JSCO2016: International Session 8 New Development of Particle Beam Therapy for Cancer

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


International Session 8: New Development of Particle Beam Therapy for Cancer


Clinical trials at HIT and MIT : Current and future strategies in particle therapy
Juergen Debus (Department of Radiation Oncology, Heidelberg University Hospital, Germany)
Heidelberg University has treated 440 patients with carbon ions from 1997 to 2008 in Darmstadt at the German Society of heavy Ions (GSI). Since the launch of the Heidelberg Ion Treatment center (HIT) in 2009 over 3700 patients have been treated at HIT with carbon ions and protons. In November 2015 the Marburg Ion Treatment center (MIT) started its operation. Many of the patients treated at HIT were included into clinical trials to proof and to confirm the value of heavy ion radiation therapy in the treatment of cancer. Moreover, differences in the use and effectiveness of different particles are being investigated.

Chordomas and chondrosarcomas of the skull base were among of the first trials initiated at HIT and two randomized phase III trials were established at HIT. Long term results from patients with adenoid cystic carcinoma treated with additional carbon ion boost revealed significantly higher local tumor control and also significantly higher overall survival.

The NIRS data set a corner stone in the design of new trials. Many of our trials also use raster scanning technique and a denser fraction schedule and may confirm the NIRS data and upcoming data from CNAO, Pavia. Other trials address the possible different effect of the RBEs of protons and carbon ions.

Future trials at HIT will include more and more moving targets. The role of ion radiotherapy in the treatment of pancreatic cancer will also be assessed in trials as well as the use of carbon ions for inoperable esophageal cancer. Furthermore, long term effects of particle therapy will be systematically investigated.


New developments in particle beam therapy
Marco Durante (TIFPA-INFN, University of Trento, Italy)
Charged particle therapy is rapidly growing in Asia, Europe, and America, but definitive proof of its superiority compared to conventional X-ray therapy is still lacking. Trials on prostate and lung cancer show no significant differences between IMRT and proton therapy. The problem in these trials is that similar doses were used, and particles were not used with optimal protocols. A recent dose escalation trial in lung cancer reported reduced survival in patients treated at higher doses, and this paradoxical result depends on the increased morbidity in the high-dose arm. This suggests that particles should be used for dose escalation. In silico tests are necessary to select the best trials, and the tumor site should be selected to enhance the physical or biological properties of protons and heavy ions.


Real-time-image gated proton beam therapy (RGPT) for cancer
Hiroki Shirato (Department of Radiation Medicine, Hokkaido University School of Medicine)
Proton Beam Therapy is accepted to be reimbersed for pediatric cancers in Japan from April 2016 to reduce the risk of secondary cancer induced by radiation. It is because the dose distribution is much better than x-ray therapy a priori for many situations. The residual problem in proton beam therapy has been contamination of neutron, which has higher risk of secondary cancer production. Spot scanning technology has been introduced to reduce the contamination of neutron. However, the spot scanning technology has not been suitable for cancers in the organs such as lung and liver which irregularly move with respiration. Interplay effect between the direction of spot scanning and the direction of respiration can deteriodate dose distribtuion in the body. A new treatment system, RGPT, was developed to solve this problem. Real-time-imaging of the fiducial markers near the tumor and gated irradiation of spot scanning proton beam have been combined and used for cancers in lung and liver. The time of treatment did not prolonged so much because of the smaller scanning volume in RGPT comparing to the free-breathing proton beam therapy. Adding to this technology, image-guided proton beam therapy using cone-beam computed tomography (CBCT) is used for the adaptive radiotherapy where shrinkage of tumor mass during several weeks of radiotherapy can be taken into account. For tumors which is situlated very close to the critical organ and target volume has the concave shape to reduce the dose to the critical organ, intensity modulated proton beam therapy (IMPT) is used successfully. We would say that proton beam therapy is improving significantly in these 10 years. However, careful clinical research is still recommended to find the appropriate condition for the proton beam therapy to be reinversed in adult cancers.


Current status and issues of proton beam therapy in Japan
Hideyuki Sakurai (Radiation Oncology, University of Tsukuba Graduate School of Comprehensive Human Sciences)
The number of patients treated by proton beam therapy (PBT) has increased since 2000 in Japan. In 2016, 11 proton facilities are available to treat patients. PBT is very useful modality for pediatric cancer; since the radiation dose to normal tissues should be reduced as much as possible because of the effect of radiation on growth, intellectual development, endocrine organ function, and secondary cancer development. Hepatocellular carcinoma is common in Asia, and most of the studies of PBT for liver cancer have been reported by Japanese investigators. PBT is also a standard treatment for nasal and paranasal lesions and lesions at the base of the skull, because the radiation dose to critical organs such as the eyes, optic nerves, and central nervous system can be reduced with PBT. For prostate cancer, comparative studies that address adverse effects, safety, patient quality of life, and socioeconomic issues should be performed to determine the appropriate use of PBT. Regarding new PBT applications, experience with PBT combined with chemotherapy is limited, although favorable outcomes have been recently reported for locally advanced lung cancer, esophageal cancer, and pancreatic cancer. Therefore, chemoproton therapy appears to be an attractive field for further clinical investigations. In conclusion, there are cost issues and considerations regarding national insurance for the use of PBT in Japan. Further studies and discussions are needed to address the use of PBT for several types of cancers, and for maintaining the quality of life of patients while retaining a high cure rate.


Current status and issues of heavy particle beam therapy in Japan
Hiroshi Tsuji (National Institute for Quantum and Radiological Sciences and Technology)
The clinical study on heavy particle beam therapy using carbon ion beam was initiated at the National Institute of Radiological Sciences (NIRS) in 1994. So far, more than 9,000 patients have been treated and the benefit of C-ion RT over other modalities was indicated in various tumor sites in terms of high local control and survival probabilities. Particularly, it was remarkable that the effectiveness to many kinds of photon-resistant tumors, such as bone and soft tissue sarcoma, skull base tumor, malignant melanoma and so on was confirmed. In addition, safe and effective treatment method with carbon-ion beam could be established in many other malignancies, such as non-squamous head and neck cancers, pancreas cancer, and post-operative recurrence of rectal cancer. Furthermore a significant reduction in overall treatment time and fraction number has been achieved with acceptable toxicities in many tumor sites of high prevalence, such as lung cancer, liver cancer, or prostate cancer.
The technical and clinical achievements at NIRS have led to the promotion of C-ion RT in Japan. At present, four carbon therapy facilities other than the NIRS are in operation. Recently, the Japan Carbon-Ion Radiation Oncology Study Group (J-CROS) was constructed with the intent of conducting multi-institutional cohort studies on the tumors where existing evidence suggests improved outcome in C-ion RT. The first work of J-CROS was the retrospective observational studies in various tumor sites. The actual data so far were gathered from four running institutes and analyzed with regard to effectiveness and toxicity of C-ion RT. Now the J-CROS is planning many prospective studies for the patients who are likely to benefit from the C-ion RT according to the results of retrospective studies. These activities of the J-CROS will result in the real standardization of this treatment.


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