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Annual Report 2020

Department of Radiation Oncology

Jun Itami, Hiroshi Igaki, Yuko Nakayama, Naoya Murakami, Kae Okuma, Koichi Inaba, Kana Takahashi, Tairo Kashihara, Tomoya Kaneda, Ayaka Takahashi, Satoshi Shima, Yuri Shimizu

Introduction

 The role of our department is to provide state-of-the-art radiation therapy to all patients who need it, 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-based neutron irradiation system for boron neutron capture therapy (BNCT) has been installed in the hospital; an epithermal neutron beam was obtained in August of 2015 and the neutron facility passed the governmental inspection concerning radiation leakage. The stability of the neutron irradiation system for BNCT has been established and a clinical trial for the governmental approval of the system is ongoing. Additionally, an MR-guided radiation therapy system (MRIdian) has been introduced for the first time in Japan in our department. After strict acceptance and commissioning procedures, MRIdian is used mainly for online adaptive radiation therapy for abdominal or pelvic tumors.

The Team and What We Do

 Our department treats the largest number of radiation oncology patients in Japan. Four linear accelerators, CyberKnife, MRIdian, four XCT-simulators, and 15 treatment planning computers are working together in online networks to provide state-of-the-art high-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 routinely performed. Stereotactic brain irradiation is performed with CyberKnife in the treatment of metastatic as well as primary brain tumors. Stereotactic body radiation therapies are performed for lung and liver tumors under respiratory gating in linear accelerators or CyberKnife. All linear accelerators have on-board kilovoltage CT imagers, which help to precisely align patient and tumor coordinates. These image-guided radiation therapy (IGRT) facilities enable the precise delivery of IMRT in head and neck cancers, brain tumors, prostate cancers, postoperative cervical cancers, and others. Gold marker fiducials have been implanted to improve the geometric precision of radiation field reproducibility. MRIdian, which is a fusion system of MRI and a radiation therapy machine, is used mainly for pancreatic cancer and other upper abdominal cancers. Brachytherapy is also intensively performed to improve local control, and many patients are referred to us 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-198 grains; and Ru-106 eye plaques. The number of patients undergoing HDR brachytherapy continues to rise. HDR interstitial irradiation is performed mainly in gynecological, genitourinary, and head and neck tumors. Additionally, there are two beds in the shielded ward on Floor 13B. Ru-106 mold therapy is performed in collaboration with ophthalmologists to treat retinoblastomas and choroidal melanomas. LDR interstitial implants are carried out using Au-198 grains for the management of head and neck tumors and gynecological malignancies. The number of patients treated in our department are shown in Table 1.

Table 1.
Table 1.

Table 1.
Table 1.

Research activities

 Clinical research is an indispensable part of the daily activities of our department. The primary interests of the research activities of the department are as follows: (1) an optimal fractionation regimen for 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 an accelerator-based BNCT system.

Clinical trials

  • Many clinical trials are ongoing, as shown below.
  • JCOG studies for lung cancers, head and neck cancers, gynecological cancer, brain tumors, esophageal cancers
  • International NRG studies for breast cancer and meningioma
  • International Study of Ophthalmic Radiation Therapy Toxicity
  • Phase I clinical trial of BNCT for melanoma and angiosarcoma of the skin
  • Development of an Adaptive Radiation Therapy System
  • Multi-institutional phase I/II trial of hybrid brachytherapy for cervical cancer
  • Other many multi- or single-institutional clinical trials are also ongoing or in preparation.

Education

 Four residents are trained in all fields of radiation oncology. Seminars on biology, physics, and clinical radiation oncology are regularly held during the evening.

Future Prospects

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

List of papers published in 2020

Journal

1. Kobayashi K, Yoshimoto S, Ando M, Matsumoto F, Murakami N, Omura G, Honma Y, Matsumoto Y, Ikeda A, Sakai A, Eguchi K, Ito A, Ryo E, Yatabe Y, Mori T. Full-coverage TP53 deep sequencing of recurrent head and neck squamous cell carcinoma facilitates prognostic assessment after recurrence. Oral Oncol, 113:105091, 2021

2. Kashihara T, Nakayama Y, Ito K, Kubo Y, Okuma K, Shima S, Nakamura S, Takahashi K, Inaba K, Murakami N, Igaki H, Ohe Y, Kusumoto M, Itami J. Usefulness of Simple Original Interstitial Lung Abnormality Scores for Predicting Radiation Pneumonitis Requiring Steroidal Treatment After Definitive Radiation Therapy for Patients With Locally Advanced Non-Small Cell Lung Cancer. Adv Radiat Oncol, 6:100606, 2021

3. Takamizawa S, Honma Y, Murakami N, Mori T, Oka H, Yamamoto S, Kashihara T, Ito K, Kubo Y, Ikeda A, Matsumoto F, Omura G, Kobayashi K, Itami J, Kato K, Yoshimoto S. Short-term outcomes of induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) in locally advanced nasopharyngeal carcinoma. Invest New Drugs, 39:564-570, 2021

4. Murakami N, Nakamura S, Kashihara T, Inaba K, Kaneda T, Takahashi K, Okuma K, Igaki H, Itami J. Increased number of prostate cancer patients selecting high dose-rate interstitial brachytherapy during the COVID-19 pandemic. Radiother Oncol, 154:274-275, 2021

5. Murakami N, Mori T, Machida R, Kodaira T, Ito Y, Shikama N, Konishi K, Matsumoto Y, Murakami Y, Nakamura N, Yamashita H, Yorozu A, Yoshimura M, Inoue K, Nozaki M, Ishikura S, Itami J, Nishimura Y, Kagami Y. Prognostic Value of Epithelial Cell Adhesion Molecules in T1-2N0M0 Glottic Cancer. Laryngoscope, 131:1522-1527, 2021

6. Kobayashi K, Murakami N, Takahashi K, Inaba K, Igaki H, Hamamoto R, Itami J. Tensor Regression-based Model to Investigate Heterogeneous Spatial Radiosensitivity After I-125 Seed Implantation for Prostate Cancer. In Vivo, 35:489-497, 2021

7. Takayanagi D, Hirose S, Kuno I, Asami Y, Murakami N, Matsuda M, Shimada Y, Sunami K, Komatsu M, Hamamoto R, Kato MK, Matsumoto K, Kohno T, Kato T, Shiraishi K, Yoshida H. Comparative Analysis of Genetic Alterations, HPV-Status, and PD-L1 Expression in Neuroendocrine Carcinomas of the Cervix. Cancers (Basel), 13:2021

8. Murakami N, Omura G, Yatsuoka W, Okamoto H, Yoshimoto S, Ueno T, Itami J. Hybrid Intracavitary-Interstitial brachytherapy in a case of nasal vestibule cancer penetrating the hard palate. BJR Case Rep, doi.org/10.1259/bjrcr.20200178 , 2021

9. Ohtsuka M, Hamada T, Miyagaki T, Shimauchi T, Yonekura K, Kiyohara E, Fujita H, Izutsu K, Okuma K, Kawai K, Koga H, Sugaya M. Outlines of the Japanese guidelines for the management of primary cutaneous lymphomas 2020. J Dermatol, 48:e49-e71, 2021

10. Yogo K, Noguchi Y, Okudaira K, Nozawa M, Ishiyama H, Okamoto H, Yasuda H, Oguchi H, Yamamoto S. Source position measurement by Cherenkov emission imaging from applicators for high-dose-rate brachytherapy. Med Phys, 48:488-499, 2021

11. Su C, Okamoto H, Nishioka S, Sakasai T, Fujiyama D, Miura Y, Tsunoda Y, Kuwahara J, Nakamura S, Iijima K, Chiba T, Kaga K, Takemori M, Nakayama H, Katsuta S, Inaba K, Igaki H, Nakayama Y, Itami J. Dosimetric effect of the intestinal gas of online adaptive stereotactic body radiotherapy on target and critical organs without online electron density correction for pancreatic cancer. Br J Radiol, 94:20200239, 2021

12. Okamoto H, Kito S, Tohyama N, Yonai S, Kawamorita R, Nakamura M, Fujimoto T, Tani S, Yomoda A, Isobe T, Furukawa H, Kotaka K, Itami J, Ikushima H, Dokiya T, Shioyama Y. Radiation protection in radiological imaging: a survey of imaging modalities used in Japanese institutions for verifying applicator placements in high-dose-rate brachytherapy. J Radiat Res, 62:58-66, 2021

13. Iijima K, Murakami N, Nakamura S, Nishioka S, Chiba T, Kuwahara J, Takemori M, Nakayama H, Kashihara T, Okuma K, Takahashi K, Inaba K, Igaki H, Okamoto H, Itami J. Configuration analysis of the injection position and shape of the gel spacer in gynecologic brachytherapy. Brachytherapy, 20:95-103, 2021

14. Iijima K, Murakami N, Okamoto H, Nakamura S, Nishioka S, Chiba T, Kuwahara J, Nakayama H, Takemori M, Aikawa A, Yoshihiro S, Kashihara T, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. A dosimetric and centeredness comparison of the conventional and novel endobronchial applicators: A preliminary study. Brachytherapy, 20:467-477, 2021

15. Yokoyama K, Murakami N, Takahashi A, Kobayashi K, Igaki H, Itami J. Radiotherapy-Induced Autoeczematization. Pract Radiat Oncol, 2021

16. Kashihara T, Nakamura S, Murakami N, Ito K, Matsumoto Y, Kobayashi K, Omura G, Mori T, Honma Y, Kubo Y, Okamoto H, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Kato K, Matsumoto F, Yoshimoto S, Itami J. Initial Experience of Intentional Internal High-Dose Policy Volumetric Modulated Arc Therapy of Neck Lymph Node Metastases ≧ 2 cm in Patients With Head and Neck Squamous Cell Carcinoma. Front Oncol, 11:651409, 2021

17. Fujimoto T, Suzuki M, Kuratsu S, Fujita I, Morishita M, Sudo T, Sakuma T, Nakamatsu Y, Sakurai Y, Takata T, Tamari Y, Tanaka H, Masunaga SI, Kinashi Y, Kondo N, Sakakibara S, Igaki H, Andoh T, Sakamoto S, Kawamoto T, Watabe T, Hara H, Fukase N, Kawakami Y, Matsumoto T, Akisue T, Ono K, Ichikawa H, Kuroda R, Hirose T. BNCT for primary synovial sarcoma. Appl Radiat Isot, 169:109407, 2021

18. Tsuchida K, Inaba K, Kashihara T, Murakami N, Okuma K, Takahashi K, Igaki H, Nakayama Y, Maejima A, Shinoda Y, Matsui Y, Komiyama M, Fujimoto H, Ito Y, Sumi M, Nakano T, Itami J. Clinical outcomes of definitive whole pelvic radiotherapy for clinical lymph node metastatic prostate cancer. Cancer Med, 9:6629-6637, 2020

19. Kashihara T, Inaba K, Komiyama M, Nakayama H, Iijima K, Nishioka S, Okamoto H, Kikkawa N, Kubo Y, Shima S, Nakamura S, Takahashi A, Takahashi K, Okuma K, Murakami N, Igaki H, Nakayama Y, Fukunaga A, Matsui Y, Fujimoto H, Itami J. The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report. BMC Urol, 20:196, 2020

20. Murakami N, Nakamura S, Kashihara T, Kato T, Shibata Y, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Galalae R, Itami J. Hyaluronic acid gel injection in rectovaginal septum reduced incidence of rectal bleeding in brachytherapy for gynecological malignancies. Brachytherapy, 19:154-161, 2020

21. Shoji M, Inaba K, Itami J, Hamada M, Okamoto H, Iwasa T, Ushigusa T, Yoshida M, Matsuyama TA, Otsuka T, Kumagai K, Hirao K, Maguire P, Qian P, Gardner E, Zei PC. Advantages and challenges for noninvasive atrial fibrillation ablation. J Interv Card Electrophysiol, 2020

22. Igaki H, Nakamura S, Kurihara H, Abe Y, Nishioka S, Fujii R, Nakamura M, Nakayama Y, Morita T, Okamoto H, Imahori Y, Itami J. Comparison of (18)FBPA uptake with (18)FDG uptake in cancer patients. Appl Radiat Isot, 157:109019, 2020

23. Hirose S, Murakami N, Takahashi K, Kuno I, Takayanagi D, Asami Y, Matsuda M, Shimada Y, Yamano S, Sunami K, Yoshida K, Honda T, Nakahara T, Watanabe T, Komatsu M, Hamamoto R, Kato MK, Matsumoto K, Okuma K, Kuroda T, Okamoto A, Itami J, Kohno T, Kato T, Shiraishi K, Yoshida H. Genomic alterations in STK11 can predict clinical outcomes in cervical cancer patients. Gynecol Oncol, 156:203-210, 2020

24. Murakami N, Mori T, Kubo Y, Yoshimoto S, Ito K, Honma Y, Ueno T, Kobayashi K, Okamoto H, Boku N, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Itami J. Prognostic impact of immunohistopathologic features in definitive radiation therapy for nasopharyngeal cancer patients. J Radiat Res, 61:161-168, 2020

25. Honma Y, Nagashima K, Hirano H, Shoji H, Iwasa S, Takashima A, Okita N, Kato K, Boku N, Murakami N, Inaba K, Ito Y, Itami J, Kanamori J, Oguma J, Daiko H. Clinical outcomes of locally advanced esophageal neuroendocrine carcinoma treated with chemoradiotherapy. Cancer Med, 9:595-604, 2020

26. Bei Y, Murakami N, Nakayama Y, Okuma K, Kashihara T, Raturi VP, Okamoto H, Takahashi K, Inaba K, Igaki H, Itami J. Stereotactic body radiation therapy for early-stage non-small-cell lung cancer in octogenarians and older: an alternative treatment. J Radiat Res, 61:586-593, 2020

27. Masui K, Yamazaki H, Suzuki G, Shimizu D, Kawabata K, Noguchi N, Takenaka T, Yoshida K, Murakami N, Naito M, Yamamoto T, Kanamura N, Komori S, Oshita A, Asai J, Yamada K. High dose rate interstitial brachytherapy for early stage lip cancer using customized dental spacer. J Radiat Res, 61:506-510, 2020

28. Murakami N, Igaki H, Okamoto H, Kashihara T, Kaneda T, Takahashi K, Inaba K, Okuma K, Itami J. Preparation for the COVID-19 pandemic in the department of radiation oncology in the National Cancer Center Hospital in Tokyo. J Radiat Res, 61:635-637, 2020

29. Murakami N, Cheng G, Yoshimoto S, Itami J. Image-guided interstitial brachytherapy boost for nasopharyngeal carcinoma: technical aspects. J Contemp Brachytherapy, 12:294-302, 2020

30. Murakami N, Yoshimoto S, Uematsu M, Kashihara T, Takahashi K, Inaba K, Okuma K, Igaki H, Nakayama Y, Masui K, Yoshida K, Itami J. Image-guided interstitial brachytherapy boost for keratinizing squamous cell carcinoma of inferior wall of the nasopharynx. BJR Case Rep, 6:20200005, 2020

31. Karube M, Murakami N, Okamoto H, Okuma K, Kashihara T, Takahashi K, Kaneda T, Inaba K, Igaki H, Kato T, Itami J. Transvaginal artificial ascites infusion as a spacer in gynecological brachytherapy: a novel technique. J Contemp Brachytherapy, 12:487-491, 2020

32. Nishio T, Nakamura M, Okamoto H, Kito S, Minemura T, Ozawa S, Kumazaki Y, Ishikawa M, Tohyama N, Kurooka M, Nakashima T, Shimizu H, Suzuki R, Ishikura S, Nishimura Y. An overview of the medical-physics-related verification system for radiotherapy multicenter clinical trials by the Medical Physics Working Group in the Japan Clinical Oncology Group-Radiation Therapy Study Group. J Radiat Res, 61:999-1008, 2020

33. Takada M, Nunomiya T, Masuda A, Matsumoto T, Tanaka H, Nakamura S, Endo S, Nakamura M, Aoyama K, Ueda O, Narita M, Nakamura T. Characterization of a real-time neutron detector for boron neutron capture therapy using a thin silicon diode. Radiat Meas, 137:106381, 2020

34. Kajikawa T, Kadoya N, Tanaka S, Nemoto H, Takahashi N, Chiba T, Ito K, Katsuta Y, Dobashi S, Takeda K, Yamada K, Jingu K. Dose distribution correction for the influence of magnetic field using a deep convolutional neural network for online MR-guided adaptive radiotherapy. Phys Med, 80:186-192, 2020

35. Kashihara T, Kobayashi K, Iijima K, Murakami N, Yoshida K, Okuma K, Nakamura S, Takahashi K, Inaba K, Igaki H, Nakayama Y, Kato T, Uno T, Itami J. A case report of a patient with bulky uterine cervical neoplasm who achieved complete response with "intentional internal high-dose policy" high-dose-rate interstitial brachytherapy. Medicine (Baltimore), 99:e20860, 2020

36. Nakata M, Yoshida K, Shimbo T, Yoshikawa N, Yoshioka H, Hori A, Sato C, Uesugi Y, Kogata Y, Masui K, Murakami N, Kashihara T, Akiyama H, Tselis N, Ohmichi M, Nihei K. High-dose-rate interstitial brachytherapy with hypoxic radiosensitizer KORTUC II for unresectable pelvic sidewall recurrence of uterine cervical cancer: a case report. J Contemp Brachytherapy, 12:606-611, 2020

37. Itami J. Modern development of high-dose-rate brachytherapy. Jpn J Clin Oncol, 50:490-501, 2020

38. Umezawa R, Ito Y, Wakita A, Nakamura S, Okamoto H, Takahashi K, Inaba K, Murakami N, Igaki H, Jingu K, Itami J. How Much Was the Elective Lymph Node Region Covered in Involved-Field Radiation Therapy for Locally Advanced Pancreatic Cancer? Evaluation of Overlap Between Gross Target Volume and Celiac Artery-Superior Mesenteric Artery Lymph Node Regions. Adv Radiat Oncol, 5:377-387, 2020

39. Yokomichi H, Inozume T, Wada M, Asai J, Igaki H, Namikawa K, Hayashi A, Fukushima S, Fujimura T, Koga H, Nakamura Y, Mochizuki M, Yamagata Z. Concordance and Discordance Rates of V-Raf Murine Sarcoma Viral Oncogene Homolog B1 (BRAF)(V600E) Status in Metastatic against Primary Lesion of Melanoma: A Meta-analysis. JMA J, 3:274-279, 2020

40. Yoshida K, Kotsuma T, Akiyama H, Yamazaki H, Takenaka T, Masui K, Tsujimoto Y, Murakami N, Uesugi Y, Shimbo T, Yoshikawa N, Yoshioka H, Nakata M, Arika T, Takaoka Y, Tanaka E, Tselis N. A new implant device to prevent edema-associated underdosage in high-dose-rate interstitial brachytherapy of mobile tongue cancer. J Contemp Brachytherapy, 11:573-578, 2019