1016/j.radonc.2016.10.009, 121, 2, 288-293, 2016.11, Background and purpose A multi-institutional observational study (J-CROS1501PR) has been carried out to analyze outcomes of carbon-ion radiotherapy (CIRT) for patients with prostate cancer. Patients and methods Data of the patients enrolled in prospective studies of following 3 CIRT institutions were analyzed: National Institute of Radiological Sciences (NIRS; Chiba, Japan), Gunma University Heavy Ion Medical Center (GHMC; Gunma, Japan), and Ion Beam Therapy Center, SAGA HIMAT Foundation (HIMAT; Saga, Japan). Endpoints of the clinical trial are biochemical recurrence-free survival (bRFS), overall survival (OS), cause-specific survival (CSS), local control rate (LCR), and acute/late adverse effects. Results A total of 2157 patients’ data were collected from NIRS (n = 1432), GHMC (n = 515), and HIMAT (n = 210). The number of patients in low-risk, intermediate-risk, and high-risk groups was 263 (12%), 679 (31%), and 1215 (56%), respectively. The five-year bRFS in low-risk, intermediate-risk, and high-risk patients was 92%, 89%, and 92%, respectively. The five-year CSS in low-risk, intermediate-risk, and high-risk patients was 100%, 100%, and 99%, respectively. The incidence of grade 2 late GU/GI toxicities was 4.6% and 0.4%, respectively, and the incidence of ⩾G3 toxicities were 0%. Conclusions Favorable overall outcomes of CIRT for prostate cancer were suggested by the analysis of the first multi-institutional data..
33. Mazen Soufi, Hidetaka Arimura, Katsumasa Nakamura, Fauzia P. Lestari, Freddy Haryanto, Taka aki Hirose, Yoshiyuki Umedu, Yoshiyuki Shioyama, Fukai Toyofuku, Feasibility of differential geometry-based features in detection of anatomical feature points on patient surfaces in range image-guided radiation therapy, International journal of computer assisted radiology and surgery, 10.1007/s11548-016-1436-x, 11, 11, 1993-2006, 2016.11, Purpose: To investigate the feasibility of differential geometry features in the detection of anatomical feature points on a patient surface in infrared-ray-based range images in image-guided radiation therapy. Methods: The key technology was to reconstruct the patient surface in the range image, i.e., point distribution with three-dimensional coordinates, and characterize the geometrical shape at every point based on curvature features. The region of interest on the range image was extracted by using a template matching technique, and the range image was processed for reducing temporal and spatial noise. Next, a mathematical smooth surface of the patient was reconstructed from the range image by using a non-uniform rational B-splines model. The feature points were detected based on curvature features computed on the reconstructed surface. The framework was tested on range images acquired by a time-of-flight (TOF) camera and a Kinect sensor for two surface (texture) types of head phantoms A and B that had different anatomical geometries. The detection accuracy was evaluated by measuring the residual error, i.e., the mean of minimum Euclidean distances (MMED) between reference (ground truth) and detected feature points on convex and concave regions. Results: The MMEDs obtained using convex feature points for range images of the translated and rotated phantom A were 1.79 ± 0.53 and 1.97±0.21mm, respectively, using the TOF camera. For the phantom B, the MMEDs of the convex and concave feature points were 0.26 ± 0.09 and 0.52 ± 0.12 mm, respectively, using the Kinect sensor. There was a statistically significant difference in the decreased MMED for convex feature points compared with concave feature points ( P< 0.001 ). Conclusions: The proposed framework has demonstrated the feasibility of differential geometry features for the detection of anatomical feature points on a patient surface in range image-guided radiation therapy..
34. Yuzuru Niibe, Tetsuo Nishimura, Tetsuya Inoue, Katsuyuki Karasawa, Yoshiyuki Shioyama, Keiichi Jingu, Hiroki Shirato, Oligo-recurrence predicts favorable prognosis of brain-only oligometastases in patients with non-small cell lung cancer treated with stereotactic radiosurgery or stereotactic radiotherapy
A multi-institutional study of 61 subjects, BMC Cancer, 10.1186/s12885-016-2680-8, 16, 1, 2016.08, Background: To investigate the prognostic value of oligo-recurrence in patients with brain-only oligometastases of non-small cell lung cancer (NSCLC) treated with stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Methods: Patients treated with SRS or SRT for brain-only NSCLC oligometastases in 6 high-volume institutions in Japan between 1996 and 2008 were reviewed. Eligible patients met 1), 2), and 4) or 1), 3), and 4) of the following: 1) NSCLC with 1 to 4 brain metastases on magnetic resonance imaging (MRI) treated with SRS or SRT; 2) control of the primary lesions (thorax) at the time of SRS or SRT for brain metastases (patients meeting this criterion formed the oligo-recurrence group); 3) with SRS or SRT for brain metastases, concomitant treatment for active primary lesions (thorax) with curative surgery or curative stereotactic body radiotherapy (SBRT), or curative chemoradiotherapy (sync-oligometastases group); and 4) Karnofsky performance status (KPS)≥70. Results: The median overall survival (OS) of all 61 patients was 26 months (95 % CI: 17.5-34.5 months). The 2-year and 5-year overall survival rates were 60.7 and 15.7 %, respectively. Stratified by oligostatus, the sync-oligometastases group achieved a median OS of 18 months (95 % CI: 14.8-21.1 months) and a 5-year OS of 0 %, while the oligo-recurrence group achieved a median OS of 41 months (95 % CI: 27.8-54.2 months) and a 5-year OS of 18.6 %. On multivariate analysis, oligo-recurrence was the only significant independent factor related to a favorable prognosis (hazard ratio: 0.253 (95 % CI: 0.082-0.043) (p=0.025). Conclusions: The presence of oligo-recurrence can predict a favorable prognosis of brain-only oligometastases in patients with NSCLC treated with SRS or SRT..
35. Makoto Shinoto, Yoshiyuki Shioyama, Akira Matsunobu, Kei Okamoto, Hiroaki Suefuji, Shingo Toyama, Hiroshi Honda, Sho Kudo, Dosimetric analysis of upper gastrointestinal ulcer after carbon-ion radiotherapy for pancreatic cancer, Radiotherapy and Oncology, 10.1016/j.radonc.2016.04.040, 120, 1, 140-144, 2016.07, Purpose The aim of this study was to clarify the incidence, clinical risk factors, and dose–volume relationship of upper gastrointestinal (GI) ulcer after carbon-ion radiotherapy (C-ion RT) for pancreatic cancer. Materials and methods Fifty-eight pancreatic cancer patients were treated with C-ion RT from April 2014 to December 2015. The total dose was 55.2 Gy (RBE) in 12 fractions. D2cm3 of GI tracts were restricted under 46 Gy (RBE); RBE-weighted absorbed dose. The association between dosimetric parameters (V10–50, Dmax, D1cm3, D2cm3) and GI ulcer was examined using Spearman's correlation. The incidence of GI ulcer was compared between the two groups divided by the cutoff value. Results Twelve patients (21%) experienced gastric ulcer including only one (2%) grade 3 ulcer. There was no grade 4/5 toxicity or duodenal ulcer. V10–30 was significantly associated with gastric ulcer. The 1-year estimated risk of gastric ulcer for the determined cutoff values were 51% vs. 10% (V10, ⩾102 cm3 or less), 42% vs. 9% (V20, ⩾24 cm3 or less), 34% vs. 4% (V30, ⩾6 cm3 or less). Conclusions The incidence of GI ulcer after C-ion RT was very low with the dose constraint of D2cm3 <46 Gy (RBE). To further minimize the risk of GI ulcer, V10–30 should also be reduced..
36. Makoto Shinoto, Shigeru Yamada, Kotaro Terashima, Shigeo Yasuda, Yoshiyuki Shioyama, Hiroshi Honda, Tadashi Kamada, Hirohiko Tsujii, Hiromitsu Saisho, Takehide Asano, Taketo Yamaguchi, Hodaka Amano, Takeshi Ishihara, Masayuki Otsuka, Masamichi Matsuda, Osamu Kainuma, Akihiro Funakoshi, Junji Furuse, Toshio Nakagori, Takuji Okusaka, Hiroshi Ishii, Tatsuya Nagakawa, Shinichiro Takahashi, Shoichi Hishinuma, Masafumi Nakamura, Hirofumi Saito, Kiyoshi Ohara, Shinichi Ohkawa, Masahiro Hiraoka, Carbon Ion Radiation Therapy with Concurrent Gemcitabine for Patients with Locally Advanced Pancreatic Cancer, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2015.12.362, 95, 1, 498-504, 2016.05, Purpose To determine, in the setting of locally advanced pancreatic cancer, the maximum tolerated dose of carbon ion radiation therapy (C-ion RT) and gemcitabine dose delivered concurrently and to estimate local effect and survival. Methods and Materials Eligibility included pathologic confirmation of pancreatic invasive ductal carcinomas and radiographically unresectable disease without metastasis. Concurrent gemcitabine was administered on days 1, 8, and 15, and the dose levels were escalated from 400 to 1000 mg/m
2
under the starting dose level (43.2 GyE) of C-ion RT. The dose levels of C-ion RT were escalated from 43.2 to 55.2 GyE at 12 fractions under the fixed recommended gemcitabine dose determined. Results Seventy-six patients were enrolled. Among the 72 treated patients, dose-limiting toxicity was observed in 3 patients: grade 3 infection in 1 patient and grade 4 neutropenia in 2 patients. Only 1 patient experienced a late grade 3 gastric ulcer and bleeding 10 months after C-ion RT. The recommended dose of gemcitabine with C-ion RT was found to be 1000 mg/m
2
. The dose of C-ion RT with the full dose of gemcitabine (1000 mg/m
2
) was safely increased to 55.2 GyE. The freedom from local progression rate was 83% at 2 years using the Response Evaluation Criteria in Solid Tumors. The 2-year overall survival rates in all patients and in the high-dose group with stage III (≥45.6 GyE) were 35% and 48%, respectively. Conclusions Carbon ion RT with concurrent full-dose gemcitabine was well tolerated and effective in patients with unresectable locally advanced pancreatic cancer..
37. Makoto Shinoto, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Akihiro Nishie, Yoshiki Asayama, Ohga Saiji, Tadamasa Yoshitake, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Hiroshi Honda, Prognostic significance of a minute amount of ascites during chemoradiotherapy for locally advanced pancreatic cancer, Anticancer Research, 36, 4, 1879-1884, 2016.04, Aim: The aim of this study was to investigate the clinical factors for predicting overall survival (OS) and the significance of a minute amount of ascites on computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC) treated with chemoradiotherapy (CRT). Patients and Methods: Between 2003 and 2011, 48 consecutive patients with LAPC were treated with CRT. Various clinical factors, including ascites, were evaluated for correlation with OS. A subset analysis of 16 patients with a minute amount of ascites was also performed. Results: The median survival duration and the 1-year OS rates were 11.5 months and 50%, respectively. A minute amount of ascites on CT and elevated carbohydrate antigen 19-9 (CA19-9) level were significantly associated with poorer OS. In 16 patients with ascites, the amount of ascites increased in the course of the disease, and these were considered to be cancerous clinically, regardless of the amount. Conclusion: A minute amount of ascites and CA19-9 were important prognostic factors in CRT. Any amount of ascites was considered an early indicator of peritoneal carcinomatosis in LAPC..
38. Masaru Ando, Yutaka Mukai, Ryo Ichi Ushijima, Yoshiyuki Shioyama, Kenji Umeki, Fumito Okada, Shin Ichi Nureki, Hiromitsu Mimata, Jun Ichi Kadota, Disseminated mycobacterium tuberculosis infection masquerading as metastasis after heavy ion radiotherapy for prostate cancer, Internal Medicine, 10.2169/internalmedicine.55.7039, 55, 22, 3387-3392, 2016.01, Fluorodeoxyglucose (FDG)-positron emission tomography with computed tomography (FDG-PET/CT) is useful in disease monitoring of malignancies after therapy, while an FDG uptake may also be present in benign diseases. We herein demonstrate a case of disseminated Mycobacterium tuberculosis mimicking systemic metastasis of prostate cancer. This case highlights that clinicians should consider Mycobacterium tuberculosis in patients with prostate cancer who demonstrate multifocal FDG uptakes masquerading as metastasis, even when the chest photographs reveal a normal appearance and a sputum examination demonstrates negative results. An invasive surgical biopsy may be required and a pathological analysis would be critical in the diagnosis of Mycobacterium tuberculosis..
39. Katsuyuki Hotta, Jiichiro Sasaki, Sho Saeki, Nagio Takigawa, Kuniaki Katsui, Koichi Takayama, Naoyuki Nogami, Yoshiyuki Shioyama, Akihiro Bessho, Junji Kishimoto, Mitsune Tanimoto, Katsuyuki Kiura, Yukito Ichinose, Gefitinib Combined with Standard Chemoradiotherapy in EGFR-Mutant Locally Advanced Non-Small-Cell Lung Cancer
The LOGIK0902/OLCSG0905 Intergroup Study Protocol, Clinical Lung Cancer, 10.1016/j.cllc.2015.08.004, 17, 1, 75-79, 2016.01, Herein, we describe an ongoing phase II trial in patients with locally advanced non-small-cell lung cancer (NSCLC) with mutated epidermal growth factor receptor (EGFR). Patients with chemotherapy-naive locally advanced disease with active EGFR mutations will receive the induction treatment, specified as gefitinib monotherapy (250 mg/body) for 8 weeks. Patients whose disease has not progressed during the induction therapy will receive cisplatin and docetaxel (40 mg/m2) on days 1, 8, 29, and 36, and concurrent 3-dimensional conformal thoracic radiotherapy with a single daily fraction of 2 Gy, for 5 consecutive days each week to provide a total dose of 60 Gy. The primary end point is overall survival at 24 months. A target sample size of 21 evaluable patients is considered sufficient to validate an expected rate of 85%, and 60% would be the lower limit of interest, with 80% power and a 1-sided α of 5%. Secondary end points include toxicity, response rate, and overall survival. This study will clarify whether tyrosine kinase inhibitors targeted to EGFR can produce a maximal effect in selected NSCLC patients with the relevant driver mutation, even in the locally advanced setting..
40. Kaori Asai, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Yoshio Matsuo, Ohga Saiji, Tadamasa Yoshitake, Kotaro Terashima, Makoto Shinoto, Keiji Matsumoto, Hidenari Hirata, Hiroshi Honda, Clinical characteristics and outcome of pneumothorax after stereotactic body radiotherapy for lung tumors, International Journal of Clinical Oncology, 10.1007/s10147-015-0833-4, 20, 6, 1117-1121, 2015.12, Backgound: We retrospectively investigated the clinical characteristics and outcome of pneumothorax after stereotactic body radiotherapy (SBRT) for lung tumors. Methods: Between April 2003 and July 2012, 473 patients with lung tumors were treated with SBRT. We identified 12 patients (2.5 %) with pneumothorax caused by SBRT, and evaluated the clinical features of pneumothorax. Results: All of the tumors were primary lung cancers. The severity of radiation pneumonitis was grade 1 in 10 patients and grade 2 in two patients. Nine patients had emphysema. The planning target volume and pleura overlapped in 11 patients, and the tumors were attached to the pleura in 7 patients. Rib fractures were observed in three patients before or at the same time as the diagnosis of pneumothorax. The median time to onset of pneumothorax after SBRT was 18.5 months (4–84 months). The severity of pneumothorax was grade 1 in 11 patients and grade 3 in one patient. Conclusion: Although pneumothorax was a relatively rare late adverse effect after SBRT, some patients demonstrated pneumothorax after SBRT for peripheral lung tumors. Although most pneumothorax was generally tolerable and self-limiting, careful follow-up is needed..
41. Yoshiyuki Shioyama, Katsumasa Nakamura, Hiroshi Honda, Toxicity and treatment evaluation, Stereotactic Body Radiation Therapy Principles and Practices, 10.1007/978-4-431-54883-6_13, 163-173, 2015.08.
42. Keiji Matsumoto, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Ohga Saiji, Toshihiro Yamaguchi, Tadamasa Yoshitake, Kaori Asai, Genyu Kakiuchi, Hiroshi Honda, Treatment planning comparison for carbon ion radiotherapy, proton therapy and intensity-modulated radiotherapy for spinal sarcoma, Anticancer Research, 35, 7, 4083-4090, 2015.07, Background/Aim: Carbon ion radiotherapy (CIRT), proton therapy (PT) and intensity-modulated radiotherapy (IMRT) are new radiation modalities suitable for treatment of spinal sarcomas. The objective of the study was to compare the treatment planning of these modalities. Patients and Methods: We conducted a treatment planning comparison of the three modalities using a phantom imitating a spinal sarcoma and then six actual cases with spinal tumors. A uniform biological effective dose (BED) of 90 Gy10 was prescribed in previously reported fractionation schedules for each modality. The surface/center spinal cord dose constraints were set to BED of 96/77 Gy(E)3, respectively. Results: CIRT achieved better homogeneity of dose distribution and coverage of target than PT independently of tumor extent around the spinal cord. In IMRT plans, the spinal cord dose was higher than that under CIRT and PT and coverage of the target deteriorated depending on the tumor extension. Conclusion: CIRT was most appropriate for the treatment of advanced spinal sarcomas..
43. Takahiro Nakamoto, Hidetaka Arimura, Katsumasa Nakamura, Yoshiyuki Shioyama, Asumi Mizoguchi, Taka aki Hirose, Hiroshi Honda, Yoshiyuki Umezu, Yasuhiko Nakamura, Hideki Hirata, A computerized framework for monitoring four-dimensional dose distributions during stereotactic body radiation therapy using a portal dose image-based 2D/3D registration approach, Computerized Medical Imaging and Graphics, 10.1016/j.compmedimag.2014.12.003, 40, 1-12, 2015.01, A computerized framework for monitoring four-dimensional (4D) dose distributions during stereotactic body radiation therapy based on a portal dose image (PDI)-based 2D/3D registration approach has been proposed in this study. Using the PDI-based registration approach, simulated 4D "treatment" CT images were derived from the deformation of 3D planning CT images so that a 2D planning PDI could be similar to a 2D dynamic clinical PDI at a breathing phase. The planning PDI was calculated by applying a dose calculation algorithm (a pencil beam convolution algorithm) to the geometry of the planning CT image and a virtual water equivalent phantom. The dynamic clinical PDIs were estimated from electronic portal imaging device (EPID) dynamic images including breathing phase data obtained during a treatment. The parameters of the affine transformation matrix were optimized based on an objective function and a gamma pass rate using a Levenberg-Marquardt (LM) algorithm. The proposed framework was applied to the EPID dynamic images of ten lung cancer patients, which included 183 frames (mean: 18.3 per patient). The 4D dose distributions during the treatment time were successfully obtained by applying the dose calculation algorithm to the simulated 4D "treatment" CT images. The mean ± standard deviation (SD) of the percentage errors between the prescribed dose and the estimated dose at an isocenter for all cases was 3.25 ± 4.43%. The maximum error for the ten cases was 14.67% (prescribed dose: 1.50. Gy, estimated dose: 1.72. Gy), and the minimum error was 0.00%. The proposed framework could be feasible for monitoring the 4D dose distribution and dose errors within a patient's body during treatment..
44. Satoshi Yoshidome, Hidetaka Arimura, Katsumasa Nakamura, Yoshiyuki Shioyama, Kazushige Atsumi, Yasuhiko Nakamura, Hideki Yoshikawa, Kei Nishikawa, Hideki Hirata, Feasibility study of automated framework for estimating lung tumor locations for target-based patient positioning in stereotactic body radiotherapy, BioMed Research International, 10.1155/2015/653974, 2015, 2015.01, Objective. To investigate the feasibility of an automated framework for estimating the lung tumor locations for tumor-based patient positioning with megavolt-cone-beam computed tomography (MV-CBCT) during stereotactic body radiotherapy (SBRT). Methods. A lung screening phantom and ten lung cancer cases with solid lung tumors, who were treated with SBRT, were employed to this study. The locations of tumors in MV-CBCT images were estimated using a tumor-template matching technique between a tumor template and the MV-CBCT. Tumor templates were produced by cropping the gross tumor volume (GTV) regions, which were enhanced by a Sobel filter or a blob structure enhancement (BSE) filter. Reference tumor locations (grand truth) were determined based on a consensus between a radiation oncologist and a medical physicist. Results. According to the results of the phantom study, the average Euclidean distances of the location errors in the original, Sobel-filtered, and BSE-filtered images were 2.0 ± 4.1 mm, 12.8 ± 9.4 mm, and 0.4 ± 0.5 mm, respectively. For clinical cases, these were 3.4 ± 7.1 mm, 7.2 ± 11.6 mm, and 1.6 ± 1.2 mm, respectively. Conclusion. The feasibility study suggests that our proposed framework based on the BSE filter may be a useful tool for tumor-based patient positioning in SBRT..
45. Tadamasa Yoshitake, Yoshiyuki Shioyama, Kaori Asai, Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Takeshi Kamitani, Toshihiro Yamaguchi, Kaori Ohshima, Keiji Matsumoto, Satoshi Kawanami, Hiroshi Honda, Impact of interstitial changes on radiation pneumonitis after stereotactic body radiation therapy for lung cancer, Anticancer Research, 35, 9, 4909-4914, 2015.01, Aim: The aim of the present study was to evaluate the impact of interstitial changes (IC) on radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT) for lung cancer. Patients and Methods: We analyzed 260 consecutive patients with primary lung cancer treated with SBRT. According to the presence or absence of IC on the pre-treatment computed tomography, patients were divided into two groups: an IC group (n=18) and a non-IC group (n=242). Results: RP of grade 2 or more was observed in 9 (50.0%) and 14 (6.7%) patients in the IC and non-IC group, respectively. All three patients with grade 5 RP were in the IC group. As indicated by multivariate analysis, the presence of IC was the only significant predictive factor of RP of grade 2 or more. Conclusion: The presence of IC was a significant indicator of grade 2 or more RP after SBRT for patients with lung cancer..
46. Yoshiyuki Shioyama, Hiroshi Tsuji, Hiroaki Suefuji, Makoto Sinoto, Akira Matsunobu, Shingo Toyama, Katsumasa Nakamura, Sho Kudo, Particle radiotherapy for prostate cancer, International Journal of Urology, 10.1111/iju.12640, 22, 1, 33-39, 2015.01, Recent advances in external beam radiotherapy have allowed us to deliver higher doses to the tumors while decreasing doses to the surrounding tissues. Dose escalation using high-precision radiotherapy has improved the treatment outcomes of prostate cancer. Intensity-modulated radiation therapy has been widely used throughout the world as the most advanced form of photon radiotherapy. In contrast, particle radiotherapy has also been under development, and has been used as an effective and non-invasive radiation modality for prostate and other cancers. Among the particles used in such treatments, protons and carbon ions have the physical advantage that the dose can be focused on the tumor with only minimal exposure of the surrounding normal tissues. Furthermore, carbon ions also have radiobiological advantages that include higher killing effects on intrinsic radio-resistant tumors, hypoxic tumor cells and tumor cells in the G0 or S phase. However, the degree of clinical benefit derived from these theoretical advantages in the treatment of prostate cancer has not been adequately determined. The present article reviews the available literature on the use of particle radiotherapy for prostate cancer as well as the literature on the physical and radiobiological properties of this treatment, and discusses the role and the relative merits of particle radiotherapy compared with current photon-based radiotherapy, with a focus on proton beam therapy and carbon ion radiotherapy..
47. Rikiya Onimaru, Hiroki Shirato, Taro Shibata, Masahiro Hiraoka, Satoshi Ishikura, Katsuyuki Karasawa, Yukinori Matsuo, Masaki Kokubo, Yoshiyuki Shioyama, Haruo Matsushita, Yoshinori Ito, Hiroshi Onishi, Phase i study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702), Radiotherapy and Oncology, 10.1016/j.radonc.2015.07.008, 116, 2, 276-280, 2015.01, Purpose To estimate the maximum tolerated dose (MTD) and to determine the recommended dose (RD) of stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinoma (NSCLC) with target volume (PTV) < 100 cc. Materials and methods The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the MTD. Dose limiting toxicity (DLT) was grade 3 radiation pneumonitis (RP) within 180 days after the start of SBRT, grade 2 RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D
95
of the PTV. Results Fifteen patients were accrued. Only 1 experienced grade 2 RP at 60 Gy in 4 fractions. It was difficult to fulfill the dose constraints at 60 Gy in 4 fractions, and the maximum dose level assigned by CRM was changed to 55 Gy in 4 fractions. The lower limit of 95% of the credible interval exceeded the adjacent level, and the RD was determined as 55 Gy in 4 fractions. Conclusions The RD of SBRT for peripheral T2N0M0 NSCLC with PTV < 100 cc was determined to be 55 Gy in 4 fractions..
48. Yasushi Nagata, Masahiro Hiraoka, Taro Shibata, Hiroshi Onishi, Masaki Kokubo, Katsuyuki Karasawa, Yoshiyuki Shioyama, Rikiya Onimaru, Takuyo Kozuka, Etsuo Kunieda, Tsutomu Saito, Keiichi Nakagawa, Masato Hareyama, Yoshihiro Takai, Kazushige Hayakawa, Norio Mitsuhashi, Satoshi Ishikura, Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 non-small cell lung cancer
Japan Clinical Oncology Group Study JCOG0403, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2015.07.2278, 93, 5, 989-996, 2015.01, Purpose To evaluate, in Japan Clinical Oncology Group study 0403, the safety and efficacy of stereotactic body radiation therapy (SBRT) in patients with T1N0M0 non-small cell lung cancer (NSCLC). Methods and Materials Eligibility criteria included histologically or cytologically proven NSCLC, clinical T1N0M0. Prescribed dose was 48 Gy at the isocenter in 4 fractions. The primary endpoint was the percent (%) 3-year overall survival. The threshold % 3-year survival to be rejected was set at 35% for inoperable patients, whereas the expected % 3-year survival was 80% for operable patients. Results Between July 2004 and November 2008, 169 patients from 15 institutions were registered. One hundred inoperable and 64 operable patients (total 164) were eligible. Patients' characteristics were 122 male, 47 female; median age 78 years (range, 50-91 years); adenocarcinomas, 90; squamous cell carcinomas, 61; others, 18. Of the 100 inoperable patients, the % 3-year OS was 59.9% (95% confidence interval 49.6%-68.8%). Grade 3 and 4 toxicities were observed in 10 and 2 patients, respectively. No grade 5 toxicity was observed. Of the 64 operable patients, the % 3-year OS was 76.5% (95% confidence interval 64.0%-85.1%). Grade 3 toxicities were observed in 5 patients. No grade 4 and 5 toxicities were observed. Conclusions Stereotactic body radiation therapy for stage I NSCLC is effective, with low incidences of severe toxicity. This treatment can be considered a standard treatment for inoperable stage I NSCLC. This treatment is promising as an alternative to surgery for operable stage I NSCLC..
49. Tadamasa Yoshitake, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Ohga Saiji, Makoto Shinoto, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Yoshio Matsuo, Shingo Baba, Hiroshi Honda, Stereotactic body radiation therapy for primary lung cancers clinically diagnosed without pathological confirmation
a single-institution experience, International Journal of Clinical Oncology, 10.1007/s10147-014-0698-y, 20, 1, 53-58, 2015.01, Background: Pathological diagnosis of small lung lesions is sometimes difficult in medically inoperable patients. The purpose of this study was to evaluate the adverse events and the outcomes of stereotactic body radiation therapy (SBRT) for lung lesions which were clinically diagnosed as primary lung cancer without pathological confirmation. Methods: Between April 2003 and April 2011, 88 patients with small lung lesions which were clinically diagnosed as primary lung cancer were treated with SBRT. The median tumor size was 19 mm (range 8–40 mm). The radiation dose was 48 Gy in four fractions in all patients. The median follow-up was 23 months (range 6–91 months). Results: Recurrence was observed in 13 patients. The local control rate, progression-free survival rate, and overall survival rate at 3 years were 90, 67, and 80 %, respectively. Two patients (2.3 %) had Grade 2 radiation pneumonitis, and six patients (6.8 %) had Grade 2 rib fractures. There were no adverse events of Grade 3 or greater. Conclusions: SBRT appears to be a safe and effective treatment option for small lung lesions that are clinically diagnosed as primary lung cancer without pathological confirmation..
50. Ohga Saiji, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Toshihiro Yamaguchi, Tadamasa Yoshitake, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Hiroshi Honda, Treatment outcome of radiotherapy for localized primary ocular adnexal MALT lymphoma - Prognostic effect of the AJCC tumor-node-metastasis clinical staging system, Anticancer Research, 35, 6, 3591-3597, 2015.01, Aim: To analyze the treatment outcome of radiotherapy for localized primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML) and evaluate the prognostic effect of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) clinical staging system for POAML. Patients and Methods: Seventy-three patients with Ann Arbor stage IE POAML who were treated with radiotherapy alone were analyzed. T-Factor based on the AJCC staging system was T1 in 28, T2 in 33 and T3 in 12 patients. Results: Out of nine patients with relapse, six had distant and three had contralateral ocular adnexal relapse. One patient died of lymphoma progression. The 5-year local control and progression-free survival (PFS) rates were 100% and 81.5%, respectively. T-Factor was not significantly associated with PFS. Conclusion: Radiotherapy achieved excellent local control and survival rates for stage IE POAML. The AJCC TNM clinical staging system was not significantly predictive for PFS of stage IE POAML..
51. Yuko Isoyama-Shirakawa, Katsumasa Nakamura, Madoka Abe, Naonobu Kunitake, Keiji Matsumoto, Ohga Saiji, Tomonari Sasaki, Satoru Uehara, Kazuhiro Okushima, Yoshiyuki Shioyama, Hiroshi Honda, Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer, Journal of radiation research, 10.1093/jrr/rrv011, 56, 3, 583-587, 2014.12, It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer..
52. Yoshiyuki Shioyama, Akira Matsunobu, Makoto Shinoto, Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Tadamasa Yoshitake, Kaori Asai, Hiroshi Honda, Stereotactic body radiotherapy for early lung cancer, Japanese Journal of Lung Cancer, 10.2482/haigan.54.910, 54, 7, 910-916, 2014.12, Although the standard treatment method for stage I non-small cell lung cancer is surgery (lobectomy), many patients are inoperable due to age andor complications. Radiotherapy is often performed in inoperable patients; however, the results of conventional fractionated radiotherapy are not satisfactory. In recent years, the high efficacy and safety of stereotactic body radiotherapy (SBRT), which can be used to deliver a targeted high dose to the tumor while minimizing effects on adjacent normal tissues, have been demonstrated, and SBRT has become a standard treatment for medically inoperable patients with stage I non-small cell lung cancer in place of conventional fractionated radiotherapy. Although the high efficacy of SBRT has been reported in operable patients, the equivalence of the treatment effect compared with surgery has not been confirmed in randomized controlled trials, and a consensus regarding the optimal treatment has not been reached. In elderly subjects or marginally operable patients in whom performing lobectomy is difficult although limited surgery (segmentectomy or wedge resection) is possible, SBRT is a reasonable and less invasive treatment option with expected results equivalent to surgical intervention. However, there is not yet sufficient evidence to confirm the efficacy and safety of this treatment over long-term follow-up, and several issues, including the optimal dose and fractionation, use of adjuvant chemotherapy, diagnosis of recurrence and effectiveness of salvage treatment after recurrence, remain to be addressed..
53. Ohga Saiji, Katsumasa Nakamura, Yoshiyuki Shioyama, Katsunori Tatsugami, Tomonari Sasaki, Takeshi Nonoshita, Tadamasa Yoshitake, Kaori Asai, Hideki Hirata, Seiji Naito, Hiroshi Honda, Acute urinary morbidity after a permanent 125I implantation for localized prostate cancer, Journal of radiation research, 10.1093/jrr/rru065, 55, 6, 1178-1183, 2014.11, We evaluated the predictive factors of acute urinary morbidity (AUM) after prostate brachytherapy. From November 2005 to January 2007, 62 patients with localized prostate cancer were treated using brachytherapy. The 125Iodine (125I) seed-delivering method was a modified peripheral pattern. The prescribed dose was 144 Gy. Urinary morbidity was scored at 3 months after implantation. The clinical and treatment parameters were analysed for correlation with AUM. In particular, in this study, Du90 (the minimal dose received by 90% of the urethra), Dup90 (the minimal dose received by 90% of the proximal half of the urethra on the bladder side) and Dud90 (the minimal dose received by 90% of the distal half of the urethra on the penile side) were analysed. We found that 43 patients (69.4%) experienced acute urinary symptoms at 3 months after implantation. Of them, 40 patients had Grade 1 AUM, one patient had Grade 2 pain, and two patients had Grade 2 urinary frequency. None of the patients had ≥Grade 3. Univariate and multivariate analysis revealed that Du90 and Dup90 were significantly correlated with AUM. In this study, Du90 and Dup90 were the most significant predictors of AUM after prostate brachytherapy..
54. Ze Jin, Hidetaka Arimura, Yoshiyuki Shioyama, Katsumasa Nakamura, Jumpei Kuwazuru, Taiki Magome, Hidetake Yabuuchi, Hiroshi Honda, Hideki Hirata, Masayuki Sasaki, Computer-assisted delineation of lung tumor regions in treatment planning CT images with PET/CT image sets based on an optimum contour selection method, Journal of radiation research, 10.1093/jrr/rru056, 55, 6, 1153-1162, 2014.11, To assist radiation oncologists in the delineation of tumor regions during treatment planning for lung cancer, we have proposed an automated contouring algorithm based on an optimum contour selection (OCS) method for treatment planning computed tomography (CT) images with positron emission tomography (PET)/CT images. The basic concept of the OCS is to select a global optimum object contour based on multiple active delineations with a level set method around tumors. First, the PET images were registered to the planning CT images by using affine transformation matrices. The initial gross tumor volume (GTV) of each lung tumor was identified by thresholding the PET image at a certain standardized uptake value, and then each initial GTV location was corrected in the region of interest of the planning CT image. Finally, the contours of final GTV regions were determined in the planning CT images by using the OCS. The proposed method was evaluated by testing six cases with a Dice similarity coefficient (DSC), which denoted the degree of region similarity between the GTVs contoured by radiation oncologists and the proposed method. The average three-dimensional DSC for the six cases was 0.78 by the proposed method, but only 0.34 by a conventional method based on a simple level set method. The proposed method may be helpful for treatment planners in contouring the GTV regions..
55. Masamitsu Hatakenaka, Katsumasa Nakamura, Hidetake Yabuuchi, Yoshiyuki Shioyama, Yoshio Matsuo, Takeshi Kamitani, Masato Yonezawa, Takashi Yoshiura, Torahiko Nakashima, Mitsuru Mori, Hiroshi Honda, Apparent diffusion coefficient is a prognostic factor of head and neck squamous cell carcinoma treated with radiotherapy, Japanese Journal of Radiology, 10.1007/s11604-013-0272-y, 32, 2, 80-89, 2014.02, Purpose: To evaluate the correlation between apparent diffusion coefficient (ADC) and prognosis in head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy. Materials and methods: We retrospectively studied 41 patients (38 male and 3 female, ages 37-85 years) diagnosed with HNSCC (14 oropharynx, 22 hypopharynx, 4 larynx, 1 oral cavity) and treated with radiotherapy, with radiation dose to gross tumor volume over 60 Gy. The association between age, gender, performance status, tumor location, T stage, N stage, stage, dose, overall treatment time, treatment method, adjuvant therapy, or ADC and prognosis was analyzed using a Cox proportional hazard test. Results: ADC calculated with b-values of 300, 500, 750, and 1,000 s/mm2 (ADC 300-1,000) alone showed a significant correlation with all of the analyses (p = 0.022 for local control, p = 0.0109 for regional control, p = 0.0041 for disease-free survival, and p = 0.0014 for overall survival). ADC calculated with b-values of 0, 100, and 200 s/mm2 (ADC 0-200) showed a significant correlation with overall survival (p = 0.0012). N stage showed a significant correlation with regional control (p = 0.0241). Performance status showed significant association with local control (p = 0.0459), disease-free survival (p = 0.023), and overall survival (p = 0.0151), respectively. Conclusion: ADC is an independent predictor of prognosis in HNSCC treated with radiotherapy..
56. Minako Ushijima, Hiroshi Yoshikawa, Yoko Onishi, Tatsuro Ishibashi, Aiko Suminoe, Yuhki Koga, Kaori Asai, Yoshiyuki Shioyama, A case of retinoblastoma with marked infiltration in the optic nerve, Japanese Journal of Clinical Ophthalmology, 68, 5, 661-664, 2014.01, Purpose: To report retinoblastoma with marked involvement of the optic nerve in an infant. Case: A 19-month-old male infant presented with opaque cornea in the left eye. Abnormal eye position had been present since one year before. Family members showed no notable events. Findings: The left eye was directed outwards with rubeosis iridis and corneal diameter of 13 mm. Echography showed tumor mass with calcification. The left optic nerve showed swelling anterior to the orbital apex. The left eye was enucleated after two courses of systemic and intrathecal chemotherapy. The optic nerve was dissected 15 mm posterior to the eyeglobe. The patient received further systemic and intrathecal chemotherapy with irradiation of the optic nerve anterior to the chiasm. He has been doing well for 34 months until present. Conclusion: Systemic and intrathecal chemotherapy followed by enucleation was effective for retinoblastoma with marked involvement of the optic nerve in an infant..
57. Daisuke Okamoto, Akihiro Nishie, Yoshiki Asayama, Tsuyoshi Tajima, Kosei Ishigami, Daisuke Kakihara, Tomohiro Nakayama, Ohga Saiji, Tadamasa Yoshitake, Yoshiyuki Shioyama, Hiroshi Honda, Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MR finding of radiation-induced hepatic injury
Relationship to absorbed dose and time course after irradiation, Magnetic Resonance Imaging, 10.1016/j.mri.2014.02.019, 32, 6, 660-664, 2014.01, Purpose: To evaluate if Gd-EOB-DTPA-enhanced MRI could identify liver tissue damage caused by radiation exposure in patients undergoing external beam radiation therapy. Materials and methods: We enrolled 11 patients who underwent Gd-EOB-DTPA-enhanced MRI during or after radiotherapy in which the radiation field included the liver. External beam radiotherapy was delivered through multiple fields using a 10-MV linear accelerator. The hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI were qualitatively evaluated for the presence of a decreased uptake of Gd-EOB-DTPA in the irradiated area in the liver. Next, signal intensity (SI) ratio of the irradiated area to the non-irradiated liver parenchyma was also calculated. The absorbed dose of the irradiated area in the liver was standardized using equivalent dose in 2. Gy fraction (EQD2) and biological effective dose (BED). The results of qualitative analysis were compared with EQD2 or BED, and linear regression analysis was performed between EQD2 or BED and SI ratio. Results: Twenty-two irradiated areas were evaluated. Qualitative analysis revealed a decreased uptake of Gd-EOB-DTPA in 14 areas and no decreased uptake of Gd-EOB-DTPA in eight areas. The thresholds of EQD2 and BED causing a decreased uptake of Gd-EOB-DTPA were considered to be 24 to 29. Gy and 29 to 35. Gy, respectively. Quantitatively, SI ratio decreased as EQD2 or BED increased (r = 0.89, p. < 0.001), and the inverse relationship between signal enhancement and the absorbed dose in the irradiated area was obtained. One area with EQD2 of 50. Gy and BED of 60Gy showed a slightly decreased uptake of Gd-EOB-DTPA on the 40th day but a clearly decreased uptake of Gd-EOB-DTPA on the 123rd day from initiation of radiotherapy. Conclusions: Gd-EOB-DTPA-enhanced MRI described RLI as a decreased uptake of Gd-EOB-DTPA matching the irradiated area. The occurrence of this finding was significantly correlated with the absorbed dose of the irradiated area in the liver..
58. Hidetaka Arimura, Genyu Kakiuchi, Yoshiyuki Shioyama, Shin Ichi Minohara, Takahiro Nakamoto, Katsumasa Nakamura, Hiroshi Honda, Mutsumi Tashiro, Tatsuaki Kanai, Hideki Hirata, Quantitative Evaluation of the Robustness of Beam Directions Based on Power Spectral Analysis of Water-Equivalent Path Length Image in Charged Particle Therapy, International Journal of Intelligent Computing in Medical Sciences and Image Processing, 10.1080/1931308X.2013.876163, 6, 1, 1-16, 2014.01, Objective: To investigate the quantitative evaluation of the robustness of particle beam directions against patient setup errors in charged particle therapy. Methods: Power spectral analysis of target water-equivalent path length (WEPL) images in beam's eye views was employed for quantitative evaluation of the robustness of beam directions. The relationship between the beam direction and the 0th moment of the power spectrum was calculated for estimating the robustness of each beam direction. We applied the proposed evaluation method to 7 head-region cancer patients. Results: The mean of the 0th moment at the conventional beam directions, which were empirically selected by a manual method, was smaller than that for the avoided beam directions with a statistically significant difference (p < 0.05), which means that the conventional beam directions were appropriate from the theoretical point of view. Conclusions: The results in this preliminary study may lead to quantitative selection of beam directions based on the relationship between the beam direction and the 0th moment derived from the target WEPL image in charged particle therapy..
59. Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Tadamasa Yoshitake, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Yoshiyuki Shioyama, Hiroshi Honda, Recent advances in radiation oncology
Intensity-modulated radiotherapy, a clinical perspective, International Journal of Clinical Oncology, 10.1007/s10147-014-0718-y, 19, 4, 564-569, 2014.01, Radiotherapy plays an important role in the treatment of various malignancies, and intensity-modulated radiotherapy (IMRT) is an attractive option because it can deliver precise conformal radiation doses to the target while minimizing the dose to adjacent normal tissues. IMRT provides a highly conformal dose distribution by modulating the intensity of the radiation beam. A number of malignancies have been targeted by IMRT; this work reviews published data on the major disease sites treated with IMRT. The dosimetric advantage of IMRT has resulted in the significant reduction of adverse effects in some tumors. However, there are few clinical trials comparing IMRT and three-dimensional conformal radiotherapy (3D-CRT), and no definite increase in survival or the loco-regional control rate by IMRT has been demonstrated in many malignancies. IMRT also requires greater time and resources to complete compared to 3D-CRT. In addition, the cost-effectiveness of IMRT versus 3D-CRT has not yet been established..
60. Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Tadamasa Yoshitake, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Makoto Shinoto, Yoshiyuki Shioyama, Akihiro Nishie, Hiroshi Honda, Thermographic visualization of the superficial vein and extravasation using the temperature gradient produced by the injected materials, Infrared Physics and Technology, 10.1016/j.infrared.2014.09.029, 67, 514-520, 2014.01, There are few effective methods to detect or prevent the extravasation of injected materials such as chemotherapeutic agents and radiographic contrast materials. To investigate whether a thermographic camera could visualize the superficial vein and extravasation using the temperature gradient produced by the injected materials, an infrared thermographic camera with a high resolution of 0.04 °C was used. At the room temperature of 26 °C, thermal images and the time course of the temperature changes of a paraffin phantom embedded with rubber tubes (diameter 3.2 mm, wall thickness 0.8 mm) were evaluated after the tubes were filled with water at 15 °C or 25 °C. The rubber tubes were embedded at depths of 0 mm, 1.5 mm, and 3.0 mm from the surface of the phantom. Temperature changes were visualized in the areas of the phantom where the tubes were embedded. In general, changes were more clearly detected when greater temperature differences between the phantom and the water and shallower tube locations were employed. The temperature changes of the surface of a volunteer's arm were also examined after a bolus injection of physiological saline into the dorsal hand vein or the subcutaneous space. The injection of 5 ml room-temperature (26 °C) saline into the dorsal hand vein enabled the visualization of the vein. When 3 ml of room-temperature saline was injected through the vein into the subcutaneous space, extravasation was detected without any visualization of the vein. The subtraction image before and after the injection clearly showed the temperature changes induced by the saline. Thermography may thus be useful as a monitoring system to detect extravasation of the injected materials..
61. Katsumasa Nakamura, Tadamasa Yoshitake, Kotaro Terashima, Tomonari Sasaki, Ohga Saiji, Kaori Asai, Keiji Matsumoto, Hidenari Hirata, Makoto Shinoto, Satoshi Yoshidome, Shigeo Anai, Yoshiyuki Shioyama, Hiroshi Honda, [The control of respiratory organ motion in the field of radiology
the viewpoint of a radiation oncologist]., Nihon Hoshasen Gijutsu Gakkai zasshi, 10.6009/jjrt.2014_JSRT_70.5.477, 70, 5, 477-482, 2014.01.
62. Tadamasa Yoshitake, Yoshiyuki Shioyama, Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Makoto Shinoto, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Hideki Hirata, Hiroshi Honda, Definitive fractionated re-irradiation for local recurrence following stereotactic body radiotherapy for primary lung cancer, Anticancer research, 33, 12, 5649-5654, 2013.12, Aim: To retrospectively evaluate the efficacy and safety of definitive fractionated re-irradiation for local recurrence following stereotactic body radiotherapy (SBRT) for primary lung cancer. Patients and Methods: Between April 2003 and December 2011, 398 patients with primary lung tumor underwent SBRT at the Kyushu University Hospital, and 46 out of these developed local recurrence after SBRT. Definitive fractionated re-irradiation was performed for 17 out of the 46 patients. The median dose of reirradiation was 60 Gy/ 30 fractions. Concurrent chemotherapy was given to four patients. Results: The median follow-up duration was 12.6 months. At one year post-reirradiation, local progression-free survival was 33.8%; progression-free survival, 30.9%; cause-specific survival, 79.3%; and overall survival, 74.7%. No severe adverse events were observed during the follow-up. Conclusion: Definitive fractionated re-irradiation is thought to be a safe alternative therapy for local recurrence following SBRT, although its efficacy may be not entirely satisfactory..
63. Koichi Takayama, Koji Inoue, Shoji Tokunaga, Takemasa Matsumoto, Tsukasa Oshima, Masayuki Kawasaki, Tomotoshi Imanaga, Mutsuo Kuba, Masafumi Takeshita, Taishi Harada, Yoshiyuki Shioyama, Yoichi Nakanishi, Phase II study of concurrent thoracic radiotherapy in combination with weekly paclitaxel plus carboplatin in locally advanced non-small cell lung cancer
LOGIK0401, Cancer chemotherapy and pharmacology, 10.1007/s00280-013-2335-2, 72, 6, 1353-1359, 2013.12, Objectives: Concurrent chemoradiotherapy for regionally advanced stage III non-small cell lung cancer is the standard treatment method. However, the clinical implications of consolidation chemotherapy following chemoradiation have been unclear. Therefore, we conducted a phase II study of concurrent weekly carboplatin plus paclitaxel treatment in combination with radiotherapy followed by vinorelbine monotherapy. The primary endpoint was the 1-year survival rate. Patients and methods: Chemonaive PS 0-1 patients with stage IIIA/B NSCLC were enrolled. During the concurrent chemoradiation phase, patients were treated with weekly paclitaxel 40 mg/m
2
plus carboplatin AUC 2. The primary tumor and involved nodes received 60 Gy in 2-Gy fractions over 6 weeks. During the consolidation phase, vinorelbine 25 mg/m
2
on days 1 and 8 was repeated for three cycles. Results: A total of 40 eligible patients (72.5 % male; median age, 63 years; range 29-74 years) were analyzed for efficacy. Squamous cell carcinoma was the most common histology (47.5 %), and more patients had clinical stage IIIB (55 %) cancer. The average radiation dose was 56.5 Gy, and the average number of carboplatin plus paclitaxel cycles was 4.93. Seventeen patients proceeded to the consolidation chemotherapy phase, and 14 completed three cycles of vinorelbine monotherapy. The objective response rate was 75.0 %, including 1 patient who achieved a complete response. Progression-free survival and overall survival (OS) were 46 weeks [95 % confidence interval (CI) 31-64 weeks] and 110 weeks (95 % CI 90-184 weeks), respectively. The OS rate at 1 and 2 years was 85.0 % (95 % CI 69.6-93.0 %) and 53.9 % (95 % CI 37.1-68.0 %), respectively. Conclusion: Concurrent chemoradiation with weekly carboplatin and paclitaxel followed by vinorelbine consolidation is effective for stage III non-small cell lung cancer and shows a generally mild toxicity profile..
64. Ohga Saiji, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Tadamasa Yoshitake, Kazushige Atsumi, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Hiroshi Yoshikawa, Yo Ichi Kawano, Hiroshi Honda, Radiotherapy for early-stage primary ocular adnexal mucosa-associated lymphoid tissue lymphoma, Anticancer research, 33, 12, 5575-5578, 2013.12, Background: Primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (POAML) is a rare disease. The purpose of this study was to evaluate the treatment outcome and patterns of failure of patients with early-stage POAML treated with radiotherapy. Patients and Methods: From 1995 to 2008, 53 patients with early-stage POAML were reviewed. Tumors were categorized as either superficial or mass-forming type. In principle, superficial lesions (n=11) were treated with 24 Gy, while the mass-forming lesions (n=42) were irradiated with 30 Gy. The median follow-up period was 3.9 years. Results: All four cases of relapse had mass-forming lesions. The 5-year overall and progression-free survival rates were 100% and 91.5%, respectively. Although 30 patients experienced grade 2 or 3 late adverse events, no patients had radiation-related retinopathy. Conclusion: Early-stage POAML can be well-controlled with radiotherapy. However, the risk of distant relapse should be noted, in particular, for mass-forming tumors..
65. Taiki Magome, Hidetaka Arimura, Yoshiyuki Shioyama, Katsumasa Nakamura, Hiroshi Honda, Hideki Hirata, Similar-case-based optimization of beam arrangements in stereotactic body radiotherapy for assisting treatment planners, BioMed Research International, 10.1155/2013/309534, 2013, 2013.12, Objective. To develop a similar-case-based optimization method for beam arrangements in lung stereotactic body radiotherapy (SBRT) to assist treatment planners. Methods. First, cases that are similar to an objective case were automatically selected based on geometrical features related to a planning target volume (PTV) location, PTV shape, lung size, and spinal cord position. Second, initial beam arrangements were determined by registration of similar cases with the objective case using a linear registration technique. Finally, beam directions of the objective case were locally optimized based on the cost function, which takes into account the radiation absorption in normal tissues and organs at risk. The proposed method was evaluated with 10 test cases and a treatment planning database including 81 cases, by using 11 planning evaluation indices such as tumor control probability and normal tissue complication probability (NTCP). Results. The procedure for the local optimization of beam arrangements improved the quality of treatment plans with significant differences (P < 0.05) in the homogeneity index and conformity index for the PTV, V10, V20, mean dose, and NTCP for the lung. Conclusion. The proposed method could be usable as a computer-aided treatment planning tool for the determination of beam arrangements in SBRT..
66. Makoto Shinoto, Shigeru Yamada, Kyosan Yoshikawa, Shigeo Yasuda, Yoshiyuki Shioyama, Hiroshi Honda, Tadashi Kamada, Hirohiko Tsujii, Usefulness of18F-fluorodeoxyglucose positron emission tomography as predictor of distant metastasis in preoperative carbon-ion radiotherapy for pancreatic cancer, Anticancer Research, 33, 12, 5579-5584, 2013.12, Aim: The purpose of this study was to evaluate the role of FDG-PET regarding the indication of preoperative carbon-ion radiotherapy (CIRT) for pancreatic cancer patients. Patients and Methods: Patients with resectable pancreatic cancer underwent preoperative CIRT. The impact of baseline SUV max on prognosis for patients was assessed by analyzing correlations with distant metastasis-free survival (DMFS) and overall survival (OS). Results: Out of 21 patients, local recurrence was observed in no patient and distant metastasis was found in 13 patients (62%). 1-year DMFS and OS in low-SUV max group were significantly higher than those in high-SUV max group (91% vs. 20% and 91% vs. 56%). SUVmax was significantly correlated with DMFS and OS. Conclusion: Our data indicated a significant correlation between SUVmax and DMFS. FDG-PET might be useful for determining the indication of preoperative short-course CIRT for patients with resectable pancreatic cancer..
67. K. Terashima, K. Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Ohga Saiji, T. Nonoshita, Tadamasa Yoshitake, K. Atsumi, Kaori Asai, Masakazu Hirakawa, S. Anai, H. Yoshikawa, Hiroshi Honda, Can a belly board reduce respiratory-induced prostate motion in the prone position? - Assessed by cine-magnetic resonance imaging, Technology in Cancer Research and Treatment, 10.7785/tcrt.2012.500334, 12, 5, 447-453, 2013.10, The purpose of this study is to evaluate the real-time respiratory motion of the prostate and surrounding tissues/organs in the supine and prone positions and to investigate, using cine-MRI, whether a belly board can reduce respiratory-induced motion in the prone position. Cine-MRI scans were made of 13 volunteers in the supine and prone positions on a flat board and in two different prone positions using a belly board. Images in cine mode were recorded for 20 seconds. For each session, the points of interest (POIs) were located at the apex, base, mid-anterior surface and mid-posterior surface of the prostate; the tip of the seminal vesicle; the pubic symphysis; and the sacrum. The maximum range and standard deviation (SD) of the displacement from the mean value were calculated. The SDs for each of the four different positions were compared using a paired t-test. Respiratory-induced prostate motion was significantly larger in the prone position than in the supine position. However, when a belly board was used in the prone position, motion in the prostate and surrounding tissues/organs was significantly reduced. There were no significant differences between the two different positions using a belly board in any of the POIs..
68. Keiji Matsumoto, Reiko Imai, Tadashi Kamada, Katsuya Maruyama, Hiroshi Tsuji, Hirohiko Tsujii, Yoshiyuki Shioyama, Hiroshi Honda, Kazuo Isu, Impact of carbon ion radiotherapy for primary spinal sarcoma, Cancer, 10.1002/cncr.28177, 119, 19, 3496-3503, 2013.10, BACKGROUND Spinal sarcomas have been one of the most challenging diseases for orthopedic surgeons. The objective of this study was to retrospectively analyze carbon ion radiotherapy (CIRT) treatment results for spinal sarcoma. METHODS Forty-seven patients with 48 medically unresectable spinal sarcomas, excluding sacral tumors, received treatment with CIRT between 1996 and 2011. All patients were enrolled in phase 1/2 and phase 2 clinical trials of CIRT for bone and soft tissue sarcoma. The applied dose ranged from 52.8 gray equivalents (GyE) to 70.4 GyE (median, 64.0 GyE) in 16 fixed fractions over 4 weeks. RESULTS The median patient age was 54 years, and the cohort included 24 men and 23 women. Thirty-five patients were without prior treatment, and 12 patients had locally recurrent tumors after previous resection. The median follow-up was 25 months, and the median survival was 44 months (range, 5.2-148 months). The 5-year local control, overall survival, and progression free rates were 79%, 52%, and 48%, respectively. None of the 15 patients who had tumors measuring <100 cm3 had a local recurrence. No fatal toxicities occurred during follow-up. One patient each had a grade 3 late skin reaction and a grade 4 late skin reaction. Vertebral body compression was observed in 7 patients. One patient had a grade 3 late spinal cord reaction. Twenty-two of the surviving 28 patients who had primary tumors remained ambulatory without supportive devices. CONCLUSIONS CIRT appears to be both effective and safe for the treatment of patients with unresectable spinal sarcoma. Cancer 2013;119:3496-3503. © 2013 American Cancer Society. Carbon ion radiotherapy (CIRT) has advantages over conventional photon therapy in the treatment of sarcoma. The authors retrospectively analyze the results from CIRT for unresectable spinal sarcomas and demonstrate that CIRT is both effective and safe for the treatment of patients who have unresectable spinal sarcoma..
69. Keiji Matsumoto, Tomonari Sasaki, Yoshiyuki Shioyama, Katsumasa Nakamura, Kazushige Atsumi, Takeshi Nonoshita, Saiji Ooga, Tadamasa Yoshitake, Satoru Uehara, Hideki Hirata, Hiroshi Honda, Treatment outcome of high-dose-rate interstitial radiation therapy for patients with stage I and II mobile tongue cancer, Japanese journal of clinical oncology, 10.1093/jjco/hyt108, 43, 10, 1012-1017, 2013.10, Objectives: The aim of the study was to investigate the outcomes of high-dose-rate interstitial radiation therapy for patients with Stage I and II mobile tongue cancer retrospectively. Methods: Sixty-seven patients with Stage I and II mobile tongue cancer were treated with highdose- rate interstitial radiation therapy, with or without external beam radiation therapy, between 1997 and 2007. The median dose of interstitial radiation therapy was 50 Gy in 10 fractions over 6 days. Thirty-five patients received external beam radiation therapy before interstitial radiation therapy. The median dose of external beam radiation therapy was 20 Gy delivered with singlelateral or bilateral fields, including the primary tumor site and upper jugular lymph nodes. Thirtyseven patients received concurrent chemotherapy, including carboplatin, cisplatin, fluorouracil or tegafur, gimeracil and oteracil (TS-1) systemically or with intra-arterial injection. Thirty-three patients received intratumoral injection of bleomycin before catheter insertion. The median follow-up time was 58.6 months (range 15.1-102.4 months). Results: The 5-year overall, cause-specific, progression-free survival rate and local control rate were 88.7, 92.1, 76.0 and 94.0%, respectively. Fourteen patients developed cervical lymph node recurrence, 11 of which were distributed within the external beam radiation therapy field. We found local failures in four cases within 2 years after the treatment and in three cases after 7 years, even though the latter were difficult to distinguish from second primary cancers. Conclusions: The treatment results of our institutions were equivalent to previous reports. Most cervical lymph node metastases occurred within the external beam radiation therapy field, which implied that the external beam radiation therapy dose of 20-30 Gy was insufficient to prevent late cervical lymph node metastases..
70. Makoto Shinoto, Yoshiyuki Shioyama, Katsumasa Nakamura, Torahiko Nakashima, Naonobu Kunitake, Yuichiro Higaki, Tomonari Sasaki, Ohga Saiji, Tadamasa Yoshitake, Kayoko Ohnishi, Kaori Asai, Hideki Hirata, Hiroshi Honda, Postoperative radiotherapy in patients with salivary duct carcinoma
Clinical outcomes and prognostic factors, Journal of radiation research, 10.1093/jrr/rrt026, 54, 5, 925-930, 2013.09, This study sought to investigate the clinical outcome and the role of postoperative radiotherapy for patients with salivary duct carcinoma (SDC) who had undergone surgery and postoperative radiotherapy. We performed a retrospective analysis of 25 SDC patients treated between 1998 and 2011 with surgery and postoperative radiotherapy. The median prescribed dose was 60 Gy (range, 49.5-61.4 Gy). The clinical target volume (CTV) was defined as the tumor bed in four patients, the tumor bed and ipsilateral neck in 14 patients, and the tumor bed and bilateral neck in six patients. Local control (LC), disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and prognostic variables were analyzed with the log-rank test. The 5-year LC, DFS and OS were 67%, 45% and 47%, respectively. Disease recurrence was found in 12 patients: seven as local, fouras regional and eight as distant failure. Perineural and lymphovascular invasion was a significant prognostic factor for LC (P = 0.03). Local failure was common, and the presence of local recurrence significantly affected the OS (P ≤ 0.05). We conclude that surgery and postoperative radiotherapy is expected to decrease the risk of local failure and contribute to good prognoses for patients with SDC. It might be advisable to have the CTV include the cranial nerves involved and the corresponding parts of the skull base in cases of pathologically positive perineural invasion..
71. Kazushige Atsumi, Katsumasa Nakamura, Koichiro Abe, Masakazu Hirakawa, Yoshiyuki Shioyama, Tomonari Sasaki, Shingo Baba, Takuro Isoda, Ohga Saiji, Tadamasa Yoshitake, Makoto Shinoto, Kaori Asai, Hiroshi Honda, Prediction of outcome with FDG-PET in definitive chemoradiotherapy for esophageal cancer, Journal of radiation research, 10.1093/jrr/rrt021, 54, 5, 890-898, 2013.09, The purpose of this study was to assess the efficacy of 18F-fluoro-2-deoxy-glucose uptake positron emission tomography (FDG-PET) for the prediction of outcome in definitive chemoradiotherapy (CRT) for esophageal cancer. We enrolled 56 patients with esophageal cancer treated with definitive CRT and examined by FDG-PET before treatment. We examined the correlation of the maximum standardized uptake value (SUVmax) in FDG-PET of the primary tumor with overall survival (OS), progression-free survival (PFS), local control (LC) and response of the primary tumor. After definitive CRT, 30 patients had a clinical complete response (CR), making the CR rate 54%. For all 56 patients, the 2-year OS rate, PFS rate and LC rates were 64%, 38% and 51%, respectively. We divided the patients into two groups according to SUVmax: SUVmax < 10 (low-SUV) and <10 (high-SUV). The 2-year OS rates in the low- and high-SUV groups were 100% and 41%, the PFS rates were 73% and 19%, the LC rates were 71% and 39%, and the CR rates were 100% and 32%, respectively. A univariate analysis revealed significant differences between the low- and high-SUV group in OS, PFS, LC and response (P = 0.0005, 0.0002, 0.048, and <0.0001, respectively). SUVmax and T stage were significantly associated with OS, PFS, LC and response. A multivariate analysis showed significant differences between the SUVmax <10 and ≥10 groups in overall survival and response (P < 0.05). Our result suggests that the SUVmax in FDG-PET of the primary tumor before treatment may have prognostic value for esophageal cancer..
72. Taiki Magome, Hidetaka Arimura, Yoshiyuki Shioyama, Asumi Mizoguchi, Chiaki Tokunaga, Katsumasa Nakamura, Hiroshi Honda, Masafumi Ohki, Fukai Toyofuku, Hideki Hirata, Computer-aided beam arrangement based on similar cases in radiation treatment-planning databases for stereotactic lung radiation therapy, Journal of radiation research, 10.1093/jrr/rrs123, 54, 3, 569-577, 2013.05, The purpose of this study was to develop a computer-aided method for determination of beam arrangements based on similar cases in a radiotherapy treatment-planning database for stereotactic lung radiation therapy. Similar-case-based beam arrangements were automatically determined based on the following two steps. First, the five most similar cases were searched, based on geometrical features related to the location, size and shape of the planning target volume, lung and spinal cord. Second, five beam arrangements of an objective case were automatically determined by registering five similar cases with the objective case, with respect to lung regions, by means of a linear registration technique. For evaluation of the beam arrangements five treatment plans were manually created by applying the beam arrangements determined in the second step to the objective case. The most usable beam arrangement was selected by sorting the five treatment plans based on eight plan evaluation indices, including the D95, mean lung dose and spinal cord maximum dose. We applied the proposed method to 10 test cases, by using an RTP database of 81 cases with lung cancer, and compared the eight plan evaluation indices between the original treatment plan and the corresponding most usable similar-case-based treatment plan. As a result, the proposed method may provide usable beam arrangements, which have no statistically significant differences from the original beam arrangements (P > 0.05) in terms of the eight plan evaluation indices. Therefore, the proposed method could be employed as an educational tool for less experienced treatment planners..
73. Hidenari Hirata, Katsumasa Nakamura, Naonobu Kunitake, Yoshiyuki Shioyama, Tomonari Sasaki, Ohga Saiji, Takeshi Nonoshita, Tadamasa Yoshitake, Kaori Asai, Kouji Inoue, Akira Nagashima, Minoru Ono, Hiroshi Honda, Association between EGFR-TKI resistance and efficacy of radiotherapy for brain metastases from EGFR-mutant lung adenocarcinoma, Anticancer Research, 33, 4, 1649-1656, 2013.04, Aim: To clarify how patients with epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma with acquired resistance to EGFR-tyrosine kinase inhibitors (TKIs) respond to radiotherapy (RT) for brain metastases. Patients and Methods: Forty-seven patients were divided into the following three groups: a TKI-naïve group with EGFR mutation (n=11), a TKI-resistant group with EGFR mutation (n=10), and an EGFR-wild-type group (n=26). Patients received stereotactic RT (n=23) or whole-brain RT (n=24). Results: The response rate for patients with TKI-resistant tumor at three months after RT tended to be lower (11%) than that of those who were TKI-naïve (82%, p=0.006) and for patients with wild-type EGFR (48%, p=0.10). On univariate analysis, central nervous system progression-free and overall survival were significantly shorter for patients with TKI-resistant tumors than for those who were TKI-naïve (p=0.018 and p=0.005, respectively). Multivariate analysis showed that TKI resistance was an independent predictor of poorer overall survival (p=0.011). Conclusion: Acquired resistance to TKIs appears to be associated with low efficacy of brain RT..
74. Yoshiyuki Shioyama, Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Tadamasa Yoshitake, Takeshi Nonoshita, Kaori Asai, Koutarou Terashima, Keiji Matsumoto, Hideki Hirata, Hiroshi Honda, Clinical results of stereotactic body radiotherapy for Stage I small-cell lung cancer
A single institutional experience, Journal of radiation research, 10.1093/jrr/rrs075, 54, 1, 108-112, 2013.01, The purpose of this study was to evaluate the treatment outcomes of stereotactic body radiotherapy (SBRT) for Stage I small-cell lung cancer (SCLC). From April 2003 to September 2009, a total of eight patients with Stage I SCLC were treated with SBRT in our institution. In all patients, the lung tumors were proven as SCLC pathologically. The patients' ages were 58-84 years (median: 74). The T-stage of the primary tumor was T1a in two, T1b in two and T2a in four patients. Six of the patients were inoperable because of poor cardiac and/or pulmonary function, and two patients refused surgery. SBRT was given using 7-8 non-coplanar beams with 48 Gy in four fractions. Six of the eight patients received 3-4 cycles of chemotherapy using carboplatin (CBDCA) + etoposide (VP-16) or cisplatin (CDDP) + irinotecan (CPT-11). The follow-up period for all patients was 6-60 months (median: 32). Six patients were still alive without any recurrence. One patient died from this disease and one died from another disease. The overall and disease-specific survival rate at three years was 72% and 86%, respectively. There were no patients with local progression of the lesion targeted by SBRT. Only one patient had nodal recurrence in the mediastinum at 12 months after treatment. The progression-free survival rate was 71%. No Grade 2 or higher SBRT-related toxicities were observed. SBRT plus chemotherapy could be an alternative to surgery with chemotherapy for inoperable patients with Stage I small-cell lung cancer. However, further investigation is needed using a large series of patients..
75. Makoto Shinoto, Shigeru Yamada, Shigeo Yasuda, Hiroshi Imada, Yoshiyuki Shioyama, Hiroshi Honda, Tadashi Kamada, Hirohiko Tsujii, Hiromitsu Saisho, Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer, Cancer, 10.1002/cncr.27723, 119, 1, 45-51, 2013.01, Background: The authors evaluated the tolerance and efficacy of carbon-ion radiotherapy (CIRT) as a short-course, preoperative treatment and determined the recommended dose needed to reduce the risk of postoperative local recurrence without excess injury to normal tissue. Methods: Patients radiographically defined with potentially resectable pancreatic cancer were eligible. A preoperative, short-course, dose-escalation study was performed with fixed 8 fractions in 2 weeks. The dose of irradiation was increased by 5% increments from 30 grays equivalents (GyE) to 36.8 GyE. Surgery was to be performed 2 to 4 weeks after the completion of CIRT. Results: The study enrolled 26 patients. At the time of restaging after CIRT, disease progression with distant metastasis or refusal ruled out 5 patients from surgery. Twenty-one of 26 patients (81%) patients underwent surgery. The pattern of initial disease progression was distant metastasis in 17 patients (65%) and regional recurrence in 2 patients (8%). No patients experienced local recurrence. The 5-year survival rates for all 26 patients and for those who underwent surgery were 42% and 52%, respectively. Conclusions: Preoperative, short-course CIRT followed by surgery is feasible and tolerable without unacceptable morbidity..
76. N. Matsushita, Hidetaka Arimura, K. Nakamura, Y. Kagami, Yoshiyuki Shioyama, Y. Nakamura, Hiroshi Honda, H. Hirata, SU‐C‐WAB‐01
Computerized Production of Statistical Clinical Target Volume Models in Prostate Cancer Radiation Treatment Planning, Medical Physics, 10.1118/1.4813953, 40, 6, 2013.01, Purpose: Inter‐and intra‐observer variability of clinical target volume (CTV) contours for prostate cancer is a critical issue in radiation treatment planning. Automated contouring based on statistical CTV models could be one of possible approaches for reducing the variability. Therefore, the purpose of our study is to develop a computerized method for producing the statistical CTV models to be used as CTV templates for automated contouring in prostate cancer radiation treatment planning. Methods: Eighteen, seventeen and sixteen radiation oncologists belonging to different facilities delineated CTV contours for low‐, intermediate‐and high‐risk prostate cancers, respectively. The low‐risk, intermediate‐risk, and high‐risk CTVs include only a prostate, a prostate plus a 1‐cm seminal vesicle base, and a prostate plus 2‐cm seminal vesicle, respectively. The statistical CTV models for the three risk types were derived based on a principal component analysis (PCA), which statistically took into account the inter‐observer variability. CTV regions were triangulated by using a marching cubes method. For matching the number of points on the surfaces of all CTV regions, the number of vertices on each CTV region was reduced to 1,000 with a quadric error metrics. All CTV regions were registered with a reference CTV by using an iterative closest point algorithm for calculation of a covariance matrix to be employed for the PCA‐based CTV modeling. Results: CTV models of three risk types were produced, which consisted of a mean CTV and PCA coefficients multiplied by eigenvectors, i.e., eigen‐CTV image. Average Euclidean distances between corresponding points of a mean CTV and the other CTVs for three risk types were 2.05 mm, 3.64 mm, 2.55 mm, respectively. Conclusion: The proposed method could provide probabilistic CTV models to be used as CTV templates in delineating CTV contours..
77. S. Yoshidome, Hidetaka Arimura, K. Nakamura, Yoshiyuki Shioyama, K. Atsumi, H. Yoshikawa, K. Nishikawa, H. Hirata, SU‐E‐J‐40
Automated Estimation of Lung Tumor Locations for Tumor‐Based Patient Setup Using MV‐CBCT Images in Stereotactic Body Radiotherapy, Medical physics, 10.1118/1.4814252, 40, 6, 2013.01, Purpose: Patient setup procedure in stereotactic radiation therapy should be performed based on a tumor region, not bone structures. The goal of this study was to develop an automated method of estimation of lung tumor locations for tumor‐based patient setup using megavoltage cone‐beam computed tomography (MV‐CBCT) images in stereotactic body radiotherapy (SBRT). Methods: Planning CT, treatment MV‐CBCT images (4.125 MV‐CBCT images/patient), and DICOM‐RT structure sets for 8 patients were employed for this study. The patients had solitary lung tumors smaller than 25 mm (range of effective diameter: 23 – 8.8 mm and median: 17.7 mm) and received SBRT. In the proposed method, the lung tumor locations were estimated in MV‐CBCT images by using tumor templates obtained from corresponding planning CT images. First, a MV‐CBCT image was globally aligned with a planning CT image by finding the location with the maximum cross‐correlation coefficient, and then a gross target volume (GTV) region in the structure set was placed in the planning CT and MV‐CBCT images. Second, a tumor template was produced by cropping the dilated GTV region in the planning CT image. Finally, a tumor location was estimated within the dilated GTV region in the MV‐CBCT image by using the tumor template matching and calculating the centroid of the dilated GTV region. Gold standards of tumor locations were determined by a radiation oncologist and two radiological technologists in the clinical practice. Results: A mean error between the gold standard and the tumor location estimated by the proposed method was 4.1 and standard deviation was 2.3 mm for 8 patients. Conclusion: The results suggest that the proposed method using the MV‐CBCT may be one of useful tools for tumor‐based patient setup in SBRT..
78. Kunihiro Suzuki, Toyoshi Yanagihara, Tetsuya Yokoyama, Yoshio Matsuo, Yoshiyuki Shioyama, Eiji Harada, Naoki Hamada, Takashige Maeyama, Koichi Takayama, Yoichi Nakanishi, A case of pyothorax-associated lymphoma whose localization diagnosis was made by PET/CT, Japanese Journal of Chest Diseases, 71, 11, 1151-1156, 2012.12, A 75-year-old man, who had been diagnosed with hypertension and right chronic pyothorax, consulted with our department because of an enlarged pyothorax shadow on chest x-ray. He had a history of artificial pneumothorax for pulmonary tuberculosis. Although CT and MRI of the chest showed no masslike lesion in the pyothorax cavity, PET/CT revealed a mass lesion with high SUV value. A CT-guided transthoracic needle aspiration cytology of the lesion was performed, and the diagnosis of pyothorax-associ-ated lymphoma (PAL) was confirmed. A PET/CT is useful for localization diagnosis of PAL..
79. Hidetaka Arimura, Wataru Itano, Yoshiyuki Shioyama, Norimasa Matsushita, Taiki Magome, Tadamasa Yoshitake, Shigeo Anai, Katsumasa Nakamura, Satoshi Yoshidome, Akihiko Yamagami, Hiroshi Honda, Masafumi Ohki, Fukai Toyofuku, Hideki Hirata, Computerized estimation of patient setup errors in portal images based on localized pelvic templates for prostate cancer radiotherapy, Journal of radiation research, 10.1093/jrr/rrs043, 53, 6, 961-972, 2012.11, We have developed a computerized method for estimating patient setup errors in portal images based on localized pelvic templates for prostate cancer radiotherapy. The patient setup errors were estimated based on a template-matching technique that compared the portal image and a localized pelvic template image with a clinical target volume produced from a digitally reconstructed radiography (DRR) image of each patient. We evaluated the proposed method by calculating the residual error between the patient setup error obtained by the proposed method and the gold standard setup error determined by consensus between two radiation oncologists. Eleven training cases with prostate cancer were used for development of the proposed method, and then we applied the method to 10 test cases as a validation test. As a result, the residual errors in the anterior-posterior, superior-inferior and left-right directions were smaller than 2 mm for the validation test. The mean residual error was 2.65 ± 1.21 mm in the Euclidean distance for training cases, and 3.10 ± 1.49 mm for the validation test. There was no statistically significant difference in the residual error between the test for training cases and the validation test (P = 0.438). The proposed method appears to be robust for detecting patient setup error in the treatment of prostate cancer radiotherapy..
80. Kaori Asai, Yoshiyuki Shioyama, Katsumasa Nakamura, Tomonari Sasaki, Ohga Saiji, Takeshi Nonoshita, Tadamasa Yoshitake, Kayoko Ohnishi, Kotaro Terashima, Keiji Matsumoto, Hideki Hirata, Hiroshi Honda, Radiation-induced rib fractures after hypofractionated stereotactic body radiation therapy
Risk factors and dose-volume relationship, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2012.01.027, 84, 3, 768-773, 2012.11, Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, ≥42.4 Gy or less), 51.6% vs. 2.0% (V40, ≥0.29 cm3 or less), 45.8% vs. 2.2% (V30, ≥1.35 cm3 or less), 42.0% vs. 8.5% (V20, ≥3.62 cm3 or less), or 25.9% vs. 10.5% (V10, ≥5.03 cm3 or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF..
81. Akira Matsunobu, Reiko Imai, Tadashi Kamada, Takeshi Imaizumi, Hiroshi Tsuji, Hirohiko Tsujii, Yoshiyuki Shioyama, Hiroshi Honda, Shin Ichiro Tatezaki, Impact of carbon ion radiotherapy for unresectable osteosarcoma of the trunk, Cancer, 10.1002/cncr.27451, 118, 18, 4555-4563, 2012.09, BACKGROUND: The authors summarized the outcomes of patients with unresectable osteosarcoma of the trunk who received carbon ion radiotherapy (CIRT). METHODS: The authors performed a retrospective analysis of 78 patients who had medically inoperable osteosarcoma of the trunk and received treatment with CIRT between 1996 and 2009. Tumor sites included the pelvis in 61 patients, the spine and paraspinal region in 15 patients, and other sites in 2 patients. The median applied CIRT dose was 70.4 Gray equivalent (GyE) in a total of 16 fixed fractions over 4 weeks. RESULTS: The minimum duration of follow-up for survivors was 14 months. Forty-eight patients remained alive. The 5-year overall survival rate was 33%, and the local control rate was 62%. Thirty-eight patients who had a clinical target volume <500 cm3 had a 5-year overall survival rate of 46% and a 5-year local control rate of 88%. Except for 3 patients who experienced severe skin/soft tissue complications requiring skin grafts, no other severe toxicities were observed. Of 9 patients who were continuously disease free for >5 years, 8 were able to walk with or without the help of a cane, and 6 were free from pain killers. CONCLUSIONS: CIRT appeared to be a safe and effective modality for the management of unresectable osteosarcoma of the trunk, providing good local control and offering a survival advantage and good long-term functional results without unacceptable morbidity. Cancer 2012..
82. Tadamasa Yoshitake, Katsumasa Nakamura, Yoshiyuki Shioyama, Tomonari Sasaki, Ohga Saiji, Takeshi Nonoshita, Kotaro Terashima, Kaori Asai, Keiji Matsumoto, Hiroshi Honda, Stereotactic body radiation therapy for stage I non-small cell lung cancer patients with chronic respiratory insufficiency requiring domiciliary oxygen therapy, Anticancer Research, 32, 9, 4041-4044, 2012.09, Background: The efficacy of stereotactic body radiation therapy (SBRT) for patients treated with domiciliary oxygen therapy is not well-known. Patients and Methods: We collected the clinical records of 15 patients with chronic respiratory insufficiency requiring domiciliary oxygen therapy at 1-3 l/min who were treated with SBRT for stage I non-small cell lung cancer. All patients were fixed with a thermoplastic body cast system. SBRT was given in 7-8 fields with an isocenter dose of 40-60 Gy in 4-10 fractions (median, 48 Gy in 4 fractions). Results: The overall 2-year and 5-year survival rates for all patients were 67.4% and 34.7%, while the disease-specific 2-year and 5-year survival rates were 90.0% and 72.0%, respectively. Pulmonary adverse effects were mild in the majority of the patients, although two patients had grade 2 radiation pneumonitis. The oxygen flow required increased slightly at follow-up periods greater than one year, but was still at an acceptable level. Conclusion: SBRT was feasible for patients requiring domiciliary oxygen therapy..
83. Masamitsu Hatakenaka, Masato Yonezawa, Takeshi Nonoshita, Katsumasa Nakamura, Hidetake Yabuuchi, Yoshiyuki Shioyama, Michinobu Nagao, Yoshio Matsuo, Takeshi Kamitani, Taiki Higo, Kei Nishikawa, Taro Setoguchi, Hiroshi Honda, Acute cardiac impairment associated with concurrent chemoradiotherapy for esophageal cancer
Magnetic resonance evaluation, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2011.12.018, 83, 1, 2012.05, Purpose: To evaluate acute cardiac effects of concurrent chemoradiotherapy (CCRT) for esophageal cancer. Methods and Materials: This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. The left ventricular function (LVF) of 31 patients with esophageal cancer who received cisplatin and 5-fluorouracil-based CCRT was evaluated using cardiac cine magnetic resonance imaging. The patients were classified into two groups according to mean LV dose. The parameters related to LVF were compared between before and during (40 Gy) or between before and after CCRT using a Wilcoxon matched-pairs single rank test, and parameter ratios (during/before CCRT, after/before CCRT) were also compared between the groups with a t test. Data were expressed as mean ± SE. Results: In the low LV-dose group (n = 10; mean LV dose <0.6 Gy), LV ejection fraction decreased significantly (before vs. during vs. after CCRT; 62.7% ± 2.98% vs. 59.8% ± 2.56% vs. 60.6% ± 3.89%; p < 0.05). In the high LV-dose group (n = 21; mean LV dose of 3.6-41.2 Gy), LV end-diastolic volume index (before vs. after CCRT; 69.1 ± 2.93 vs. 57.0 ± 3.23 mL/m 2), LV stroke volume index (38.6 ± 1.56 vs. 29.9 ± 1.60 mL/m 2), and LV ejection fraction (56.9% ± 1.79% vs. 52.8% ± 1.15%) decreased significantly (p < 0.05) after CCRT. Heart rate increased significantly (before vs. during vs. after CCRT; 66.8 ± 3.05 vs. 72.4 ± 4.04 vs. 85.4 ± 3.75 beats per minute, p < 0.01). Left ventricle wall motion decreased significantly (p < 0.05) in segments 8 (before vs. during vs. after CCRT; 6.64 ± 0.54 vs. 4.78 ± 0.43 vs. 4.79 ± 0.50 mm), 9 (6.88 ± 0.45 vs. 5.04 ± 0.38 vs. 5.27 ± 0.47 mm), and 10 (9.22 ± 0.48 vs. 8.08 ± 0.34 vs. 8.19 ± 0.56 mm). The parameter ratios of LV end-diastolic volume index, stroke volume index, wall motion in segment 9, and heart rate showed significant difference (p < 0.05) after CCRT between the groups. Conclusions: Concurrent chemoradiotherapy for esophageal cancer impairs LVF from an early treatment stage. This impairment is prominent in patients with high LV dose..
84. Madoka Abe, Kotaro Terashima, Iwao Hara, Yoshiyuki Shioyama, Mioko Matsuo, Satoru Uehara, Successful hyperbaric oxygen therapy for laryngeal radionecrosis after chemoradiotherapy for mesopharyngeal cancer
Case report and literature review, Japanese Journal of Radiology, 10.1007/s11604-011-0046-3, 30, 4, 340-344, 2012.05, Laryngeal radionecrosis is one of the most troublesome late complications of radiotherapy, because it is frequently resistant to treatment and laryngectomy is required in the worst case. Here, we report a case of laryngeal radionecrosis, successfully treated by use of hyperbaric oxygen (HBO) therapy, in which laryngectomy was avoided. A 67-year-old male received radical chemoradiotherapy (CRT) for mesopharyngeal cancer, which included radiotherapy with a total dose of 71.4 Gy/38 Fr and chemotherapy with CDDP + S-1. He developed dyspnea and throat pain 9 months after completion of CRT. Laryngoscopy revealed vocal cord impairment because of severe laryngeal edema. He was diagnosed as having laryngeal radionecrosis and initially received conservative therapy combined with antibiotics, steroids, and prostaglandins. Because his dyspnea was persistent despite this treatment, HBO therapy was administered 20 times, and resulted in complete remission of the dyspnea. HBO therapy, therefore, is regarded as an effective conservative therapeutic option for laryngeal radionecrosis..
85. Kazushige Atsumi, Yoshiyuki Shioyama, Hidetaka Arimura, Kotaro Terashima, Takaomi Matsuki, Ohga Saiji, Tadamasa Yoshitake, Takeshi Nonoshita, Daisuke Tsurumaru, Kayoko Ohnishi, Kaori Asai, Keiji Matsumoto, Katsumasa Nakamura, Hiroshi Honda, Esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer
Frequency and prediction, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2011.01.047, 82, 5, 1973-1980, 2012.04, Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer..
86. Ryohei Sasaki, Koichi Yasuda, Eisuke Abe, Nobue Uchida, Mitsuhiko Kawashima, Takashi Uno, Masayuki Fujiwara, Yoshiyuki Shioyama, Yoshikazu Kagami, Yuta Shibamoto, Kensei Nakata, Yoshie Takada, Tetsuya Kawabe, Kazuyuki Uehara, Kenichi Nibu, Syogo Yamada, Multi-institutional analysis of solitary extramedullary plasmacytoma of the head and neck treated with curative radiotherapy, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2010.11.037, 82, 2, 626-634, 2012.02, Purpose: The purpose of this study was to elucidate the efficacy and optimal method of radiotherapy in the management of solitary extramedullary plasmacytoma occurring in the head and neck regions (EMPHN). Methods and Materials: Sixty-seven patients (43 male and 24 female) diagnosed with EMPHN between 1983 and 2008 at 23 Japanese institutions were reviewed. The median patient age was 64 years (range, 12-83). The median dose administered was 50 Gy (range, 30-64 Gy). Survival data were calculated by the Kaplan-Meier method. Results: The median follow-up duration was 63 months. Major tumor sites were nasal or paranasal cavities in 36 (54%) patients, oropharynx or nasopharynx in 16 (23%) patients, orbita in 6 (9%) patients, and larynx in 3 (5%) patients. The 5- and 10-year local control rates were 95% and 87%, whereas the 5- and 10-year disease-free survival rates were 56% and 54%, respectively. There were 5 (7.5%), 12 (18%), and 8 (12%) patients who experienced local failure, distant metastasis, and progression to multiple myeloma, respectively. In total, 18 patients died, including 10 (15%) patients who died due to complications from EMPHN. The 5- and 10-year overall survival (OS) rates were 73% and 56%, respectively. Radiotherapy combined with surgery was identified as the lone significant prognostic factor for OS (p = 0.04), whereas age, gender, radiation dose, tumor size, and chemotherapy were not predictive. No patient experienced any severe acute morbidity. Conclusions: Radiotherapy was quite effective and safe for patients with EMPHN. Radiotherapy combined with surgery produced a better outcome according to survival rates. These findings require confirmation by further studies with larger numbers of patients with EMPHN..
87. Hidetaka Arimura, A. Mizoguchi, Yoshiyuki Shioyama, K. Nakamura, S. Yoshidome, T. Hirose, S. Anai, Y. Umezu, Hiroshi Honda, Masafumi Ohki, F. Toyofuku, H. Hirata, SU‐E‐J‐117
Computer‐Assisted Verification of Accumulated Dose Distribution during the Treatment Time Based on Estimation of Four‐Dimensional Dose Distribution Using an Electronic Portal Imaging Device, Medical Physics, 10.1118/1.4734953, 39, 6, 2012.01, Purpose: The accumulated dose distributions during the course of radiation treatment are substantially important for verifying whether treatment dose distributions are produced according to planned dose distributions. The purpose of this study was to develop a computer‐assisted verification method of accumulated dose distribution during the irradiation of a tumor based on estimation of four‐dimensional (4D) dose distribution using an electronic portal imaging device (EPID). Methods: The 4D ‘treatment’ computed tomography (CT) images during the irradiation were estimated based on affine transformations including respiratory motions, which were derived by registration between a planning portal dose image and treatment portal dose dynamic image. Planning portal dose images were calculated from planning CT images and an algorithm for calculation of dose spatial distribution. Treatment portal dose images were estimated from EPID dynamic images obtained during a treatment time. The planning portal dose images were registered to the treatment portal dose images to obtain the affine transformation, which could include respiratory motion in a patient body. The CT images at a treatment time were determined by deforming the planning CT images using the affine transformation matrix. 4D dose distributions during a treatment delivery were obtained by applying a dose calculation algorithm to the 4D treatment CT images. Finally, accumulated dose distributions during the course of radiation treatment were verified with planned dose distributions. Results: We applied the proposed method to EPID dynamic images of 2 lung cancer patients, and evaluated the difference in accumulated dose distribution between the plan and treatment using a gamma evaluation (3mm/3%). The average pass rate for 2 cases was 78.2%. Conclusions: The proposed method can be used for adaptively modifying the plan based on the dose discrepancy between the plan and treatment. This work was partially supported by Grant‐in‐Aid for Scientific Research (C) (22611011) and Okawa Foundation for Information and Telecommunications..
88. N. Matsushita, Hidetaka Arimura, Yoshiyuki Shioyama, T. Magome, K. Nakamura, Y. Umezu, Tadamasa Yoshitake, S. Anai, S. Yoshidome, Hiroshi Honda, Masafumi Ohki, F. Toyofuku, H. Hirata, SU‐E‐J‐26
Automated Estimation Method of Patient Setup Errors Using Simulated Portal Images for Prostate Cancer Radiotherapy, Medical Physics, 10.1118/1.4734859, 39, 6, 2012.01, Purpose: We developed a novel automated estimation method for patient setup errors based on simulated and real portal images for prostate cancer radiotherapy. Methods: The estimation of patient setup errors in this study was based on a template matching technique with a cross‐correlation coefficient and Sobel filter between the real portal image and localized pelvic template of reference image, which were DRR (digitally reconstructed radiography) images and simulated portal images. The simulated portal image was derived by projecting a CT image according to an inverse exponential power law of x‐ray attenuation for a water‐equivalent path length of each voxel of the CT image on each ray from a source to each pixel on the EPID (electric portal imaging device). A localized pelvic template of each patient in AP (anterior‐posterior) or lateral view was automatically extracted from the DRR or simulated portal images by cropping a rectangular region, which was determined by using the mean pelvic template and four anatomical feature points. We applied the proposed method to three prostate cancer cases, and evaluated it using the residual error between the patient setup error obtained by proposed method and the gold standard setup error determined by two radiation oncologists. Results: The average residual errors of the patient setup error for the DRR and simulated portal images were 0.79 and 1.26 mm in the left‐right (LR) direction, 3.17 and 2.05 mm in the superior‐inferior (SI) direction, 1.69 and 5.82 mm in the anterior‐posterior (AP) direction, 3.84 and 6.94 mm in Euclidean distance (ED), respectively. If we used the simulated portal image for LR and SI directions and the DRR image for AP direction, the Euclidean distance was 3.22 mm. Conclusions: The proposed method has a potential to correctly estimate patient setup errors for prostate cancer radiotherapy..
89. T. Magome, Hidetaka Arimura, Yoshiyuki Shioyama, A. Mizoguchi, C. Tokunaga, K. Nakamura, Hiroshi Honda, Masafumi Ohki, F. Toyofuku, H. Hirata, TU‐E‐BRB‐01
Similar‐Case‐Based Optimization of Beam Arrangements in Stereotactic Body Radiation Therapy, Medical Physics, 10.1118/1.4735950, 39, 6, 2012.01, Purpose: The quality of a treatment plan for stereotactic body radiotherapy (SBRT) depends on an experience of each treatment planner. Therefore, the treatment plans are subjectively determined by comparison of several treatment plans developed by time consuming iterative manners, while considering the benefit to a tumor and the risk to the surrounding normal tissues. The aim of our study was to develop an automated optimization method for beam arrangements based on similar cases in a database including plans designed by senior experienced treatment planners. Methods: Our proposed method consists of three steps. First, similar cases were automatically selected based on image features from the treatment planning point of view. We defined four types of image features relevant to planning target volume (PTV) location, PTV shape, lung size, and spinal cord positional features. Second, the beam angles of the similar case were registered to the objective case with respect to lung regions using a linear registration technique. Third, the beam direction of the objective case was locally optimized based on the cost function considering radiation absorption in normal tissues and organs at risk. The proposed method was evaluated with 10 test cases and a treatment planning database including 81 cases by using eight planning evaluation indices such as D95, lung V20, and maximum spinal cord dose. Results: The proposed method may provide usable beam directions, which have no statistically significant differences with the original beam directions (P > 0.05) in terms of the seven planning evaluation indices. Moreover, the mean value of D95 for 10 test cases was improved with a statistically significant difference by using the proposed method, compared with the original beam directions (P = 0.03). Conclusions: The proposed method could be used as a computer‐assisted treatment planning tool for determination of beam directions in SBRT..
90. G. Kakiuchi, Hidetaka Arimura, Yoshiyuki Shioyama, S. Minohara, A. Mizoguchi, K. Nakamura, Hiroshi Honda, F. Toyofuku, Masafumi Ohki, H. Hirata, WE‐G‐BRCD‐04
Development of Automated Determination Method of Robust Beam Directions against Patient Setup Errors Based on Spatial Distribution of Electron Density in Particle Therapy, Medical Physics, 10.1118/1.4736181, 39, 6, 2012.01, Purpose: The three‐dimensional (3D) dose distribution covering a tumor region tends to be more breakable if the beam's eye view (BEV) of the 3D electron density (ED) map in a beam direction changes more abruptly with large fluctuations. Our aim of this study was to develop an automated determination method of robust beam directions against the patient setup error based on the ED‐based BEV in the beam direction in the particle therapy. Methods: The basic idea of our proposed method was to find the robust beam directions, whose the ED‐based BEV has the spatial fluctuations with low special frequency and small amplitude. For evaluation of the spatial fluctuation in the ED‐based BEV in a beam direction, we obtained power spectra of the ED‐based BEVs in all directions, i.e., 0 to 355 degree, with an interval of 5 degree. It was assumed that as the average spatial frequency and amplitude of the fluctuation in the ED‐based BEV in a beam direction is lower and smaller, respectively, the absolute value of a gradient of the power spectrum becomes larger. Therefore the gradient of the power spectrum was calculated for determination of the robust beam direction. The ED‐based BEV was produced by projecting a 3D electron density map derived from the computed tomography (CT) image from a beam source to the distal end of a planning target volume (PTV). Four cases of head and neck cancer patients were selected for evaluation of the proposed method. Results: As a preliminary result, radiation oncologists agreed with most beam directions, which seem to be robust against patient setup errors, suggested by the proposed method. Conclusions: Our proposed method could be feasible to suggest the robust beam directions against patient setup errors in hadron particle therapy..
91. Yoshiyuki Shioyama, Makoto Shinoto, Akira Matsunobu, Keiji Matsumoto, Tadamasa Yoshitake, Tadashi Kamada, Hirohiko Tsujii, Hiroshi Honda, [Heavy ion radiotherapy for malignant tumors
current status and future direction]., Fukuoka igaku zasshi = Hukuoka acta medica, 103, 4, 73-81, 2012.01.
92. Kazushige Atsumi, Katsumasa Nakamura, Satoshi Yoshidome, Yoshiyuki Shioyama, Tomonari Sasaki, Ohga Saiji, Tadamasa Yoshitake, Makoto Shinoto, Kaori Asai, Katsumi Sakamoto, Masakazu Hirakawa, Hiroshi Honda, [Remote radiation planning support system]., Fukuoka igaku zasshi = Hukuoka acta medica, 103, 8, 159-162, 2012.01, We constructed a remote radiation planning support system between Kyushu University Hospital (KUH) in Fukuoka and Kyushu University Beppu Hospital (KBH) in Oita. Between two institutions, radiology information system for radiotherapy division (RT-RIS) and radiation planning system (RTPS) were connected by virtual private network (VPN). This system enables the radiation oncologists at KUH to perform radiotherapy planning for the patients at KBH. The detail of the remote radiation planning support system in our institutions is as follows: The radiation oncologist at KBH performs radiotherapy planning and the data of the patients are sent anonymously to the radiation oncologists at KUH. The radiation oncologists at KUH receive the patient's data, access to RTPS at KBH, verify or change the radiation planning at KBH: Radiation therapy is performed at KBH according to the confirmed plan by the radiation oncologists at KUH. Our remote radiation planning system is useful for providing radiation therapy with safety and accuracy..
93. Torahiko Nakashima, Satoshi Toh, Hideki Shiratsuchi, Ryuji Yasumatsu, Junichi Fukushima, Katsumasa Nakamura, Yoshiyuki Shioyama, Shizuo Komune, Laryngeal preservation for hypopharyngeal cancer by radiotherapy with S-1 and vitamin A (TAR therapy), Japanese Journal of Cancer and Chemotherapy, 39, 5, 759-763, 2012, The objective of this study was to analyze the outcome of hypopharyngeal cancer patients who underwent triple combination treatment with S-1, vitamin A and radiation (TAR therapy), and to analyze the role of TAR therapy for treating locally advanced hypopharyngeal cancer patients. 146 patients (stage I: 10 cases, stage II: 22 cases, stage III: 23 cases, stage IV: 91 cases) with hypopharyngeal squamous cell carcinoma were treated with TAR therapy (S-1; orally, 65 mg/m2/day, twice a day; vitamin A (retinol palmitate): 50, 000 I U/day, intra-musculary on each day of radiation; radiation: 1.5-2 Gy/day, 5 days/week). Histologic complete responders at 30-40 Gy continued TAR therapy up to 60-70 Gy. Nonresponders at 30-40 Gy underwent surgery. The overall 5-year survival and disease-specific 5-year survival rates were 50.5% and 59% respectively. The cumulative 3-year laryngeal preservation rate for stage I was 100%, 82.5% for stage II, 66.6% for stage III, and 35% for stage IV. Laryngeal preservation was fair in T1/T2 patients (81 %), but not satisfactory in T3/T4 patients (21.4%). S1 is administered orally, and TAR therapy can be conducted in the clinic with low toxicity. However, protocols with high intensity may be necessary to improve laryngeal preservation for locally advanced (T4) hypopharyngeal cancer..
94. Hideki Hirata, K. Nakamura, Yoshiyuki Shioyama, Hiroshi Honda, Acute reaction and injury in radiotherapy
Clinico-biophysic correlation, Japanese Journal of Clinical Radiology, 56, 12, 1676-1684, 2011.11, Scatter radiation has lower LET and may bring low dose hypersensitivity. There are biphasic effects such as cell death and physiological-biochemical effect. Cure inflammatory process may occur in necrosis but not in apoptosis. Careful prescription single dose could avoid serious side effect. The late effect may relates bystander effect and recall phenomenon through continuing production of the cytokine such as TGF β..
95. Masamitsu Hatakenaka, Yoshiyuki Shioyama, K. Nakamura, Hidetake Yabuuchi, Y. Matsuo, S. Sunami, Takeshi Kamitani, T. Yoshiura, Torahiko Nakashima, K. Nishikawa, Hiroshi Honda, Apparent diffusion coefficient calculated with relatively high b-values correlates with local failure of head and neck squamous cell carcinoma treated with radiotherapy, American Journal of Neuroradiology, 10.3174/ajnr.A2610, 32, 10, 1904-1910, 2011.11, BACKGROUND AND PURPOSE: Few studies have investigated the relationship between ADC and clinical outcome in HNSCC. Our hypothesis has that relatively high pretreatment ADC would correlate with local failure of HNSCC treated with radiation therapy. MATERIALS AND METHODS: This includes prospective and validation studies. Seventeen patients treated with radiation therapy for primary HNSCC completed the prospective study. Variables considered to affect local failure including MR imaging-related parameters such as ADC and its change ratio were compared between patients with local failure and controls, and those showing difference or association with local failure were further tested by survival analysis. Furthermore, variables were analyzed in 40 patients enrolled in the validation study. RESULTS: Relatively high ADC calculated with b-values (300, 500, 750, and 1000 s/mm 2) before treatment, high ADC increase ratio, and treatment method (chemoradiotherapy versus radiation therapy alone) revealed significant difference between patients with local failure and controls or association with local failure. In Cox proportional hazard testing, high ADC before treatment alone showed significant association with local failure (P = .0186). In the validation study, tumor volume before treatment, high ADC before treatment, T stage (T12 versus T34), and treatment method showed significance. Tumor volume before treatment (P = .0217) and high ADC before treatment (P = .0001) revealed significant association with local failure in Cox proportional hazard testing. High ADC before treatment was superior to tumor volume before treatment regarding association with local failure. CONCLUSIONS: These results suggest pretreatment ADC obtained at high b-values as well as tumor volume correlate with local failure of HNSCC treated with radiation therapy..
96. Masamitsu Hatakenaka, Katsumasa Nakamura, Hidetake Yabuuchi, Yoshiyuki Shioyama, Yoshio Matsuo, Kayoko Ohnishi, Shunya Sunami, Takeshi Kamitani, Taro Setoguchi, Takashi Yoshiura, Torahiko Nakashima, Kei Nishikawa, Hiroshi Honda, Pretreatment apparent diffusion coefficient of the primary lesion correlates with local failure in head-and-neck cancer treated with chemoradiotherapy or radiotherapy, International Journal of Radiation Oncology Biology Physics, 10.1016/j.ijrobp.2010.05.051, 81, 2, 339-345, 2011.10, Purpose: This study was performed to evaluate whether the apparent diffusion coefficient (ADC) of a primary lesion correlates with local failure in primary head-and-neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy or radiotherapy. Methods and Materials: We retrospectively studied 38 patients with primary HNSCC (12 oropharynx, 20 hypopharynx, 4 larynx, 2 oral cavity) treated with chemoradiotherapy or radiotherapy with radiation dose to gross tumor volume equal to or over 60 Gy and who underwent pretreatment magnetic resonance imaging, including diffusion-weighted imaging. Ten patients developed local failure during follow-up periods of 2.0 to 9.3 months, and the remaining 28 showed local control during follow-up periods of 10.5 to 31.7 months. The variables that could affect local failure (age, tumor volume, ADC, T stage, N stage, dose, treatment method, tumor location, and overall treatment time) were analyzed using logistic regression analyses for all 38 patients and for 17 patients with Stage T3 or T4 disease. Results: In univariate logistic analysis for all 38 cases, tumor volume, ADC, T stage, and treatment method showed significant (p < 0.05) associations with local failure. In multivariate analysis, ADC and T stage revealed significance (p < 0.01). In univariate logistic analysis for the 17 patients with Stage T3 or T4 disease, ADC and dose showed significant (p < 0.01) associations with local failure. In multivariate analysis, ADC alone showed significance (p < 0.05). Conclusions: The results suggest that pretreatment ADC, along with T stage, is a potential indicator of local failure in HNSCC treated with chemoradiotherapy or radiotherapy..
97. Torahiko Nakashima, Ryuji Yasumatsu, Satoshi Toh, Hideki Shiratsuchi, Takeshi Kamitani, Yoshiyuki Shioyama, Katsumasa Nakamura, Shizuo Komune, Advanced maxillary sinus cancer treated with concurrent chemoradiotherapy with intra-arterial cisplatin/docetaxel and oral S-1
Own experience and literature review, Case Reports in Oncology, 10.1159/000332759, 4, 3, 492-498, 2011.09, Intra-arterial (IA) chemotherapy for head and neck cancer is effective and multiple IA concurrent chemoradiation (CCRT) protocols have been reported. However, the role of IA CCRT in the multimodality treatment of head and neck cancer is still controversial. We have treated 5 cases of unresectable T4 maxillary sinus squamous cell carcinoma with IA cisplatin (CDDP) and docetaxel (DOC) and CCRT with oral S-1. We report our experience and the effectiveness and feasibility of this combination as an alternative choice of treatment for inoperable head and neck cancer. The patients received an IA infusion of CDDP (50-70 mg/m 2) and DOC (50-60 mg/m 2) through the femoral artery, followed by CCRT with oral S-1. The IA infusion was repeated up to 3 times and the radiation was dosed at up to 60-70 Gy. Complete response was achieved in 4 patients and partial response in one, giving an overall response rate of 100%. The most common grade 3 or 4 toxicities were anorexia (80%), mucositis (80%) and leukopenia (80%), all of which were manageable. CCRT with IA CDDP/DOC and oral S-1 was effective and tolerated. Although preliminary, the response rate encourages further pursuit and definitive evaluation of this combination for the treatment of inoperable advanced head and neck cancer..
98. Makoto Shinoto, Yoshiyuki Shioyama, Tomonari Sasaki, Katsumasa Nakamura, Hiroki Ohura, Yasushi Toh, Yuichiro Higaki, Toshihiro Yamaguchi, Kayoko Ohnishi, Kazushige Atsumi, Hideki Hirata, Hiroshi Honda, Clinical results of definitive chemoradiotherapy for patients with synchronous head and neck squamous cell carcinoma and esophageal cancer, American Journal of Clinical Oncology: Cancer Clinical Trials, 10.1097/COC.0b013e3181e84b4b, 34, 4, 362-366, 2011.08, Objectives: To assess the efficacy and toxicity of radical chemoradiotherapy for patients with synchronous head and neck squamous cell carcinoma (HNSCC) and esophageal cancer (EC). Methods: Thirty-four patients with synchronous HNSCC and EC were treated mainly with radical chemoradiotherapy at the same time. Median external radiation dose for HNSCC and EC was 70 Gy (range, 60-70.5 Gy), except for 2 patients with tongue cancer, who underwent brachytherapy and 60 Gy (range, 45-70 Gy), respectively. Thirty-one patients were treated with concurrent chemoradiotherapy with cisplatin and/or 5-fluorouracil or TS-1 (oral anticancer agent that combines tegafur, a metabolically activated prodrug of 5-fluorouracil, with 5-chloro-2, 4-dihydoroxypyridine, and potassium oxonate). Results: Thirty-three patients completed the intended treatment. The response rate was 94%, with 26 complete responses (76%) and 6 partial responses (18%). At a median follow-up of 17.3 months, 2-year rates of overall survival, cause-specific survival, and disease-free survival were 44%, 52%, and 33%, respectively. Initial failure patterns were local failure in 14 patients (63%), regional progression in 3 patients (13%), and distant metastasis in 6 patients (27%). The most common acute toxicity was myelosuppression, with 8 patients experiencing grade 3-4 toxicity. Three patients experienced grade 3 mucositis and pharyngitis. No patients experienced late morbidity of grade 3 or higher. Conclusions: Definitive chemoradiotherapy for patients with synchronous HNSCC and EC is feasible with a low mortality rate and acceptable morbidity..
99. Toru Chikui, Shintarou Kawano, Toshiyuki Kawazu, Masamitsu Hatakenaka, Syouzou Koga, Masahiro Ohga, Yoshio Matsuo, Syunya Sunami, Tsuyoshi Sugiura, Yoshiyuki Shioyama, Makoto Obara, Kazunori Yoshiura, Prediction and monitoring of the response to chemoradiotherapy in oral squamous cell carcinomas using a pharmacokinetic analysis based on the dynamic contrast-enhanced MR imaging findings, European Radiology, 10.1007/s00330-011-2102-x, 21, 8, 1699-1708, 2011.08, Objectives To evaluate whether a pharmacokinetic analysis is useful for both predicting and monitoring the response to chemoradiotherapy (CRT) in oral cancer. Methods Patients with oral squamous cell carcinoma treated with preoperative CRT and surgery were enrolled. They underwent dynamic contrast-enhanced MRI before (n=23), and after CRT (n=20). We estimated four parameters: arrival time of contrast medium (TA), exchange rate constant from the extracellular extravascular space (EES) to plasma (kep), elimination of contrast medium from the central compartment (kel) and an amplitude scaling constant (AH) using the Brix model. The histological evaluation of the effects of CRT was performed according to Ohboshi and Shimosato's classification. We analysed the correlation between the parameters and the histological evaluation. Results The pre-CRT AH between the responders and nonresponders was significantly different (P=0.046), however, the three parameters (TA, K ep, K el) were not significantly different among the groups (P=0.76, P=0.60, P=0.09). As AH decreased, the tumour response improved. The change in the AH between the pre- and post-CRT of responders was significantly higher than that of non-responders (P=0.043). Conclusion The AH, which is affected by the ratio of the EES, was an important parameter for predicting and monitoring the tumour response to CRT..
100. Kayoko Ohnishi, Yoshiyuki Shioyama, Masamitsu Hatakenaka, Katsumasa Nakamura, Koichiro Abe, Takashi Yoshiura, Ohga Saiji, Takeshi Nonoshita, Tadamasa Yoshitake, Torahiko Nakashima, Hiroshi Honda, Prediction of local failures with a combination of pretreatment tumor volume and apparent diffusion coefficient in patients treated with definitive radiotherapy for hypopharyngeal or oropharyngeal squamous cell carcinoma, Journal of radiation research, 10.1269/jrr.10178, 52, 4, 522-530, 2011.08, Purpose: The purpose of this study was to investigate the clinical factors for predicting local failure after definitive radiotherapy in oropharyngeal or hypopharyngeal squamous cell carcinoma. Materials and Methods: Between July 2006 and December 2008, 64 consecutive patients with squamous cell carcinoma of the hypopharynx or the oropharynx treated with definitive radiotherapy were included in this study. Clinical factors, such as pretreatment hemoglobin (Hb) level, T-stage, gross tumor volume of primary tumors (pGTV), and maximum standardized uptake value (SUV max) on FDG-PET, were evaluated for the correlation with local failure. A subset analysis of 32 patients with MR images including diffusion-weighted images (DWI) as a pretreatment evaluation was also performed. The Kaplan-Meier curves, the log-rank test, and the Cox proportional hazards model were used to evaluate these clinical factors. Results: Eleven of 64 patients experienced local recurrence, with a median follow-up time of 15 months. In the univariate analysis, Hb level (p = 0.0261), T-stage (p = 0.012), pGTV (p = 0.0025), and SUV max (p = 0.024) were significantly associated with local failure. In the multivariate analysis, pGTV (p = 0.0070) remained an adverse factor for local control. In the subset analysis of 32 patients with DWI, the median apparent diffusion coefficient (ADC) value of primary tumors on DWI was 0.79 × 10 -3 mm 2/s (range, 0.40-1.60 × 10 -3 mm 2/s). Patients with a high ADC value (> 0.79 × 10 -3 mm 2/s) had a significantly lower local control rate than patients with a low ADC value (100% vs. 44%, p = 0.0019). The rate of local failure among patients with a large pGTV and a high ADC value was 55% (6/11), whereas no local failures occurred (0%, 0/21) among patients with a small pGTV or a low ADC. Conclusions: These results suggest that a combination of a large tumor volume and a high ADC value could be predictive of local recurrence after definitive radiotherapy in hypopharyngeal or oropharyngeal squamous cell carcinoma..
101. Kayoko Ohnishi, Yoshiyuki Shioyama, Katsumasa Nakamura, Torahiko Nakashima, Ohga Saiji, Takeshi Nonoshita, Tadamasa Yoshitake, Kotaro Terashima, Shizuo Komune, Hiroshi Honda, Concurrent chemoradiotherapy with S-1 as first-line treatment for patients with oropharyngeal cancer, Journal of radiation research, 10.1269/jrr.10081, 52, 1, 47-53, 2011.02, Purpose: S-1 is an oral fluoropyrimidine. The purpose of this study was to review the clinical outcomes of S-1 with concurrent radiotherapy for patients with oropharyngeal cancer. Materials and Methods: Between 2002 and 2007, 38 patients with oropharyngeal cancer treated concurrently with S-1 and definitive radiotherapy were reviewed. The clinical stage was Stage I in 4 patients, Stage II in 7, Stage III in 7, and Stage IV in 20. S-1 was administered orally twice daily for 4 consecutive weeks followed by a 2-week drug withdrawal. The initial dose of S-1 was 65 mg/m2/day. All patients were treated using three-dimensional conformal radiotherapy with a median total dose of 65.1 Gy (range, 60.0-71.0 Gy). Clinical outcomes and major acute toxicities were analyzed based on medical records and clinical follow-up. Results: With a median follow-up time of 33 months, the 3-year estimates of local-regional control, distant metastases-free survival, disease-free survival, and overall survival for all patients were 75%, 80%, 65%, and 80%, respectively. The 3-year estimates of local-regional control according to stage were 100% for Stages I and II, 86% for Stage III, and 56% for Stage IV. The rate of ≥ Grade 3 acute mucositis was 32%, and the rate of ≥ Grade 3 hematological toxicities was 8%. No other severe toxicities were observed. Conclusions: Concurrent chemoradiotherapy with S-1 was found to be effective, especially for early disease. The treatment-related toxicities were acceptable, and the incidence of myelotoxicity was low. Further study must be carried out to compare with other chemotherapy regimens..
102. Shigeo Anai, Hidetaka Arimura, Katsumasa Nakamura, Fujio Araki, Takaomi Matsuki, Hideki Yoshikawa, Satoshi Yoshidome, Yoshiyuki Shioyama, Hiroshi Honda, Nobuo Ikeda, Estimation of focal and extra-focal radiation profiles based on Gaussian modeling in medical linear accelerators, Radiological Physics and Technology, 10.1007/s12194-011-0118-1, 4, 2, 173-179, 2011.01, The X-ray source or focal radiation is one of the factors that can degrade the conformal field edge in stereotactic body radiotherapy. For that reason, it is very important to estimate the total focal radiation profiles of linear accelerators, which consists of X-ray focal-spot radiation and extra-focal radiation profiles. Our purpose in this study was to propose an experimental method for estimating the focal-spot and extra-focal radiation profiles of linear accelerators based on triple Gaussian functions. We measured the total X-ray focal radiation profiles of the accelerators by moving a slit in conjunction with a photon field p-type silicon diode. The slit width was changed so that the extra-focal radiation could be optimally included in the total focal radiation. The total focal radiation profiles of an accelerator at 4-MV and 10-MV energies were approximated with a combination of triple Gaussian functions, which correspond to the focal-spot radiation, extra-focal radiation, and radiation transmitted through the slit assembly. As a result, the ratios of the Gaussian peak value of the extra-focal radiation to that of the focal spot for 4 and 10 MV were 0.077 and 0.159, respectively. The peak widths of the focal-spot and extra-focal radiation profiles were 0.57 and 25.0 mm for 4 MV, respectively, and 0.60 and 22.0 mm for 10 MV, respectively. We concluded that the proposed focal radiation profile model based on the triple Gaussian functions may be feasible for estimating the X-ray focal-spot and extra-focal radiation profiles..
103. Hidetaka Arimura, Taiki Magome, Shigeo Anai, Yoshiyuki Shioyama, Katsumasa Nakamura, [Medical imaging processing and evaluation in radiation therapy]., Nippon Hoshasen Gijutsu Gakkai zasshi, 10.6009/jjrt.67.76, 67, 1, 76-83, 2011.01.
104. yuko shirakawa, Takashi Yoshiura, Hiwatashi Akio, Koji Yamashita, Hironori Kamano, Yoshiyuki Shioyama, Kouichiro Abe, Toshiyuki Amano, Akira Nakamizo, Koji Yoshimoto, Hiroyuki Honda, Rina Torisu, Satoshi Suzuki, Hiroshi Honda, Pseudoprogression following concurrent temozolomide and radiotherapy in a patient with glioblastoma
findings on functional imaging techniques., Fukuoka igaku zasshi = Hukuoka acta medica, 101, 12, 257-264, 2010.12, Concurrent temozolomide (TMZ) and radiotherapy became the new standard of care for patients diagnosed with glioblastoma multiforme (GBM). Recently, there has been an increasing awareness of progressive and enhancing lesions on MR images immediately after treatment. These lesions may be a treatment effect, so-called pseudoprogression. We experienced one case pathologically and clinically diagnosed as pseudoprogression. The lesion showed a high apparent diffusion coefficient on diffusion-weighted imaging, low blood volume on perfusion imaging, and low uptake of 18F-fluorodeoxyglucose on positron emission tomography. The lesion was pathologically diagnosed as pseudoprogression after additional surgical resection..
105. Satoshi Nomoto, Yoshiyuki Shioyama, Ohga Saiji, Katsumasa Nakamura, Hiroshi Honda, Advanced olfactory neuroblastoma treated with combined conventional and hypofractionated stereotactic radiotherapy, Journal of Cancer Research and Therapeutics, 10.4103/0973-1482.77088, 6, 4, 581-584, 2010.10, Three patients with olfactory neuroblastoma (ONB) of the nasal and/or paranasal cavity were treated with a combination of conventional radiotherapy (RT) and hypofractionated stereotactic radiation therapy (SRT). Radiation doses of 30 to 50 Gy were delivered in 12 to 25 fractions using conventional RT, and then an additional 20 to 25 Gy was delivered in 5 fractions using SRT. Follow-up time was 42, 53, 65 months, three patients were alive, and local control was obtained in all, complete response (CR) in 2 and partial response (PR) in 1. Two patients had recurrence out of the radiation field and received salvage therapy. According to the Radiation Therapy Oncology Group (RTOG) acute/late radiation morbidity scoring criteria, there were no adverse effects of grade 3 or higher. The combined treatment with conventional RT and hypofractionated SRT achieved excellent local control without serious adverse effects..
106. Takeshi Nonoshita, Yoshiyuki Shioyama, Katsumasa Nakamura, Torahiko Nakashima, Ohga Saiji, Tadamasa Yoshitake, Kayoko Ohnishi, Kotaro Terashima, Kaori Asai, Hiroshi Honda, Concurrent chemoradiotherapy with S-1 for T2N0 Glottic squamous cell carcinoma, Journal of radiation research, 10.1269/jrr.09134, 51, 4, 481-484, 2010.08, In this study, we evaluated the feasibility, efficacy and toxicity of concurrent chemoradiotherapy with S-1 (tegafur-gimeracil-oteracil potassium) for T2N0 glottic carcinoma. A total of 23 patients with T2N0 glottic carcinoma received chemoradiotherapy with S-1. Radiotherapy consisted of five daily fractions of 2 Gy per week, to a total median dose of 70 Gy. S-1 was administered 65 mg/m2 per day for 4 weeks, beginning on the day therapy was started, followed by 2 weeks off the drug and twice a day until the end of radiotherapy. Initial local control rate of the primary tumor was achieved in all patients. The median follow-up period for all patients was 38 months. The 3-year local control rate was 95.4%. Regarding adverse reactions, grade 3 mucositis upon clinical examination, mucositis upon functional/symptomatic examination, dysphagia, hepatic toxicity and anemia were observed in 13, 2, 2, 1 and 1 patients, respectively. This chemoradiotherapy did not result in grade 4 acute toxicity or severe late toxicity. Chemoradiotherapy with S-1 was feasible, well tolerated and effective. This therapy is suggested as a possible regimen for improving local control of T2N0 glottic carcinoma..
107. Terashima K, Shioyama Y, Nomoto S, Ohga S, Nonoshita T, Ohnishi K, Atsumi K, Yabuuchi H, Hirata H, aHonda H, A case of radiation fibrosis appearing as mass-like consolidation after SBRT with elevation of serum CEA.
, Case Report in Medicine, in press, 2010.05.
108. Isoyama Y, Shioyama Y, Nomoto S, Ohga S, Nonoshita T, Onishi K, Matsuura S, Atsumi K, Terashima K, Hirata H, Honda H. , Carboplatin and etoposide combined with radiotherapy for limited-stage small-cell esophageal carcinoma: three cases and review of the literature, Jpn J Radiol, 28(3): 181-187, 2010, 2010.04.
109. Yuko Isoyama, Yoshiyuki Shioyama, Satoshi Nomoto, Ohga Saiji, Takeshi Nonoshita, Kayoko Onishi, Shuji Matsuura, Kazushige Atsumi, Kotaro Terashima, Hideki Hirata, Hiroshi Honda, Carboplatin and etoposide combined with radiotherapy for limited-stage small-cell esophageal carcinoma
Three cases and review of the literature, Japanese Journal of Radiology, 10.1007/s11604-009-0403-7, 28, 3, 181-187, 2010.04, Purpose. Small-cell esophageal carcinoma (SCEC) is a rare disease for which standard therapy has not yet been established. We report the results of three cases of limited- stage SCEC treated with combination therapy using carboplatin (CBDCA) and etoposide (VP-16) and radiotherapy. Materials and methods. The clinical stage according to the Japanese Classifi cation of Esophageal Cancer 7th ed. was stage III in 2 cases and stage IVa in 1. These patients with limited-stage SCEC were treated at our institution with four cycles of CBDCA and VP-16, either concurrent with radiotherapy for the second two cycles (n = 2) or followed by radiotherapy after the last cycle (n = 1). Results. A complete response (CR) was obtained for all three patients, resulting in a response rate of 100%. Two patients are alive at 16.4 and 22.5 months after initial treatment. One patient died with myeloid leukemia at 43.5 months after initial treatment. None of the patients had loco-regional recurrence. Brain metastasis was detected in one patient at 7 months after initial therapy and was treated with stereotactic radiotherapy combined with whole brain irradiation. Conclusion. CBDCA and VP-16 in combination with radiotherapy should be considered an important treatment option for SCEC..
110. Kazushige Atsumi, Yoshiyuki Shioyama, Satoshi Nomoto, Ohga Saiji, Takashi Toba, Tomonari Sasaki, Naonobu Kunitake, Tadamasa Yoshitake, Katsumasa Nakamura, Hiroshi Honda, Chemoradiation for small cell esophageal carcinoma
Report of 11 cases from multi-institution experience, Journal of radiation research, 10.1269/jrr.09074, 51, 1, 15-20, 2010.02, Small cell esophageal carcinoma(SCEC) is a rare disease with aggressive behavior and poor prognosis. Because of the rarity of this disease, standard therapy has not yet been established. The objective of this retrospective study was to report the outcomes of SCEC treated with chemotherapy and radiotherapy from a retrospective study of 11 patients. We enrolled 11 SCEC patients who were treated with radiation therapy (more than 50 Gy) and chemotherapy between May 1996 and October 2007. Patients' age ranged from 44 to 77 years (mean: 69 years). In all patients, pathological examination of the specimen obtained by biopsy revealed small cell carcinoma. All patients were treated with chemotherapy and radiation therapy. The mean follow-up time was 14.7 months, and the median overall survival time of all patients was 13.2 months (range: 4.2-43.6 months). The 1-year and 3-year overall survival rates were 63% and 24%, respectively, while the 1-year and 3-year progression-free survival rates were 45% and 14%, respectively. Five of seven patients with complete response (CR) developed recurrent disease. Recurrence sites were distant metastases in four patients and lymph node outside the radiation field in one patient. Chemoradiation should be considered as one of the important treatment options for the loco-regional control in the patients with SCEC..
111. Katsumasa Nakamura, Haruo Yoshikawa, Tomoharu Akai, Satoshi Nomoto, Yoshiyuki Shioyama, Yasuo Kuwabara, Kengo Yoshimitsu, Corrugated fiberboard as a positioning insert for patients undergoing radiotherapy, Journal of radiation research, 10.1269/jrr.09076, 51, 1, 87-90, 2010.02, We have developed a new body fixation system for single patient use, which consists of a vacuum cushion, a thermoplastic fixation sheet which is used to suppress involuntary and voluntary patient movement, and a triple-wall corrugated fiberboard base plate to which both the vacuum cushion and the thermoplastic sheet are affixed. To evaluate the characteristics of the fiberboard as a patient-positioning insert, the photon beam attenuation of a fiberboard base plate, a carbon-fiber base plate, and a vacuum-formed cushion were compared. The strength of the fiberboard was also evaluated. The attenuation for the carbonfiber base plate was 3.7% and 2.6% in 4 MV and 10 MV photon beams, respectively, while the results were less for the fiberboard base plate, i.e. 1.9% and 1.6%. The vacuum-formed cushion had a minimal effect on transmission. None of the materials subsided under the weight loading of 20 g/cm2. There was no difference between the thicknesses of the fiberboard before and after a 50 times daily load with the 60 kg weight of a volunteer. Corrugated fiberboard is a robust and low attenuating material that functions well as a patient-positioning insert..
112. Kazushige Atsumi, Yoshiyuki Shioyama, Katsumasa Nakamura, Satoshi Nomoto, Ohga Saiji, Tadamasa Yoshitake, Takeshi Nonoshita, Masanobu Ueda, Hideki Hirata, Hiroshi Honda, Predictive factors of esophageal stenosis associated with tumor regression in radiation therapy for locally advanced esophageal cancer, Journal of radiation research, 10.1269/jrr.09073, 51, 1, 9-14, 2010.02, The purpose of this retrospective study was to clarify the predictive factors correlated with esophageal stenosis within three months after radiation therapy for locally advanced esophageal cancer. We enrolled 47 patients with advanced esophageal cancer with T2-4 and stageII-III who were treated with definitive radiation therapy and achieving complete response of primary lesion at Kyushu University Hospital between January 1998 and December 2005. Esophagography was performed for all patients before treatment and within three months after completion of the radiation therapy, the esophageal stenotic ratio was evaluated. The stenotic ratio was used to define four levels of stenosis: stenosis level 1, stenotic ratio of 0-25%; 2, 25-50%; 3,50-75%; 4,75-100%. We then estimated the correlation between the esophageal stenosis level after radiation therapy and each of numerous factors. The numbers and total percentages of patients at each stenosis level were as follows: level 1: n = 14 (30%); level 2: 8 (17%); level 3: 14 (30%); and level 4: 11 (23%). Esophageal stenosis in the case of full circumference involvement tended to be more severe and more frequent. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. The extent of involved circumference and wall thickness of tumor region were significantly correlated with esophageal stenosis associated with tumor regression in radiation therapy (p = 0.0006, p = 0.005). For predicting the possibility of esophageal stenosis with tumor regression within three months in radiation therapy, the extent of involved circumference and esophageal wall thickness of the tumor region may be useful..
113. Atsumi K, Shioyama Y, Nomoto S, Ohga S, Toba T, Sasaki T, Kunitake N, Yoshitake T, Nakamura K, Honda H, Chemoradiation for Small Cell Esophageal Carcinoma: Report of 11 Cases from Multi-institution Experience., J Radiat Res, 51: 15-20, 2010
, 2010.01.
114. Nakamura K, Yoshikawa H, Akai T, Nomoto S, Shioyama Y, Kuwabara Y, Yoshimitsu K, Corrugated Fiberboard as a Positioning Insert for Patients Undergoing Radiotherapy, J Radiat Res, 51: 87-90, 2010
, 2010.01.
115. Atsumi K, Shioyama Y, Nakamura K, Nomoto S, Ohga S, Yoshitake T, Nonoshita T, Ueda M, Hirata H, Honda H, Predictive Factors of Esophageal Stenosis Associated with Tumor Regression in Radiation Therapy for Locally Advanced Esophageal Cancer, J Radiat Res, 51: 9-14, 2010, 2010.01.
116. Kotaro Terashima, Yoshiyuki Shioyama, Satoshi Nomoto, Ohga Saiji, Takeshi Nonoshita, Kayoko Ohnishi, Kazushige Atsumi, Hidetake Yabuuchi, Hideki Hirata, Hiroshi Honda, A case of radiation fibrosis appearing as mass-like consolidation after SBRT with elevation of serum CEA, Case Reports in Medicine, 10.1155/2010/986706, 2010, 2010.01, We report a case of radiation fibrosis appearing as mass-like consolidation, which was difficult to distinguish fromlocal recurrence. A 72-year-old woman was diagnosed as having primary lung cancer (cT1N0M0 stage IA) in the right upper lobe and was treated with SBRT of 48 Gy in 4 fractions. After 12 months, mass-like consolidation appeared around the irradiated area, and after 13 months, it had increased in size. FDG-PET revealed high uptake (SUV max = 5.61) for the consolidation. CT-guided biopsy was performed, but we could not confirm the diagnosis. Considering her poor respiratory function and her age, short-interval follow-up was performed. After 15 months, the consolidation enlarged at the dorsal side, and carcinoembryonic antigen (CEA) became elevated (14.6 ng/mL). Serum KL-6 (436 U/mL) and SP-D (204 ng/mL) were also elevated. However, after 16 months, serum CEA slightly decreased. The consolidation gradually retracted on follow-up CT images. CEA, KL-6, and SP-D were also decreased by degrees. After 40 months, there is no evidence of local recurrence..
117. Torahiko Nakashima, Katsumasa Nakamura, Hideki Shiratsuchi, Ryuji Yasumatsu, Satoshi Toh, Yoshiyuki Shioyama, Shizuo Komune, Clinical outcome of partial glossectomy or brachytherapy in early-stage tongue cancer, Journal of Otolaryngology of Japan, 10.3950/jibiinkoka.113.456, 113, 5, 456-462, 2010.01, Partial glossectomy and low-tlose-rate (LDR) brachytherapy are both effective in early-stage tongue cancer without lymph node metastasis, although head and neck surgeons and radiation oncologists disagree on which treatment is superior. Because our subjects select the treatment modality, we compared treatment results between 39 subjects undergoing partial glossectomy and 107 undergoing brachytherapy for stage I/II tongue cancer. Local recurrence was observed in 10% and cervical lymph node recurrence in 23% following partial glossectomy, versus local recurrence in 13% and cervical lymph node recurrence in 24% following brachytherapy. Disease-free 5-year survival was 87.0% following partial glossectomy and 90.7% following brachytherapy. Because incidence of local recurrence, nodal metastasis, and prognosis were the same regardless of treatment modality, treatment should be based on the age, performance status, and quality of life among subjects..
118. Masamitsu Hatakenaka, Takashi Yoshiura, Yoshiyuki Shioyama, Hiroshi Honda, Future of diagnostic radiology
prediction of treatment outcome using MRI, Fukuoka igaku zasshi = Hukuoka acta medica, 101, 3, 41-45, 2010.01.
119. Akira Matsunobu, Yoshiyuki Shioyama, Satoru Uehara, Ohga Saiji, Kazushige Atsumi, Taisei Matsumura, Naotaka Sakamoto, Masahiro Yoshikawa, Atsushi Iguchi, Hiroshi Honda, High-dose-rate brachytherapy with external beam radiotherapy for localized or locally advanced prostate cancer, Fukuoka igaku zasshi = Hukuoka acta medica, 101, 4, 75-83, 2010.01, PURPOSE: To evaluate the therapeutic outcomes and late toxicities in patients treated by high-dose-rate brachytherapy (HDR-BT) with external beam radiotherapy (EBRT) for localized or locally advanced prostate cancer. MATERIALS AND METHODS: From May 2004 to September 2008, 86 men were treated by HDR-BT with EBRT for localized or locally advanced prostate cancer at the National Hospital Organization Kyushu Medical center. The median EBRT and HDR-BT doses were 40 Gy and 30 Gy, respectively. RESULT: With a median follow-up of 24 months, the 3-year overall, disease specific, and biochemical relapse-free survival rates in all patients were 97.3%, 100%, and 83.6% respectively. The 3-year biochemical relapse-free survival rate of the patients categorized to low or intermediate risk group (91.8%) was significantly better than that of the patients categorized to the high risk group (74.3%) (p = 0.042). There was no significant difference of biochemical relapse-free survival regarding to the other clinical factors (age, T-stage, Gleason score, initial prostate-specific antigen level, neoadjuvant hormone therapy, and total dose of EBRT and HDR-BT). Late Grade2 and Grade3 gastrointestinal toxicities were observed in 8 patients (9.3%) and 2 patients (2.3%), respectively. Late Grade2 genitourinary toxicities were observed in 12 patients (13.9%). There was no patient suffered from late Grade3 or greater genitourinary toxicities. CONCLUSION: HDR-BT with EBRT can be safe and effective for localized or locally advanced prostate cancer..
120. Yoshitake T, Shioyama Y, Nakamura K, Ohga S, Nonoshita T, Ohnishi K, Terashima K, Arimura H, Hirata H, Honda H. , A clinical evaluation of visual feedback-guided breath-hold reproducibility of tumor location, Phys Med Biol, 54(23):7171-7182, 2009
, 2009.12.
121. Ohnishi K, Shioyama Y, Nomoto S, Sasaki T, Ohga S, Yoshitake T, Toba T, Atsumi K, Shiinoki T, Terashima H, Honda H. , Spontaneous pneumothorax after stereotactic radiotherapy for non-small-cell lung cancer
, Jpn J Radiol, 27(7):269-274, 2009, 2009.08.
122. Nonoshita T, Shioyama Y, Nomoto S, Ohga S, Ohnishi K, Atsumi K, Terashima K, Matsuura S, Nakamura K, Hirata H, Honda H. , Effective palliative radiotherapy in primary malignant melanoma of the esophagus: a case report, CASE Journal , 2: 6928, 2009
, 2009.08.
123. Ogawa K, Nakamura K, Sasaki T, Onishi H, Koizumi M, Shioyama Y, Araya M, Mukumoto N, Mitsumori M, Teshima T; the Japanese Patterns of Care Study Working Subgroup of Prostate Cancer., External Beam Radiotherapy for Clinically Localized Hormone-Refractory Prostate Cancer: Clinical Significance of Nadir Prostate-Specific Antigen Value Within 12 Months., Int J Radiat Oncol Biol Phys , Epub ahead of print, 2009.03.
124. Arimura H, Egashira Y, Shioyama Y, Nakamura K, Yoshidome S, Anai S, Nomoto S, Honda H, Toyofuku F, Higashida Y, Onizuka Y, Terashima H., Computerized method for estimation of the location of a lung tumor on EPID cine images without implanted markers in stereotactic body radiotherapy., Phys Med Biol. 2009; , 54(3):665-677, 2009.02.
125. Hata M, Tokuuye K, Shioyama Y, Nomoto S, Inadome Y, Fukumitsu N, Nakayama H, Sugahara S, Ohara K, Noguchi M, Akine Y., Malignant myoepithelioma in the maxillary sinus: case report and review of the literature., Anticancer Res. , 29(2):497-501., 2009.02.
126. Nomoto S, Shioyama Y, Ohga S, Nonoshita T, Ohnishi K, Atsumi K, Terashima K, Nakashima T, Nakamura K, Hirata H, Honda H., Preliminary results of radiation therapy for locally advanced or recurrent adenoid cystic carcinomas of the head and neck using combined conventional radiation therapy and hypofractionated inverse planned stereotactic radiation therapy., Fukuoka Igaku Zasshi. , 100(2):59-66.
, 2009.02.
127. Nonoshita T, Shioyama Y, Kunitake N, Nakamura K, Nomoto S, Ohga S, Toriya Y, Ono M, Honda H., Retrospective analysis: concurrent chemoradiotherapy and adjuvant chemotherapy for T2N0 glottic squamous cell carcinoma.
, Fukuoka Igaku Zasshi, 100(1):26-31.
, 2009.01.
128. Ogawa K, Yoshii Y, Shikama N, Nakamura K, Uno T, Onishi H, Itami J, Shioyama Y, Iraha S, Hyodo A, Toita T, Kakinohana Y, Tamaki W, Ito H, Murayama S, Spinal recurrence from intracranial germinoma: risk factors and treatment outcome for spinal recurrence., Int J Radiat Oncol Biol Phys. , 72(5):1347-1354., 2008.12.
129. Nakamura K, Shioyama Y, Tokumaru S, Hayashi N, Oya N, Hiraki Y, Kusuhara K, Toita T, Suefuji H, Hayabuchi N, Terashima H, Makino M, Jingu K, Variation of clinical target volume definition among Japanese radiation oncologists in external beam radiotherapy for prostate cancer, Jpn J Clin Oncol, 38(4):275-280, 2008.04.
130. Ogawa K, Nakamura K, Sasaki T, Onishi H, Koizumi M, Araya M, Shioyama Y, Okamoto A, Mitsumori M, Teshima T, Japanese Patterns of Care Study Working Subgroup of Prostate Cancer.Radical external beam radiotherapy for prostate cancer in Japan: differences in the patterns of care among Japan, Germany, and the United States., Radiat Med, 26(2):57-62, 2008.02.
131. Yoshitake T, Nakamura K, Shioyama Y, Nomoto S, Ohga S, Toba T, Shiinoki T, Anai S, Terashima H, Kishimoto J, Honda H, Breath-hold monitoring and visual feedback for radiotherapy using a charge-coupled device camera and a head-mounted display: system development and feasibility., Radiat Med, 26(1):50-55., 2008.01.
132. Shioyama Y, Nakamura K, Ohga S, Nomoto S, Sasaki T, Yamaguchi T, Toba T, Yoshitake T, Terashima H, Honda H. , Radiation therapy for recurrent esophageal cancer after surgery: clinical results and prognostic factors., Jpn J Clin Oncol., 2007.12.
133. Nishie A, Yoshimitsu K, Nakayama T, Hatakenaka M, Irie H, Shioyama Y, Matsuura S, Nishihara Y, Kobayashi K, Honda H, In vitro imaging of human monocytic cellular activity using superparamagnetic iron oxide, Comput Med Imaging Graph, 31(8):638-42, 2007.12.
134. Nonoshita T, Sasaki T, Hirata H, Toh Y, Shioyama Y, Nakamura K, Honda H., High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer., Radiat Med, 25(8):373-7., 2007.10.
135. Sasaki T, Nakamura K, Shioyama Y, Toh Y, Okamura K, Ohura H, Hirata H, Honda H, Treatment outcomes of radiotherapy for patients with stage I esophageal cancer: a single institute experience, Am J Clin Oncol, 30(5):514-519, 2007.10.
136. Atsumi K. Shioyama Y, Nomoto S, Ohga S, Yoshitake T, Toba T, Ohnishi K, Terashima H, Tanaka K, Matsuda S, Nakamura K, Iwamoto Y, Honda H., Long-term tumor control of a fibrosarcoma in the left lower extremity after thermoradiotherapy and limb-sparing surgical resection., Thermal Medicine , 23(3): 145-150, 2007.09.
137. Urashima Y, Nakamura K, Shioyama Y, Nomoto S, Ohga S, Toba T, Yoshitake T, Chikui T, Kawazu T, Jingu K, Terashima H, Honda H, Treatment of early tongue carcinoma with brachytherapy: results over a 25-year period, Anticancer Res, 27(5B): 3519-3523, 2007.09.
138. Nakamura K, Shioyama Y, Nomoto S, Ohga S, Toba T, Yoshitake T, Anai S, Terashima H, Honda H , Reproducibility of the abdominal and chest wall position by voluntary breath-hold technique using a laser-based monitoring and visual feedback system.
, Int J Radiat Oncol Biol Phys, 2007.05.
139. Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Kakihara D, Shioyama Y, Nishihara Y, Yamaguchi K, Honda H. , Significance of mesenteric lymphadenopathy after pancreaticoduodenectomy for periampullary carcinomas: evaluation with serial MDCT studies.

, Eur J Radiol. 2007 Mar;61(3):491-8. Epub 2006 Nov 16. , 61(3):491-8.
, 2007.03.
140. Yoshitake T, Nakamura K, Shioyama Y, Sasaki T, Ooga S, Abe M, Urashima Y, Urabe K, Terashima H, Honda H. , Erythema multiforme and Stevens-Johnson syndrome following radiotherapy.
, Radiat Med. , 25(1):27-30.
, 2007.01.
141. Urashima Y, Nakamura K, Shioyama Y, Sasaki T, Ohga S, Toba T, Kunitake N, Chikui T, Kawazu T, Yamada T, Terashima H, Honda H. , Long-term functional outcome of brachytherapy for carcinoma of the mobile tongue: focus on the atrophic change of irradiated tongue.

, Jpn J Clin Oncol. , 36(11):681-7.

, 2006.11.
142. Sasaki T, Nakamura K, Ogawa K, Onishi H, Otani Y, Koizumi M, Shioyama Y, Teshima T; Japanese Patterns of Care Study Working Subgroup of Prostate Cancer., Postoperative radiotherapy for patients with prostate cancer in Japan; Changing trends in national practice between 1996-98 and 1999-2001: Patterns of care study for prostate cancer.
, Jpn J Clin Oncol. , 36(10):649-54.
, 2006.10.
143. Nakamura K, Shioyama Y, Kawashima M, Saito Y, Nakamura N, Nakata K, Hareyama M, Takada T, Karasawa K, Watanabe T, Yorozu A, Tachibana H, Suzuki G, Hayabuchi N, Toba T, Yamada S. , Multi-institutional analysis of early squamous cell carcinoma of the hypopharynx treated with radical radiotherapy.
, Int J Radiat Oncol Biol Phys., 65(4):1045-50. , 2006.07.
144. Terashima K, Shioyama Y, Nakamura K, Ohga S, Nomoto S,. Yamaguchi T, Toba T, Yabuuchi H, Nakashima T, Terashima H, Honda H, Long-term local control of recurrent adenoid cystic carcinoma in the parotid gland with radiotherapy and intraarterial infusion chemotherapy, Radiat Med, 24(4):287-91., 2006.05.
145. Sasaki T, Nakamura K, Shioyama Y, Ohga S, Toba T, Urashima Y, Yoshitake T, Terashima H, Koga H, Naito S, Noma H, Komatsu K, Yamaguchi A, Hiratsuka Y, Hirano T, Hanada K, Abe M, Fujisawa Y, Honda H. , Low pre-radiotherapy prostate-specific antigen level is a significant predictor of treatment success for postoperative radiotherapy in patients with prostate cancer.
, Anticancer Res. , 26(3B):2367-74. , 2006.05.
146. Nemoto K, Yamada S, Nishio M, Aoki M, Nakamura R, Matsumoto Y, Sasamoto R, Saitoh Y, Takayama M, Mitsuhashi N, Gomi K, Kanesaka N, Kobayashi M, Ohnishi H, Sasaki S, Tamamura H, Mitsumori M, Nishimura Y, Tsujino K, Takemoto M, Uchida N, Yamamoto M, Shioyam, Results of radiation therapy for superficial esophageal cancer using the standard radiotherapy method recommended by the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) Study Group.

, Anticancer Res., 26(2B):1507-12. , 2006.04.
147. Ogawa K, Nakamura K, Onishi H, Sasaki T, Koizumi M, Shioyama Y, Komiyama T, Miyabe Y, Teshima T; Japanese Patterns of Care Study Working Subgroup of Prostate Cancer. , Radical external beam radiotherapy for clinically localized prostate cancer in Japan: differences in the patterns of care between Japan and the United States.
, Anticancer Res. , 26(1B):575-80.

, 2006.02.
148. Urashima Y, Nakamura K, Kunitake N, Shioyama Y, Sasaki T, Ooga S, Kuratomi Y, Yamamoto T, Kawazu T, Chikui T, Jingu K, Terashima H, Honda H., Is glossectomy necessary for late nodal metastases without clinical local recurrence after initial brachytherapy for N0 tongue cancer? A retrospective experience in 111 patients who received salvage therapy for cervical failure.
, Jpn J Clin Oncol. , 36(1):3-6. Epub 2006 Jan 17.
, 2006.01.
149. Ogawa K, Nakamura K, Onishi H, Sasaki T, Koizumi M, Shioyama Y, Komiyama T, Miyabe Y, Teshima T; Japanese Patterns of Care Study Working Subgroup of Prostate Cancer. , Radical external beam radiotherapy for prostate cancer in Japan: results of the 1999-2001 patterns of care process survey.

, Jpn J Clin Oncol. , 36(1):40-5, 2006.01.
150. Yoshitake T, Nakamura K, Shioyama Y, Sasaki T, Ohga S, Yamaguchi T, Toba T, Anai S, Terashima H, Honda H., A machine vision system with CCD cameras for patient positioning in radiotherapy: a preliminary report.
, Fukuoka Igaku Zasshi., 96(12):399-405.
, 2005.12.
151. Muto E, Shioyama Y, Nakamura K, Ohga S, Nomoto S, Toba T, Yoshitake T, Soeda H, Terashima H, Honda H, Adult rhabdomyosarcoma in the nasal and paranasal sinuses showing complete local response to a combination of chemotherapy and radiotherapy using 3D-CRT and IMRT, Fukuoka Igaku Zasshi, 96(10):363-369, 2005.10.
152. Ogawa K, Nakamura K, Onishi H, Sasaki T, Koizumi M, Shioyama Y, Komiyama T, Miyabe Y, Teshima T; Japanese Patterns of Care Study Working Subgroup of Prostate Cancer, Radical external beam radiotherapy for clinically localized prostate cancer in Japan: changing trends in the patterns of care process survey between 1996-1998 and 1999-2001.

, Anticancer Res. , 25, 5, 3507-3511, 25(5):3507-11. , 2005.09.
153. Shioyama Y, Nakamura K, Anai S, Sasaki T, Ohga S, Saku M, Urashima Y, Yoshitake T, Toba T, Terashima H, Honda H, Stereotactic radiotherapy for lung and liver tumors using a body cast system: Setup accuracy and preliminary clinical outcome, Radiat Med , 23(6); 407-413, 2005.08.
154. Nakamura K, Shioyama Y, Sasaki T, Ohga S, Saku M, Urashima Y, Yoshitake T, Nakashima T, Kuratomi Y, Komune S, Terashima H, Honda H. , Chemoradiation therapy with or without salvage surgery for early squamous cell carcinoma of the hypopharynx.

, Int J Radiat Oncol Biol Phys, 10.1016/j.ijrobp.2004.11.012, 62, 3, 680-683, 62(3):680-3. , 2005.07.
155. Ohga S, Nakamura K, Shioyama Y, Sasaki T, Urashima Y, Terashima H, Honda H., Stage I and II non-Hodgkin's lymphoma: results of combined of THP-COP chemotherapy and radiotherapy.

, Radiat Med., 23(3):156-61., 2005.05.
156. Ohguri T, Imada H, Nomoto S, Yahara K, Hisaoka M, Hashimoto H, Tokura Y, Nakamura K, Shioyama Y, Honda H, Terashima H, Moroi Y, Furue M, Korogi Y., Angiosarcoma of the scalp treated with curative radiotherapy plus recombinant interleukin-2 immunotherapy, Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1446-53., 10.1016/j.ijrobp.2004.08.008, 61, 5, 1446-1453, 61(5):1446-53., 2005.04.
157. Shioyama Y, Nakamura K, Sasaki T . Ooga S, Urashima Y, Kimura M, Uehara S, Terashima H, Honda H, Clinical results of radiation therapy for stage I esophageal cancer: a single institutional experience, Am J Clinic Oncol 28: 75-80, 2005, 10.1097/01.coc.0000139021.91718.ee, 28, 1, 75-80, 28: 75-80, 2005.02.
158. Abe K, Sasaki M, Kuwabara Y, Koga H, Baba S, Kaneko K, Hayashi K, Shioyama Y, Tajiri T, Suita S, Honda H., Extraosseous accumulation of (99m)Tc-HMDP to radiation nephropathy, mimicking recurrent neuroblastoma.
, Ann Nucl Med, 10.1007/BF02986333, 19, 1, 35-40, 19(1):35-40.
, 2005.02.
159. Tsunashima Y, Sakae T, Shioyama Y, Kagei K, Terunuma T, Nohtomi A, Akine Y., Correlation between the respiratory waveform measured using a respiratory sensor and 3D tumor motion in gated radiotherapy.

, Int J Radiat Oncol Biol Phys. , 10.1016/j.ijrobp.2004.06.026, 60, 3, 951-958, 60(3):951-8. , 2004.11.
160. Nagao E, Nishie A, Yoshimitsu K, Irie H, Shioyama Y, Naito S, Matsuura S, Honda H., Gluteal muscular and sciatic nerve metastases in advanced urinary bladder carcinoma: case report., Abdom Imaging. , 10.1007/s00261-003-0154-3, 29, 5, 619-622, 29(5):619-22
, 2004.09.
161. Shioyama Y, Tokuuye K, Okumura T, Kagei K, Sugahara S, ,Ohara K, Akine Y, Ishikawa S, Satoh H, Sekizawa K, Clinical Evaluation of Proton Radiotherapy for Non-small-cell Lung Cancer., Int.J.Radiat Oncol Biol Phisc, 10.1016/0360-3016(02)04416-4, 56, 1, 7-13, 56: 7-13, 2003.05.
162. Kagei K, Tokuuye K, Okumura T, Ohara K, Shioyama Y, Sugahara S, Akine Y, Long-term Results of Proton Beam Therapy for Carcinoma of the Uterine Cervix, Int.J.Radiat Oncol Biol Phisc, 10.1016/S0630-3016(02)04075-0, 55, 5, 1265-1271, 55: 1265-1271, 2003.01.
163. Respiration gated CT scanning for radiation treatment planning by guided respiration method..
164. Ohara K, Tsunoda H, Nishida M, Sugahara S, Hashimoto T, Shioyama Y, Hasezawa K, Yoshikawa H, Akine Y, Itai Y., Use of Small Pelvic Field Instead of Whole Pelvic Field in Postoperative Radiotherapy for Node-negaive , High-risk Stages I and II Cervical Squamous Cell Carcinoma., Int J Gynecol Cancer, 13(2):170-176., 2003.03.
165. Sasaki M, Sugio K, Kuwabara Y, Koga H, Nakagawa M, Chen T, Kaneko K, Hayashi K, Shioyama Y, Sakai S, Honda H., Alternation of tumor suppressor genes (Rb, p16, p27 and p53) and an increased FDG uptake in lung cancer., Ann Nucl Med., 10.1007/BF02990021, 17, 3, 189-196, 17(3); 189-196, 2003.05.
166. Sasaki T, Nakamura K, Shioyama Y, Ohga S, Urashima Y, Terashima H, Koga H, Naito S, Noma H, Komatsu K, Yamaguchi A, Honda H., Efficacy of modest dose irradiation in combination with long-term endocrinal treatment for high-risk prostate cancer: a preliminary report.
, Jpn J Clin Oncol. , 10.1093/jjco/hyh059, 34, 7, 420-424, 34(7):420-4.
, 2004.07.
167. Nakamura K, Teshima T, Takahashi Y, Imai A, Koizumi M, Mitsuhashi N, Shioyama Y, Inoue T; Japanese PCS Working Subgroup of Prostate Cancer, Radiotherapy for localized hormone-refractory prostate cancer in Japan.

, Anticancer Res, 24, 5B, 3141-3145, 24(5B):3141-5.
, 2004.09.