Gated carbon-ion scanning treatment for pancreatic tumour with field specific target volume and organs at risk.

OBJECTIVE: To assess the feasibility of treatment planning for pancreatic tumours subject to respiratory motion using field-specific target volumes (FTV) and field-specific organs at risk (FOAR) using four-dimensional computed tomography (4DCT). METHODS: Fourteen pancreatic cancer patients underwent 4DCT. Radiation oncologists contoured the gross tumour volume (GTV), clinical target volume (CTV), spinal cord, duodenum, kidneys, and stomach. The gating duty cycle was set to 30 % around exhalation. FTV and FOAR were calculated using the 4DCT dataset. Planning target volumes (PTV) and planning organs at risk volumes (PRV) were defined as equal to FTV and FOAR, respectively. A dose of 55.2Gy relative biological effectiveness (RBE) was planned to target the PTV from four beam angles. A single field uniform dose (SFUD) plan was selected. The dose distribution, including intrafractional motion changes, was generated. RESULTS: The mean volume of target receiving 95 % of the planned doses was 96.4±4.1 % to the GTV and 94.7±0.9 % to the CTV. The highest dose to 2cc of duodenal volume was 27.5Gy (RBE). The volume of the stomach receiving ⩾30Gy (RBE) was <7.0cc in all patients. All metrics for OARs satisfied dose constraints. CONCLUSION: Dose to the CTV was covered sufficiently by the 4DCT-generated FTV, and dose to OARs was reduced by 4DCT-generated FOAR. This methodology may prevent adverse reactions while preserving local tumour control.

Comparison of carbon-ion passive and scanning irradiation for pancreatic cancer.

PURPOSE: To compare carbon-ion beam dose distribution between passive and scanning radiation therapies for locally advanced pancreatic cancer. MATERIALS AND METHODS: Thirteen pancreatic cancer patients were included in this study. Four types of treatment planning with respiratory gating were calculated for each patient: a four-field box with passive irradiation (Plan 1), scanning irradiation (Plan 2), a three-field (150°, 180° and 210°) protocol with passive irradiation (Plan 3), and scanning irradiation (Plan 4). The irradiation plans each delivered 55.2Gy (RBE) to the planning target volume (PTV) and were compared with respect to doses to the PTV and organs at risk (OARs). RESULTS: Plan 3 exceeded the dose assessment metrics to the spinal cord. Scanning irradiation plans (Plan 2 and, particularly, Plan 4) offered significantly reduced dosage to the stomach and the duodenum compared with passive irradiation. CONCLUSION: Three-field oblique scanning irradiation for pancreatic cancer has the potential to reduce gastrointestinal exposure and influence of peristalsis on dose distribution.

Definitive radiotherapy for early-stage hypopharyngeal squamous cell carcinoma.

The present study analyzed the outcomes of patients with early-stage hypopharyngeal squamous cell carcinoma (HPSCC) treated with radical radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). We retrospectively reviewed the clinical records of 33 patients with early-stage HPSCC who underwent RT or CCRT between January 1999 and December 2011. Of the 33 patients who were treated, 12 had Stage I and 21 had Stage II disease. Patients with Stage I were typically treated with RT, while patients with Stage II were treated with CCRT (concurrent chemotherapy: 5FU, cisplatin or TS-1). The median follow-up period was 81 months, ranging from 15 to 155 months. The 5-year overall survival rates, cause specific survival rates, locoregional control rates, and progression-free survival rates were 58, 75, 56, and 49 %, respectively. Of the 33 patients, 51 % experienced second primary malignancies. Esophageal carcinoma occurred in several cases, and was diagnosed either during screening after treatment for the second primary malignancy or simultaneously with the second primary malignancy. Advanced-stage second malignancies significantly influenced the survival of the patients and the control rate for HPSCC. Treatment emphasizing the quality of life after treatment is needed, if a poor prognosis is expected because of advanced-stage second primary malignancy.

[Heavy ion radiotherapy for recurrence of an esophageal primary malignant melanoma].

A 55-year-old man, with a prior diagnosis of primary malignant melanoma of the esophagus, had undergone esophagectomy 6 years prior. During the postoperative follow-up, a flat tumor with black pigmentation, about 2 cm in diameter, was detected during upper gastrointestinal endoscopy. A pathological examination of the biopsy specimen showed a recurrent malignant melanoma. He underwent heavy ion radiotherapy for the tumor, and it disappeared after 6 months. Subsequently, a mediastinal lymph node metastasis was detected a year after radiotherapy. He received heavy ion radiotherapy for that tumor, and it was reduced in size a year after radiotherapy. At present, the patient is alive, 13 years after the initial radiotherapy. Although malignant melanoma is generally considered to be a radioresistant cancer, heavy ion radiotherapy led to a favorable outcome. This is the first reported case of heavy ion radiotherapy for treating the recurrence of a primary malignant melanoma of the esophagus.

Phase I study of weekly docetaxel and cisplatin arterial infusion for recurrent head and neck cancer.

BACKGROUND: We planned a phase I study of weekly arterial infusion of docetaxel and cisplatin via a superficial temporal artery for recurrent head and neck cancer to determine the optimal dose. METHODS: The dose of cisplatin was fixed and the dose of docetaxel was escalated from 8 mg/m(2) , with an increase of 2 mg/m(2) per step, to identify the maximum tolerated dose (MTD). In total, 4 courses of weekly chemotherapy were administered. RESULTS: Twelve patients were recruited to this trial. The MTD of docetaxel was 14 mg/m(2) . At this dose level, dose-limiting toxicity was observed in 2 of 3 patients. One patient experienced grade 3 leukopenia, while the other experienced grade 3 leukopenia. Myelosuppression was the dose-limiting toxicity for this regimen. CONCLUSION: The recommended dose for weekly arterial infusion of docetaxel was identified as 12 mg/m(2) combined with weekly cisplatin at 40 mg/m(2) , with 4 courses of each.

A new method using MRI to delineate areas of head and neck cancer targeted by intra-arterial infusion via a superficial temporal artery.

To determine whether anticancer drugs delivered via arterial infusion can permeate entire tumors using a new MRI flow check method. We infused 20 ml of contrast medium (2 ml of Gd-GDPA plus 18 ml of normal saline) over a period of 10 min using a continuous injection pump, then immediately performed MRI using a 1.5 T unit. Images were obtained in 5-mm-thick continuous sections in two or three planes (axial, coronal, and sagittal) depending on the extent of the tumor, and enhanced fast gradient echo 3 D (EFGRE3D) images with a special inversion at lipids were photographed using a neurovascular array coil. The new MRI flow check method delineated an area of tongue cancer perfused with drugs more accurately than conventional methods.The MRI flow check method provides accurate information about areas of arterial infusion.