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Annual Report 2018

Department of Radiation Oncology

Jun Itami, Yuko Nakayama, Hiroshi Igaki, Naoya Murakami, Kae Okuma, Koichi Inaba, Kana Takahashi, Tairo Kashihara, Satoshi Shima, Hiroyuki Okamoto, Satoshi Nakamura, Shie Nishioka, Kotaro Iijima

Introduction

 The role of the department is to provide state-of-the-art radiation therapy to all the patients, to educate and develop the expertise of radiation oncologists, radiation technologists, and medical physicists, and to lead new developments in radiation oncology in Japan as well as worldwide. All departmental activities are dedicated to cancer patients. A linear accelerator for the hospital-based boron neutron capture therapy (BNCT) was installed in the new facility; an epithermal neutron beam had already been obtained in August 2015 and the neutron facility passed the governmental inspection concerning radiation leakage. Now the stability of the BNCT accelerator has been established and physical and biological experiments are under way. Additionally, an MRI-guided radiation therapy machine (MRIdian) was introduced for the first time in Japan in our department. After strict acceptance and commissioning procedures, MRIdian is used mainly for abdominal tumors.

The Team and What We Do

 The Department is one of the biggest radiation oncology departments in Japan. Four linear accelerators, CyberKnife, MRIdian, four XCT-simulators, and 15 treatment planning computers are working together under online networks to provide state-of-art precision external beam radiation therapy. In addition to the conventional X-ray and electron therapies, stereotactic irradiations of brain and body tumors and intensity-modulated radiation therapy (IMRT) are performed routinely. Stereotactic brain irradiation is performed with CyberKnife in the treatment of metastatic as well as primary brain tumors. Stereotactic body tumor irradiation is performed in lung and liver tumors under respiratory gating in linear accelerators or CyberKnife. All linear accelerators have onboard kilovoltage CT imagers, which help to align patient and tumor coordinates precisely. These image guided radiation therapy (IGRT) facilities enable the precise delivery of IMRT in head and neck cancers, brain tumors, prostate cancers, and postoperative cervical cancers. Gold marker fiducials have been implanted to improve geometric precision of radiation field reproducibility. MRIdian, which is the fusion of MRI and a radiation therapy machine, is used mainly for pancreatic cancer, and other upper abdominal cancers. Brachytherapy is also performed very intensively to improve local control and many patients are referred to from all over Japan. For brachytherapy the following modalities are being employed, an Ir-192 high dose rate (HDR) after-loading system including dedicated CT simulator and fluoroscopy, an I-125 seed implantation system, and other low dose rate (LDR) brachytherapy systems using Au grains, and ruthenium eye plaques. The number of patients undergoing HDR brachytherapy continued to rise constantly. This department is the only institution in Tokyo where HDR interstitial as well as intracavitary irradiations can be performed. The HDR interstitial radiation is performed mainly in gynecological, genitourinary, and head and neck tumors. Additionally, there are two beds in the shielded ward in Floor 13B. Ruthenium mold therapy is performed by ophthalmologists to treat retinoblastomas and choroidal melanomas. LDR interstitial implants are carried out by radiation oncologists using Au-198 grains for the management of head and neck tumors and gynecological malignancies.

Research activities

 Clinical research is an indispensable part of the daily activities of the department. The primary interests of the research activities of the department are 1) an optimal fractionation regimen for the pain palliation of bone metastasis; 2) the safety and feasibility of shortened fractionation regimen for various malignancies, especially for breast cancer and vocal cord cancer; 3) Image-guided HDR and LDR brachytherapy for genitourinary and gynecologic cancers; 4) hypofractionated stereotactic irradiation of brain and body tumors; 5) adaptive radiation therapy in accordance with the intratherapeutic tumor and normal tissue change by MRIdian and 6) Development of accelerator based BNCT system.

Clinical trials

  • Metastatic brain tumor: Phase II trial of hippocampal sparing IMRT
  • Lung cancer: Various JCOG studies
  • Lung cancer: Stereotactic radiation therapy for histologically non-verified lung tumors.
  • Pediatrics: Phase II clinical trial on multimodality therapy in localized Ewing sarcomas and related tumors (JESS 04).
  • Head and neck cancers: Various JCOG studies including IMRT for nasopharyngeal and oropharyngeal cancers
  • Breast cancer: Phase II trial of SAVI applicator HDR brachytherapy after partial mastectomy.
  • Liver cancer: Phase I trial on stereotactic hypofractionated radiation to hepatocellular carcinoma.
  • Cervical cancer: Phase I/II trial of hybrid brachytherapy of cervical cancer
  • Development of an Adaptive Radiation Therapy System

Education

 Four residents are trained in all fields of radiation oncology except particle beam therapy. Seminars about biology, physics, and clinical radiation oncology are regularly held during the evening. This year, trainees from China and Chile studied and researched in the Department.

Future prospects

 With the expanding indications of radiation therapy, further manpower will be required and research perspectives will be considerably widened. Radiation oncology is one of the most promising disciplines in oncology.

Table 1. Number of Patients undergoing Radiation Therapy
Table 1. Number of Patients undergoing Radiation Therapy

Table 1. Number of Patients undergoing Radiation Therapy
Table 1. Number of Patients undergoing Radiation Therapy(Full Size)

List of papers published in 2018

Journal

 1. Murakami N, Kobayashi K, Shima S, Tsuchida K, Kashihara T, Tselis N, Umezawa R, Takahashi K, Inaba K, Ito Y, Igaki H, Nakayama Y, Masui K, Yoshida K, Kato T, Itami J. A hybrid technique of intracavitary and interstitial brachytherapy for locally advanced cervical cancer: initial outcomes of a single-institute experience. BMC Cancer, 19:221, 2019

 2. Murakami N, Shima S, Kashihara T, Tselis N, Kato T, Takagawa Y, Masui K, Yoshida K, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction. J Contemp Brachytherapy, 11:1-7, 2019

 3. Okamoto H, Nishioka S, Iijima K, Nakamura S, Sakasai T, Miura Y, Takemori M, Nakayama H, Morishita Y, Shimizu M, Abe Y, Igaki H, Nakayama Y, Itami J. Monte Carlo modeling of a 60Co MRI-guided radiotherapy system on Geant4 and experimental verification of dose calculation under a magnetic field of 035 T. J Radiat Res, 60:116-123, 2019

 4. Kashihara T, Murakami N, Iizumi S, Sakamoto Y, Nakamura S, Iijima K, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Okusaka T, Uno T, Itami J. Hemorrhage from Ascending Colon and Gluteal Muscle Associated with Sorafenib and Radiation Therapy: Radiation Dose Distribution Corresponded with Colonoscopy Findings and Computed Tomography Images. Pract Radiat Oncol, 2019

 5. Murakami N, Arai Y, Takagawa Y, Okuma K, Takahashi K, Inaba K, Igaki H, Nakayama Y, Itami J. Inferior vena cava syndrome caused by retroperitoneal fibrosis after pelvic irradiation: A case report. Gynecol Oncol Rep, 27:19-21, 2019

 6. Kasamatsu T, Ishikawa M, Murakami N, Okada S, Ikeda SI, Kato T, Itami J. Identifying selection criteria for non-radical hysterectomy in FIGO stage IB cervical cancer. J Obstet Gynaecol Res, 45:882-891, 2019

 7. Watanabe S, Honma Y, Murakami N, Igaki H, Mori T, Hirano H, Okita N, Shoji H, Iwasa S, Takashima A, Kato K, Kobayashi K, Matsumoto F, Yoshimoto S, Itami J, Boku N. Induction chemotherapy with docetaxel, cisplatin and fluorouracil followed by concurrent chemoradiotherapy for unresectable sinonasal undifferentiated carcinoma: Two cases of report. World J Clin Cases, 7:765-772, 2019

 8. Nakamura S, Igaki H, Okamoto H, Wakita A, Ito M, Imamichi S, Nishioka S, Iijima K, Nakayama H, Takemori M, Kobayashi K, Abe Y, Okuma K, Takahashi K, Inaba K, Murakami N, Nakayama Y, Nishio T, Masutani M, Itami J. Dependence of neutrons generated by 7Li(p,n) reaction on Li thickness under free-air condition in accelerator-based boron neutron capture therapy system employing solid-state Li target. Phys Med, 58:121-130, 2019

 9. Sekii S, Ito Y, Harada K, Kitaguchi M, Takahashi K, Inaba K, Murakami N, Igaki H, Sasaki R, Itami J. Intrafraction esophageal motion in patients with clinical T1N0 esophageal cancer. Rep Pract Oncol Radiother, 23:398-401, 2018

10. Yoshida K, Otani Y, Nose T, Yoden E, Asahi S, Tsukiyama I, Dokiya T, Saeki T, Fukuda I, Sekine H, Kumazaki Y, Takahashi T, Kotsuma T, Masuda N, Nakashima K, Matsumura T, Nakagawa S, Tachiiri S, Moriguchi Y, Itami J, Oguchi M. Case report of a dose-volume histogram analysis of rib fracture after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study. J Contemp Brachytherapy, 10:274-278, 2018

11. Toita T, Ohno T, Ikushima H, Nishimura T, Uno T, Ogawa K, Onishi H, Dokiya T, Itami J. National survey of intracavitary brachytherapy for intact uterine cervical cancer in Japan. J Radiat Res, 59:469-476, 2018

12. Okamoto H, Minemura T, Nakamura M, Mizuno H, Tohyama N, Nishio T, Wakita A, Nakamura S, Nishioka S, Iijima K, Fujiyama D, Itami J, Nishimura Y. Establishment of postal audit system in intensity-modulated radiotherapy by radiophotoluminescent glass dosimeters and a radiochromic film. Phys Med, 48:119-126, 2018

13. Umezawa R, Inaba K, Nakamura S, Wakita A, Okamoto H, Shima S, Tsuchida K, Kashihara T, Kobayashi K, Harada K, Takahashi K, Murakami N, Ito Y, Igaki H, Jingu K, Itami J. Long-term Results of External Beam Radiotherapy for Prostate Cancer with Prostate-specific Antigen of More Than 50 ng/ml and Without Evidence of Lymph Node or Distant Metastasis. Anticancer Res, 38:2303-2309, 2018

14. Okamoto H, Murakami N, Carvajal CC, Miura Y, Wakita A, Nakamura S, Nishioka S, Iijima K, Inaba K, Ito Y, Kato T, Toita T, Itami J. Positional uncertainty of vaginal cuff and feasibility of implementing portable bladder scanner in postoperative cervical cancer patients. Phys Med, 45:1-5, 2018

15. Kashihara T, Nakamura S, Wakita A, Okamoto H, Inaba K, Umezawa R, Shima S, Tsuchida K, Kobayashi K, Takahashi K, Murakami N, Ito Y, Igaki H, Fujimoto H, Uno T, Itami J. Importance of the site of positive surgical margin in salvage external beam radiation therapy for biochemical recurrence of prostate cancer after radical prostatectomy. Cancer Med, 7:1723-1730, 2018

16. Yamaguchi T, Kato K, Nagashima K, Iwasa S, Honma Y, Takashima A, Hamaguchi T, Ito Y, Itami J, Boku N, Higuchi K. Type of second primary malignancy after achieving complete response by definitive chemoradiation therapy in patients with esophageal squamous cell carcinoma. Int J Clin Oncol, 23:652-658, 2018

17. Yoshimoto M, Honda N, Kurihara H, Hiroi K, Nakamura S, Ito M, Shikano N, Itami J, Fujii H. Non-invasive estimation of 10B-4-borono-L-phenylalanine-derived boron concentration in tumors by PET using 4-borono-2-18F-fluoro-phenylalanine. Cancer Sci, 109:1617-1626, 2018

18. Kobayashi K, Matsumoto F, Miyakita Y, Mori T, Shimoi T, Murakami N, Yoshida A, Arakawa A, Omura G, Fukasawa M, Matsumoto Y, Matsumura S, Itami J, Narita Y, Yoshimoto S. Impact of Surgical Margin in Skull Base Surgery for Head and Neck Sarcomas. J Neurol Surg B Skull Base, 79:437-444, 2018

19. Oashi K, Namikawa K, Tsutsumida A, Takahashi A, Itami J, Igaki H, Inaba K, Yamazaki N. Surgery with curative intent is associated with prolonged survival in patients with cutaneous angiosarcoma of the scalp and face -a retrospective study of 38 untreated cases in the Japanese population. Eur J Surg Oncol, 44:823- 829, 2018

20. Murakami N, Ueno T, Yatsuoka W, Okamoto H, Tselis N, Masui K, Yoshida K, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. Dose coverage comparison between "interstitial catheter-only" and "hybrid intracavitary-interstitial brachytherapy" for early stage squamous cell carcinoma of the buccal mucosa. J Contemp Brachytherapy, 10:486-491, 2018

Book

1. Yoshioka Y, Itami J, Oguchi M, Nakano T (ed), Brachytherapy: Techniques and Evidences, Singapore, Springer Singapore, 2019