Heavy Particle Radiotherapy Research Articles

Robot-Assisted Resection of Exposed Colon With TaTME After Heavy Ion Radiotherapy for Locally Recurrent Rectal Cancer: A Case Report

Introduction Heavy ion radiotherapy has shown promising results in treating pelvic recurrence of rectal cancer. We report a case in which a patient underwent robot-assisted low anterior resection with transanal mesorectal excision (TaTME) following heavy ion radiotherapy, owing to challenges associated with spacer placement. Case presentation A 54-year-old man was diagnosed with upper rectal cancer. He underwent robot-assisted low anterior resection. Eight courses of CapeOX were administered as postoperative adjuvant chemotherapy. Immediately after completion of adjuvant chemotherapy (8 months postoperatively), computed tomography (CT) scan revealed a 30-mm large nodule on the dorsal surface of the oral anastomotic intestine, which was detected by positron emission tomography–CT. Given that the tumor had an indistinct border with the sacrum and its superior margin extended to the second sacrum, it was concluded that a combined sacral resection was not advisable, and heavy ion radiotherapy was indicated. Robot-assisted low anterior resection combined with TaTME was performed approximately 2 months after heavy particle radiotherapy [73.6 Gy (relative biological effectiveness)/16 sessions]. CT scan conducted 3 months after irradiation revealed substantial shrinkage of the recurrent tumor. Conclusion Robot-assisted resection of exposed colon with TaTME after heavy ion radiotherapy is regarded as an effective strategy for treating locally recurrent rectal cancer.

Incidental Finding of Late Metastasizing Melanoma to the Duodenum by PET-CT: About a Case Report

Three years later after primary resection from skin melanoma with right inguinal lymphadenectomy, a Caucasian 62-year old female patient underwent at Helios Hospital Pforzheim investigations because of persistent high grade fever episodes. A very high suspicious mass of tumor was incidental identified and described in the descending duodenum and head of pancreas after PET-CT scan. Upper endoscopic examination with ultrasonography showed a 30 mm tumor mass arising from the descending part of the duodenum, which had invaded the head of pancreas and caused loop obstruction. Endoscopic biopsy revealed neoplastic cells with melanin granules and positive for Melan-A/SOX10 staining, indicating the presence of a metastatic malignant melanoma. It showed no BRAF-Mutation. These additional staining’s were evaluated after surgery. The colonoscopy showed not tumor finding. After tumor board procedure we strongly recommended surgical resection, and the patient accepted surgery. She underwent in Department of General Surgery at Helios Hospital Pforzheim the pylorus preserving pancreatico-duodenectomy. In the surgically resected Whipple specimen, the mass was 5x4 cm large, solid and ulcerated. Histologically the tumor infiltrated all duodenal layers and the tissue around them. Immunocytochemistry and electronic microscopy findings confirmed the diagnosis of malignant melanoma; similar to the skin specimen from the right thigh; therefore, the duodenal lesion was considered to be a metastasizing skin melanoma from the right thigh. The post operatory evolution was good, and was released from the hospital after 13 days. She underwent immunotherapy with Ipilimumab and Nivoluma. No recur was registrated during 5 months close follow-up. The history of the patient began three years earlier. She underwent a resection of skin melanoma. The initial skin melanoma was localized on anterior side of the right thigh (lower limb). At that time pathological specimen confirmed as malignant melanoma Clark level IV, pT2aN1bM0 as TNM-Staging, positive for BRAF-Wild-type by Mutation Analysis. Our patient also underwent another removal of skin melanoma from the back area just a couple of months after the first surgery. Pathological results from the second specimen confirmed as skin melanoma Clark level II, pT1a as TNM-Staging. She received chemotherapy and heavy particle radiotherapy after surgery. No suspect mass was identified on regular follow-up during 12 months after primary operation. Recurrence was registrated in the scar on the right thigh (lower limb) and right inguinal site, two years later. No suspect mass was identified on follow-up CT-Scan’s from head, lung and abdomen. She received immunotherapy and no additional chemotherapy or radiotherapy

Evaluation of X-ray and carbon-ion beam irradiation with chemotherapy for the treatment of cervical adenocarcinoma cells in 2D and 3D cultures.

Cervical cancer is the second most common cancer in women and causes more than 250,000 deaths worldwide. Among these, the incidence of cervical adenocarcinomas is increasing. Cervical adenocarcinoma is not only difficult to detect and prevent in the early stages with screening, but it is also resistant to chemotherapy and radiotherapy, and its prognosis worsens significantly as the disease progresses. Furthermore, when recurrence or metastasis is observed, treatment options are limited and there is no curative treatment. Recently, heavy-particle radiotherapy has attracted attention owing to its high tumor control and minimal damage to normal tissues. In addition, heavy particle irradiation is effective for cancer stem cells and hypoxic regions, which are difficult to treat. In this study, we cultured cervical adenocarcinoma cell lines (HeLa and HCA-1) in two-dimensional (2D) or three-dimensional (3D) spheroid cultures and evaluated the effects of X-ray and carbon-ion (C-ion) beams. X-ray irradiation decreased the cell viability in a dose-dependent manner in 2D cultures, whereas this effect was attenuated in 3D spheroid cultures. In contrast, C-ion irradiation demonstrated the same antitumor effect in 3D spheroid cultures as in 2D cultures. In 3D spheroid cultures, X-rays and anticancer drugs are attenuated because of hypoxia inside the spheroids. However, the impact of the C-ion beam was almost the same as that of the 2D culture, because heavy-particle irradiation was not affected by hypoxia. These results suggest that heavy-particle radiotherapy may be a new therapeutic strategy for overcoming the resistance of cervical adenocarcinoma to treatment.

Electromagnetic-Structural Analysis of a Superconducting Magnet With Active Shielding for a Rotating Gantry

As a magnet utilized for a rotating gantry in heavy particle radiotherapy, a superconducting magnet with active shielding has been proposed to reduce the magnet weight. The magnet is composed of a dipole coil and an active shielding coil wound with NbTi wires. In this study, an electromagnetic-structural analysis of the magnet with active shielding was conducted using an FEM model. The results of the analysis indicate that the coil deformation, due to an electromagnetic force, slightly affects the field quality but negligible for the operation. The design concept of superconducting magnets with active shielding is valid in terms of magnetic field and the support structure for a rotating gantry. In addition, based on the previous study, the weight of the superconducting magnet with active shielding was revaluated. As a result, the superconducting magnet with active shielding can be one-third lighter than a superconducting magnet surrounded with an iron yoke, in terms of the magnet weight per unit length.

Laparoscopic distal pancreatectomy for metastatic melanoma originating from the choroidal membrane: a case report

BackgroundMetastatic melanoma originating from the choroidal membrane is extremely rare. Here, we report a case of laparoscopic distal pancreatectomy for malignant melanoma that developed after heavy-particle therapy for malignant choroidal melanoma.Case presentationA 43-year-old Japanese woman underwent 70 Gy heavy-particle radiotherapy for a right choroidal malignant melanoma. Positron emission tomography-computed tomography examination was performed 4 years after treatment, when contrast accumulation was observed on the posterior wall of the stomach. Endoscopic ultrasonography and computed tomography showed a mass with contrast enhancement in contact with the stomach wall. Based on the imaging findings, a gastrointestinal stromal tumor of the posterior wall of the lower gastric corpus with extramural growth was suspected. Laparoscopic surgery was performed under general anesthesia. A black-pigmented tumor originating from the pancreas was discovered. Following an intraoperative diagnosis of metastasis of malignant melanoma, a laparoscopic distal pancreatectomy was performed. The pathological diagnosis was pancreatic metastasis of malignant melanoma. The patient was treated with adjuvant immune checkpoint inhibitors and chemotherapy after surgery, which led to long-term survival.ConclusionsIncluding this case, only eight case reports on pancreatic resection for metastatic ocular malignant melanoma have been reported. The ocular malignant melanoma with distant metastasis has a poor prognosis. Therefore, in our case, careful follow-up is required. A single pancreatic metastasis from a malignant melanoma of the choroid can be successfully managed by laparoscopic radical resection of the pancreas, and molecularly targeted adjuvant chemotherapy.

Design of Lightweight Superconducting Magnets for a Rotating Gantry With Active Shielding

In order to reduce the weight of superconducting magnets used in a rotating gantry for heavy particle radiotherapy, the design study of a cosine-theta superconducting magnet with active shielding was conducted. The superconducting magnet with active shielding was composed of a dipole coil and an active shield coil. The cross-section of each coil was designed, based on a cosine-theta current distribution made by the arrangement of a superconducting wire with NbTi filaments. The result of the design study indicated that the designed coil cross-sections can meet the requirements regarding the magnetic field distribution and the load factor for the magnet operation. Additionally, the weight of the superconducting magnet with active shielding was evaluated while comparing that of the superconducting magnet with an iron yoke. As a result, the superconducting magnet with the active shielding has a possibility to reduce the weight significantly.

Adenoid Cystic Carcinoma.

Sinonasal adenoid cystic carcinoma is a rare malignancy characterized by an insidious growth pattern and a tendency for perineural spread along major and minor nerves, resulting in invasion of the skull base and intracranial extension. Therefore, many patients present with advanced disease and involvement of critical structures, making treatment difficult and potentially associated with high morbidity. Surgery represents the mainstay of treatment of the primary tumor. Complete resection of the tumor with negative margins, whenever feasible, is associated with better survival outcomes. However, in the case of extensive involvement of vital structures (e.g., carotid artery, cavernous sinus, optic nerve, Meckel's cave) or when radical surgery could seriously affect the patient's quality of life, a function-preserving subtotal removal of the tumor followed by irradiation can be proposed. The role of surgery is limited to a biopsy in unresectable lesions that are more suitable for non-surgical treatments (e.g., exclusive chemoradiation). Given the difficulty in obtaining negative margins and the propensity for submucosal and perineural spread, adjuvant radiotherapy is strongly recommended. Recently, heavy-particle radiotherapy using protons or carbon ions has emerged as a promising treatment with improved local control. Local failures (60%) and distant metastases (40%) are common and can occur even decades after definitive treatment. The 5-year overall survival ranges from 55 to 70% and it exceeds that of other sinonasal malignancies, but dramatically drops down at 10 years (40%) and further decreases at 20 years (15%). Therefore, a prolonged follow-up of at least 15 years, and possibly lifelong, is mandatory.

Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive solid tumours with an estimated 5-year overall survival rate of 7% for all stages combined. In this highly resistant disease that is located in the vicinity of many radiosensitive organs, the role of radiotherapy (RT) and indications for its use in this setting have been debated for a long time and are still under investigation. Although a survival benefit has yet to be clearly demonstrated for RT, it is the only technique, other than surgery, that has been demonstrated to lead to local control improvement. The adjuvant approach is now strongly challenged by neoadjuvant treatments that could spare patients with rapidly progressive systemic disease from unnecessary surgery and may increase free margin (R0) resection rates for those eligible for surgery. Recently developed dose-escalated RT treatments, designed either to maintain full-dose chemotherapy or to deliver a high biologically effective dose, particularly to areas of contact between the tumour and blood vessels, such as hypofractionated ablative RT (HFA-RT) or stereotactic body RT (SBRT), are progressively changing the treatment landscape. These modern strategies are currently being tested in prospective clinical trials with encouraging preliminary results, paving the way for more effective treatment combinations using novel targeted therapies. This review summarizes the current literature regarding the use of RT for the treatment of primary PDAC, describes the limitations of conventional RT, and discusses the emerging role of dose-escalated RT and heavy-particle RT.

Intestinal-type adenocarcinoma of the sinonasal tract: an update.

Intestinal-type adenocarcinoma (ITAC) is one of the most frequent sinonasal tumors, especially in European countries. The purpose of this article is to review the most recent literature, with special emphasis on biological and genetic profile and treatment guidelines. Results on large series support transnasal endoscopic surgery as the technique of choice in the large majority of patients with ITAC. Adjuvant radiotherapy is recommended in advanced-stage and high-grade lesions. More robust data are required to confirm that early-stage, low-grade lesions can be treated with exclusive surgery. The efficacy of new chemotherapy and biotherapy regimens and the added value of heavy particle radiotherapy are currently under evaluation. With a 5-year overall survival ranging between 53 and 83%, which is mainly impacted by local recurrences, ITAC requires a more detailed understanding of its biology. Genetic and biological studies have identified alterations in the molecular pathways of EGFR, MET, and H-RAS which might be considered as potential targets for biotherapy. Surgery still plays a key role in the treatment of ITAC, but multidisciplinary management is mandatory. Although further validation is needed, the role of nonsurgical treatment strategies is rising, in agreement with the progresses made in the biological profiling of the disease.

Influence of Winding Accuracy on Magnetic Field Distribution in YBCO Pancake Coil for Cyclotron Application

In recent years, YBCO high-temperature superconducting (HTS) tapes have been expected to be applied to devices in power systems or in other industrial applications, owing to their rapidly improving quality and productivity. Our objective is to develop an HTS cyclotron with a compact body, high efficiency of output power, and high performance in heavy particle radiotherapy. In such an application, extremely high precision is required in the range 0.01% to 0.1% of magnetic field, both spatially and temporally. An isochronous field along with an azimuthally varying field is generated by an air-core pancake coil system during construction. Therefore, developing a technology for extremely high coil-winding accuracy is very important. In this study, we constructed an experimental model of a YBCO pancake coil using a high-precision coil winding machine. Then, the winding error in the radial and axial directions was experimentally evaluated using a pair of laser displacement meters and a surface roughness tester. We also developed a numerical simulation model to analyze the influence of winding error on the magnetic field distribution. The relationship between the winding error and the magnetic field of the meter-class YBCO coil assuming a real system was also evaluated by numerical simulation.

Downsizing of Accelerator Technology for Heavy Particle Radiotherapy and Disseminate of Cancer Treatment

Downsizing of Accelerator Technology for Heavy Particle Radiotherapy and Disseminate of Cancer Treatment

Track Structure of High-Energy Ions in Heavy Particle Radiotherapy

Track Structure of High-Energy Ions in Heavy Particle Radiotherapy

29P-E-1 重粒子線治療用高エネルギーイオンによるトラック構造の微視的研究(E会場 知的システム基礎・医療基礎,一般講演)

29P-E-1 重粒子線治療用高エネルギーイオンによるトラック構造の微視的研究(E会場 知的システム基礎・医療基礎,一般講演)

A case of maxillary osteosarcoma with epuloid growth

This report presents a case of maxillary osteosarcoma that was initially considered to be granulomatous epulis. A pedunculated mass was found on the buccal gingiva in the right maxillary molar region in a 45-year-old male patient at the initial examination. The clinical and pathological findings indicated that the mass was an epulis. However, a partial maxillectomy was performed under general anesthesia because the rapidly enlarged mass was clinically diagnosed as a maxillary tumor. A pathological examination of the resected specimen revealed that the maxillary tumor was osteosarcoma with a partially positive surgical stump. A total resection of the maxilla was performed under general anesthesia because recurrence was observed at 3 years postoperatively. Recurrence of a tumor that invaded into the cranial base was found at 2.5 years after reoperation despite three courses of adjuvant chemotherapy. Heavy particle radiotherapy was administered. Unfortunately, the patient died at 6 years and 2 months after the first operation due to tumor growth and a gradual worsening of his general condition. The experience from the present case suggested that an early diagnosis and an appropriate surgical therapy is very important for a satisfactory treatment outcomes of the jawbone osteosarcoma.

Late Effects of Heavy Particle Radiotherapy for Pelvic Tumors

Late Effects of Heavy Particle Radiotherapy for Pelvic Tumors

A Novel Color Former Organogel for Radiation Detection Systems

Abstract A novel leuco phenoxazine color former containing l-phenylalanine at the protecting group was prepared for radiation detection systems. It forms elongated self-assembled fibers in common organic solvents, leading to that efficient gelation. FE-SEM and FT-IR of the xerogel showed the color former formed a three-dimensional net-like structure. The color former organogel showed sufficient sensitivity to γ rays that it can be used for imaging in heavy particle radiotherapy and has good potential for three-dimensional radiation detection systems.

Heavy-Particle Radiotherapy: System Design and Application

The requirements for an accelerator and a beam-delivery system for medical application are described (pointing out terms of heavy-particle radiotherapy), based on 15 years of experience with carbon-ion radiotherapy at HIMAC. The present heavy-particle radiotherapy and system are reviewed here. With a view to further development of carbon-ion radiotherapy, recent progress in heavy-particle radiotherapy and a new system are also described. Finally, the clinical applications are summarized.

10 cases of bone and soft tissue sarcomas treated with heavy particle radiotherapy

10 cases of bone and soft tissue sarcomas treated with heavy particle radiotherapy

Response of the FBX system to a carbon beam: its potential as a dosimeter in heavy particle radiotherapy

The FBX aqueous chemical dosimeter contains 0.2 mol m−3 ferrous ammonium sulphate, 5.0 mol m−3 benzoic acid and 0.20 mol m−3 xylenol orange in 40.0 mol m−3 sulphuric acid. The dosimeter can measure photon and electron doses in the range 0.1 to 3000 cGy in radiotherapy. The response of this dosimeter was measured for a 53.2 MeV carbon beam in the present work. Our initial result indicates that the sensitivity of the FBX system to the carbon beam as compared to cobalt-60 gamma rays is 25.5%, and thus we believe that the FBX system could be a useful dosimeter for carbon beams and similar heavy ions considered useful in radiotherapy.

Stereotactic Helium Ion Bragg Peak Radiosurgery for Angiographically Occult Intracranial Vascular Malformations

Between July 1983 and July 1989, we treated 35 patients with surgically inaccessible, symptomatic angiographically occult vascular malformations (AOVMs) using stereotactic heavy-charged-particle radiosurgery. AOVMs were located in the brainstem (19), thalamus or internal capsule (9), basal ganglia (3), deep cerebral hemisphere and motor area (3), or cerebellopontine angle (1). All patients presented with clinical and radiological evidence of previous hemorrhage, usually with multiple episodes of hemorrhage. Treatment volumes ranged from 80 to 15,200 mm3 and treatment doses from 7.7 to 34.6 Gy. Mean follow-up was 40 months, with 31 patients followed for at least 2 years. Clinical outcome was excellent in 46%, good in 34% and poor in 14%; 6% died. Twenty-seven patients in excellent and good condition prior to treatment remained stable or improved neurologically. Two patients initially in poor condition, who had previously received conventional radiotherapy, died at 9 and 14 months after treatment, respectively. Six patients experienced recurrent hemorrhage 2-60 months following treatment. Three of these patients made a complete recovery. Although a larger number of treated patients must be followed over longer periods of time, stereotactic heavy-particle radiotherapy may be a valuable treatment modality for surgically inaccessible intracranial AOVMs.