Annual Report 2022
Department of Radiation Oncology
Hiroshi Igaki, Yuko Nakayama, Naoya Murakami, Kae Okuma, Tomoya Kaneda, Koichi Inaba, Kana Takahashi, Tairo Kashihara, Ayaka Nagao, Madoka Sakuramachi, Kanako Kojima
Introduction
The role of our department is to provide state-of-the-art radiation therapy to all patients who need it, to educate and develop the expertise of radiation oncologists, radiation technologists, and medical physicists, and to lead new developments in radiation oncology in Japan and globally. All departmental activities are dedicated to patients with cancer. A linear accelerator-based neutron irradiation system for boron neutron capture therapy (BNCT) has been installed in the hospital; an epithermal neutron beam was obtained and a clinical trial of BNCT for cutaneous melanoma is ongoing. Additionally, an MR linear accelerator, MRIdianR, has been introduced for the first time in Japan in our department. After strict acceptance and commissioning procedures, MRIdian is used primarily for online adaptive radiation therapy for abdominal, pelvic, and thoracic tumors.
The Team and What We Do
Our department treats the largest number of patients requiring radiation therapy in Japan. Four linear accelerators, CyberKnife, MRIdian, a brachytherapy system, four XCT-simulators, and 19 treatment planning computers are working together in online networks to provide state-of-the-art high-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 routinely performed. Stereotactic brain irradiation is performed with CyberKnife for metastatic and primary brain tumor treatment. Stereotactic body radiation therapies are performed for lung and liver tumors under respiratory gating in linear accelerators, MRIdian, or CyberKnife. All linear accelerators have on-board kilovoltage CT imagers, which assist in precisely aligning patient and tumor coordinates. These image-guided radiation therapy (IGRT) equipment enables the precise delivery of IMRT in head and neck cancers, brain tumors, prostate cancers, postoperative cervical cancers, and other cancers. MR linear accelerator system, MRIdianR, is primarily used for abdominal and thoracic tumors with respiratory motions. Brachytherapy is also performed to improve local control, with the following modalities: an Ir-192 high dose rate (HDR) after-loading system, including a dedicated CT simulator and fluoroscopy, and other low dose rate (LDR) brachytherapy systems using Au-198 grains and Ru-106 eye plaques. HDR interstitial irradiation is performed mainly in gynecological, genitourinary, and head and neck tumors. Additionally, there are two beds in the shielded ward on Floor 13B. Ru-106 mold therapy is performed in collaboration with ophthalmologists to treat retinoblastomas and choroidal melanomas. LDR interstitial implants are conducted using Au-198 grains for the management of head and neck tumors and gynecological malignancies. The number of patients treated in our department is shown in Table 1.
Research Activities
Clinical research is an essential component of the daily activities of our department. The primary interests of the research activities of the department are as follows: (1) online adaptive radiation therapy using an MR linear accelerator system; (2) clinical applications of accelerator-based boron neutron capture therapy for skin and other tumors; (3) image-guided brachytherapy for genitourinary and gynecologic cancers; (4) development of new medical devices for radiotherapy; (5) hypofractionated stereotactic irradiation of brain and body tumors; (6) an optimal fractionation regimen for pain palliation of bone metastasis.
Clinical Trials
Many clinical trials are ongoing, as shown below.
JCOG studies for lung cancers, head and neck cancers, brain tumors, gynecological cancer, and esophageal cancers
International NRG studies for breast cancer and meningioma
International Study of Ophthalmic Radiation Therapy Toxicity
Multi-institutional phase II clinical trial of online adaptive stereotactic body radiotherapy for prostate cancer using MR linear accelerators
Phase II clinical trial of BNCT for skin angiosarcoma
Development of an Adaptive Radiation Therapy System
Many other multi- or single-institutional clinical trials are also ongoing or in preparation.
Education
Residents are trained in all fields of radiation oncology in our department. Seminars on biology, physics, and clinical radiation oncology are regularly held in the evening.
Future Prospects
With the expanding of radiation therapy indications, additional manpower will be required and research perspectives will be considerably broadened. Radiation oncology is one of the most promising disciplines in oncology.
List of papers published in 2022
Journal
1. Yazaki S, Salgado R, Shimoi T, Yoshida M, Shiino S, Kaneda T, Kojima Y, Sumiyoshi-Okuma H, Nishikawa T, Sudo K, Noguchi E, Murata T, Takayama S, Suto A, Ohe Y, Yonemori K. Impact of adjuvant chemotherapy and radiotherapy on tumour-infiltrating lymphocytes and PD-L1 expression in metastatic breast cancer. British journal of cancer, 128:568-575, 2023
2. Kashihara T, Nakayama Y, Okuma K, Takahashi A, Kaneda T, Katagiri M, Nakayama H, Kubo Y, Ito K, Nakamura S, Takahashi K, Inaba K, Murakami N, Saito T, Okamoto H, Itami J, Kusumoto M, Ohe Y, Igaki H. Impact of interstitial lung abnormality on survival after adjuvant durvalumab with chemoradiotherapy for locally advanced non-small cell lung cancer. Radiotherapy and oncology, 180:109454, 2023
3. Ishiguro A, Ogata D, Okuma K, Kashihara T, Murakami N, Hiki K, Yamakawa K, Jinnai S, Takahashi A, Namikawa K, Igaki H, Yamazaki N. Malignant melanoma treatment using brachytherapy: Two case reports and 15 case series. The Journal of dermatology, 50:94-97, 2023
4. Kashihara T, Ogata D, Okuma K, Nakamura S, Nakayama H, Mori T, Takahashi A, Namikawa K, Takahashi A, Takahashi K, Kaneda T, Inaba K, Murakami N, Okamoto H, Nakayama Y, Yamazaki N, Igaki H. Clinical significance of local control of primary tumour in definitive radiotherapy for scalp angiosarcomas. Skin research and technology, 29:e13243, 2023
5. Kon M, Okamoto H, Nakamura S, Iijima K, Chiba T, Takemori M, Nakayama H, Nakaichi T, Mikasa S, Fujii K, Urago Y, Ishikawa M, Sofue T, Katsuta S, Inaba K, Igaki H, Aso T. Planning study: prone versus supine position for stereotactic body radiotherapy in prostate by CyberKnife. Journal of radiation research, 64:186-194, 2023
6. Murakami N, Okuma K, Takahashi A, Kato T, Igaki H. Is it time to modify the Japanese Uterine Cervical Cancer Guidelines to recommend a higher dose for radio-resistant tumors? Japanese journal of clinical oncology, 53:179-181, 2023
7. Matsumura A, Asano T, Hirose K, Igaki H, Kawabata S, Kumada H. Initiatives Toward Clinical Boron Neutron Capture Therapy in Japan. Cancer biotherapy & radiopharmaceuticals, 38:201-207, 2023
8. Takemori M, Nakamura S, Sofue T, Ito M, Goka T, Miura Y, Iijima K, Chiba T, Nakayama H, Nakaichi T, Mikasa S, Takano Y, Kon M, Shuto Y, Urago Y, Nishitani M, Kashihara T, Takahashi K, Murakami N, Nishio T, Okamoto H, Chang W, Igaki H. Failure modes and effects analysis study for accelerator-based Boron Neutron Capture Therapy. Medical physics, 50:424-439, 2023
9. Murakami N, Takano A, Niizeki I, Sakuramachi M, Kashihara T, Okamoto H, Ito M, Ueno T, Igaki H. Nursing management of patients receiving interstitial brachytherapy for head and neck malignancies. Brachytherapy, 22:214-220, 2023
10. Mizuno N, Okamoto H, Minemura T, Kawamura S, Tohyama N, Kurooka M, Kawamorita R, Nakamura M, Ito Y, Shioyama Y, Aoyama H, Igaki H. Establishing quality indicators to comprehensively assess quality assurance and patient safety in radiotherapy and their relationship with an institution’s background. Radiotherapy and oncology, 179:109452, 2023
11. Nakaichi T, Okamoto H, Kon M, Takaso K, Aikawa A, Nakamura S, Ijima K, Chiba T, Nakayama H, Takemori M, Mikasa S, Fujii K, Urago Y, Goka T, Shimizu Y, Igaki H. Commissioning and performance evaluation of commercially available mobile imager for image guided total body irradiation. Journal of applied clinical medical physics, 24:e13865, 2023
12. Murakami N, Watanabe M, Uno T, Sekii S, Tsujino K, Kasamatsu T, Machitori Y, Aoshika T, Kato S, Hirowatari H, Kaneyasu Y, Nakagawa T, Ikushima H, Ando K, Murata M, Yoshida K, Yoshioka H, Murata K, Ohno T, Okonogi N, Saito AI, Ichikawa M, Okuda T, Tsuchida K, Sakurai H, Yoshimura R, Yoshioka Y, Yorozu A, Kunitake N, Okamoto H, Inaba K, Kato T, Igaki H, Itami J. Phase I/II prospective clinical trial for the hybrid of intracavitary and interstitial brachytherapy for locally advanced uterine cervical cancer. Journal of gynecologic oncology, 34:e24, 2023
13. Murakami N, Masui K, Yoshida K, Noda SE, Watanabe M, Takenaka T, Ii N, Atsumi K, Umezawa R, Inaba K, Iijima K, Kubo A, Igaki H, Shikama N, Ikushima H. Hands-on seminar for image-guided adaptive brachytherapy and intracavitary/interstitial brachytherapy for uterine cervical cancer. Japanese journal of clinical oncology, 53:508-513, 2023
14. Nakayama H, Okamoto H, Nakamura S, Iijima K, Chiba T, Takemori M, Nakaichi T, Mikasa S, Fujii K, Sakasai T, Kuwahara J, Miura Y, Fujiyama D, Tsunoda Y, Hanzawa T, Igaki H, Chang W. Film measurement and analytical approach for assessing treatment accuracy and latency in a magnetic resonance-guided radiotherapy system. Journal of applied clinical medical physics, 24:e13915, 2023
15. Okamoto H, Murakami N, Isohashi F, Kasamatsu T, Hasumi Y, Kobayashi H, Ishikawa M, Nakamura M, Nishio T, Igaki H, Ishikura S, Yaegashi N, Mizowaki T, Nishimura Y, Toita T. Plan quality association between dummy run and individual case review in a prospective multi-institutional clinical trial of postoperative cervical cancer patients treated with intensity-modulated radiotherapy: Japan clinical Oncology Group study (JCOG1402). Radiotherapy and oncology, 183:109630, 2023
16. Soyano T, Kozuka T, Kashihara K, Murakami Y, Yonese J, Sasamura K, Shimoyachi N, Kashihara T, Yoshioka Y, Oguchi M. Intensity-modulated radiation therapy for intermediate-risk prostate cancer: does ADT still have an impact in the dose-escalated external beam radiation therapy era? Japanese journal of clinical oncology, 53:514-521, 2023
17. 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, 2023
18. Hosoya T, Takahashi M, Honda-Kitahara M, Miyakita Y, Ohno M, Yanagisawa S, Omura T, Kawauchi D, Tamura Y, Kikuchi M, Nakano T, Yoshida A, Igaki H, Matsushita Y, Ichimura K, Narita Y. MGMT gene promoter methylation by pyrosequencing method correlates volumetric response and neurological status in IDH wild-type glioblastomas. Journal of neuro-oncology, 157:561-571, 2022
19. Ohno M, Miyakita Y, Takahashi M, Yanagisawa S, Tamura Y, Kawauchi D, Kikuchi M, Igaki H, Yoshida A, Satomi K, Matsushita Y, Ichimura K, Narita Y. Assessment of therapeutic outcome and role of reirradiation in patients with radiation-induced glioma. Radiation oncology (London, England), 17:85, 2022
20. Omura T, Takahashi M, Ohno M, Miyakita Y, Yanagisawa S, Tamura Y, Kikuchi M, Kawauchi D, Nakano T, Hosoya T, Igaki H, Satomi K, Yoshida A, Sunami K, Hirata M, Shimoi T, Sudo K, Okuma HS, Yonemori K, Suzuki H, Ichimura K, Narita Y. Clinical Application of Comprehensive Genomic Profiling Tests for Diffuse Gliomas. Cancers, 14:2454, 2022
21. Kawauchi D, Ohno M, Miyakita Y, Takahashi M, Yanagisawa S, Omura T, Yoshida A, Kubo Y, Igaki H, Ichimura K, Narita Y. Early Diagnosis and Surgical Intervention Within 3 Weeks From Symptom Onset Are Associated With Prolonged Survival of Patients With Glioblastoma. Neurosurgery, 91:741-748, 2022
22. Hosoya T, Takahashi M, Davey C, Sese J, Honda-Kitahara M, Miyakita Y, Ohno M, Yanagisawa S, Omura T, Kawauchi D, Ozeki Y, Kikuchi M, Nakano T, Yoshida A, Igaki H, Matsushita Y, Ichimura K, Narita Y. Volumetric Analysis of Glioblastoma for Determining Which CpG Sites Should Be Tested by Pyrosequencing to Predict Temozolomide Efficacy. Biomolecules, 12:1379, 2022
23. Itami J, Kobayashi K, Mori T, Honma Y, Kubo Y, Murakami N, Omura G, Okuma K, Inaba K, Takahashi K, Kashihara T, Shimizu Y, Takahashi A, Nakayama Y, Matsumoto F, Yoshimoto S, Igaki H. Non-Robustness of Ang’s Risk Classification in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma in Japanese Patients. Cancers, 14:2442, 2022
24. Shimizu Y, Murakami N, Mori T, Takahashi K, Kubo Y, Yoshimoto S, Honma Y, Nakamura S, Okamoto H, Iijima K, Takahashi A, Kaneda T, Kashihara T, Inaba K, Okuma K, Nakayama Y, Igaki H, Itami J. Clinical impact of p16 positivity in nasopharyngeal carcinoma. Laryngoscope investigative otolaryngology, 7:994-1001, 2022
25. Miyata Y, Murakami N, Honma Y, Mori T, Yoshimoto S, Kashihara T, Takemori M, Nakayama Y, Itami J, Ogo E, Igaki H. Technical report: a high-dose-rate interstitial brachytherapy boost for residual sinonasal undifferentiated carcinoma. Journal of radiation research, 63:879-883, 2022
26. Kubo S, Shinkawa H, Asaoka Y, Ioka T, Igaki H, Izumi N, Itoi T, Unno M, Ohtsuka M, Okusaka T, Kadoya M, Kudo M, Kumada T, Kokudo N, Sakamoto M, Sakamoto Y, Sakurai H, Takayama T, Nakashima O, Nagata Y, Hatano E, Harada K, Murakami T, Yamamoto M. Liver Cancer Study Group of Japan Clinical Practice Guidelines for Intrahepatic Cholangiocarcinoma. Liver cancer, 11:290-314, 2022
27. Takamori H, Urabe F, Matsuzaki J, Kimura S, Sasaki H, Kimura T, Inaba K, Nakamura E, Matsui Y, Fujimoto H, Ochiya T. Circulating microRNA profiling for prediction of oncological outcomes in prostate cancer patients following radical prostatectomy. The Prostate, 82:1537-1546, 2022
28. Asami Y, Hiranuma K, Takayanagi D, Matsuda M, Shimada Y, Kato MK, Kuno I, Murakami N, Komatsu M, Hamamoto R, Kohno T, Sekizawa A, Matsumoto K, Kato T, Yoshida H, Shiraishi K. Predictive model for the preoperative assessment and prognostic modeling of lymph node metastasis in endometrial cancer. Scientific reports, 12:19004, 2022
29. Okumura M, Ogata D, Namikawa K, Tsutsui K, Takahashi A, Okuma K, Kashihara T, Igaki H, Akiyama M, Yamazaki N. Postoperative radiation therapy improves prognoses in extramammary Paget’s disease presenting with multiple lymph node metastases. The Journal of dermatology, 49:1005-1011, 2022
30. Nakaichi T, Nakamura S, Ito K, Takahashi K, Takemori M, Kashihara T, Kunito K, Murakami N, Iijima K, Chiba T, Nakayama H, Mikasa S, Nishio T, Okamoto H, Itami J, Kurihara H, Igaki H. Analyzing spatial distribution between (18)F-fluorodeoxyglucose and (18)F-boronophenylalanine positron emission tomography to investigate selection indicators for boron neutron capture therapy. EJNMMI physics, 9:89, 2022
31. Kawahara D, Tsuneda M, Ozawa S, Okamoto H, Nakamura M, Nishio T, Nagata Y. Deep learning-based auto segmentation using generative adversarial network on magnetic resonance images obtained for head and neck cancer patients. Journal of applied clinical medical physics, 23:e13579, 2022
32. Okamoto H, Iijima K, Chiba T, Takemori M, Nakayama H, Fujii K, Kon M, Mikasa S, Nakaichi T, Urago Y, Aikawa A, Katsuta S, Nakamura S, Igaki H. Technical note: Analysis of brachytherapy source movement by high-speed camera. Medical physics, 49:4804-4811, 2022
33. Murakami N, Ohno T, Toita T, Ando K, Ii N, Okamoto H, Kojima T, Tsujino K, Masui K, Yoshida K, Ikushima H. Japanese Society for Radiation Oncology Consensus Guidelines of combined intracavitary and interstitial brachytherapy for gynecological cancers. Journal of radiation research, 63:402-411, 2022
34. Murakami N, Ando K, Murata M, Murata K, Ohno T, Aoshika T, Kato S, Okonogi N, Saito AI, Kim JY, Yoshioka Y, Sekii S, Tsujino K, Lowanichkiattikul C, Pattaranutaporn P, Kaneyasu Y, Nakagawa T, Watanabe M, Uno T, Umezawa R, Jingu K, Kanemoto A, Wakatsuki M, Shirai K, Igaki H, Itami J. An Asian multi-national multi-institutional retrospective study comparing intracavitary versus the hybrid of intracavitary and interstitial brachytherapy for locally advanced uterine cervical carcinoma. Journal of radiation research, 63:412-427, 2022
35. Murakami N, Watanabe M, Uno T, Sekii S, Tsujino K, Kasamatsu T, Machitori Y, Aoshika T, Kato S, Hirowatari H, Kaneyasu Y, Nakagawa T, Ikushima H, Ando K, Murata M, Yoshida K, Yoshioka H, Murata K, Ohno T, Okonogi N, Saito A, Ichikawa M, Okuda T, Tsuchida K, Sakurai H, Yoshimura R, Yoshioka Y, Yorozu A, Okamoto H, Inaba K, Kato T, Igaki H, Itami J. Large volume was associated with increased risk of acute non-hematologic adverse events in the hybrid of intracavitary and interstitial brachytherapy for locally advanced uterine cervical cancer: preliminary results of prospective phase I/II clinical trial. Japanese journal of clinical oncology, 52:859-868, 2022
36. Takagawa Y, Murakami N, Igaki H, Okamoto H, Itami J. High-dose-rate interstitial brachytherapy as a suitable option for metastatic extraskeletal myxoid chondrosarcoma - a case report. Journal of contemporary brachytherapy, 14:198-204, 2022
37. Kobayashi R, Murakami N, Chiba T, Okuma K, Inaba K, Takahashi K, Kaneda T, Kashihara T, Takahashi A, Shimizu Y, Nakayama Y, Kato T, Ito Y, Igaki H. Effect of Hyaluronate Acid Injection on Dose-Volume Parameters in Brachytherapy for Cervical Cancer. Advances in radiation oncology, 7:100918, 2022
38. Nishioka S, Okamoto H, Chiba T, Sakasai T, Okuma K, Kuwahara J, Fujiyama D, Nakamura S, Iijima K, Nakayama H, Takemori M, Tsunoda Y, Kaga K, Igaki H. Identifying risk characteristics using failure mode and effect analysis for risk management in online magnetic resonance-guided adaptive radiation therapy. Physics and imaging in radiation oncology, 23:1-7, 2022
39. Murakami N, Okuma K, Kato T, Igaki H. Now is it time to implement spacers in cervical cancer brachytherapy? Journal of radiation research, 63:696-698, 2022
40. Miyata Y, Murakami N, Okuma K, Shimizu Y, Takahashi A, Kashihara T, Kaneda T, Takahashi K, Inaba K, Sakuramachi M, Kojima K, Aoshika T, Morishima K, Nakayama Y, Itami J, Kato T, Ogo E, Igaki H. Salvage image-guided freehand interstitial brachytherapy for pelvic sidewall recurrence after hysterectomy for uterine malignancies. Brachytherapy, 21:647-657, 2022
41. Inada M, Nishimura Y, Ishikura S, Ishikawa K, Murakami N, Kodaira T, Ito Y, Tsuchiya K, Murakami Y, Saito J, Akimoto T, Nakata K, Yoshimura M, Teshima T, Toshiyasu T, Ota Y, Minemura T, Shimizu H, Hiraoka M. Organs-at-risk dose constraints in head and neck intensity-modulated radiation therapy using a dataset from a multi-institutional clinical trial (JCOG1015A1). Radiation oncology (London, England), 17:133, 2022
42. Okamoto H, Igaki H, Chiba T, Shibuya K, Sakasai T, Jingu K, Inaba K, Kuroda K, Aoki S, Tatsumi D, Nakamura M, Kadoya N, Furuyama Y, Kumazaki Y, Tohyama N, Tsuneda M, Nishioka S, Itami J, Onishi H, Shigematsu N, Uno T. Practical guidelines of online MR-guided adaptive radiotherapy. Journal of radiation research, 63:730-740, 2022
43. Nakano T, Aoyama H, Onodera S, Igaki H, Matsumoto Y, Kanemoto A, Shimamoto S, Matsuo M, Tanaka H, Oya N, Matsuyama T, Ohta A, Maruyama K, Tanaka T, Kitamura N, Akazawa K, Maebayashi K. Reduced-dose WBRT combined with SRS for 1-4 brain metastases aiming at minimizing neurocognitive function deterioration without compromising brain tumor control. Clinical and translational radiation oncology, 37:116-129, 2022
44. Okonogi N, Murakami N, Ando K, Murata M, Murata K, Aoshika T, Kato S, Saito AI, Kim JY, Yoshioka Y, Sekii S, Tsujino K, Lowanichkiattikul C, Pattaranutaporn P, Kaneyasu Y, Nakagawa T, Watanabe M, Uno T, Umezawa R, Jingu K, Kanemoto A, Wakatsuki M, Shirai K, Igaki H, Ohno T, Itami J. An Asian multi-national, multi-institutional, retrospective study on image-guided brachytherapy in cervical adenocarcinoma and adenosquamous carcinoma. Journal of contemporary brachytherapy, 14:311-320, 2022