Carbon Ion Radiotherapy For Adenocarcinoma of The Head and Neck

Purpose/Objective(s)To estimate the toxicity and efficacy of carbon ion radiotherapy for adenocarcinoma of the head-and-neck.Materials/MethodsBetween April 1997 and February 2012, a total of 50 patients with adenocarcinoma of the head-and-neck were treated with carbon ion radiotherapy. None of these patients had either regional lymph node or distant metastasis before radiotherapy.The prescribed tumor doses were 57.6 or 64.0 GyE in 16 fractions over four weeks. All patients provided written informed consent before enrollment in this study.The National Institute of Radiological Sciences Ethical Committee on Human Clinical Research has approved this study.ResultsThe patients consisted of 29 males and 21 females aged from 26 to 80 years with an average age of 61 years. As for the tumor sites studied, there were 15 paranasal sinus, 9 orbit, 7 nasal cavity, 7 major salivary gland, 5 pharynx, 4 oral cavity, 2 external ear canal and 1 parapharyngeal space. Forty-one of 50 patients with unresectable tumors or with recurrence and residual tumors after other treatment were permitted to partake in the carbon ion radiotherapy. The gross tumor volume ranged from 1.8 to 227.7 ml, with an average of 67.2 ml.Median follow-up time was 42.5 months (range, 3.9-179.8 months). Although acute grade 3 skin and mucosal reactions appeared in 2 of 50 patients (4%) and 8 of 45 patients (18%), almost all of the late skin and mucosal reactions were grade 1 or less. At the time of analysis, there was no evidence of any unexpected severe toxicity to the critical organs. The 5-year local control and overall survival rates of all patients were 83% and 55%, respectively. As for the T stage studied, the 5-year local control rates were 88% for stage from T1 to T3, 74% for T4 and 88% for recurrence and residual tumors after other treatment. The 5-year overall survival rates were 88% for stage from T1 to T3, 42% for T4 and 54% for recurrence and residual tumors after other treatment, respectively.ConclusionsOur results showed acceptable toxicities and excellent therapeutic effectiveness for adenocarcinomas.ASTRO\u27s 55th Annual Meetin

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy.

Osteoradionecrosis (ORN) is a critical complication after carbon ion (C-ion) or photon radiotherapy (RT) for head and neck tumors. However, the risk factors for ORN after C-ion RT remain unclear. Therefore, the present study aimed to investigate the effects of the dose-volume relationship on and risk factors for ORN development after C-ion RT. We, however, focused on the maxillary bone because most tumors treated with C-ion RT were primarily located in the sinonasal cavity

Experience of long-term management for osteoradionecrosis of the maxilla after carbon ion radiotherapy

Purpose: The aim of this study is to evaluate the incident of maxillary osteoradionecrosis (ORN) in patients who underwent carbon ion radiotherapy (CIRT) for head and neck cancer.Materials and Methods: From April 1997 to April 2006, 239 patients with the head and neck cancers were treated with CIRT with a dose of 57.6 GyE per 16 fractions. Patients whose alveolar process and palatine process of maxilla had been irradiated more than 10 percent of the prescribed dose were selected. We retrospectively investigated the incidence and treatment of ORN. Results: Sixty seven patients were enrolled in this study. Of the 67 patients, 33 patients (49.3%) developed ORN. Sixteen patients (23.9%) received no treatment, 13 patients (19.4%) with exposed sequestrum received conservative therapy. Four patients (6.0%) with failure of conservative therapy were undergone sequestrectomy.After sequestrectomy, all of 4 patients showed no signs of sequestrum re-exposure or symptom exacerbation during the average follow up period of 36.7 months (range, 4-58 months). In addition, masticatory function was maintained using dento-maxillary prosthesis in all cases.Conclusions: Although 33 patients developed ORN, only 4 patients needed the surgical treatment. However we could control the clinical symptoms and improved the QOL for the 4 patients after surgical intervention.Heavy Ion in Therapy and Space Radiation Symposium 2013(HITSRS2013

Carbon ion radiotherapy for skull base and paracervical chordomas

High linear energy transfer charged particles such as carbon ions have excellent dose localizing properties, and this can cause excellent local control while minimizing the effect on normal tissues. Between April 1997 and January 2012, 50 patients with skull base and paracervical chordomas were treated with carbon ion radiotherapy at National Institute of Radiological Sciences in Japan. In this study, we investigated the toxicity and efficacy of carbon ion radiotherapy for skull base and paracervical chordomas. The 50 patients consisted of 23 males and 27 females. Their ages ranged from 16 to 76 years, with a median of 55 years. Thirty-four tumors located in the skull base region and 16 in the paracervical region. The planning target volume ranged from 11 to 481 ml, with a median of 84 ml. The patients were treated with a median dose of 60.8 GyE (range; 48-60.8 GyE) in 16 fractions over 4 weeks. Acute toxicity was assessed based on the RTOG score, and late toxicity was determined based on the RTOG/ EORTC score. Local control was defined as showing no evidence of tumor regrowth in the irradiated volume. The follow-up periods ranged from 4 to 163 months, with a median of 54 months. There was no evidence of any serious acute reactions (Grade ≥4). Regarding late reactions, two patients decreased visual acuity and 2 developed mucosal ulcerations in the irradiated volume. The 5-year local and loco-regional control rates were 88.6% and 78.7%, respectively. The 5-year overall survival and progression free survival rates were 88.2% and 68.7%, respectively. The 5-year local control and overall survival rates for 40 patients treated with a dose of 60.8 GyE were 92.7% and 88.4%, respectively. Carbon ion radiotherapy with a dose of 60.8 GyE in 16 fractions was safe and effective for skull base and paracervical chordomas.17th Annual Scientific Meeting and Education Day of the Society for Neuro-Oncolog

Correlation of Obsteoradionecrosis with Dosimetric Parameters in Carbon Ion Radiotherapy

Purpose: The purpose of this study is to analyze the relation between the irradiation dose of maxilla and osteoradionecrosis after carbon ion radiotherapy using dose-volume histograms.Materials and Methods: From April 1997 to April 2006, 243 patients with tumors in the head and neck region were treated with carbon ion radiotherapy in our institution. Analysis was performed to 59 patients whose alveolar process and palatine process of maxilla had been included in the irradiated volume and had not been infiltrated by the tumor. These patients had a follow-up period of at least 2 years.We evaluated the prognostic factors of osteoradionecrosis in carbon ion radiotherapy, using dose-volume histograms.Results: The median age of 59 patients (31 men, 28 women) was 58 years. The prescribed tumor dose was 57.6 GyE in 16 fractions over 4 weeks. Dose-volume histogram analysis revealed that the percentages of maxilla volume receiving more than 50 GyE (V50) were significantly higher in patients with >grade 1 osteonecrosis than in those with grade 0. The number of teeth within radiation fields and were correlated with osteoradionecrosis.Conclusions: V50 and the number of teeth within radiation fields were significant risk factors for >grade 1 osteoradionecrosis induced by carbon ion radiotherapy administered in 16 fractions.Heavy Ion in Therapy and Space Radiation Symposium 2013(HITSRS2013