Carbon Ion Radiotherapy in a Hypofractionation Regimen for Stage I Non-Small Cell Lung Cancer

In 1994, we began using carbon-ion radiotherapy (CIRT) for the treatment of peripheral stage I nonsmall cell lung cancer (NSCLC). Between 1994 and 1999, a phase I/II dose escalation study of the treatment of stage I peripheral NSCLC was conducted to determine the optimal dose of therapy and evaluate whether progressing to hypofractionated CIRT was feasible. Another purpose of these trials was to develop precise and safe irradiation techniques with maximum sparing of normal tissue. Two phase I/II clinical trials demonstrated the optimal doses of 90.0 GyE in 18 fractions over six weeks (Protocol #9303) and 72.0 GyE in nine fractions over three weeks (Protocol #9701) for achieving more than 95% local control with minimal pulmonary toxicity.As a next step, we conducted two successive phase II trials. The first trial (Protocol #9802) used a regimen of 72 GyE per nine fractions over three weeks, and the second trial (Protocol #0001) used a regimen of four fractions over one week at a fixed dose of 52.8 GyE for stage IA patients and 60GyE for stage IB patients. In these phase II trials, the local control rate (LCR) for all patients was 91.5%, while that for patients with T1 and T2 tumors was 96.3% and 84.7%, respectively. The 5-year cause-specific survival rate (CSS) was 67.0% (IA: 84.4, IB: 43.7), and the overall survival (OS)rate was 45.3% (IA: 53.9, 1B: 34.2). No adverse events greater than grade 2 occurred in the lungs.In 2003, we initiated a phase I/II clinical trial (Protocol #0201) as a dose escalation study using a single fraction. The initial total dose was 28.0 GyE administered and escalated in increments of 2.0GyE each, up to 50.0 GyE. That clinical trial ended in February 2012 and remains in follow-up. In this article, we investigated the preliminary results of this phase I/II trial.The Cancer Symposium: Advanced Radiation Oncology Treatment Strategies with Photon, Proton, and Carbon Ion Radiatio

Carbon Ion Radiotherapy in a Hypofractionated Regimen for Stage I Non-Small Cell Lung Cancer

AbstractBeginning in 1994, we conducted a phase I/II clinical trial for stage I non-small cell lung cancer (NSCLC) by using carbon ion beams alone, demonstrating optimal doses of 90.0 GyE in 18 fractions over six weeks and 72.0 GyE in nine fractions over three weeks for achieving more than 95% local control with minimal pulmonary damage. Following this schedule, we conducted phase II clinical trials for stage I NSCLC from 1999 to 2003. In the present study, the total dose was fixed at 72.0 GyE in nine fractions over three weeks, and at 52.8 GyE for stage IA and 60.0 GyE for stage 1B in four fractions in one week. We also conducted a phase I/II single fractionation clinical trial as a dose escalation study. The total dose was increased from 28.0 GyE to 50.0 GyE. In the first and second phase II trials, the local control rate for all patients was 91.5%, and those for patients with T1 and T2 tumors were 96.3% and 84.7%, respectively. The five-year overall survival rate was 45.3%. No adverse effects greater than grade 2 occurred in the lung. In a single fractionation trial, the five-year local control rate for 151 patients was 79.2%, and the control rates for T1 and T2 tumors were 83.6% and 72.2%, respectively. No adverse effects greater than grade 2 occurred in the lung. Carbon beam radiotherapy, an excellent new modality in terms of a high quality of life and activities of daily living, was proven to be a valid alternative to surgery for patients with stage I cancer, especially for elderly and inoperable patients

Carbon Ion Radiotherapy for Lung Cancer

Although stage I non-small cell lung cancer can often be cured by surgical resection, in some cases, surgery cannot be performed or is refused by the patient. There is a critical need to develop safe and effective treatments to reduce the mortality of lung cancer in such patients. Carbon ion radiotherapy for lung cancer was first performed in Novenber of 2009, and 918patients have been treated as of December 2010. For peripheral type stage Ilung cancer, the treatment period was gradually shortened from 6 weeks(18fractions)to 3 weeks(9 fractions)to 1week(4 fractions)to determine the safety and efficacy of the treatment. Aclinical trial examining the treatment of patients in a single day is just ending. In the phase II clinical trial, the adverse effect on normal tissue was 91.8% in a five years local control rate, not showing a pulmonary response grade of 3 or more, which indicates clinically problematic cases. It appears that carbon ion radiotherapy contributes to the reduction of lung cancer mortality, and may reprsent a valid alternative local therapy for inoperable cases

Carbon Ion Radiotherapy for Perupheral Stage1 Non-Small Cell Lung Cancer

The National Institute of Radiological Sciences in Chiba, Japan (NIRS) has highest number of patients with lung cancer treated with carbon ion beams in the world. This report describes the techniques and clinical trials that have been undertaken at NIRS and preliminary results of a current study on single-fraction irradiation. The data are compared to recent results for the treatment of peripheral stage I lung cancer from the literature

Verification system for image-guided radiation therapy by using in-treatment 4D CBCT

2nd European Society for Therapeutic Radiology and Oncolog

Carbon ion radiotherapy for oligo-recurrence in the lung.

The clinical results after carbon ion radiotherapy for the metastatic lung tumors believed to be in the state of oligo-recurrence were evaluated. One hundred and sixteen lesions in 91 patients with lung cancer metastasis were treated with carbon ion radiotherapy at our institute from April 1997 to February 2011. Regarding the prescribed dose, total dose ranged between 40 gray equivalents (GyE) and 80 GyE, and fraction size ranged from 1 to 16 fractions. After a median followup period of 2.3 years (range, 0.3-13.1 years), the statistical overall survival rate and local control rate were 71.2% and 91.9% at 2 years after treatment, respectively. Treatment-related side effects were not a clinical problem. When classified by the primary organ, there were 49 cases of lung cancer, 20 cases of colorectal cancer, and 22 cases of others. The overall survival rate and local control rate for lung metastasis cases from lung cancer at 2 years after treatment were 81.5% and 92.4%, respectively, and 65.0% and 92.0% regarding lung metastasis from colorectal cancer. Carbon ion beam therapy for the metastatic lung tumors is a safe therapy, and the therapeutic effect is comparable to the outcome obtained from reported surgical resections

Carbon Ion Radiotherapy in Hypo-Fractionation Regimen and Single Dose for Stage I Non-small-Cell Lung Cancer

AbstractIt has been more than one decade since we started carbon ion radiation therapy (CIRT) for non-small-cell lung cancer (NSCLC) in November 1994. From 1994 to 1999, we conducted a phase I/II clinical trial for stage I NSCLC with CIRT and demonstrated an optimal dose of 90 GyE in 18 fractions over 6 weeks and 72 GyE in 9 fractionsover 3 weeks for achieving more than 90% local control with minimal pulmonary damage. In the following phase II study from 1999 to 2003, the total dose was fixed at 72 GyE in 9 fractions over 3 weeks and at 52.8 GyE for stage IA and at 60 GyE for stage IB in 4 fractions over 1 week. Targets were irradiated from four oblique direc- tions. A respiratory-gated irradiation system was used for all irradiation sessions. On these twophase II schedules combined, the 5-year local control rate for 13 1 primary tumors of 129 patients was 91.5%. The local control rate for Tl and T2 tumors was 96.3 and 84.7%, respectively. While there was significant difference in control rate between Tl and T2, there was no significant difference in histology between squamous and non-squamous type. The 5-year cause-specific survival rate of the patients was 67.0% (IA: 84.4, IB: 43.7), and their overall survival was 45.3% (IA: 53.9, IB: 34.2). No adverse effects greater than grade III occurred in the lung. In this way, the treatment period and fractionation were shortened and lessened from 18 fractions over 6 weeks to 9 fractions over 3 weeks and further to 4 fractions over one week. Finally it reached a single dose.Since 2003, 210 patients have already been treated with CIRT in single dose increasing 28, 32, 34, 36, 38, 40, 42, 44, 46, and 48 GyE. Compared with the previous fractionation regimen, CIRT in single- dose is demonstrating low morbidity and high QOL. The 5-year local control rate of 131 tumors with doses more than 36 GyE was higher than80%. The 5-year cause-specific and overall sur- vival rate of 131 patients were 1.5 and 52.6%, respectively. Of the whole evaluate, we will finally recommend that CIRT in single dose is the best for the treatment of the peripheral type of stage I NSCLC