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Annual Report 2024

II. Radiological Oncology

Tomonori Goka, Ako Aikawa, Miyuki Murata, Yoshihiro Shibata, Yusuke Watanabe, Tatsuya Sakasai, Junichi Kuwahara, Kazuyoshi Nabeoka, Takayuki Mori, Yusuke Miyamoto, Yuuto Tanaka, Sonoe Sawada, Yasunori Syutou, Yasunori Shuto, Midori Nonaka, Masataka Ueda, Yusaku Kasai, Ruka Hata, Yuka Kondo, Sayaka Shimoda, Koushin Arai, Amane Hashimoto, Homare Murata, Kanami Kimura, Touma Sasada

The Team and What We Do

  • We operate four general-purpose linear accelerator (LINAC) systems, one CyberKnife system, one MRIdian system for real-time adaptive radiation therapy (currently out of clinical service since November), and one sealed brachytherapy system. Additionally, we have two ExacTrac high-precision positioning support systems, which enhance our capacity for high-precision irradiation and improve treatment continuity through the parallel installation of identical systems.
  • Due to equipment renewal, the CyberKnife system was used for stereotactic radiotherapy in 98 patients-97 with head and neck tumors and 1 with a trunk lesion-during the period up to October.
  • Total body irradiation (TBI) was performed in 59 patients as part of bone marrow transplantation.
  • Sealed brachytherapy using ruthenium was performed in 11 patients.
  • High Dose Rate Remote After Loading System (RALS) therapy was performed in 134 patients, with 69 intracavitary treatments and 410 interstitial treatments, totaling 479 procedures.
  • A Phase II clinical trial of Boron Neutron Capture Therapy (BNCT) has been initiated.
  • In response to COVID-19, comprehensive infection control measures were enforced, and a business continuity plan was developed to ensure the safety and stability of clinical operations.

Education

  • Based on the educational program, we implemented rotations between the diagnostic and therapeutic technology units to deepen understanding of both departments' operations and to enhance technical breadth and responsiveness.
  • To improve the safety and accuracy of radiation therapy, one technologist was rotated to the Radiation Quality Control Unit. Through involvement in treatment planning and quality assurance tasks, the program promoted the acquisition of more specialized and practical knowledge and skills.
  • To review and improve operations, a training session was held focusing on the radiation therapy workflow. By thoroughly examining each step and streamlining the work process, the initiative contributed to accident prevention and improved procedural accuracy.
  • The radiological technologist residency program has entered its third year. This year, two new residents were recruited, and a three-year training program is being implemented to develop fundamental skills, advanced knowledge and techniques, as well as a professional attitude required of healthcare personnel. This initiative has proven effective in both accelerating readiness and fostering human resource development.

Future Prospects

  • We are actively cooperating to obtain regulatory approval for the BNCT system under the Pharmaceuticals and Medical Devices Act and to realize its early clinical application.
  • We are working to streamline quality control methods for the MRIdian system and to establish training approaches for operators, contributing to the safe and widespread adoption of radiation therapy.
  • We aim to further enhance the safety of treatments and procedures using high-dose-rate remote after loading systems (RALS), and to provide more precise and accurate therapy.
  • To ensure a stable clinical system, we plan to replace equipment that has been in use for over 10 years with newer models that reflect future technological trends, such as higher precision and adaptive radiation therapy.
  • We actively participate in clinical trials and studies in the field of radiation oncology, contributing to the advancement of treatment technologies and the improvement of safety.

List of papers published in 2024

Journal

1. Kashihara T, Nakamura S, Yamazaki N, Takahashi A, Namikawa K, Ogata D, Nakano E, Okuma K, Kaneda T, Mori T, Ito K, Itami J, Shimada K, Nakagama H, Igaki H. Boron neutron capture therapy for cutaneous angiosarcoma and malignant melanoma: First in-human phase I clinical trial. Radiotherapy and oncology, 202:110607, 2025

2. Takahashi K, Kagami Y, Yoshimura R, Morota M, Murakami N, Nakamura S, Okamoto H, Nagao A, Sakuramachi M, Kashihara T, Kaneda T, Inaba K, Okuma K, Nakayama Y, Itami J, Igaki H. Prospective study of once-daily accelerated partial breast irradiation using 3-dimensional conformal external beam radiotherapy for Japanese women: 12-year outcomes, toxicity, and cosmesis. Breast cancer (Tokyo, Japan), 32:197-207, 2025

3. Igaue S, Yamamoto S, Shiraishi K, Itoyama M, Imazeki H, Yokoyama K, Honma Y, Kashihara T, Kurita D, Ishiyama K, Oguma J, Daiko H, Kato K. Correlation Between Histopathological Response of Esophageal Squamous Cell Carcinoma to Neoadjuvant DCF Therapy and the Clinical Efficacy of Palliative Chemotherapy for Recurrence. Journal of gastrointestinal cancer, 56:60, 2025

4. Kobayashi Y, Nakamura S, Takemori M, Nakaichi T, Shuto Y, Ito K, Takahashi K, Kashihara T, Yonemura M, Endo H, Kunito K, Okamoto H, Chiba T, Nakayama H, Oshika R, Kishida H, Itami J, Kurihara H, Igaki H. Comparison of dose distribution with and without reflecting heterogeneous boron distribution using (18)F-BPA positron emission tomography in boron neutron capture therapy. Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine, 219:111720, 2025

5. Watanabe Y, Chen YW, Igaki H, Arakawa A, Tao K, Sugiyama M, Nakajima M, Shirakawa N, Yanagisawa S, Miyakita Y, Yoshida A, Isohashi K, Ono K, Narita Y, Ogawa C. Boron neutron capture therapy prolongs survival in a patient with a recurrent malignant peripheral nerve sheath tumor-A case report. Pediatric blood & cancer, 71:e31011, 2024

6. Kashihara T, Urago Y, Okamoto H, Takemori M, Nakayama H, Mikasa S, Nakaichi T, Iijima K, Chiba T, Kuwahara J, Nakamura S, Chang W, Matsui Y, Igaki H. A preliminary study on rectal dose reduction associated with hyaluronic acid implantation in brachytherapy for prostate cancer. Asian journal of urology, 11:286-293, 2024

7. Nakamura S, Takemori M, Nakaichi T, Shuto Y, Kashihara T, Iijima K, Chiba T, Nakayama H, Urago Y, Nishina S, Kobayashi Y, Kishida H, Imamichi S, Takahashi K, Masutani M, Okamoto H, Nishio T, Itami J, Igaki H. A method for delivering the required neutron fluence in an accelerator-based boron neutron capture therapy system employing a lithium target. Scientific reports, 14:11253, 2024

8. Okamoto H, Sakuramachi M, Yatsuoka W, Ueno T, Katsura K, Murakami N, Nakamura S, Iijima K, Chiba T, Nakayama H, Shuto Y, Takano Y, Kobayashi Y, Kishida H, Urago Y, Nishitani M, Nishina S, Arai K, Igaki H. A novel method for determining dose distribution on panoramic reconstruction computed tomography images from radiotherapy computed tomography. Imaging science in dentistry, 54:129-137, 2024

9. Okamoto H, Nonaka M, Chiba T, Kaneda T, Kobayashi Y, Nakamura S, Nakayama H, Iijima K, Shuto Y, Yonemura M, Oshika R, Kishida H, Urago Y, Nishitani M, Nishina S, Sakamoto T, Shibata Y, Goka T, Igaki H. Dosimetric impact of the respiratory motion of the liver dome in stereotactic body radiotherapy for spine metastasis: A planning study. Journal of applied clinical medical physics, 25:e14403, 2024

10. Kawaguchi Y, Watanabe Y, Miyakita Y, Ohno M, Ogawa C, Takahashi M, Yanagisawa S, Mukai T, Igaki H, Sugino H, Yoshida A, Narita Y. Successful treatment of pediatric patients with high-grade gliomas featuring leptomeningeal metastases by targeting BRAF V600E mutations with dabrafenib plus trametinib: two illustrative cases. International cancer conference journal, 13:256-262, 2024

11. Uezono H, Onoe T, Shikama N, Ono Y, Hirata H, Ito Y, Yasuda K, Imano N, Kikuchi K, Kashihara T, Kawamoto T, Nakamura N. Uptake of ultra-hypofractionated radiation therapy following breast-conserving surgery among patients with early-stage breast cancer: a multi-institutional questionnaire survey. Breast cancer (Tokyo, Japan), 31:1071-1079, 2024

12. Murata S, Horinouchi H, Morishita M, Kaku S, Shinno Y, Okuma Y, Yoshida T, Goto Y, Yamamoto N, Kashihara T, Okuma K, Kusumoto M, Ohe Y. Impact of Durvalumab on the Duration and Complexity of Corticosteroid Therapy for Pneumonitis After Chemoradiotherapy. Clinical lung cancer, 25:e369-e378.e3, 2024

13. Ohno M, Takahashi M, Yanagisawa S, Osawa S, Tsuchiya T, Fujita S, Igaki H, Narita Y. Development of a scoring system to predict local recurrence in brain metastases following complete resection and observation. Journal of neuro-oncology, 170:297-305, 2024

14. Tsuchiya T, Ohno M, Watanabe Y, Fujita S, Miyazaki B, Sugino H, Igaki H, Yoshida A, Takahashi M, Yanagisawa S, Osawa S, Ogawa C, Narita Y. Pediatric atypical teratoid/rhabdoid tumor in the cauda equina with rapid tumor progression: illustrative case. Journal of neurosurgery. Case lessons, 8:CASE24219, 2024

15. Nakamura S, Tanaka H, Kato T, Akita K, Takemori M, Kasai Y, Kashihara T, Takai Y, Nihei K, Onishi H, Igaki H. A national survey of medical staffs' required capability and workload for accelerator-based boron neutron capture therapy. Journal of radiation research, 65:712-724, 2024

16. Zenda S, Kashihara T, Saito T, Okamoto H, Kadoya N, Chiba T, Noda SE, Kawaguchi T, Jingu K, Shibuya K, Uno T, Igaki H. Two-fractionated stereotactic magnetic resonance-guided adaptive radiation therapy for patients with prostate cancer (SMART PRO trial): protocol for a confirmatory clinical trial. BMJ open, 14:e082899, 2024

17. Iijima K, Nakayama H, Nakamura S, Chiba T, Shuto Y, Urago Y, Nishina S, Kishida H, Kobayashi Y, Takatsu J, Kuwahara J, Aikawa A, Goka T, Kaneda T, Murakami N, Igaki H, Okamoto H. Analysis of human errors in the operation of various treatment planning systems over a 10-year period. Journal of radiation research, 65:603-618, 2024