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国立がん研究センター 中央病院

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Department of Diagnostic Radiology

Yasuaki Arai, Yasunori Mizuguchi, Gen Iinuma, Miyuki Sone, Hiroaki Kurihara, Nachiko Uchiyama, Hirokazu Watanabe, Minoru Machida, Mari Kikuchi, Tomoko Manabe, Mototaka Miyake, Syunsuke Sugawara, Hideaki Kobayashi, Koji Tomita

Introduction

The Department of Diagnostic Radiology provides a wide range of modalities, including interventional radiology (IR), general radiology, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, mammography and nuclear medicine. The Center for Interventional Radiology, launched in 2014, continues to provide various IR treatments for patients referred from other hospitals or clinics as well as patients at our hospital. We seek individuals with outstanding leadership capabilities, proven academic and administrative experience, the vision to build and sustain programs at the forefront of imaging research, and a commitment to clinical experience.

Table 1. Routine activities

Research activities

CT colonography (CTC) has been successfully introduced as an effective option for preoperative staging and colorectal screening in our center. Nearly 2,000 patients and/or candidates were examined with this modality in 2013. For the preparation of screening CTC, electronic cleansing with fecal barium tagging and automated CO2 gas insufflation systems have been established in the formal National Cancer Center (NCC) collaboration studies with the associated companies. Furthermore, we are now developing computer-aided detection (CAD) for colorectal lesions, especially for flat lesions. The main purpose of our CTC research work is to conduct a multi-center trial to establish evidence regarding fully digitalized CTC for a colorectal screening system in Japan.

With use of one positron emission tomography (PET)/MRI scanner and three PET/CT scanners, molecular imaging of multi tracers consisting of [18F] FDG, [18F] FBPA, [11C] choline, [11C] methionine and [64Cu]-DOTA-antibody has been studied for cancer patients to improve the sensitivity and specificity of detecting tumor sites or tumor characteristics. [18F]-FDG dynamic PET sampling with Patrak-plot analysis allows us to calculate the glucose metabolic rate of the tumor site. [18F]-FBPA PET has been conducted in 22 cancer patients this year. [11C]-choline and [11C]-methionine PET examinations have been scheduled routinely for two days per week. As for [64Cu]-DOTA-antibody PET imaging, [64Cu]-DOTA-trastuzumab PET has been conducted in HER-2 positive breast cancer patients. Respiratory-gated PET was evaluated to reduce breathing-induced artifacts using a four-dimensional PET protocol. It provided better localization and quantification of tumors around the lower thorax to the upper abdomen. For cancer treatment, internal radiotherapy was carried out in 20 thyroid cancer patients with use of radioactive iodine (I-131) chloride.

In accordance with the achievement of collaborative research with the associated company since 2009, Digital breast tomosynthesis (DBT) has been introduced as an effective routine option for preoperative evaluation since March 2014. Up to December 2015, 1,067 patients were examined.

A multicenter study has started to establish the CT classification of lung adenocarcinomas corresponding to the new International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society (IASLC/ ATS/ERS) pathological classification and to build the database of small adenocarcinomas. Digital Imaging and Communications in Medicine (DICOM) data of resected lung cancers from each institute have been accumulated and evaluated in collaboration with the Japanese Society of Thoracic Radiology.

The Japan Response Evaluation Criteria in Solid Tumors (RECIST) working group has developed a tumor response evaluation computer system, which is capable of semiautomatic RECIST evaluation and is compliant with DICOM data.

Image guided preoperative Breast Marking using ultrasound alone or combined with mammography has been performed for partial mastectomy cases in which it is difficult to determine the spread of disease. This technique makes it possible to resect abnormal lesions more precisely and helps to prevent both re-operation and local recurrence. A total of 85 cases were handled from January 2015 to December 2015.

We investigate the correlation between the image findings and clinical course of ovarian clear cell carcinoma.

Clinical trials

A major departmental research theme is establishing evidence for interventional radiology procedures. We have led a multi-institutional cooperat ive study group of intervent ional radiology (JIVROSG: Japan Interventional Radiology in Oncology Study Group) since 2002 as a steering organization of 95 participating domestic institutions. In this study group, we are investigating the efficacy of palliative interventional radiology in randomized controlled trials (RCTs) to compare it with other therapies. These palliative RCTs include: a phase III study evaluating the efficacy of peritoneo-venous shunting (JIVROSG-0803); a phase III study evaluating the efficacy of percutaneous vertebroplasty for painful bone metastases (JIVROSG-0804); a phase III study evaluating the efficacy of percutaneous transesophageal gastric tubing (JIVROSG-0805); and a phase III study evaluating the efficacy of stenting for superior vena cava/inferior vena cava (SVC/ IVC) syndrome (JIVROSG-0807). JIVROSG-0807 and JIVROSG-0805 completed patient enrollment in 2013 and 2014, respectively. A feasibility study of Epirubicin-eluting-bead Embolization for Hepatocellular Carcinoma (JIVROSG-1301) also completed patient enrollment in 2014. Other ongoing clinical trials are a phase II study evaluating the efficacy of arterial infusion chemotherapy and radiotherapy for unresectable maxillary carcinoma (JIVROSG-0808), a phase II trial of palliative intra-arterial epirubicin/5FU therapy for patients with chemotherapy-refractory locally advanced or metastatic breast cancer (JIVROSG-1107 RESAIC-II) and a phase II study evaluating the efficacy and safety of n-butyl-2-cyanoacrylate (NBCA) in embolization (JIVROSG-0802). A phase I/II study of radiofrequency ablation (RFA) for pelvic malignant tumors (JIVROSG-0204) was stopped in 2014 due to the insufficient number and speed of patient enrollment.

Education

The clinical education and training of young radiologists is an important part of our department's activities. During 2015, six residents and one short-term resident were trained by our department. Educational opportunities were also provided to six overseas physicians from Malaysia, Taiwan, and India. We have several clinical or educational conferences. A daily clinical interventional radiology (IVR) case conference, a weekly educational case conference on diagnostic radiology, and a monthly IVR research conference, are held.

Future prospects

The Department of Radiology strives for excellence in clinical care, education, and research. Our goal is to provide outstanding patient-centered radiology services and to establish evidence in this area. Future challenges include promoting the active role of the Center for Interventional Radiology and facilitating imaging as biomarkers for personalized cancer treatments such as molecular-targeted agents, immunoagents, and boron neutron capture therapy.

List of papers published in 2015

Journal

  1. Kono Y, Shimizu Y, Wakatsuki Y, Yasui N, Aso T, Kawamoto H, Kurihara H. Letter to the editor. Radiat Prot Dosimetry, 163:533-534, 2015
  2. Mori M, Tsunoda H, Takamoto Y, Murai M, Kikuchi M, Honda S, Suzuki K, Yamauchi H. MRI and ultrasound evaluation of invasive lobular carcinoma of the breast after primary systemic therapy. Breast Cancer, 22:356-365, 2015
  3. Yang Y, Suzuki K, Abe E, Li C, Uno M, Akiyama F, Yamauchi H, Kikuchi M, Ohde S, Deshpande G, Shibahara Y, Nakamura Y, Sasano H. The significance of combined CK5/6 and p63 immunohistochemistry in predicting the risks of subsequent carcinoma development in intraductal papilloma of the breast. Pathol Int, 65:81-88, 2015
  4. Asamura H, Chansky K, Crowley J, Goldstraw P, Rusch VW, Vansteenkiste JF, Watanabe H, Wu YL, Zielinski M, Ball D, Rami-Porta R, International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol, 10:1675-1684, 2015
  5. Horikawa M, Miyayama S, Irie T, Kaji T, Arai Y. Development of Conventional Transarterial Chemoembolization for Hepatocellular Carcinomas in Japan: Historical, Strategic, and Technical Review. AJR Am J Roentgenol, 205:764-773, 2015
  6. Hiraki T, Koizumi J, Arai Y, Sakurai Y, Kumada H, Nambu Y, Hori S. Transcatheter arterial embolization of hypervascular tumors with HepaSphere: prospective multicenter open label clinical trial of microspheres in Japan. Jpn J Radiol, 33:479-486, 2015
  7. Sofue K, Arai Y, Takeuchi Y, Tsurusaki M, Sakamoto N, Sugimura K. Ultrasonography-guided central venous port placement with subclavian vein access in pediatric oncology patients. J Pediatr Surg, 50:1707-1710, 2015
  8. Inaba Y, Yamaura H, Sato Y, Kato M, Kawada H, Murata S, Hasegawa T, Arai Y. Side-Hole Catheter Placement with Fixation and Embolization in Common Hepatic Artery for Hepatic Arterial Infusion Chemotherapy (Modified CHA-Coil Method) for Patients with Celiac Artery Stenosis or Occlusion. Cardiovasc Intervent Radiol, 38:1621-1626, 2015
  9. Arai Y, Aoyama T, Inaba Y, Okabe H, Ihaya T, Kichikawa K, Ohashi Y, Sakamoto J, Oba K, Saji S. Phase II study on hepatic arterial infusion chemotherapy using percutaneous catheter placement techniques for liver metastases from colorectal cancer (JFMC28 study). Asia Pac J Clin Oncol, 11:41-48, 2015
  10. Sone M, Nakajima Y, Woodhams R, Shioyama Y, Tsurusaki M, Hiraki T, Yoshimatsu M, Hyodoh H, Kubo T, Takeda S, Minakami H. Interventional radiology for critical hemorrhage in obstetrics: Japanese Society of Interventional Radiology (JSIR) procedural guidelines. Jpn J Radiol, 33:233-240, 2015
  11. Yoshimoto M, Kurihara H, Fujii H. Theragnostic imaging using radiolabeled antibodies and tyrosine kinase inhibitors. ScientificWorldJournal, 2015:842101, 2015
  12. Morita S, Onaya H, Kishi Y, Hiraoka N, Arai Y. Multiple Intraglandular Metastases in a Patient with Invasive Ductal Carcinoma of the Pancreas. Intern Med, 54:1753-1756, 2015
  13. Kurihara H, Hamada A, Yoshida M, Shimma S, Hashimoto J, Yonemori K, Tani H, Miyakita Y, Kanayama Y, Wada Y, Kodaira M, Yunokawa M, Yamamoto H, Shimizu C, Takahashi K, Watanabe Y, Fujiwara Y, Tamura K. 64Cu-DOTA-trastuzumab PET imaging and HER2 specificity of brain metastases in HER2-positive breast cancer patients. EJNMMI Res, 5:8, 2015
  14. Kinuya S, Yoshinaga K, Higuchi T, Jinguji M, Kurihara H, Kawamoto H. Draft guidelines regarding appropriate use of (131)I-MIBG radiotherapy for neuroendocrine tumors : Guideline Drafting Committee for Radiotherapy with (131)I-MIBG, Committee for Nuclear Oncology and Immunology, The Japanese Society of Nuclear Medicine. Ann Nucl Med, 29:543-552, 2015

Book

  1. Sone M, Arai Y. Section B. Coils and Plugs - 5. Gelfoam. In: Marcelo G, Riccardo L, Gary PS (eds), Embolization Therapy: Principles and Clinical Applications, Netherland, Wolters Kluwer, 2015
  2. Arai Y. Section D. Liquid Agents - 9. Glue. In: Marcelo G, Riccardo L, Gary PS (eds), Embolization Therapy: Principles and Clinical Applications, Netherland, Wolters Kluwer, 2015