Researcher Profile and Settings

Affiliation

• Hokkaido University Hospital　Radiology

Job Title

• Assistant Professor

URL

http://kaken.nii.ac.jp/d/r/70507582.ja.html

J-Global ID

• 201301035935334720

Research Areas

• Life sciences / Radiology

Educational Organization

•  Master's degree program　Graduate School of Medicine
•  Doctoral (PhD) degree program　Graduate School of Medicine

Academic & Professional Experience

• 2012 北海道大学 医学(系)研究科(研究院) その他

Research Activities

Published Papers

• A Single-Institution Prospective Study To Evaluate the Safety and Efficacy of Real- Time Image-Gated Spot-Scanning Proton Therapy (RGPT) for Prostate Cancer.

  Kentaro Nishioka, Takayuki Hashimoto, Takashi Mori, Yusuke Uchinami, Rumiko Kinoshita, Norio Katoh, Hiroshi Taguchi, Koichi Yasuda, Yoichi M Ito, Seishin Takao, Masaya Tamura, Taeko Matsuura, Shinichi Shimizu, Hiroki Shirato, Hidefumi Aoyama

  Advances in radiation oncology 9 (5) 101464 - 101464 2024/05 

  PURPOSE: In real-time image-gated spot-scanning proton therapy (RGPT), the dose distribution is distorted by gold fiducial markers placed in the prostate. Distortion can be suppressed by using small markers and more than 2 fields, but additional fields may increase the dose to organs at risk. Therefore, we conducted a prospective study to evaluate the safety and short-term clinical outcome of RGPT for prostate cancer. METHODS AND MATERIALS: Based on the previously reported frequency of early adverse events (AE) and the noninferiority margin of 10%, the required number of cases was calculated to be 43 using the one-sample binomial test by the Southwest Oncology Group statistical tools with the one-sided significance level of 2.5% and the power 80%. Patients with localized prostate cancer were enrolled and 3 to 4 pure gold fiducial markers of 1.5-mm diameter were inserted in the prostate. The prescribed dose was 70 Gy(relative biologic effectiveness) in 30 fractions, and treatment was performed with 3 fields from the left, right, and the back, or 4 fields from either side of slightly anterior and posterior oblique fields. The primary endpoint was the frequency of early AE (≥grade 2) and the secondary endpoint was the biochemical relapse-free survival rate and the frequency of late AE. RESULTS: Forty-five cases were enrolled between 2015 and 2017, and all patients completed the treatment protocol. The median follow-up period was 63.0 months. The frequency of early AE (≥grade 2) was observed in 4 cases (8.9%), therefore the noninferiority was verified. The overall 5-year biochemical relapse-free survival rate was 88.9%. As late AE, grade 2 rectal bleeding was observed in 8 cases (17.8%). CONCLUSIONS: The RGPT for prostate cancer with 1.5-mm markers and 3- or 4- fields was as safe as conventional proton therapy in early AE, and its efficacy was comparable with previous studies.
• Probability of normal tissue complications for hematologic and gastrointestinal toxicity in postoperative whole pelvic radiotherapy for gynecologic malignancies using intensity-modulated proton therapy with robust optimization.

  Takaaki Yoshimura, Ryota Yamada, Rumiko Kinoshita, Taeko Matsuura, Takahiro Kanehira, Hiroshi Tamura, Kentaro Nishioka, Koichi Yasuda, Hiroshi Taguchi, Norio Katoh, Keiji Kobashi, Takayuki Hashimoto, Hidefumi Aoyama

  Journal of radiation research 2024/03/17 

  This retrospective treatment-planning study was conducted to determine whether intensity-modulated proton therapy with robust optimization (ro-IMPT) reduces the risk of acute hematologic toxicity (H-T) and acute and late gastrointestinal toxicity (GI-T) in postoperative whole pelvic radiotherapy for gynecologic malignancies when compared with three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated X-ray (IMXT) and single-field optimization proton beam (SFO-PBT) therapies. All plans were created for 13 gynecologic-malignancy patients. The prescribed dose was 45 GyE in 25 fractions for 95% planning target volume in 3D-CRT, IMXT and SFO-PBT plans and for 99% clinical target volume (CTV) in ro-IMPT plans. The normal tissue complication probability (NTCP) of each toxicity was used as an in silico surrogate marker. Median estimated NTCP values for acute H-T and acute and late GI-T were 0.20, 0.94 and 0.58 × 10-1 in 3D-CRT; 0.19, 0.65 and 0.24 × 10-1 in IMXT; 0.04, 0.74 and 0.19 × 10-1 in SFO-PBT; and 0.06, 0.66 and 0.15 × 10-1 in ro-IMPT, respectively. Compared with 3D-CRT and IMXT plans, the ro-IMPT plan demonstrated significant reduction in acute H-T and late GI-T. The risk of acute GI-T in ro-IMPT plan is equivalent with IMXT plan. The ro-IMPT plan demonstrated potential clinical benefits for reducing the risk of acute H-T and late GI-T in the treatment of gynecologic malignances by reducing the dose to the bone marrow and bowel bag while maintaining adequate dose coverage to the CTV. Our results indicated that ro-IMPT may reduce acute H-T and late GI-T risk with potentially improving outcomes for postoperative gynecologic-malignancy patients with concurrent chemotherapy.
• Impact of adaptive radiotherapy on survival in locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy.

  Yusuke Uchinami, Koichi Yasuda, Hideki Minatogawa, Yasuhiro Dekura, Noboru Nishikawa, Rumiko Kinoshita, Kentaro Nishioka, Norio Katoh, Takashi Mori, Manami Otsuka, Naoki Miyamoto, Ryusuke Suzuki, Keiji Kobashi, Yasushi Shimizu, Jun Taguchi, Nayuta Tsushima, Satoshi Kano, Akihiro Homma, Hidefumi Aoyama

  Radiation oncology journal 42 (1) 74 - 82 2024/03 

  PURPOSE: To investigate the clinical significance of adaptive radiotherapy (ART) in locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Eligible patients were treated with concurrent chemoradiotherapy using IMRT. Planning computed tomography in ART was performed during radiotherapy, and replanning was performed. Since ART was started in May 2011 (ART group), patients who were treated without ART up to April 2011 (non-ART group) were used as the historical control. The Kaplan-Meier method was used to calculate overall survival (OS), locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). LRFS for the primary tumor (LRFS_P) and regional lymph node (LRFS_LN) were also studied for more detailed analysis. Statistical significance was evaluated using the log-rank test for survival. RESULTS: The ART group tended to have higher radiation doses. The median follow-up period was 127 months (range, 10 to 211 months) in the non-ART group and 61.5 months (range, 5 to 129 months) in the ART group. Compared to the non-ART group, the ART group showed significantly higher 5-year PFS (53.8% vs. 81.3%, p = 0.015) and LRFS (61.2% vs. 85.3%, p = 0.024), but not OS (80.7% vs. 80.8%, p = 0.941) and DMFS (84.6% vs. 92.7%, p = 0.255). Five-year LRFS_P was higher in the ART group (61.3% vs. 90.6%, p = 0.005), but LRFS_LN did not show a significant difference (91.9% vs. 96.2%, p = 0.541). CONCLUSION: Although there were differences in the patient backgrounds between the two groups, this study suggests the potential effectiveness of ART in improving locoregional control, especially in the primary tumor.
• Brain metastases in Japanese NSCLC patients: prognostic assessment and the use of osimertinib and immune checkpoint inhibitors-retrospective study.

  Hajime Higaki, Kentaro Nishioka, Manami Otsuka, Noboru Nishikawa, Motoyasu Shido, Hideki Minatogawa, Yukiko Nishikawa, Rikiya Takashina, Takayuki Hashimoto, Norio Katoh, Hiroshi Taguchi, Rumiko Kinoshita, Koichi Yasuda, Takashi Mori, Yusuke Uchinami, Fuki Koizumi, Yoshihiro Fujita, Shuhei Takahashi, Takahiro Hattori, Noriaki Nishiyama, Hidefumi Aoyama

  Radiation oncology (London, England) 18 (1) 25 - 25 2023/02/07 

  BACKGROUND: The Graded Prognostic Assessment for lung cancer using molecular markers (Lung-molGPA) has not been validated for use with Japanese non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) and the factors impacting survival need to be assessed. METHODS: We retrospectively analyzed 294 NSCLC patients who were newly diagnosed with BM between 2013 and 2020 and had received radiotherapy for BM initially at the Hokkaido Cancer Center. We evaluated the effect on the prognosis of Lung-molGPA items, the expression of PD-L1 (classified as high, low, and no expression), and the treatment history. The main outcome was the survival measured from the day of the diagnosis of BM, and log-rank tests were performed to evaluate the results. RESULTS: The median overall survival (OS) times for adenocarcinoma by groups of GPA scores (0‒1.0, 1.5‒2.0, 2.5‒3.0, and 3.5‒4.0) were 5.5, 14.8, 28.3, and 39.0 months (p < 0.0001), respectively. The median survival times for non-adenocarcinoma by groups of GPA scores (0‒1.0, 1.5‒2.0, and 2.5‒3.0) were 3.2, 11.0, and 16.0 months (p = 0.0011), respectively. In adenocarcinoma patients with gene mutations, osimertinib significantly improved the outcome (median OS: 34.2 and 17.6 months with and without osimertinib, respectively (p = 0.0164)). There was no significant difference in the OS between patients who were initially treated with tyrosine-kinase inhibitor for BM and those who initially received radiotherapy (p = 0.5337). In patients tested for PD-L1 expression, the median survival times after the diagnosis of BM were 5.6, 22.5, and 9.3 months for the high-, low- and no-expression groups (p = 0.2198), respectively. Also, in patients with high PD-L1 expressions, those with ICI had survival (median OS, 8.6 months) than those without (median OS, 3.6 months). CONCLUSIONS: We confirmed that Lung-molGPA successfully classified Japanese NSCLC patients with BM by the prognosis. Osimertinib prolonged survival of EGFR-positive NSCLC patients with BM, and ICI was effective in patients with high PD-L1 expressions.
• Distribution of human papilloma virus genotypes and treatment outcomes in definitive radiotherapy for cervical cancer.

  Rumiko Kinoshita, Takashi Mitamura, Fumi Kato, Takahiro Hattori, Hajime Higaki, Shuhei Takahashi, Yoshihiro Fujita, Manami Otsuka, Fuki Koizumi, Yusuke Uchinami, Takashi Mori, Kentaro Nishioka, Takayuki Hashimoto, Yoichi M Ito, Hidemichi Watari, Hidefumi Aoyama

  Journal of radiation research 64 (2) 463 - 470 2023/01/03 

  Most oncogenic human papilloma virus (HPV) genotypes stratify into two species, α-7 HPV and α-9 HPV. There are several studies that evaluate the relationship between HPV species and treatment outcomes and reports that HPV species is prognostic. The HPV genotyping was conducted using biopsy specimens which had been stored in these studies. We conducted the study using the HPV test performed by cytology specimens which is less invasive and more useful in clinical settings. This study enrolled 46 patients who received HPV genotyping before the definitive radiotherapy. The results of the HPV genotyping were classified into HPVα-7, HPVα-9 and negatives. Of the 46 patients, 10 were positive for HPVα-7, 21 positive for HPVα-9 and 15 were negative. The median follow-up period was 38 months (range 4-142). The HPVα-7, HPVα-9 and negative groups showed the 3-year overall survival (OS; 59.3%, 80.4% and 72.2% [P = 0.25]); local control (LC; 67.5%, 81% and 80% [P = 0.78]); pelvic control (PC) (50%, 81% and 72.7% [P = 0.032]); pelvic lymph node (PLN) control (78.7%, 95% and 92.3% [P = 0.012]); distant metastasis free (DMF) survival (50%, 75.4% and 42.8% [P = 0.098]); and progression free survival (PFS) rate of patients (30%, 66.7% and 38.9% [P = 0.085]), respectively. Patients with HPVα-7 showed statistically significant poorer PC than the HPVα-9 group, in multivariate analysis. This result is consistent with previous studies for HPV positive patients. The HPV negativity rate was higher in this study than in other studies and further work on this may be needed for clinical use.
• 【がん免疫療法の展望:免疫チェックポイント阻害薬の併用療法に中心に】免疫チェックポイント阻害薬の併用療法のエビデンス 免疫チェックポイント阻害薬と放射線治療

  安田 耕一, 志藤 元泰, 小泉 富基, 高橋 周平, 藤田 祥博, 大塚 愛美, 宮崎 智彦, 西川 昇, 打浪 雄介, 森 崇, 西岡 健太郎, 木下 留美子, 田口 大志, 加藤 徳雄, 橋本 孝之, 青山 英史

  腫瘍内科 (有)科学評論社 30 (1) 23 - 28 1881-6568 2022/07
• 北海道大学病院放射線治療科関連施設における子宮頸癌に対する根治放射線治療に関するアンケート結果について

  木下 留美子, 打浪 雄介, 高橋 周平, 小泉 富基, 森 崇, 西岡 健太郎, 田口 大志, 橋本 孝之, 高邑 明夫, 西岡 井子, 北原 利博, 土屋 和彦, 井上 哲也, 有本 卓郎, 出倉 康裕, 米坂 祥朗, 鈴木 恵士郎, 川島 和之, 小野寺 俊輔, 喜多村 圭, 長谷川 雅一, 鬼丸 力也, 富田 雅義, 池田 潤, 西山 典明, 青山 英史

  北海道放射線医学雑誌 (NPO)メディカルイメージラボ 2 13 - 18 2022/03 [Refereed][Not invited]
   

  子宮頸癌に対する根治的放射線治療において子宮内から照射を行う腔内照射は必要不可欠な要素である。腔内照射の設備の維持・更新および子宮頸癌根治照射人数等について北海道大学病院放射線治療科関連病院にアンケートを行った。道内の施設の子宮頸癌根治照射人数は年間10人以下の施設が大半で、腔内照射設備を保有している施設の年間の腔内照射人数は5-9人が4施設、10人以上が2施設であった。腔内照射設備を保有している6施設の内4施設で設備の維持・更新が採算面で難しいという理由で腔内照射の休止を検討している事が明らかとなった。北海道内の子宮頸癌に対する根治照射を継続して行うためには、腔内照射設備を持つ施設への適切な紹介システムの構築と腔内照射が可能な施設の地域性を考慮した適切な集約化が必要と考えられた。(著者抄録)
• 再照射 小児がんに対する陽子線再照射

  橋本 孝之, 森 崇, 西岡 健太郎, 打浪 雄介, 安田 耕一, 木下 留美子, 田口 大志, 加藤 徳雄, 清水 伸一, 青山 英史

  日本小児血液・がん学会雑誌 (一社)日本小児血液・がん学会 58 (2) 89 - 93 2187-011X 2021/08 

  陽子線治療は通常のX線による放射線治療に比べて線量集中性に優れ,標的への線量を保ったまま周囲の正常組織線量を低減することで,小児がん患者の急性期並びに晩期有害事象の軽減が可能である.2016年4月からは20歳未満の限局性固形悪性腫瘍に対する根治的な陽子線照射が保険適応となり,各施設で小児がんの陽子線治療実施件数が増加傾向にある.局所領域再発に対する再照射は,腫瘍進行抑制・症状緩和と,時に治癒や長期の腫瘍制御による健康状態・QOLの維持をもたらす可能性がある.小児患者に対する再照射における重要臓器・器官の累積耐容線量や安全性は確立していないが,中枢神経腫瘍に対する陽子線再照射により,有害事象の発生を抑えた良好な治療成績が報告されている.今後,小児がん再発の治療選択肢における陽子線再照射の有用性については,前向き臨床試験での評価が必要と考える.(著者抄録)
• 尿量の経日変化および前立腺体積が放射線治療時の前立腺の位置に与える影響(The Impact of Daily Urinary Volume Variations and Prostate Volume on Prostate Position During Radiotherapy)

  Nishioka Kentaro, Hashimoto Takayuki, Yokota Isao, Katoh Norio, Kinoshita Rumiko, Yasuda Koichi, Takao Seishin, Yoshimura Takaaki, Aoyama Hidefumi, Shimizu Shinichi

  日本医学放射線学会学術集会抄録集 80回 S193 - S194 0048-0428 2021/03
• The Impact of Daily Urinary Volume Variations and Prostate Volume on Prostate Position During Radiotherapy(和訳中)

  Nishioka Kentaro, Hashimoto Takayuki, Yokota Isao, Katoh Norio, Kinoshita Rumiko, Yasuda Koichi, Takao Seishin, Yoshimura Takaaki, Aoyama Hidefumi, Shimizu Shinichi

  日本医学放射線学会学術集会抄録集 80回 S193 - S194 0048-0428 2021/03
• Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?

  Kentaro Nishioka, Kento Gotoh, Takayuki Hashimoto, Takashige Abe, Takahiro Osawa, Ryuji Matsumoto, Isao Yokota, Norio Katoh, Rumiko Kinoshita, Koichi Yasuda, Toshiaki Yakabe, Takaaki Yoshimura, Seishin Takao, Nobuo Shinohara, Hidefumi Aoyama, Shinichi Shimizu, Hiroki Shirato

  BJR|Open 3 (1) 2021/01 [Refereed][Not invited]
   

  The purpose of this study is to investigate whether verbal instructions are sufficient for bladder volume (BV) control not to deteriorate prostate position reproducibility in image-guided spot scanning proton therapy (SSPT) for localized prostate cancer. A total of 268 treatment sessions in 12 consecutive prostate cancer patients who were treated with image-guided SSPT with fiducial markers were retrospectively analyzed. In addition to strict rectal volume control procedures, simple verbal instructions to void urine one hour before the treatment were used here. The BV was measured by a Bladder Scan just before the treatment, and the prostate motion was measured by intraprostatic fiducial markers and two sets of X-ray fluoroscopy images. The correlation between the BV change and prostate motion was assessed by linear mixed-effects models and systematic and random errors according to the reproducibility of the BV. The mean absolute BV change during treatment was from −98.7 to 86.3 ml (median 7.1 ml). The mean absolute prostate motion of the patients in the left-right direction was −1.46 to 1.85 mm; in the cranial-caudal direction it was −6.10 to 3.65 mm, and in the anteroposterior direction −1.90 to 5.23 mm. There was no significant relationship between the BV change and prostate motion during SSPT. The early and late genitourinary and gastrointestinal toxicity was minimal with a minimum follow up of 4.57 years. Simple verbal instructions about urination was suggested to be sufficient to control the BV not to impact on the prostate motion and clinical outcomes in image-guided SSPT. Careful attention to BV change is still needed when the seminal vesicle is to be treated. Our data demonstrated that there was no apparent relationship between BV changes and prostate position reproducibility and simple verbal instruction about urination could be sufficient for image-guided SSPT.
• Normal Tissue Complication Probability for Hematologic and Gastrointestinal Toxicity in Postoperative Whole Pelvic Radiotherapy for Gynecologic Malignancies using Intensity Modulated Proton Therapy with Robust Optimization

  T. Yoshimura, R. Yamada, R. Kinoshita, H. Tamura, T. Matsuura, S. Takao, M. Tamura, S. Tanaka, N. Nagae, K. Kobashi, H. Aoyama, S. Shimizu

  International Journal of Radiation Oncology*Biology*Physics 108 (3) e494 - e494 0360-3016 2020/11
• Automatic Bladder Delineation on MR Images Using a Convolution Neural Network for Online Image-Guided Radiotherapy

  K. Nishioka, Y. Nomura, T. Hashimoto, R. Kinoshita, N. Katoh, H. Taguchi, K. Yasuda, T. Mori, Y. Uchinami, M. Otsuka, T. Matsuura, S. Takao, R. Suzuki, S. Tanaka, T. Yoshimura, H. Aoyama, S. Shimizu

  International Journal of Radiation Oncology*Biology*Physics 108 (3) e288 - e289 0360-3016 2020/11
• 画像誘導治療の今後について 画像誘導陽子線治療の将来展望

  田口 大志, 橋本 孝之, 加藤 徳雄, 木下 留美子, 安田 耕一, 西岡 健太郎, 森 崇, 打浪 雄介, 宮本 直樹, 高尾 聖心, 清水 伸一, 青山 英史

  日本癌治療学会学術集会抄録集 58回 SY14 - 3 2020/10
• Predicting metastasis in clinically negative axillary lymph nodes with minimum apparent diffusion coefficient value in luminal A-like breast cancer.

  Kato F, Kudo K, Yamashita H, Baba M, Shimizu A, Oyama-Manabe N, Kinoshita R, Li R, Shirato H

  Breast cancer (Tokyo, Japan) 26 (5) 628 - 636 1340-6868 2019/04 [Refereed][Not invited]
   

  BACKGROUND: We investigated the usefulness of the minimum ADC value of primary breast lesions for predicting axillary lymph node (LN) status in luminal A-like breast cancers with clinically negative nodes in comparison with the mean ADC. METHODS: Forty-four luminal A-like breast cancers without axillary LN metastasis at preoperative clinical evaluation, surgically resected with sentinel LN biopsy, were retrospectively studied. Mean and minimum ADC values of each lesion were measured and statistically compared between LN positive (n = 12) and LN negative (n = 32) groups. An ROC curve was drawn to determine the best cutoff value to differentiate LN status. Correlations between mean and minimum ADC values and the number of metastatic axillary LNs were investigated. RESULTS: Mean and minimum ADC values of breast lesions with positive LN were significantly lower than those with negative LN (mean 839.9 ± 110.9 vs. 1022.2 ± 250.0 × 10- 6 mm2/s, p = 0.027, minimum 696.7 ± 128.0 vs. 925.0 ± 257.6 × 10- 6 mm2/s, p = 0.004). The sensitivity and NPV using the best cutoff value from ROC using both mean and minimum ADC were 100%. AUC of the minimum ADC (0.784) was higher than that of the mean ADC (0.719). Statistically significant negative correlations were observed between both mean and minimum ADCs and number of positive LNs, with stronger correlation to minimum ADC than mean ADC. CONCLUSIONS: The minimum ADC value of primary breast lesions predicts axillary LN metastasis in luminal A-like breast cancer with clinically negative nodes, with high sensitivity and high NPV.
• The clinical features of radiation cataract in patients with ocular adnexal mucosa-associated lymphoid tissue lymphoma

  Kanae Fukutsu, Satoru Kase, Kan Ishijima, Rumiko Kinoshita, Susumu Ishida

  Radiation Oncology 13 (1) 1045 - 1047 1748-717X 2018/05/16 [Refereed][Not invited]
   

  Background: To examine the clinical features of radiation cataract in patients with ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: Twenty-one patients with 26 eyes diagnosed with ocular adnexal MALT lymphoma (26 eyes), who were treated in Hokkaido University Hospital, were retrospectively reviewed based on medical records. Results: Out of the 21 patients, 16 patients (21 eyes) received radiation therapy (RT) with a total dose of 30 Gy. All cases eventually achieved complete remission. Eight of these patients (11 eyes: 52.3%) required cataract surgery after RT. The mean age at surgery was 56.8 (40-70) years. The mean latency between RT and the indication for surgery was 43.3 months. The percentage of females was significantly higher in patients who required surgery (P < 0.01), compared with those without surgery. The eyes of patients who received bolus technique on radiation treatment developed cataract more frequently (P < 0.05). In contrast, none of the patients without RT required cataract surgery. Conclusions: Patients with ocular adnexal MALT lymphoma who underwent surgery for radiation cataract were seen more often in relatively young, female patients, and surgery was required about 3 years after RT. A long-term observation may be needed for patients after RT for a tumor. A female sex and the bolus technique may be risk factors for radiation cataract.
• Prospective study to evaluate the safety of the world-first spot-scanning dedicated, small 360-degree gantry, synchrotron-based proton beam therapy system

  Kentaro Nishioka, Anussara Prayongrat, Kota Ono, Shunsuke Onodera, Takayuki Hashimoto, Norio Katoh, Tetsuya Inoue, Rumiko Kinoshita, Koichi Yasuda, Takashi Mori, Rikiya Onimaru, Hiroki Shirato, Shinichi Shimizu

  Journal of Radiation Research 59 i63 - i71 0449-3060 2018/03/01 [Refereed][Not invited]
   

  © The Author(s) 2017. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology. This is a report of a single-institution prospective study evaluating the safety of a spot-scanning dedicated, small 360-degree gantry, synchrotron-based proton beam therapy (PBT) system. Data collection was performed for 56 patients with 59 treatment sites who received proton beam therapy at Hokkaido University Hospital between March 2014 and July 2015. Forty-one patients were male and 15 were female. The median age was 66 years. The primary lesion sites were prostate (n = 17), bone/soft tissue (n = 10), liver (n = 7), lung (n = 6), central nervous system (n = 5), colon (n = 2), pancreas (n = 2), kidney (n = 2) and others (n = 5). Chemotherapy was administered in 11 patients. The prescribed total dose was from 20 to 76 GyE (Radiobiological equivalent dose, RBE = 1.1), with the median dose of 65 GyE in 4 to 35 fractions. No PBT-related Common Terminology Criteria for Adverse Events Grade 4 or 5 toxicities were observed; the incidence of early PBT-related Grade 4 adverse events was 0% (95% confidence interval 0 to 6.38%). The most common Grade 3 toxicities were hematologic toxicity (12.5%) unlikely to be related to the PBT. One patient developed a left femoral neck fracture (Grade 3) at 14.5 months after PBT for chondrosarcoma of the left pelvis. The pathological findings showed no other malignancies, suggesting that it was possibly related to the PBT. In conclusion, the spot-scanning dedicated, synchrotron-based PBT system is feasible, but further studies on its long-term safety and efficacy are warranted.
• Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers

  Kentaro Nishioka, Shinichi Shimizu, Nobuo Shinohara, Yoichi M. Ito, Takashige Abe, Satoru Maruyama, Norio Katoh, Rumiko Kinoshita, Takayuki Hashimoto, Naoki Miyamoto, Rikiya Onimaru, Hiroki Shirato

  RADIATION ONCOLOGY 12 (1) 44  1748-717X 2017/03 [Refereed][Not invited]
   

  Background: Current adaptive and dose escalating radiotherapy for muscle invasive bladder cancer requires knowledge of both inter-fractional and intra-fractional motion of the bladder wall involved. The purpose of this study is to characterize inter-and intra-fractional movement of the partial bladder wall using implanted fiducial markers and a real-time tumor-tracking radiotherapy system. Methods: Two hundred fifty one sessions with 29 patients were analysed. After maximal transurethral bladder tumor resection and 40 Gy of whole bladder irradiation, up to six gold markers were implanted transurethrally into the bladder wall around the tumor bed and used for positional registration. We compared the systematic and random uncertainty of positions between cranial vs. caudal, left vs. right, and anterior vs. posterior tumor groups. The variance in intrafractional movement and the percentage of sessions where 3 mm and 5 mm or more of intrafractional wall movement occurring at 2, 4, 6, 8, 10, and at more than 10 min until the end of a session were determined. Results: The cranial and anterior tumor group showed larger interfractional uncertainties in the position than the opposite side tumor group in the CC and AP directions respectively, but these differences did not reach significance. Among the intrafractional uncertainty of position, the cranial and anterior tumor group showed significantly larger systematic uncertainty of position than the groups on the opposite side in the CC direction. The variance of intrafractional movement increased over time; the percentage of sessions where intrafractional wall movement was larger than 3 mm within 2 min of the start of a radiation session or larger than 5 mm within 10 min was less than 5%, but this percentage was increasing further during the session, especially in the cranial and anterior tumor group. Conclusions: More attention for intrafractional uncertainty of position is required in the treatment of cranial and anterior bladder tumors especially in the CC direction. The optimal internal margins in each direction should be chosen or a precise intrafractional target localization system is required depending on the tumor location and treatment delivery time in the setting of partial bladder radiotherapy.
• 乳房温存術後接線照射後にFitz‐Hugh‐Curtis症候群様の肝周囲炎を来した1例

  出倉康裕, 森崇, 西川由記子, 木下留美子, 橋本孝之, 白土博樹, 西岡健太郎, 清水伸一, 細田充主, 山下啓子

  Japanese Journal of Radiology (公社)日本医学放射線学会 35 (Supplement) 4 - 4 1867-1071 2017/02/25 [Not refereed][Not invited]
  
• 前立腺癌の放射線治療時における尿量の変動の解析

  後藤謙斗, 西岡健太郎, 松崎有華, 松浦妙子, 高尾聖心, 橋本孝之, 木下留美子, 西川由記子, 清水伸一, 白土博樹

  日本放射線腫瘍学会高精度放射線外部照射部会学術大会プログラム・抄録集 30th 55  2017 [Not refereed][Not invited]
  
• NTCP modeling analysis of acute hematologic toxicity in whole pelvic radiation therapy for gynecologic malignancies - A dosimetric comparison of IMRT and spot-scanning proton therapy (SSPT)

  Takaaki Yoshimura, Rumiko Kinoshita, Shunsuke Onodera, Chie Toramatsu, Ryusuke Suzuki, Yoichi M. Ito, Seishin Takao, Taeko Matsuura, Yuka Matsuzaki, Kikuo Umegaki, Hiroki Shirato, Shinichi Shimizu

  PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS 32 (9) 1095 - 1102 1120-1797 2016/09 [Refereed][Not invited]
   

  Purpose: This treatment planning study was conducted to determine whether spot scanning proton beam therapy (SSPT) reduces the risk of grade >= 3 hematologic toxicity (HT3+) compared with intensity modulated radiation therapy (IMRT) for postoperative whole pelvic radiation therapy (WPRT). Methods and materials: The normal tissue complication probability (NTCP) of the risk of HT3+ was used as an in silico surrogate marker in this analysis. IMRT and SSPT plans were created for 13 gynecologic malignancy patients who had received hysterectomies. The IMRT plans were generated using the 7-fields step and shoot technique. The SSPT plans were generated using anterior-posterior field with single field optimization. Using the relative biological effectives (RBE) value of 1.0 for IMRT and 1.1 for SSPT, the prescribed dose was 45 Gy(RBE) in 1.8 Gy(RBE) per fractions for 95% of the planning target volume (PTV). The homogeneity index (HI) and the conformity index (CI) of the PTV were also compared. Results: The bone marrow (BM) and femoral head doses using SSPT were significantly lower than with IMRT. The NTCP modeling analysis showed that the risk of HT3+ using SSPT was significantly lower than with IMRT (NTCP = 0.04 +/- 0.01 and 0.19 +/- 0.03, p = 0.0002, respectively). There were no significant differences in the CI and HI of the PTV between IMRT and SSPT (CI = 0.97 +/- 0.01 and 0.96 +/- 0.02, p = 0.3177, and HI = 1.24 +/- 0.11 and 1.27 +/- 0.05, p = 0.8473, respectively). Conclusion: The SSPT achieves significant reductions in the dose to BM without compromising target coverage, compared with IMRT. The NTCP value for HT3+ in SSPT was significantly lower than in IMRT. (C) 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license.
• 椎体IMRTとその精度に関する研究

  安田耕一, 清水伸一, 橋本孝之, SUTHERLAND Ken, 白土博樹, 土屋和彦, 加藤徳雄, 鬼丸力也, 木下留美子, 井上哲也, 西岡健太郎, 西川由記子, 森崇, 原田慶一, 原田八重, 鈴木隆介, 寅松千枝, 松浦妙子, 高尾聖心, 宮本直樹, 伊藤陽一

  Japanese Journal of Radiology (公社)日本医学放射線学会 34 (Supplement) 5 - 5 1867-1071 2016/02/25 [Not refereed][Not invited]
  
• NTCP Modeling Analysis of Acute Hematologic Toxicity in Whole-Pelvic Radiation Therapy for Gynecologic Malignancies: A Dosimetric Comparison of IMRT and Spot-Scanning Proton Therapy

  T. Yoshimura, R. Kinoshita, S. Onodera, C. Toramatsu, R. Suzuki, Y.M. Ito, S. Takao, T. Matsuura, Y. Matsuzaki, S. Shimizu, K. Umegaki, H. Shirato

  International Journal of Radiation Oncology*Biology*Physics 93 (3) E254 - E254 0360-3016 2015/11
• Development of a Real-Time Image Gated Proton Beam Therapy (RGPT) System and Its Initial Clinical Application to Respiratory Moving Liver Tumors

  S. Shimizu, N. Katoh, S. Takao, T. Matsuura, N. Miyamoto, T. Hashimoto, K. Nishioka, T. Yoshimura, Y. Matsuzaki, R. Kinoshita, Y. Nishikawa, R. Onimaru, K. Umegaki, H. Shirato

  International Journal of Radiation Oncology*Biology*Physics 93 (3) S42 - S42 0360-3016 2015/11
• Early results of urethral dose reduction and small safety margin in intensity-modulated radiation therapy (IMRT) for localized prostate cancer using a real-time tumor-tracking radiotherapy (RTRT) system

  Shinichi Shimizu, Kentaro Nishioka, Ryusuke Suzuki, Nobuo Shinohara, Satoru Maruyama, Takashige Abe, Rumiko Kinoshita, Norio Katoh, Rikiya Onimaru, Hiroki Shirato

  RADIATION ONCOLOGY 9 118  1748-717X 2014/05 [Refereed][Not invited]
   

  Background: We prospectively assessed the utility of intensity-modulated radiation therapy (IMRT) with urethral dose reduction and a small margin between the clinical target volume (CTV) and the planning target volume (PTV) for patients with localized prostate cancer. Methods: The study population was 110 patients in low- (14.5%), intermediate- (41.8%), and high-risk (43.6%) categories. Three gold fiducial markers were inserted into the prostate. A soft guide-wire was used to identify the urethra when computed tomography (CT) scan for treatment planning was performed. A dose constraint of V70 < 10% was applied to the urethral region. Margins between the CTV-PTV were set at 3 mm in all directions. Patients were treated with 70 Gy IMRT in 30 fractions (D95 of PTV) over 7.5 weeks. The patient couch was adjusted to keep the gold markers within 2.0 mm from their planned positions with the use of frequent on-line verification. Results: The median follow-up period was 31.3 (3.2 to 82.1) months. The biochemical relapse-free survival (bRFS) rates at 3 years were 100%, 93.8% and 89.5% for the low-, intermediate-, and high-risk patients, respectively. The incidences of acute adverse events (AEs) were 45.5% and 0.9% for grades 1 and 2, respectively. The late AEs were grade 1 cystitis in 10.0% of the patients, rectal bleeding in 7.3%, and urinary urgency in 6.4%. Only three patients (2.7%) developed grade 2 late AEs. Conclusions: On-line image guidance with precise correction of the table position during radiotherapy achieved one of the lowest AEs rates with a bRFS equal to the highest in the literature.
• Naming rule for radiation therapy

  安田耕一, 土屋和彦, 井上哲也, 西岡健太郎, 原田慶一, 西川由記子, 鬼丸力也, 清水伸一, 加藤徳雄, 木下留美子, 小野寺俊介, 白土博樹, 鈴木隆介, 藤田勝久, 辻真太郎, 山崎理衣

  Jpn J Radiol (公社)日本医学放射線学会 32 (Supplement) 7 - 7 1867-1071 2014/02/25 [Not refereed][Not invited]
  
• 北海道大学病院における髄膜腫に対する強度変調放射線治療(IMRT)の初期成績

  西川由記子, 原田慶一, 西岡健太郎, 安田耕一, 井上哲也, 土屋和彦, 小野寺俊輔, 木下留美子, 加藤徳雄, 清水伸一, 鬼丸力也, 白土博樹, 鈴木隆介, 石川正純

  Jpn J Radiol (公社)日本医学放射線学会 32 (Supplement) 5 - 5 1867-1071 2014/02/25 [Not refereed][Not invited]
  
• Prospective phase II study of image-guided local boost using a real-time tumor-tracking radiotherapy (RTRT) system for locally advanced bladder cancer

  Nishioka K, Shimizu S, Shinohara N, Ito Y. M, Abe T, Maruyama S, Kinoshita R, Harada K, Nishikawa N, Miyamoto N, Onimaru R, Shirato H

  Jpn J Clin Oncol 44 (1) 28 - 35 1465-3621 2014 [Refereed][Not invited]
  
• Dosimetric comparison between intensity-modulated radiotherapy and standard wedged tangential technique for whole-breast radiotherapy in Asian women with relatively small breast volumes

  Kazuhiko Tsuchiya, Rumiko Kinoshita, Shinichi Shimizu, Kentaro Nishioka, Keiichi Harada, Noboru Nishikawa, Ryusuke Suzuki, Hiroki Shirato

  Radiological Physics and Technology 7 (1) 67 - 72 1865-0341 2014 [Refereed][Not invited]
   

  We sought to investigate whether intensity-modulated radiotherapy (IMRT) has a dosimetric advantage compared to the standard wedged tangential technique (SWT) for whole-breast radiotherapy (WBRT) in Asian women with relatively small breast volume. Computed tomography images of 25 Asian patients with early-stage breast cancer (right 15, left 10) used for WBRT planning were examined. After contouring the target volumes and bilateral lungs and, for left-side treatment, the heart, 4 plans were made for each patient: namely, SWT, tangential-field IMRT (T-IMRT), 3-field IMRT (3F-IMRT), and 4-field IMRT (4F-IMRT). The prescribed dose was 5000 cGy. The median planning target volume (PTV) for WBRT was 552.6 cc (range 288.8-1518.4 cc). Compared to SWT, (1) T-IMRT achieved significant improvement for dose homogeneity in the PTV (p < 0.001) and the dose received by 2 % (D2) of the PTV (p < 0.001). T-IMRT also reduced the bilateral lung mean dose (p < 0.001) and the ipsilateral lung volume which received more than 20 Gy (V20) (p = 0.01). (2) 3F-IMRT resulted in a significant increase in the mean dose to the ipsilateral lung (p < 0.001) and to the contralateral lung (p < 0.001). (3) 4F-IMRT also resulted in a significant increase in the mean dose to the ipsilateral lung (p < 0.001) and to the contralateral lung (p < 0.001). Tangential-field IMRT provided an improved dose distribution compared with SWT for WBRT in Asian women with a relatively small breast volume. © Japanese Society of Radiological Technology and Japan Society of Medical Physics 2013.
• Prospective Phase II Study of Image-guided Local Boost Using a Real-time Tumor-tracking Radiotherapy (RTRT) System for Locally Advanced Bladder Cancer

  Kentaro Nishioka, Shinichi Shimizu, Nobuo Shinohara, Yoichi M. Ito, Takashige Abe, Satoru Maruyama, Rumiko Kinoshita, Keiichi Harada, Noboru Nishikawa, Naoki Miyamoto, Rikiya Onimaru, Hiroki Shirato

  JAPANESE JOURNAL OF CLINICAL ONCOLOGY 44 (1) 28 - 35 0368-2811 2014/01 [Refereed][Not invited]
   

  The real-time tumor-tracking radiotherapy system with fiducial markers has the advantage that it can be used to verify the localization of the markers during radiation delivery in real-time. We conducted a prospective Phase II study of image-guided local-boost radiotherapy for locally advanced bladder cancer using a real-time tumor-tracking radiotherapy system for positioning, and here we report the results regarding the safety and efficacy of the technique. Twenty patients with a T2-T4N0M0 urothelial carcinoma of the bladder who were clinically inoperable or refused surgery were enrolled. Transurethral tumor resection and 40 Gy irradiation to the whole bladder was followed by the transurethral endoscopic implantation of gold markers in the bladder wall around the primary tumor. A boost of 25 Gy in 10 fractions was made to the primary tumor while maintaining the displacement from the planned position at less than 2 mm during radiation delivery using a real-time tumor-tracking radiotherapy system. The toxicity, local control and survival were evaluated. Among the 20 patients, 14 were treated with concurrent chemoradiotherapy. The median follow-up period was 55.5 months. Urethral and bowel late toxicity (Grade 3) were each observed in one patient. The local-control rate, overall survival and cause-specific survival with the native bladder after 5 years were 64, 61 and 65. Image-guided local-boost radiotherapy using a real-time tumor-tracking radiotherapy system can be safely accomplished, and the clinical outcome is encouraging. A larger prospective multi-institutional study is warranted for more precise evaluations of the technological efficacy and patients quality of life.
• Co-Overexpression of GEP100 and AMAP1 Proteins Correlates with Rapid Local Recurrence after Breast Conservative Therapy

  Rumiko Kinoshita, Jin-Min Nam, Yoichi M. Ito, Kanako C. Hatanaka, Ari Hashimoto, Haruka Handa, Yutaro Otsuka, Shigeru Hashimoto, Yasuhito Onodera, Mitsuchika Hosoda, Shunsuke Onodera, Shinichi Shimizu, Shinya Tanaka, Hiroki Shirato, Mishie Tanino, Hisataka Sabe

  PLOS ONE 8 (10) e76791  1932-6203 2013/10 [Refereed][Not invited]
   

  A major problem of current cancer research and therapy is prediction of tumor recurrence after initial treatment, rather than the simple biological characterization of the malignancy and proliferative properties of tumors. Breast conservation therapy (BCT) is a well-approved, standard treatment for patients with early stages of breast cancer, which consists of lumpectomy and whole-breast irradiation. In spite of extensive studies, only 'age' and 'Ki-67 positivity' have been identified to be well correlated with local recurrence after BCT. An Arf6 pathway, activated by GEP100 under receptor tyrosine kinases (RTKs) and employs AMAP1 as its effector, is crucial for invasion and metastasis of some breast cancer cells. This pathway activates beta 1 integrins and perturbs E-cadherin-based adhesions, hence appears to be integral for epithelial-mesenchymal transdifferentiation (EMT). We here show that expression of the Arf6 pathway components statistically correlates with rapid local recurrence after BCT. We retrospectively analyzed four hundred seventy-nine patients who received BCT in Hokkaido University Hospital, and found 20 patients had local recurrence. We then analyzed pathological samples of patients who experienced local recurrence by use of Kaplan-Meier analysis, Stepwise regression analysis and the t-test, coupled with immunostaining, and found that co-overexpression of GEP100 and AMAP1 correlates with rapidity of the local recurrence. Their margin-status, node-positivity, and estrogen receptor (ER)-or progesterone receptor (PgR)positivity did not correlated with the rapidity. This study is the first to show that expression of a certain set of proteins correlates with the rapidity of local recurrence. Our results are useful not only for prediction, but highlight the possibility of developing novel strategies to block local recurrence. We also discuss why mRNAs encoding these proteins have not been identified to correlate with local recurrence by previous conventional gene expression profiling analyses.
• β1-integrin via NF-κB signaling is essential for acquisition of invasiveness in a model of radiation treated in situ breast cancer

  Jin-Min Nam, Kazi M. Ahmed, Sylvain Costes, Hui Zhang, Yasuhito Onodera, Adam B. Olshen, Kanako C. Hatanaka, Rumiko Kinoshita, Masayori Ishikawa, Hisataka Sabe, Hiroki Shirato, Catherine C. Park

  Breast Cancer Research 15 (4) R60  1465-5411 2013/07/25 [Refereed][Not invited]
   

  Introduction: Ductal carcinoma in situ (DCIS) is characterized by non-invasive cancerous cell growth within the breast ducts. Although radiotherapy is commonly used in the treatment of DCIS, the effect and molecular mechanism of ionizing radiation (IR) on DCIS are not well understood, and invasive recurrence following radiotherapy remains a significant clinical problem. This study investigated the effects of IR on a clinically relevant model of Akt-driven DCIS and identified possible molecular mechanisms underlying invasive progression in surviving cells.Methods: We measured the level of phosphorylated-Akt (p-Akt) in a cohort of human DCIS specimens by immunohistochemistry (IHC) and correlated it with recurrence risk. To model human DCIS, we used Akt overexpressing human mammary epithelial cells (MCF10A-Akt) which, in three-dimensional laminin-rich extracellular matrix (lrECM) and in vivo, form organotypic DCIS-like lesions with lumina expanded by pleiomorphic cells contained within an intact basement membrane. In a population of cells that survived significant IR doses in three-dimensional lrECM, a malignant phenotype emerged creating a model for invasive recurrence.Results: P-Akt was up-regulated in clinical DCIS specimens and was associated with recurrent disease. MCF10A-Akt cells that formed DCIS-like structures in three-dimensional lrECM showed significant apoptosis after IR, preferentially in the luminal compartment. Strikingly, when cells that survived IR were repropagated in three-dimensional lrECM, a malignant phenotype emerged, characterized by invasive activity, up-regulation of fibronectin, α5β1-integrin, matrix metalloproteinase-9 (MMP-9) and loss of E-cadherin. In addition, IR induced nuclear translocation and binding of nuclear factor-kappa B (NF-κB) to the β1-integrin promoter region, associated with up-regulation of α5β1-integrins. Inhibition of NF-κB or β1-integrin signaling abrogated emergence of the invasive activity.Conclusions: P-Akt is up-regulated in some human DCIS lesions and is possibly associated with recurrence. MCF10A-Akt cells form organotypic DCIS-like lesions in three-dimensional lrECM and in vivo, and are a plausible model for some forms of human DCIS. A population of Akt-driven DCIS-like spheroids that survive IR progresses to an invasive phenotype in three-dimensional lrECM mediated by β1-integrin and NF-κB signaling. © 2013 Nam et al. licensee BioMed Central Ltd.
• Integration of a real-time tumor monitoring system into gated proton spot-scanning beam therapy: An initial phantom study using patient tumor trajectory data

  Taeko Matsuura, Naoki Miyamoto, Shinichi Shimizu, Yusuke Fujii, Masumi Umezawa, Seishin Takao, Hideaki Nihongi, Chie Toramatsu, Kenneth Sutherland, Ryusuke Suzuki, Masayori Ishikawa, Rumiko Kinoshita, Kenichiro Maeda, Kikuo Umegaki, Hiroki Shirato

  MEDICAL PHYSICS 40 (7) 071729  0094-2405 2013/07 [Refereed][Not invited]
   

  Purpose: In spot-scanning proton therapy, the interplay effect between tumor motion and beam delivery leads to deterioration of the dose distribution. To mitigate the impact of tumor motion, gating in combination with repainting is one of the most promising methods that have been proposed. This study focused on a synchrotron-based spot-scanning proton therapy system integrated with real-time tumor monitoring. The authors investigated the effectiveness of gating in terms of both the delivered dose distribution and irradiation time by conducting simulations with patients' motion data. The clinically acceptable range of adjustable irradiation control parameters was explored. Also, the relation between the dose error and the characteristics of tumor motion was investigated. Methods: A simulation study was performed using a water phantom. A gated proton beam was irradiated to a clinical target volume (CTV) of 5 x 5 x 5 cm(3), in synchronization with lung cancer patients' tumor trajectory data. With varying parameters of gate width, spot spacing, and delivered dose per spot at one time, both dose uniformity and irradiation time were calculated for 397 tumor trajectory data from 78 patients. In addition, the authors placed an energy absorber upstream of the phantom and varied the thickness to examine the effect of changing the size of the Bragg peak and the number of required energy layers. The parameters with which 95% of the tumor trajectory data fulfill our defined criteria were accepted. Next, correlation coefficients were calculated between the maximum dose error and the tumor motion characteristics that were extracted from the tumor trajectory data. Results: With the assumed CTV, the largest percentage of the data fulfilled the criteria when the gate width was +/- 2 mm. Larger spot spacing was preferred because it increased the number of paintings. With a prescribed dose of 2 Gy, it was difficult to fulfill the criteria for the target with a very small effective depth (the sum of an assumed energy absorber's thickness and the target depth in the phantom) because of the sharpness of the Bragg peak. However, even shallow targets could be successfully irradiated by employing an adequate number of paintings and by placing an energy absorber of sufficient thickness to make the effective target depth more than 12 cm. The authors also observed that motion in the beam direction was the main cause of dose distortion, followed by motion in the lateral plane perpendicular to the scan direction. Conclusions: The results suggested that by properly adjusting irradiation control parameters, gated proton spot-scanning beam therapy can be robust to target motion. This is an important first step toward establishing treatment plans in real patient geometry. (C) 2013 American Association of Physicists in Medicine.
• Evaluation of inter-observer variability of bladder boundary delineation on cone-beam CT

  Kentaro Nishioka, Shinichi Shimizu, Rumiko Kinoshita, Tetsuya Inoue, Shunsuke Onodera, Koichi Yasuda, Keiichi Harada, Yukiko Nishikawa, Rikiya Onimaru, Hiroki Shirato

  RADIATION ONCOLOGY 8 185  1748-717X 2013/07 [Refereed][Not invited]
   

  Background: In-room cone-beam computerized tomography (CBCT) imaging is a promising method to reduce setup errors, especially in organs such as the bladder that often have large intrafractional variations due to organ movement. CBCT image quality is limited by low contrast and imaging artifacts, but few data have been reported about inter-observer variability of bladder boundary delineation on CBCT. The aim of this work was to analyze and evaluate the inter-observer contouring uncertainties of bladder boundary delineation on CBCT images in a prospective fashion. Methods: Five radiation oncologists contoured 10 bladders using the CBCT datasets of consecutive 10 patients (including 4 females) who were irradiated to the pelvic region. Prostates were also contoured in male patients. Patients who had had prostatectomy were excluded. The coefficient of variation (COV), conformity index (CIgen), and coordinates of center-of-mass (COM) of the bladder and prostate were calculated for each patient. Results: The mean COV for the bladder and prostate was 0.08 and 0.20, respectively. The mean CIgen of the bladder and prostate was 0.81 and 0.66, respectively. The root mean square (RMS) of the inter-observer standard deviation (s) of the COM displacement in the left-right (LR) and anterior-posterior (AP) direction was 0.79, 0.87 and 0.54 for the bladder and 0.63, 0.99 and 1.72 for the prostate. Regarding the mean COV and CIgen for the bladder, the differences between males and females were not significant. Conclusions: Inter-observer variability for bladder delineation on CBCT images was substantially small regardless of gender. We believe that our results support the applicability of CBCT in adaptive radiotherapy for bladder cancer.
• High-dose-rate Intra-cavitary Brachytherapy Combined with External Beam Radiation Therapy for Under 40-Year-old Patients with Invasive Uterine Cervical Carcinoma: Clinical Outcomes in 118 Patients in a Japanese Multi-institutional Study, JASTRO

  Hideomi Yamashita, Yuzuru Niibe, Takafumi Toita, Tomoko Kazumoto, Tetsuo Nishimura, Takeshi Kodaira, Hidehiro Eto, Rumiko Kinoshita, Kayoko Tsujino, Hiroshi Onishi, Mitsuhiro Takemoto, Kazushige Hayakawa

  JAPANESE JOURNAL OF CLINICAL ONCOLOGY 43 (5) 547 - 552 0368-2811 2013/05 [Refereed][Not invited]
   

  The current study was designed to evaluate the clinical outcomes of curative intent radiation therapy for young patients with invasive uterine cervical carcinoma in Japan.One hundred and eighteen patients aged 40 were registered in the multi-institutional study of the Japanese Society of Therapeutic Radiology and Oncology (JASTRO) from 26 major institutions in Japan. The age range was 2439 years and the maximum tumor diameter was 2.09.2 cm. The International Federation of Gynecology and Obstetrics clinical stages were Ib, IIa, IIb, IIIa, IIIb and IVa in 17, 6, 40, 2, 50 and 3, respectively. Curative intent radiation therapy consisted of the combination of external beam radiation therapy and high-dose rate intra-cavitary brachytherapy. The total dose of external beam radiation therapy ranged between 44 and 68 Gy. Both the median and mode of total high-dose-rate intra-cavitary brachytherapy dose to point A were 24 Gy in four fractions. Ninety-six patients (58) received chemotherapy.The 5-year overall survival rate and local control rate of all patients were 61 and 65, respectively. The 5-year overall survival rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 88, 100, 75, 100, 37 and 0, respectively. The 5-year local control rates of International Federation of Gynecology and Obstetrics Stage Ib, IIa, IIb, IIIa, IIIb and IVa were 82, 75, 75, 100, 51 and 0, respectively. Sixteen patients experienced grade 3 or greater late radiation morbidity.The 5-year overall survival rate of young patients with Stage IIIb was comparatively low at 37.
• What is the appropriate size criterion for proton radiotherapy for hepatocellular carcinoma? A dosimetric comparison of spot-scanning proton therapy versus intensity-modulated radiation therapy

  Chie Toramatsu, Norio Katoh, Shinichi Shimizu, Hideaki Nihongi, Taeko Matsuura, Seishin Takao, Naoki Miyamoto, Ryusuke Suzuki, Kenneth Sutherland, Rumiko Kinoshita, Rikiya Onimaru, Masayori Ishikawa, Kikuo Umegaki, Hiroki Shirato

  RADIATION ONCOLOGY 8 48  1748-717X 2013/03 [Refereed][Not invited]
   

  Background: We performed a dosimetric comparison of spot-scanning proton therapy (SSPT) and intensity-modulated radiation therapy (IMRT) for hepatocellular carcinoma (HCC) to investigate the impact of tumor size on the risk of radiation induced liver disease (RILD). Methods: A number of alternative plans were generated for 10 patients with HCC. The gross tumor volumes (GTV) varied from 20.1 to 2194.5 cm(3). Assuming all GTVs were spherical, the nominal diameter was calculated and ranged from 3.4 to 16.1 cm. The prescription dose was 60 Gy for IMRT or 60 cobalt Gy-equivalents for SSPT with 95% planning target volume (PTV) coverage. Using IMRT and SSPT techniques, extensive comparative planning was conducted. All plans were evaluated by the risk of RILD estimated using the Lyman-normal-tissue complication probability model. Results: For IMRT the risk of RILD increased drastically between 6.3-7.8 cm nominal diameter of GTV. When the nominal diameter of GTV was more than 6.3 cm, the average risk of RILD was 94.5% for IMRT and 6.2% for SSPT. Conclusions: Regarding the risk of RILD, HCC can be more safely treated with SSPT, especially if its nominal diameter is more than 6.3 cm.
• 動体追跡装置を用いた位置照合に基づく膀胱癌放射線治療時のマージンの解析

  西岡健太郎, 清水伸一, 安部崇重, 丸山覚, 鬼丸力也, 木下留美子, 小野寺俊輔, 原田慶一, 篠原信雄, 白土博樹

  日本医学放射線学会総会抄録集 (公社)日本医学放射線学会 72nd S397 - S397 0048-0428 2013/02/28 [Not refereed][Not invited]
  
• Dose comparison study between RapidArc and fixed-field IMRT for postoperative whole pelvic irradiation with cervical cancer

  土屋和彦, 原田慶一, 西岡健太郎, 木下留美子, 清水伸一, 白土博樹

  Jpn J Radiol 31 (Supplement 1) 11  1867-1071 2013/02/25 [Not refereed][Not invited]
  
• beta 1-integrin via NF-kappa B signaling is essential for acquisition of invasiveness in a model of radiation treated in situ breast cancer

  Jin-Min Nam, Kazi M. Ahmed, Sylvain Costes, Hui Zhang, Yasuhito Onodera, Adam B. Olshen, Kanako C. Hatanaka, Rumiko Kinoshita, Masayori Ishikawa, Hisataka Sabe, Hiroki Shirato, Catherine C. Park

  BREAST CANCER RESEARCH 15 (4) 1465-542X 2013 [Refereed][Not invited]
   

  Introduction: Ductal carcinoma in situ (DCIS) is characterized by non-invasive cancerous cell growth within the breast ducts. Although radiotherapy is commonly used in the treatment of DCIS, the effect and molecular mechanism of ionizing radiation (IR) on DCIS are not well understood, and invasive recurrence following radiotherapy remains a significant clinical problem. This study investigated the effects of IR on a clinically relevant model of Akt-driven DCIS and identified possible molecular mechanisms underlying invasive progression in surviving cells. Methods: We measured the level of phosphorylated-Akt (p-Akt) in a cohort of human DCIS specimens by immunohistochemistry (IHC) and correlated it with recurrence risk. To model human DCIS, we used Akt overexpressing human mammary epithelial cells (MCF10A-Akt) which, in three-dimensional laminin-rich extracellular matrix (lrECM) and in vivo, form organotypic DCIS-like lesions with lumina expanded by pleiomorphic cells contained within an intact basement membrane. In a population of cells that survived significant IR doses in three-dimensional lrECM, a malignant phenotype emerged creating a model for invasive recurrence. Results: P-Akt was up-regulated in clinical DCIS specimens and was associated with recurrent disease. MCF10A-Akt cells that formed DCIS-like structures in three-dimensional lrECM showed significant apoptosis after IR, preferentially in the luminal compartment. Strikingly, when cells that survived IR were repropagated in three-dimensional lrECM, a malignant phenotype emerged, characterized by invasive activity, up-regulation of fibronectin, alpha 5 beta 1-integrin, matrix metalloproteinase-9 (MMP-9) and loss of E-cadherin. In addition, IR induced nuclear translocation and binding of nuclear factor-kappa B (NF-kappa B) to the beta 1-integrin promoter region, associated with up-regulation of alpha 5 beta 1-integrins. Inhibition of NF-kappa B or beta 1-integrin signaling abrogated emergence of the invasive activity. Conclusions: P-Akt is up-regulated in some human DCIS lesions and is possibly associated with recurrence. MCF10A-Akt cells form organotypic DCIS-like lesions in three-dimensional lrECM and in vivo, and are a plausible model for some forms of human DCIS. A population of Akt-driven DCIS-like spheroids that survive IR progresses to an invasive phenotype in three-dimensional lrECM mediated by beta 1-integrin and NF-kappa B signaling.
• Safety, Stability, and Location of Implantation of Multiple Gold Markers Into the Soft Bladder Wall by Rigid Cystoscopy

  Nishioka K, Shimizu S, Onimaru R, Kinoshita R, Kato N, Harada K, Abe T, Maruyama S, Shinohara N, Shirato H

  International Journal of Radiation Oncology Biology Physics 87 (2) S397  0360-3016 2013 [Refereed][Not invited]
  
• 陽子線治療における最適な治療ワークフローの検討

  高尾聖心, 松浦妙子, 寅松千枝, 二本木英明, 宮本直樹, 清水伸一, 木下留美子, 松田浩二, 木谷貴雄, 梅垣菊男, 白土博樹

  医学物理 Supplement 32 (3) 169 - 170 1345-5362 2012/09/13 [Not refereed][Not invited]
  
• リンフォーマの画像診断と新規治療のプラクティス 皮膚悪性リンパ腫に対する放射線治療

  鬼丸 力也, 清水 伸一, 土屋 和彦, 加藤 徳雄, 木下 留美子, 井上 哲也, 小野寺 俊輔, 安田 耕一, 西岡 健太郎, 白土 博樹

  日本皮膚悪性腫瘍学会学術大会プログラム・抄録集 日本皮膚悪性腫瘍学会 28回 82 - 82 2012/06 [Not refereed][Not invited]
  
• Outcomes of young patients (age younger than 40) with cervical cancer treated with (chemo) radiotherapy: A Japanese multi-institutional study.

  Takuro Ariga, Yuzuru Niibe, Takafumi Toita, Tomoko Kazumoto, Hidehiro Eto, Osamu Suzuki, Rumiko Kinoshita, Kayoko Tsujino, Mitsuhiro Takemoto, Takeshi Kodaira, Hideomi Yamashita, Kazushige Hayakawa

  JOURNAL OF CLINICAL ONCOLOGY 30 (15) 0732-183X 2012/05 [Refereed][Not invited]
  
• 治療計画シミュレーションによる陽子線スキャニング専用機の線量分布の検証

  二本木英明, 寅松千枝, 松浦妙子, 高尾聖心, 宮本直樹, 梅垣菊男, 清水伸一, 木下留美子, 白土博樹

  医学物理 Supplement 32 (1) 190  1345-5362 2012/04/01 [Not refereed][Not invited]
  
• Prognostic Significance of Clusterin Expression in Advanced-Stage Cervical Cancer Treated With Curative Intended Radiotherapy

  Hidemichi Watari, Rumiko Kinoshita, Yimin Han, Lei Wang, Masayoshi Hosaka, Hiroshi Taguchi, Kazuhiko Tsuchiya, Shinya Tanaka, Hiroki Shirato, Noriaki Sakuragi

  INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER 22 (3) 465 - 470 1048-891X 2012/03 [Refereed][Not invited]
   

  Objective: Overexpression of clusterin (CLU), an antiapoptotic molecule, has been reported to induce resistance to radiotherapy (RT) in a variety of cancer cell types. The aim of this study was to evaluate the significance of CLU expression to predict survival of patients with advanced-stage cervical cancer who received curative intended RT. Methods: Biopsy tissue specimens of advanced-stage cervical cancer before curative intended RT were obtained from 34 patients who were treated at Hokkaido University Hospital between 1998 and 2008 and whose complete medical records were available. The expression of CLU protein was analyzed by immunohistochemistry. Findings were evaluated in relation to several clinicopathological factors. Survival analyses were performed using the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Results: Clusterin protein was mainly present in the cytoplasm of cervical cancer cells. The expression of CLU protein in cervical cancer tissues before curative intended RT was not significantly related to any clinicopathological factors analyzed, including age, clinical stage, histologic type, and response to RT. Univariate analysis on prognostic factors showed that histologic type (P = 0.001), and CLU expression (P = 0.02) were related to survival. Multivariate analysis revealed that both histologic type (P = 0.002), and CLU expression (P = 0.02) were independent prognostic factors for overall survival. Conclusion: We conclude that CLU could be a new molecular marker to predict overall survival of patients with advanced-stage cervical cancer treated with curative intended RT.
• 北海道大学病院における乳房外Paget病の放射線治療経験

  原田慶一, 木下留美子, 加藤徳雄, 西岡健太郎, 清水伸一, 鬼丸力也, 白土博樹

  日本医学放射線学会総会抄録集 71st S375  0048-0428 2012/02/29 [Not refereed][Not invited]
  
• 北海道大学病院における乳房温存療法の治療成績

  木下留美子, 清水伸一, 西岡健太郎, 原田慶一, 小野寺俊輔, 田口大志, 細田充主, 田口和典, 高橋弘昌, 白土博樹

  日本医学放射線学会総会抄録集 71st S318  0048-0428 2012/02/29 [Not refereed][Not invited]
  
• Improvement of tracking accuracy and stability by recursive image processing in real-time tumor-tracking radiotherapy system

  Miyamoto Naoki, Sutherland Kenneth, Suzuki Ryusuke, Matsuura Taeko, Toramatsu Chie, Takao Seishin, Nihongi Hideaki, Kinoshita Rumiko, Shimizu Shinichi, Onimaru Rikiya, Umegaki Kikuo, Shirato Hiroki, Ishikawa Masayori

  MEDICAL IMAGING 2012: IMAGE-GUIDED PROCEDURES, ROBOTIC INTERVENTIONS, AND MODELING 8316 83160  0277-786X 2012 [Refereed][Not invited]
  
• The Role of Spot Scanning Proton Therapy in the Treatment of Large Abdominal Tumors: A Comparative Planning Study of Hepatocellular Carcinoma

  Toramatsu C, Katoh N, Shimizu S, Nihongi H, Matsuura T, Takao S, Miyamoto N, Kinoshita R, Umegaki K, Shirato H

  International Journal of Radiation Oncology Biology Physics 84 (3) S327 - S328 0360-3016 2012 [Refereed][Not invited]
  
• Interfractional Setup Error and Intrafractional Bladder Motion During Radiation Therapy for Bladder Tumors

  Nishioka K, Shimizu S, Onimaru R, Kinoshita R, Harada K, Nishikawa N, Abe T, Maruyama S, Shinohara N, Shirato H

  International Journal of Radiation Oncology Biology Physics 84 (3) S769  0360-3016 2012 [Refereed][Not invited]
  
• Dosimetric Study for Shallow-Seated Tumor Using Passive/active Scanning Proton Beam

  Toramatsu C, Matsuura T, Nihongi H, Takao S, Miyamoto N, Shimizu S, Kinoshita R, Umegaki K, Shirato H

  Medical Physics 39 (6) 3821 - 3822 0094-2405 2012 [Refereed][Not invited]
  
• Pattern of ipsilateral breast tumor recurrence after breast conservation therapy

  KINOSHITA RUMIKO, SHIMIZU SHIN'ICHI, TSUCHIYA KAZUHIKO, KATO NORIO, TAGUCHI HIROSHI, TAKAHASHI MASATO, TAKAHASHI HIROMASA, SHIRATO HIROKI

  臨床放射線 56 (13) 1813 - 1818 0009-9252 2011/12/10 [Not refereed][Not invited]
  
• 乳房温存術後の全乳房照射における接線照射と強度変調放射線治療との比較

  土屋和彦, 木下留美子, 清水伸一, 森崇, 原田慶一, 白土博樹

  日本医学放射線学会総会抄録集 70th S371  0048-0428 2011/02/28 [Not refereed][Not invited]
  
• 乳房温存療法後局所再発症例の検討

  木下留美子, 清水伸一, 土屋和彦, 加藤徳雄, 田口大志, 高橋将人, 高橋弘昌, 白土博樹

  日本医学放射線学会秋季臨床大会抄録集 46th S506  0048-0428 2010/08/25 [Not refereed][Not invited]
  
• 口唇癌の放射線治療のretrospective study

  香泉和寿, 安田耕一, 長谷川雅一, 鬼丸力也, 清水伸一, 木下留美子, 井上哲也, 加藤徳雄, 小野寺俊輔, 田口大志, 溝口史樹, 青山英史, 白土博樹, 西岡健, 武島嗣英

  Jpn J Radiol (公社)日本医学放射線学会 28 (Supplement 1) 7 - 7 1867-1071 2010/07/25 [Not refereed][Not invited]
  
• The impact of 18F-fluoromisonidazole PET for H&N cancer and the applying for IMRT

  YASUDA KOICHI, HASEGAWA MASAICHI, ONIMARU RIKIYA, KINOSHITA RUMIKO, KATO NORIO, TAGUCHI HIROSHI, SHIMIZU SHIN'ICHI, INOUE TETSUYA, ONODERA SHUNSUKE, MIZOGUCHI FUMIKI, AOYAMA HIDEFUMI, SHIRATO HIROKI, SHIGA SATORU, OKAMOTO SHOZO, TAMAKI NAGARA, ISHIKAWA MASAZUMI, SUTHERLAND KENNETH, BENGUA GERARD, MIYAMOTO NAOKI, SUZUKI TAKASUKE

  Jpn J Radiol (公社)日本医学放射線学会 28 (Supplement 1) 14 - 14 1867-1071 2010/07/25 [Not refereed][Not invited]
  
• 乳房温存手術後接線照射における被照射腋窩リンパ節領域の検討

  田口大志, 清水伸一, 木下留美子, 白土博樹, 高橋弘昌, 高橋將人, 細田充主, 藤堂省

  北海道外科雑誌 54 (2) 188  0288-7509 2009/12/20 [Not refereed][Not invited]
  
• 機能温存をめざした頭頸部癌治療update 強度変調放射線治療(intensity modulated radiotherapy;IMRT)

  鬼丸力也, 木下留美子, 長谷川雅一, 安田耕一, 白土博樹

  ENTONI (株)全日本病院出版会 (103) 14 - 20 1346-2067 2009/06/15 [Not refereed][Not invited]
   

  頭頸部癌に対する放射線治療は形態・機能温存を目的とした治療であるが、晩期反応に苦しむ患者さんも多かった。従来の放射線治療の欠点を解消すべく発展してきた強度変調放射線治療(intensity modulated radiotherapy;IMRT)は腫瘍には十分な線量を、リスク臓器には少ない線量を照射することを可能にした。IMRTを行う際には、CTで標的体積を設定する必要があるが、その際には正確な病期診断が必要である。また、治療計画の最適化や検証などの作業が必要であり、人手と時間を要する治療である。IMRTにより視神経などのリスク臓器のそばまで浸潤した腫瘍を従来の放射線治療よりも合併症を少なく治療できると期待されている一方、リスク臓器と指定しなかった臓器には高線量が照射される可能性があり注意が必要である。(著者抄録)
• Clinical results of intensity modulated radiotherapy (IMRT) for head and neck cancer: Experience of Hokkaido University Hospital

  Rikiya Onimaru, Masakazu Hasegawa, Koichi Yasuda, Rumiko Kinoshita, Hiroki Shirato, Akihiro Homma, Nobuhiko Oridate, Satoshi Fukuda

  Toukeibu Gan 35 (3) 245 - 249 1349-5747 2009 [Not refereed][Not invited]
   

  We evaluated the clinical outcome of 37 patients who had received intensity modulated radiation therapy (IMRT) in Hokkaido University Hospital from May 2002 to December 2007. Thirteen patients had nasopharyngeal cancer, 19 had oropharyngeal cancer, 3 had hypopharyngeal cancer, 1 had maxillary sinus cancer, and 1 had oral cancer. One patient who had oropharyngeal cancer died of pharyngeal abscess which was a treatment-related complication. Three patients died of other cancers. One patient with nasopharyngeal cancer had local recurrence. In patients with oropharyngeal cancer, recurrence at the primary site occurred in 3 patients, and residual/recurrence at neck lymph nodes occurred in 2 patients. One patient with hypopharyngeal cancer had residual neck lymph node metastasis. Some patients experienced severe reactions to the radiation. One patient had pharyngeal abscess and died of this treatment complication. One patient who had nasopharyngeal cancer experienced hearing loss and angle closure glaucoma. © 2009, Japan Society for Head and Neck Cancer. All rights reserved.
• 定位放射線治療による予後改善に関する研究 定位放射線治療による臨床試験の研究

  白土博樹, 鬼丸力也, BENGUA Gerard, 石川正純, 井上哲也, 清水伸一, 木下留美子, 青山英史

  定位放射線治療による予後改善に関する研究 平成20年度 総括研究報告書 12-13  2009 [Not refereed][Not invited]
  
• Skull base MeningiomaにおけるIMRTの利用—当院治療成績を踏まえて—

  小野寺俊輔, 白土博樹, 青山英史, 田口大志, 加藤徳雄, 木下留美子, 鬼丸力也, 清水伸一, 井上哲也, 安田耕一

  日本医学放射線学会秋季臨床大会抄録集 (公社)日本医学放射線学会 44th S521 - S521 0048-0428 2008/09/24 [Not refereed][Not invited]
  
• 北海道大学における非小細胞肺癌に対する体幹部定位放射線治療の治療成績

  鬼丸力也, 加藤徳雄, 井上哲也, 田口大志, 清水伸一, 長谷川雅一, 安田耕一, 小野寺俊輔, 木下留美子, 青山英史, 白土博樹

  日本放射線腫よう学会誌 20 (Supplement 1) 128  1040-9564 2008/09/22 [Not refereed][Not invited]
  
• 動体追跡装置を用い安全域3mmで行ったホルモン非併用の前立腺癌放射線治療

  清水伸一, 大坂康博, 鬼丸力也, 長谷川雅一, 田口大志, 加藤徳雄, 木下留美子, 青山英史, 白土博樹

  日本放射線腫よう学会誌 20 (Supplement 1) 143  1040-9564 2008/09/22 [Not refereed][Not invited]
  
• 75歳以上の高齢者に対する子宮頚癌の放射線治療

  木下留美子, 田口大志, 加藤徳雄, 清水伸一, 溝口史樹, 米坂祥朗, 北原利博, 白土博樹

  日本放射線腫よう学会誌 20 (Supplement 1) 146  1040-9564 2008/09/22 [Not refereed][Not invited]
  
• Frontiers of Three-dimensional Conformal Radiation Therapy: Image-guided Radiation Therapy and Four-dimensional Radiation Therapy

  KINOSHITA RUMIKO, ONODERA YUYA, SHIRATO HIROKI, SHIMIZU SHIN'ICHI, ONIMARU RIKIYA, AOYAMA HIDEFUMI

  画像診断 (株)学研メディカル秀潤社 28 (6) 560 - 566 0285-0524 2008/04/25 [Not refereed][Not invited]
  
• Intramedullary spinal cord metastasis treated with radiation therapy: Report of 3 cases

  Shogo Endo, Kazutoshi Hida, Shunsuke Yano, Masaki Ito, Shigeru Yamaguchi, Daina Kashiwazaki, Rumiko Kinoshita, Hiroki Shirato, Yoshinobu Iwasaki

  NEUROLOGICAL SURGERY 36 (4) 345 - 349 0301-2603 2008/04 [Not refereed][Not invited]
   

  Objectives Intramedurally spinal cord metastasis (ISCM) tends to be seen in the end period of the malignant tumor, so it is important to choose a therapeutic method regarding the QOL (quality of life) of the patient. In this study, we reported three cases of ISCM treated by radiation therapy alone, and demonstrated the utility of this therapeutic procedure. Patients and Methods From 2005 to 2006, 3 cases of ISCM underwent radiotherapy in our institution. The mean age of the patients was 64.0 years old, and all patients were men, having lung carcinoma as their primary lesions. The lesions were located at the cervical cord in one case and the conus medullaris in the other two cases. They were treated by radiotherapy at the department of radiology in our institute. Results The tumor size and intramedullary high signal area on MR images after the radiotherapy were reduced in all patients. During the clinical course, neurological symptoms were improved in two patients, and progression of the symptoms was stopped in one patient. All of the patients obtained a better ADL due to the radiotherapy. Conclusions Radiotherapy has an advantage over surgical treatment in that it involves less invasion. The treatment brought improvements of clinical symptoms and radiological findings in the patients with ISCM. So, radiotherapy could be used as one of the major treatments for patients with ISCM who desire a better QOL after treatment.
• 下咽頭癌における(化学)放射線療法後の救済手術の治療成績

  瀧 重成, 本間 明宏, 古田 康, 折舘 伸彦, 鈴木 章之, 古沢 純, 坂下 智博, 木下 留美子, 白戸 博樹, 福田 諭

  頭頸部癌 (一社)日本頭頸部癌学会 33 (2) 163 - 163 1349-5747 2007/05 [Not refereed][Not invited]
  
• 頭頚部癌のDOC併用放射線療法;副作用軽減を目的としたステロイド使用について

  小野寺俊輔, 木下留美子, 藤野賢治, 加藤徳雄, 田口大志, 鬼丸力也, 大阪康博, 清水伸一, 鈴木恵士郎, 西岡健, 白土博樹

  Radiat Med 25 15  0288-2043 2007/04/25 [Not refereed][Not invited]
  
• 動体追跡装置を用いた照射中の乳腺表面の動きの検討

  木下留美子, 清水伸一, 加藤徳雄, 藤野賢治, 鬼丸力也, 白土博樹

  日本医学放射線学会学術集会抄録集 66th S212  0048-0428 2007/02/28 [Not refereed][Not invited]
  
• INTENSITY-MODULATED RADIATION THERAPY (IMRT) FOR HEAD AND NECK REGION

  KINOSHITA RUMIKO, TSUCHIYA KAZUHIKO, OMORI KEIICHI, OBINATA KEN'ICHI, FUJITA KATSUHISA, AOYAMA HIDEFUMI, OITA MASATAKA, NISHIOKA TAKESHI, SUZUKI KEISHIRO, SHIRATO HIROKI

  日本放射線腫瘍学会誌 一般社団法人 日本放射線腫瘍学会 18 (4) 191 - 197 1040-9564 2006/12 [Not refereed][Not invited]
   

  Intensity-modulated radiation therapy (IMRT) can produce highly conformal dose distributions. In head and neck region, IMRT has been used for the purpose of reduction parotid glands dose. Generally accepted, more precise set-up and careful observation are needed for IMRT than those of conventional RT, because it takes longer treatment time for IMRT and its dose gradient spreads within field. Our institute has developed real-time tumor-tracking (RTRT) systems and it realizes precise set-up and observation during treatment. We have used IMRT with RTRT system for head and neck region for 9 patients with 3-mm as the planning target volume margin. Salivary glands function was evaluated by subjective symptoms using visual analogue scale (VAS). After median follow-up of 17 months, all patients were alive without local relapse and distant metastasis. The mean VAS score of each periods were 9.6, 51.4, 55.1, 39.7and 47.9 mm at pre-treatment, 1-4 months, 5-8 months, 9-12 months, and 13 months or more after the radiotherapy respectively. IMRT with RTRT set-up system was shown to be feasible.
• Uncertainty in treatment of head-and-neck tumors by use of intraoral mouthpiece and embedded fiducials.

  Oita M, Ohmori K, Obinata K, Kinoshita R, Onimaru R, Tsuchiya K, Suzuki K, Nishioka T, Ohsaka H, Fujita K, Shimamura T, Shirato H, Miyasaka K

  International journal of radiation oncology, biology, physics 5 64 (5) 1581 - 1588 0360-3016 2006/04 [Refereed][Not invited]
  
• Speed and amplitude of lung tumor motion precisely detected in four-dimensional setup and in real-time tumor-tracking radiotherapy.

  Shirato H, Suzuki K, Sharp GC, Fujita K, Onimaru R, Fujino M, Kato N, Osaka Y, Kinoshita R, Taguchi H, Onodera S, Miyasaka K

  International journal of radiation oncology, biology, physics 4 64 (4) 1229 - 1236 0360-3016 2006/03 [Refereed][Not invited]
   

  BACKGROUND: To reduce the uncertainty of registration for lung tumors, we have developed a four-dimensional (4D) setup system using a real-time tumor-tracking radiotherapy system. METHODS AND MATERIALS: During treatment planning and daily setup in the treatment room, the trajectory of the internal fiducial marker was recorded for 1 to 2 min at the rate of 30 times per second by the real-time tumor-tracking radiotherapy system. To maximize gating efficiency, the patient's position on the treatment couch was adjusted using the 4D setup system with fine on-line remote control of the treatment couch. RESULTS: The trajectory of the marker detected in the 4D setup system was well visualized and used for daily setup. Various degrees of interfractional and intrafractional changes in the absolute amplitude and speed of the internal marker were detected. Readjustments were necessary during each treatment session, prompted by baseline shifting of the tumor position. CONCLUSION: The 4D setup system was shown to be useful for reducing the uncertainty of tumor motion and for increasing the efficiency of gated irradiation. Considering the interfractional and intrafractional changes in speed and amplitude detected in this study, intercepting radiotherapy is the safe and cost-effective method for 4D radiotherapy using real-time tracking technology.
• Real-time and precise monitoring of the breast motion during irradiation using real-time tumor-tracking radiotherapy (RTRT) system

  Kinoshita R, Shimizu S, Katoh N, Onimaru R, Shirato H, Miyasaka

  International Journal of Radiation Oncology Biology Physics 66 (3) S608  0360-3016 2006 [Refereed][Not invited]
  

MISC

• 免疫チェックポイント阻害薬と放射線治療—Clinical evidences for the combination of immune checkpoint inhibitor and radiation therapy—特集 がん免疫療法の展望 : 免疫チェックポイント阻害薬の併用療法に中心に ; 免疫チェックポイント阻害薬の併用療法のエビデンス

  安田 耕一, 志藤 元泰, 小泉 富基, 高橋 周平, 藤田 祥博, 大塚 愛美, 宮﨑 智彦, 西川 昇, 打浪 雄介, 森 崇, 西岡 健太郎, 木下 留美子, 田口 大志, 加藤 徳雄, 橋本 孝之, 青山 英史  腫瘍内科 = Clinical oncology / 腫瘍内科編集委員会 編  30-  (1)  23  -28  2022/07
• Proton beam therapy for reirradiation in pediatric cancer

  橋本孝之, 森崇, 西岡健太郎, 打浪雄介, 安田耕一, 木下留美子, 田口大志, 加藤徳雄, 清水伸一, 青山英史  日本小児血液・がん学会雑誌(Web)  58-  (2)  2021
• 画像誘導陽子線治療の将来展望

  田口大志, 橋本孝之, 橋本孝之, 加藤徳雄, 木下留美子, 安田耕一, 西岡健太郎, 西岡健太郎, 森崇, 打浪雄介, 宮本直樹, 高尾聖心, 清水伸一, 清水伸一, 青山英史  日本癌治療学会学術集会(Web)  58th-  2020
• 乳癌眼窩尖部転移により視力低下をきたし、放射線治療により著明な改善を認めた1例

  湊川 英樹, 安田 耕一, 打浪 雄介, 白土 博樹, 土屋 和彦, 加藤 徳雄, 木下 留美子, 石田 直子, 山下 啓子, 石嶋 漢  Japanese Journal of Radiology  36-  (Suppl.)  11  -11  2018/02  [Not refereed][Not invited]
  
• リンパ脈管筋腫症(LAM)を合併した乳癌に対し乳房温存術後に術後照射を施行した2例

  木下留美子, 長江伸樹, 西岡健太郎, 橋本孝之, 清水伸一, 白土博樹, 加藤扶美, 石田直子, 山下啓子, 清水薫子, 鈴木雅, 今野哲  北海道外科雑誌  63-  (2)  2018
• 甲状腺癌分化癌の骨転移に対するIMRTを含めた外照射の治療成績

  安田耕一, 加藤徳雄, 岡本祥三, 木下留美子, 志賀哲, 水町貴諭, 畠山博充, 本間明宏, 田口純, 清水康, 森崇, 土屋和彦, 白土博樹  頭けい部癌  43-  (2)  221  -221  2017/05/10  [Not refereed][Not invited]
  
• Tufted angiomaに対し放射線治療を行った1例

  長江伸樹, 森崇, 木下留美子, 鬼丸力也, 白土博樹, 西村真智子, 畑中佳奈子, 木村鉄宣  Japanese Journal of Radiology  35-  (Supplement)  4  2017/02/25  [Not refereed][Not invited]
  
• Radiation Dose to Internal Mammary Lymph Node in Standard Tangential Breast Irradiation

  R. Kinoshita, S. Shimizu, Y. Nishikawa, K. Nishioka, T. Hashimoto, R. Suzuki, H. Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  96-  (2)  E17  -E18  2016/10  [Not refereed][Not invited]
  
• Initial dosimetoric study of whole pelvic irradiation using spot scanning proton therapy

  YOSHIMURA Takaaki, ONODERA Shunsuke, TORAMATSU Chie, KINOSHITA Rumiko, SHIMIZU Shinichi, UMEGAKI Kikuo, SHIRATO Hiroki  医学物理 Supplement  34-  (1)  143  2014/04/01  [Not refereed][Not invited]
  
• 頸部転移性骨腫瘍におけるスポットスキャニング照射法を用いた陽子線治療の線量分布評価

  吉村 高明, 安田 耕一, 寅松 千枝, 高尾 聖心, 松浦 妙子, 二本木 英明, 木下 留美子, 鬼丸 力也, 白土 博樹, 石川 正純  Japanese Journal of Radiology  32-  (Suppl.)  7  -7  2014/02  [Not refereed][Not invited]
  
• II‐IV期上咽頭癌に対する化学放射線同時併用療法:併用化学療法に関する後ろ向き比較検討

  TSUCHIYA KAZUHIKO, YASUDA KOICHI, KINOSHITA RUMIKO, ONIMARU RIKIYA, SHIRATO HIROKI, HONMA AKIHIRO, FUKUDA SATOSHI, SHIMIZU YASUSHI, AKITA HIROTOSHI  頭けい部癌  39-  (2)  218  -218  2013/05/21  [Not refereed][Not invited]
  
• 北海道大学病院における上咽頭癌の治療 10年間(2000〜2010)のまとめ

  土屋 和彦, 安田 耕一, 西川 由記子, 木下 留美子, 鬼丸 力也, 原田 慶一, 井上 哲也, 加藤 徳雄, 清水 伸一, 白土 博樹, 西岡 健, 鈴木 恵士郎, 田口 大志, 長谷川 雅一, 折舘 伸彦, 本間 明宏, 鈴木 清護, 畠山 博充, 加納 里志, 水町 貴諭, 坂下 智博, 福田 諭, 竹内 啓, 田口 純  耳鼻咽喉科展望  56-  (補冊2)  174  -175  2013/05  [Not refereed][Not invited]
  
• Retrospective Comparison Between Cisplatin Plus Fluorouracil and Weekly Cisplatin in Concurrent Chemoradiation Therapy Setting for Stage II-IV Nasopharyngeal Carcinoma

  K. Tsuchiya, K. Yasuda, Y. Nishikawa, R. Kinoshita, R. Onimaru, H. Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  84-  (3)  S484  -S485  2012/11  [Not refereed][Not invited]
  
• Decreasing Acute and Late Toxicity Using Urethral Dose Reduction and Smaller Safety Margin Around CTV for Prostate Cancer Intensity Modulated Radiation Therapy (IMRT) With a Real-time Tumor-tracking (RTRT) System

  S. Shimizu, K. Nishioka, R. Onimaru, R. Kinoshita, K. Harada, N. Nishikawa, T. Abe, S. Maruyama, N. Shinohara, H. Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  84-  (3)  S181  -S181  2012/11  [Not refereed][Not invited]
  
• Co-overexpression of GEP100 With EGFR Correlates With Early Recurrence After Breast Conservation Therapy (BCT)

  R. Kinoshita, J. Nam, M. Hosoda, C. Kubota K, M. Tanino, A. Hashimoto, Y. M. Ito, S. Tanaka, H. Sabe, H. Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  84-  (3)  S227  -S228  2012/11  [Not refereed][Not invited]
  
• Improvement of tracking accuracy and stability by recursive image processing in real-time tumor-tracking radiotherapy system

  Naoki Miyamoto, Kenneth Sutherland, Ryusuke Suzuki, Taeko Matsuura, Chie Toramatsu, Seishin Takao, Hideaki Nihongi, Rumiko Kinoshita, Shinichi Shimizu, Rikiya Onimaru, Kikuo Umegaki, Hiroki Shirato, Masayori Ishikawa  Progress in Biomedical Optics and Imaging - Proceedings of SPIE  8316-  2012/05/01  [Not refereed][Not invited]
   

  In the real-time tumor-tracking radiotherapy (RTRT) system, the fiducial markers are inserted in or near the target tumor in order monitor the respiratory-induced motion of tumors. During radiation treatment, the markers are detected by continuous fluoroscopy operated at 30 frames/sec. The marker position is determined by means of a template pattern matching technique which is based on the normalized cross correlation. With high tube voltage, large current and long exposure, the fiducial marker will be recognized accurately, however, the radiation dose due to X-ray fluoroscopy increases. On the other hand, by decreasing the fluoroscopy parameter settings, the fiducial marker could be lost because the effect of statistical noise is increased. In the respiratory-gated radiotherapy, the error of the image guidance will induce the reduction of the irradiation efficiency and accuracy. In order to track the marker stably and accurately in low dose fluoroscopy, we propose the application of a recursive filter. The effectiveness of the image processing is investigated by tracking the static marker and the dynamic marker. The results suggest that the stability and the accuracy of the marker tracking can be improved by applying the recursive image filter in low dose imaging. © 2012 Copyright Society of Photo-Optical Instrumentation Engineers (SPIE).
• 変異p53が癌浸潤転移シグナル経路を創出し活性化する

  橋本あり, 橋本茂, 吉河歩, 杉野弘和, 半田悠, 木下留美子, 畑中佳奈子, 三上修治, 谷野美智枝, 味藤静, 佐藤宏紀, 大塚勇太郎, 芳野日南子, 加戸由加里, NAM Jin‐Min, 小野寺康仁, 田中伸哉, 白土博樹, 佐邊壽孝  日本分子生物学会年会プログラム・要旨集(Web)  35th-  2W10II-1 (WEB ONLY)  2012  [Not refereed][Not invited]
  
• TGFβ1はGEP100-Arf6-AMAP1経路の活性化によりEMTを誘導し、この活性化は癌幹細胞性と関連する(TGFβ1 activates GEP100-Arf6-AMAP1 pathway to induce EMT, and possible relationship of this activation to cancer stemness)

  橋本 あり, 平野 真理子, 谷野 美智枝, 梅本 勉, 小野寺 康仁, 佐藤 宏紀, 木下 留美子, 南 ジンミン, 大塚 勇太郎, 福田 諭, 白土 博樹, 相沢 慎一, 橋本 茂, 田中 伸哉, 佐邊 壽孝  日本生化学会大会・日本分子生物学会年会合同大会講演要旨集  83回・33回-  2P  -0237  2010/12  [Not refereed][Not invited]
  
• 若年者子宮頸癌の放射線治療成績 日本放射線腫瘍学会研究課題全国調査

  新部 譲, 戸板 孝文, 楮本 智子, 西村 哲夫, 古平 毅, 江藤 英博, 鈴木 修, 木下 留美子, 山下 英臣, 辻野 佳世子, 大西 洋, 兼安 祐子, 武本 充広, 山内 智香子, 早川 和重  日本婦人科腫瘍学会雑誌  27-  (3)  277  -277  2009/06  [Not refereed][Not invited]
  
• 上咽頭癌に対するCDDP,5‐FUを用いた放射線化学療法の治療成績

  木下留美子, 長谷川雅一, 安田耕一, 田口大志, 鬼丸力也, 土屋和彦, 西岡健, 本間明宏, 折館伸彦, 福田諭, 白土博樹  頭けい部癌  35-  (2)  93  -93  2009/05/20  [Not refereed][Not invited]
  
• 強度変調放射線治療(IMRT)の中長期成績 北海道大学病院での頭頸部癌に対する強度変調放射線治療の成績

  鬼丸 力也, 長谷川 雅一, 安田 耕一, 木下 留美子, 白土 博樹, 本間 明宏, 折舘 伸彦, 福田 諭  頭頸部癌  35-  (2)  65  -65  2009/05  [Not refereed][Not invited]
  
• 放射線治療におけるFDG‐PETでのSUVと正確な標的体積設定への影響因子

  藤野賢治, 田口大志, 加藤徳雄, 木下留美子, 鬼丸力也, 長谷川雅一, 溝口史樹, 青山英史, 白土博樹, 志賀哲, 玉木長良, 加藤千恵次, 梶智人  Radiat Med  27-  (Supplement 1)  6  2009/04/25  [Not refereed][Not invited]
  
• 放射線治療におけるFDG-PETでのSUVと正確な標的体積設定への影響因子

  藤野 賢治, 田口 大志, 加藤 徳雄, 木下 留美子, 鬼丸 力也, 長谷川 雅一, 溝口 史樹, 青山 英史, 白土 博樹, 志賀 哲, 玉木 長良, 加藤 千恵次, 梶 智人  Japanese Journal of Radiology  27-  (Suppl.)  6  -6  2009/04  [Not refereed][Not invited]
  
• 当院における遠隔放射線治療の現状について

  鈴木恵士郎, 木下留美子, 鬼丸力也, 安田耕一, 小野寺俊介, 加藤徳雄, 田口大志, 藤野賢治, 青山英史, 白上博樹, 宮坂和男  Radiat Med  26-  (Suppl.I)  3  -3  2008/04/25  [Not refereed][Not invited]
  
• IMRTとIGRT:Inverse Planningの理論と装置に求められる性能

  石川正純, 鈴木恵士朗, 木下留美子, 藤田勝久, 山崎理衣, 笈田将皇, 白土博樹  頭けい部癌  33-  (2)  64  2007/05/15  [Not refereed][Not invited]
  
• 動体追跡装置を用いた前立腺癌の放射線治療のPSA再発及び副作用発生率

  大坂康博, 青山英史, 田口大志, 加藤徳雄, 木下留美子, 藤野賢治, 鬼丸力也, 鈴木恵士郎, 白土博樹  日本医学放射線学会学術集会抄録集  66th-  S247  -S247  2007/02/28  [Not refereed][Not invited]
  
• 多発肺腫瘍に対する3ケ月以内の連続した定位照射の安全性と有効性の検討

  鬼丸力也, 藤野賢治, 田口大志, 加藤徳雄, 木下留美子, 安田耕一, 鈴木恵士郎, 白土博樹, 宮坂和男  日本医学放射線学会学術集会抄録集  66th-  S233  -S233  2007/02/28  [Not refereed][Not invited]
  
• Utilization the fusion image of CT and FDG-PET for radiation therapy planning in lung cancer

  FUJINO MASASHI, TAGUCHI TAISHI, KATO TOKUO, AOYAMA HIDEFUMI, SUZUKI KEISHIRO, ONIMARU RIKIYA, KINOSHITA RUMIKO, YASUDA KOICHI, SHIRATO HIROKI, KATO CHIETSUGU, SHIGA SATORU, TAMAKI NAGAYOSHI, ONODERA SHUNSUKE  臨床放射線  52-  (1)  137  -144  2007/01/10  [Not refereed][Not invited]
   

  肺癌の放射線治療計画にFDG-PETを用いstandardized uptake value(SUV)の数値で腫瘍の局在範囲を決定できるようにするための基礎的研究として、現在一般に行われているCT-planningと比較して劣らずにgross tumor volumeを設定できるか否かをファントム実験で検討した。結果、息止め下でのFDG-PET施行は、肺のように体内で呼吸性移動する臓器の癌においてSUVを真の値に近づけるうえでCT-planningより優れている可能性が示唆された。
• 手術不能Stage I非小細胞肺癌に対する動体追跡照射のマージンと効果の探索的検討

  鬼丸力也, 白土博樹, 藤野賢治, 田口大志, 加藤徳雄, 木下留美子, 鈴木恵士郎, 青山英史, 宮坂和男  日本放射線腫よう学会誌  18-  (Supplement 1)  217  2006/10/25  [Not refereed][Not invited]
  
• 膵癌に対する4次元強度変調放射線治療(4D‐IMRT)に向けての基礎的研究

  安田耕一, 加藤徳雄, 青山英史, 田口大志, 藤野賢治, 木下留美子, 鬼丸力也, 鈴木恵士朗, 白土博樹, 宮坂和男  日本放射線腫よう学会誌  18-  (Supplement 1)  170  2006/10/25  [Not refereed][Not invited]
  
• 放射線照射中における解剖学的変化について 腫瘍体積,正常組織体積の解析

  木下 留美子, 土屋 和彦, 田口 大志, 鈴木 恵士郎, 西岡 健, 白土 博樹, 大森 桂一  頭頸部癌  32-  (2)  200  -200  2006/05  [Not refereed][Not invited]
  
• 前立腺癌における動体追跡装置を用いた尿道線量低減強度変調放射線治療の検討

  大坂康博, 青山英史, 田口大志, 加藤徳雄, 木下留美子, 藤野賢治, 鬼丸力也, 鈴木恵士郎, 白土博樹, 宮坂和男  日本医学放射線学会学術集会抄録集  65th-  S211  -S211  2006/02/25  [Not refereed][Not invited]
  
• Prediction of four-dimensional (4D) tumor response using finite element method (FEM) and radiobiological model for adaptive radiotherapy

  H. Taguchi, S. Takao, Y. Kogure, H. Shirato, S. Tadano, K. Suzuki, R. Onimaru, N. Katoh, R. Kinoshita  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  66-  (3)  S596  -S596  2006  [Not refereed][Not invited]
  
• 動体追跡照射装置を用いた迎撃照射

  鬼丸力也, 藤野賢治, 田口大志, 加藤徳雄, 木下留美子, 鈴木恵士郎, 青山英史, 白土博樹  日本放射線腫よう学会誌  17-  (Supplement 1)  61  -61  2005/10/25  [Not refereed][Not invited]
  
• 粒子線,IMRTのあたらしい放射線治療 高精度光子線治療の現状と将来

  白土博樹, 大坂康博, 篠原信雄, 鬼丸力也, 鈴木恵士郎, 加藤紀雄, 山崎浩一, 藤野賢治, 木下留美子, 田口大志  日本癌治療学会誌  40-  (2)  208  2005/09/22  [Not refereed][Not invited]
  
• Estimation of dose distribution from the fluoroscopy in real-time tumor tracking radiotherapy (RTRT) for stereotactic body radiotherapy (SBRT)

  M Oita, R Onimaru, K Suzuki, H Aoyama, M Fujino, N Kato, R Kinoshita, K Fujita, H Shirato, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  76-  S147  -S147  2005/09  [Not refereed][Not invited]
  
• バルーン閉塞下TAEを施行した腎動静脈奇形の1例

  澤田 明宏, 清水 匡, 藤野 賢治, 木下 留美子, 阿保 大介, 作原 祐介, 児玉 芳尚, 船窪 正勝, 渡辺 佳明, 宮坂 和男  IVR: Interventional Radiology  20-  (3)  319  -319  2005/07
• 肺腫ようの胸部単純写真での存在部位から推定する通常の放射線治療でのinternal margin

  鬼丸力也, 藤野賢治, 白土博樹, 鈴木恵士郎, 田口大志, 加藤徳雄, 木下留美子, 宮坂和男  日本医学放射線学会学術集会抄録集  64th-  S344  2005/02/25  [Not refereed][Not invited]
  
• 前立腺癌の動体追跡装置を用いた尿道線量低減強度変調放射線治療

  大坂康博, 青山英史, 鬼丸力也, 田口大志, 木下留美子, 加藤徳雄, 鈴木恵士郎, 白土博樹, 宮坂和男  日本放射線腫よう学会誌  16-  (Supplement 1)  91  2004/11  [Not refereed][Not invited]
  
• 回結腸静脈経由,門脈血栓溶解術を施行した1例

  吉田 慶之, 児玉 芳尚, 清水 匡, 澤田 明宏, 作原 祐介, 阿保 大介, 木下 留美子, 宮坂 和男  IVR: Interventional Radiology  18-  (4)  396  -396  2003/10
• 血管造影が診断に最も有用であった小インスリノーマの1例

  阿保 大介, 澤田 明宏, 清水 匡, 児玉 芳尚, 作原 祐介, 吉田 慶之, 木下 留美子, 宮坂 和男  IVR: Interventional Radiology  18-  (4)  396  -396  2003/10
• PTCDカテーテル断裂をきたした1例

  木下 留美子, 児玉 芳尚, 清水 匡, 澤田 明宏, 作原 祐介, 阿保 大介, 吉田 慶之, 宮坂 和男  IVR: Interventional Radiology  18-  (4)  397  -397  2003/10
• 子宮動脈塞栓術 片側子宮動脈塞栓症例の検討

  作原 祐介, 清水 匡, 児玉 芳尚, 澤田 明宏, 阿保 大介, 吉田 慶之, 木下 留美子, 宮坂 和男  IVR: Interventional Radiology  18-  (4)  398  -398  2003/10
• 肝細胞癌に対する動注化学療法の検討

  澤田 明宏, 清水 匡, 児玉 芳尚, 作原 祐介, 阿保 大介, 吉田 慶之, 木下 留美子, 宮坂 和男  IVR: Interventional Radiology  18-  (4)  393  -393  2003/10

Research Grants & Projects

• Development of minimum invasive real-time markerless image guided radiotherapy technique using minimum space information.

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2018/04 -2021/03 

  Author : Shimizu Shinichi

   

  In the real-time tumor tracking radiotherapy, feature point information, that is used for gating, is obtained by fluoroscopic X-ray images. There still problems exist:1.X-ray exposure from diagnostic X ray that used for gating 2.insertion of a gold marker etc. as a feature pointReduce or eliminate X-ray exposure by making the observing area through diagnostic X-rays as small as possible to acquire target movement information or establishing the method of processing gating information obtained using MRI technology without using fluoroscopy were considered to be the goal of this study. X-rays are still optimal for acquiring organ motion information within human body necessary for gating treatment in real time, but a method for limiting the range was achieved in this study. In addition, we succeeded in trying to visualize the position of organs with MRI image data without using X-rays when preparing for treatment, and there were expectations for the promotion of future research.
• Attempt of 4D-IGRT by Volume Matching Method of 4D-CBCT and Therapy Planning CT

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2015/04 -2018/03 

  Author : Shimizu Shinichi

   

  We conduct research using 2 axis of diagnostic X-ray fluoroscope that consist real-time tumour-tracking (RTRT) system installed in a proton beam treatment gantry. With the use of the system, we conduct a research aimed constructing a 4D-IGRT radiotherapy system that can treat cancer in consideration of spatial and temporal fluctuations and also respiratory movement of tumors. Four-dimensional cone beam CT (4D-CBCT) image is obtained from the fluoroscopic image of the RTRT system. From the 4D-CBCT image group composed of a plurality of respiratory phases, a CT image that represent the same respiratory phase as the CT image used for the treatment plan is selected. We develop an advanced real time image guidance system aiming marker-less 4D-RT using selected CBCT image and its source image.
• The evaluation of late adverse effects of adjuvant radiotherapy using in silico sarrogate end marker

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2015 -2017 

  Author : Kinoshita Rumiko, Yoshimura Takaaki

   

  IMRT and spot sccaning proton therapy(SSPT) plans were created for 13 gynecologic malignancy patients who had received hysterectomies and irradiation to the pelvic region. The Bone marrow(BM）dose using SSPT was significantly lower than with IMRT. The NTCP modeling analysis showed that the risk of grade≧3 hematologic toxicity (HT3+) using SSPT was significantly lower than with IMRT The SSPT achieves significant reductions in the dose to BM without compromising target coverage, compared with IMRT. The NTCP value for HT3+ in SSPT was significantly lower than in IMRT. Dose volume anlaysis was carried out to eveluate the dose to the internal mammary lymph node(IMN) and normal tissure using 50 patients who reieved breaset concervation therapy(BCT). The IMN-PTV mean doses were less than 30 Gy in all cases.The IMN dose in standard tangential irradiation for BCT is insufficient for treatment.
• Study for the realization of tailor maid high precision radiotherapy for breast cancer based on molecular biology

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2012 -2014 

  Author : Kinoshita Rumiko

   

  Two studies about breast conservation therapy (BCT) were performed.First study was performed to investigate whether the presence of the receptor tyrosine kinase-GEP100-Arf6-AMAP1 pathway correlate with local recurrence (LR) after BCT. Using 19 specimens with LR, immunohistochemical staining of EGFR, HER2, GEP100 and AMAP1 was performed. Strongly positive for both GEP100 and AMAP1 group shows a shorter time to LR after the completion of radiotherapy than the others.This study shows that co-overexpression of GEP100 and AMAP1 protein correlate with rapid LR after BCT. Next, dosimetric comparison study which compare spot scanning proton therapy (SSPT) to intensity modulated radiotherapy (IMRT). Three different planning target volume (PTV) which include affected breast with or without regional lymph node. Dose to PTVs and organ at risks (OARs; ipsilateral lung, heart and contralateral lung) were calculated and compared. The SSPT reduced the dose to OARs with adequate target coverage.
• Early pathological evaluation for irradiation effectiveness in uterine cervical cancer

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2012 -2014 

  Author : TANINO Mishie, HIDEMICHI Watari, SHINYA Tanaka, RUMIKO Kinoshita

   

  Ionizing irradiation is an effective treatment for uterine cervical cancer, however, a higher rate of recurrence with more aggressive phenotypes is a vital issue. Although epithelial-mesenchymal transition (EMT) is involved in irradiation-induced cancer progression, the role for such phenotypic transition in uterine cervical cancer remains unknown. To investigate the mechanism of irradiation-dependent tumor progression, cervical cancer cell lines were irradiated multifractionated 20Gy in two weeks. Knocking down Snail and Yap cell lines were established. EMT regulators, Hippo pathway effector, mesenchymal and stemness proteins were increased after irradiation. In phenotypical analysis, cells exhibited an upregulation of migration, invasion, numbers of focal adhesion. Knocking down Snail and Yap inhibit increase in mesenchymal markers. In conclusion, we propose inhibiting both EMT and Hippo pathway is useful to prevent malignat transtion after irradiation.
• Research for Real-time Tracking Medical Science

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research

  Date (from‐to) : 2009 -2012 

  Author : SHIRATO Hiroki, HONMA Sato, TAMAKI Nagara, KUGE Yuji, MIZUTA Masahiro, DATE Hiroyuki, TANAKA Masaki, HAGA Hisashi, NISHIOKA Takeshi, KATO Motothugu, CHAMOTO Kenji, OIZUMI Satoshi, MATSUNAGA Naofumi, OKIMOTO Tomoaki, HAYAKAWA Kazushige, NISHIO Teiji, TADANO Shigeru, ISHIKAWA Masayori, ONODERA Yasuhito, SHIBUYA Keiko, HAMADA Toshiyuki, ONIMARU Rikiya, SHIMIZU Shinichi, TSUCHIYA Kazuhiko, KATOH Norio, KINOSHITA Rumiko, INOUE Tetsuya, ONODERA Syunsuke, TAKAO Seishin, KAGA Kichizo, TERAE Satoshi, ONODERA Yuya, SAKUHARA Yusuke, MANABE Noriko, ABO Daisuke, KATO Fumi, KHIN KHIN Tha, NAM Jin-min, SABE Hisataka, INUBUSHI Masayuki, SHINAGAWA Naofumi, KENNETH Sutherland

   

  Up to now, in the field of basic medicine from micro-level to animal level, to track and quantify the three-dimensional spatial information along the time axis in real-time has not caught up with the accuracy in the field of clinical medicine. By handing big data of “motion in life, a new idea of real-time radiotherapy and a new precise four-dimensional computed tomography has been developed based on the data of actual tumor motion in the human body.

Educational Activities

Teaching Experience