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国立がん研究センター 中央病院

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Department of Radiation Oncology

Jun Itami, Yoshinori Ito, Hiroshi Igaki, Naoya Murakami, Koichi Inaba, Kana Takahashi, Rei Umezawa, Shuhei Sekii, Mayuka Kitaguchi, Ken Harada, Hiroyuki Okamoto, Shie Nishioka, Akihisa Wakita, Satoshi Nakamura

Introduction

The role of the Department is to provide state-of-the-art radiation therapy to all relevant patients, 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 for hospital-based boron neutron capture therapy (BNCT) was installed in the new facility and an epithermal neutron beam could be obtained in August 2015 and the neutron facility passed the governmental inspection for radiation leakage. The Department is now fully involved in the development of BNCT. Through the assistance of the management of the center, the number of medical physicists was increased to four

Routine activities

The Department of Radiation Oncology of the National Cancer Center Hospital is one of the biggest radiation oncology departments in Japan. Five linear accelerators, CyberKnife, one X-ray simulator, three XCT-simulators, and 15 treatment planning computers are working together through on-line networks to provide state-of-the-art 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 performed routinely. Stereotactic brain irradiation is performed with CyberKnife in the treatment of metastatic as well as primary brain tumors. Stereotactic body tumor irradiation is performed in lung and liver tumors under respiratory gating in linear accelerators or CyberKnife. Four of the five 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, and postoperative cervical cancers. Gold marker fiducials have been implanted to improve geometric precision of radiation field reproducibility.

Brachytherapy is also intensively performed to improve local control and many patients are referred from all over Japan. For brachytherapy, the following modalities are being employed: an Ir-192 high dose rate (HDR) afterloading system including dedicated CT simulator and fluoroscopy, an I-125 seed implantation system, and other low dose rate (LDR) brachytherapy systems using Au grains, Ir-thin wires, and ruthenium eye plaques. The number of patients undergoing HDR brachytherapy continued to rise constantly. This Department is the only institution in Tokyo where HDR interstitial as well as intracavitary irradiations can be performed. HDR interstitial radiation is used mainly in gynecological, genitourinary, and head and neck tumors. Additionally, there are two beds in the shielded ward in Floor 13B. Ruthenium mold therapy is performed by ophthalmologists to treat retinoblastomas and choroidal melanomas. LDR interstitial implants are carried out by radiation oncologists using Au-198 grains and Ir-192 thin wires for the management of head and neck tumors and gynecological malignancies.

Research activities

Clinical research is an indispensable part of the daily activities of the Department. The primary interests of the research activities of the Department are 1) an optimal fractionation regimen for the 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; and 6) development of an accelerator-based BNCT system.

Clinical trials

Brain tumors

A multicenter phase II/III trial on interferon-beta and temozolomide combination therapy for newly diagnosed glioblastomas.

Metastatic brain tumor

Phase II trial of hippocampal sparing IMRT

Lung cancer

Phase II trial on high dose thorax irradiation excluding prophylactic mediastinal lymph node radiation concurrent with CDDP+VNL in unresectable stage III non-small-cell lung cancers (NSCLCs).

Lung cancer

Stereotactic radiation therapy for histologically non-verified lung tumors.

Pediatrics

Phase II clinical trial on multimodality therapy in localized Ewing sarcomas and related tumors (The Japan Ewing Sarcoma Study Group (JESS 04)).

Head and neck cancers

Various JCOG (The Japan Clinical Oncology Group) studies including IMRT for nasopharyngeal and oropharyngeal cancers.

Breast cancer

Phase II trial of SAVI applicator HDR brachytherapy after partial mastectomy.

Liver cancer

Phase I trial on stereotactic hypofractionated radiation to hepatocellular carcinoma.

Cervical cancer

Phase I/II trial of hybrid brachytherapy of cervical cancer.

F-BPA PET/CT

Feasibility study of F-BPA PET/CT in detecting malignancies with comparison to FDG PET/CT.

Development of an Adaptive Radiation Therapy System

Education

Five residents are trained in all fields of radiation oncology except particle beam therapy. Seminars about biology, physics, and clinical radiation oncology are regularly held in the evenings.

Future prospects

With the introduction of BNCT, new manpower will be required and research perspectives will be greatly widened. Additionally, installment of an MRI-Cobalt system is planned.


Table 1.

List of papers published in 2015

Journal

  1. Murakami N, Yoshimoto S, Matsumoto F, Ueno T, Ito Y, Watanabe S, Kobayashi K, Harada K, Kitaguchi M, Sekii S, Takahashi K, Yoshio K, Inaba K, Morota M, Sumi M, Saito Y, Itami J. Severe gastrointestinal bleeding in patients with locally advanced head and neck squamous cell carcinoma treated by concurrent radiotherapy and Cetuximab. J Cancer Res Clin Oncol, 141:177-184, 2015
  2. Satoh T, Dokiya T, Yamanaka H, Saito S, Ishiyama H, Itami J, Shibuya H, Nakano T, Shigematsu N, Aoki M, Egawa S, Hashimoto M, Nishimura T, Yorozu A. Postmortem radiation safety and issues pertaining to permanent prostate seed implantation in Japan. Brachytherapy, 14:136-141, 2015
  3. Miyashita M, Kawakami S, Kato D, Yamashita H, Igaki H, Nakano K, Kuroda Y, Nakagawa K. The importance of good death components among cancer patients, the general population, oncologists, and oncology nurses in Japan: patients prefer "fighting against cancer". Support Care Cancer, 23:103-110, 2015
  4. Murakami N, Kobayashi K, Nakamura S, Wakita A, Okamoto H, Tsuchida K, Kashihara T, Harada K, Yamada M, Sekii S, Takahashi K, Umezawa R, Inaba K, Ito Y, Igaki H, Itami J. A total EQD2 greater than 85 Gy for trachea and main bronchus D2cc being associated with severe late complications after definitive endobronchial brachytherapy. J Contemp Brachytherapy, 7:363-368, 2015
  5. Murakami N, Okamoto H, Isohashi F, Murofushi K, Ohno T, Yoshida D, Saito M, Inaba K, Ito Y, Toita T, Itami J. A surveillance study of intensity-modulated radiation therapy for postoperative cervical cancer in Japan. J Radiat Res, 56:735-741, 2015
  6. Kobayashi K, Murakami N, Wakita A, Nakamura S, Okamoto H, Umezawa R, Takahashi K, Inaba K, Igaki H, Ito Y, Shigematsu N, Itami J. Dosimetric variations due to interfraction organ deformation in cervical cancer brachytherapy. Radiother Oncol, 117:555-558, 2015
  7. Murakami N, Kühnel A, Schmid TE, Ilicic K, Stangl S, Braun IS, Gehrmann M, Molls M, Itami J, Multhoff G. Role of membrane Hsp70 in radiation sensitivity of tumor cells. Radiat Oncol, 10:149, 2015
  8. Otani Y, Nose T, Dokiya T, Saeki T, Kumazaki Y, Asahi S, Tsukiyama I, Fukuda I, Sekine H, Shikama N, Takahashi T, Yoshida K, Kotsuma T, Masuda N, Yoden E, Nakashima K, Matsumura T, Nakagawa S, Tachiiri S, Moriguchi Y, Itami J, Oguchi M. A Japanese prospective multi-institutional feasibility study on accelerated partial breast irradiation using interstitial brachytherapy: treatment planning and quality assurance. Radiat Oncol, 10:126, 2015