Feasibility Of Carbon Ion Radiotherapy Research Articles

EP-1496 Feasibility of carbon ion radiotherapy for the melanoma of the lower genital tract

EP-1496 Feasibility of carbon ion radiotherapy for the melanoma of the lower genital tract

Health Technology Assessment of Carbon-ion Beam Radiotherapy: A Systematic Review of Clinical Effectiveness and Safety for 54 Oncological Indications in 12 Tumour Regions.

Due to the unique physical dose distribution of carbon-ion radiotherapy (CIRT), CIRT can be regarded as a novel tumour irradiation technique - potentially advantageous for various tumour types. Yet it is unclear in how far, superiority or inferiority can be claimed when comparing CIRT to standard irradiation. This study aimed to assess the scientific evidence regarding the effectiveness and safety of CIRT. A systematic literature review was performed using the European Network for Health Technology Assessment (EUnetHTA) Core Model® for rapid relative effectiveness assessment. The literature search for clinical outcome studies on CIRT was performed using four databases [Cochrane (Central), Centre for Research and Dissemination (CRD), Embase and OVID MEDLINE]. The Cochrane Risk of Bias Tool (for randomised controlled trials) and the Institute of Health Economics (IHE-18) Checklist (for observational studies) were used to assess the risk of bias of the included studies. The evidence synthesis was restricted to 54 oncological indications in 12 broad tumour regions and studies with a low or moderate risk of bias, published between 2005 and 2017. Twenty-seven studies were eligible for the qualitative synthesis of the evidence regarding the effectiveness and safety of CIRT: One randomised controlled trial that primarily focused on the feasibility of CIRT, three case-control studies, three before- and after- studies with a focus on quality of life, and 20 further studies of case series. Overall, insufficient scientific evidence was found for superiority or inferiority of CIRT when compared to standard irradiation for 13/54 oncologicaI indications in 7/12 tumour regions (skull base tumours, brain cancer, cancer in the ear-nose-throat region, bone and soft-tissue tumours, lung cancer, prostate cancer, gastrointestinal tumours). No scientific evidence was found for the remaining 41/54 oncological indications. CIRT is undoubtedly, theoretically, a promising cancer treatment. To date, however, it lacks randomised controlled trials assessing the long-term effectiveness and harms associated with the use of CIRT. CIRT must be considered as an experimental treatment due to the lack of high-quality clinical research.

Feasibility of Carbon Ion Radiotherapy in the Treatment of Gynecological Melanoma.

Malignant melanoma of the lower genital tract is a rare disease known to have a poor prognosis. Because of the high rate of distant metastasis and unsatisfactory survival benefit, a more conservative treatment approach, instead of extensive surgery, may be warranted. Gynecological melanoma is a radioresistant tumor, an ideal disease to test the biological efficacy of carbon ion radiotherapy (CIRT). To report our preliminary experience with CIRT in the treatment of gynecological melanoma at the National Center of Oncological Hadrontherapy (CNAO). Between January 2016 and February 2017, four patients were admitted for CIRT at CNAO. A case of cervical melanoma was treated with palliative aim because of large volume macroscopic disease, while three cases of vaginal melanoma were irradiated with a total dose of 68.8 Gy (relative biological effectiveness) in 16 fractions delivered over 4 weeks (4 days a week). The age of women ranged between 49 and 72 (median=60.5 years) years. Treatment was well tolerated in all patients and all women completed the scheduled treatment course. During CIRT, toxicity was mild. For patients with vaginal disease, local control was 10.23 and 12.6 months, while that for cervical malignant melanoma was 7.3 months. All patients experienced systemic progression, with median distant metastasis-free survival of 11.7 months. The median overall survival for the whole patient group was 11.41 months. In our first experiences, CIRT appears to be a safe non-invasive option for malignant melanoma of the lower genital tract, but more data and longer follow-up are necessary in order to evaluate the effectiveness and late effects.

Review of carbon ion radiotherapy for skull base tumors (especially chordomas)

AimTo review the clinical feasibility of carbon ion radiotherapy (C-ion RT) for skull base tumors, especially for chordomas which are often seen in the skull base area. BackgroundSkull base tumors treated by C-ion RT consist of primary chordomas and chondrosarcomas, and enormously extended head and neck cancer with a histology of adenoid cystic carcinomas, adenocarcinomas and malignant melanomas. These tumors are located on anatomically complex sites where they are close to important normal tissues and therefore demand better physical dose distribution to avoid unnecessary doses for surrounding normal tissues. These tumors are also known as radio-resistant tumors for low linear energy transfer (LET) radiotherapy and show favorable results after treatment by high LET carbon ion radiotherapy. Materials and methodsBiological reports of C-ions for the chordoma cell line, clinical results of C-ion RT for skull base tumors, dose comparative studies between two representative facilities and tumor control probability (TCP) of chordomas by C-ion RT were reviewed. ResultsC-ion RT for skull base tumors, especially for chordomas, shows favorable results of tumor control and acceptable complications. The C-ion dose of 57.36 gray equivalent (GyE)/16 fractions/4 weeks will deliver 90% of local control for chordomas. The limiting doses for surrounding normal tissues are clearly revealed. The dose difference between institutes was assumed within 10%. ConclusionsC-ion RT is recommended for skull base tumors because of high LET characteristics and clinical results.

Feasibility of carbon ion radiotherapy for locally advanced sinonasal adenocarcinoma

Background and purposeTo evaluate the safety and efficacy of carbon ion radiotherapy (CIRT) for locally advanced sinonasal adenocarcinoma. Material and methodsTwenty-two patients with sinonasal adenocarcinoma were treated with CIRT. CIRT was the primary treatment for 16 patients. Four patients received CIRT for local recurrence after surgery and two for residual tumour after surgery or chemotherapy. At the start of CIRT, 1 patient had T-classification (T) 2 disease, 2 had T3 disease, 5 had T4a disease, and 14 had T4b disease. Fourteen patients were treated with 57.6Gy equivalent (GyE)/16 fractions, and 8, with 64.0GyE/16 fractions. ResultsThe median follow-up period was 43months for all patients. The 3-year local control and loco-regional control rates for all patients were 76.9% (95% confidence interval [CI]=56.7–97.1%) and 61.3% (95% CI=38.5–84.1%), respectively. The 3-year overall survival and disease-specific survival rates were 59.1% (95% CI=38.6–79.6%) and 65.6% (95% CI=44.9–86.3%), respectively. Acute reactions of grade 3 of the skin and mucosa were observed in 2 and 4 patients, respectively. Late reactions included lateral visual loss (5 patients), mucosal ulceration (1 patient), and brain necrosis with clinical symptoms (1 patient). In the 5 patients who developed visual loss, the optic nerve was close to the tumour. ConclusionsCIRT was effective and generally safe for locally advanced sinonasal adenocarcinoma.

Carbon ion radiotherapy for oligo-recurrent lung metastases from colorectal cancer: a feasibility study

BackgroundThe purpose of this study was to evaluate the efficacy and feasibility of carbon ion radiotherapy (CIRT) for oligo-recurrent lung tumors from colorectal cancer (CRC).MethodsFrom May 1997 to October 2012, 34 consecutive patients with oligo-recurrent pulmonary metastases from CRC were treated with CIRT. The patients were not surgical candidates for medical reasons or patient refusal. Using a respiratory-gated technique, carbon ion therapy was delivered with curative intent using 4 coplanar beam angles. A median dose of 60 GyE (range, 44–64.8 GyE) was delivered to the planning target volume (PTV), with a median daily dose of 15 GyE (range, 3.6–44 GyE). Treatment outcome was analyzed in terms of local control rate (LCR), survival rate, and treatment-related complications.ResultsIn total, 34 patients with 44 oligo-recurrent pulmonary lesions were treated with CIRT. Median follow-up period was 23.7 months. The 2- and 3-year actuarial LCRs of the treated patients were 85.4% ± 6.2% and 85.4% ± 6.2%, respectively. Overall survival was 65.1% ± 9.5% at 2 years, and 50.1% ± 10.5% at 3 years. Although survival rates were relatively worse in the subsets of patients aged < 63 years or with early metastasis (< 36 months after resection of primary site), these factors were not significantly correlated with overall survival (P = 0.13 and 0.19, respectively). All treatment-related complications were self-limited, without any grade 3–5 toxicity.ConclusionsCIRT is one of the most effective nonsurgical treatments for colorectal lung metastases, which are relatively resistant to stereotactic body radiotherapy. CIRT is considered to be the least invasive approach even in patients who have undergone repeated prior thoracic metastasectomies.

Carbon ion radiation therapy for prostate cancer: Results of a prospective phase II study

Background and purpose To determine the efficacy and feasibility of carbon ion radiotherapy (C-ion RT) for prostate cancer. Patients and methods Between April 2000 and November 2003, 175 patients received C-ion RT using a recommended dose fractionation (66.0 GyE/20 fractions) established from prior studies. C-ion RT alone was performed for 33 patients constituting a low-risk group (Stage ⩽ T2a and PSA < 20 ng/ml and Gleason score ⩽ 6); the remaining 142 high-risk patients received an additional androgen deprivation therapy (ADT). Results The 4-year overall survival and bNED rates were 91% and 87%, respectively. Local control was achieved in all but one patient. The 4-year bNED rates were 87% in the low-risk group and 88% in the high-risk group. In very advanced diseases (Stage ⩾ T3a or PSA ⩾20 ng/ml or Gleason score ⩾ 8), there was significant difference in the bNED rate according to period of ADT administration (ADT ⩾ 24 months: 93%, ADT < 24 months: 73%, p < 0.01). Grade 2 late toxicities developed in 4 patients (2%) for the rectum and 9 patients (5%) for the genitourinary system but no Grade 3 or higher toxicity was observed. Conclusions The effectiveness of C-ion RT for prostate cancer has been well confirmed. Based on these results, new study of a C-ion RT modified for the administration strategy of ADT according to the patient risk has been started by dividing patients into 3 groups, high-risk, intermediate-risk, and low-risk.