Researcher Profile and Settings

Affiliation

• Faculty of Medicine　Internal Medicine　Department of Radiology

Job Title

• Professor

J-Global ID

• 200901068120006420

Research Interests

• Radiation Oncology   

Research Areas

• Life sciences / Radiology

Educational Organization

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

Academic & Professional Experience

• 2019/12 - Today Hokkaido University Faculty of Medicine, Department of Radiation Oncology Professor
• 2010/04 - 2019/11 Niigata University Graduate School of Medical and Dental Sciences, Department of Radiology and Radiation Oncology Professor
• 2008/07 - 2010/03 Hokkaido University Graduate School of Medicine, Department of Radiology Associate Professor
• 2007/08 - 2008/06 Hokkaido University Graduate School of Medicine Department of Radiology Lecturer
• 2002/04 - 2007/08 Hokkaido University Hospital Department of Radiology Assistant Professor
• 2002/04 - 2002/08 Hokkaido University Hospital Department of Radiology
• 1996/04 - 1998/03 Hokkaido University Hospital Resident
• 1994/05 - 1996/03 Sapporo City General Hospital Resident

Education

• 1998/04 - 2002/03  Hokkaido University  Graduate School of Medicine  Radiology
• 1988/04 - 1994/03  Hokkaido University  School of Medicine

Association Memberships

• 日本量子医科学会   日本放射線腫瘍学会   米国放射線腫瘍学会(ASTRO)   米国放射線腫瘍学会   米国腫瘍学会（ASCO)   日本医学放射線学会   日本定位照射学会   JASTROプログラム委員   ASCO   ASTRO   JASTRO   JRS   

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.
• A new predictive parameter for dose‐volume metrics in intensity‐modulated radiation therapy planning for prostate cancer: Initial phantom study

  Yuki Saito, Ryusuke Suzuki, Naoki Miyamoto, Kenneth Lee Sutherland, Takahiro Kanehira, Masaya Tamura, Takashi Mori, Kentaro Nishioka, Takayuki Hashimoto, Hidefumi Aoyama

  Journal of Applied Clinical Medical Physics 2024/04 [Refereed][Not invited]
  
• 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.
• Correction: Treatment outcomes of radiotherapy with concurrent weekly cisplatin in older patients with locally advanced head and neck squamous cell carcinoma.

  Yusuke Uchinami, Koichi Yasuda, Satoshi Kano, Manami Otsuka, Seijiro Hamada, Takayoshi Suzuki, Nayuta Tsushima, Shuhei Takahashi, Yoshihiro Fujita, Tomohiko Miyazaki, Hajime Higaki, Jun Taguchi, Yasushi Shimizu, Tomohiro Sakashita, Akihiro Homma, Hidefumi Aoyama

  Discover. Oncology 15 (1) 18 - 18 2024/01/25
• Radiotherapy with or without chemotherapy for locally advanced head and neck cancer in elderly patients: analysis of the Head and Neck Cancer Registry of Japan.

  Koichi Yasuda, Yusuke Uchinami, Satoshi Kano, Jun Taguchi, Daisuke Kawakita, Megumi Kitayama, Kentaro Nishioka, Takashi Mori, Fuki Koizumi, Yuri Fujii, Yasushi Shimizu, Keiji Kobashi, Seiichi Yoshimoto, Ken-Ichi Nibu, Akihiro Homma, Hidefumi Aoyama

  International journal of clinical oncology 2023/12/29 [Refereed][Not invited]
   

  BACKGROUND: Whether concurrent chemotherapy with radiotherapy (CRT) is effective for elderly patients with head and neck cancer is a controversial topic. This study aimed to analyze the effectiveness of CRT vs. radiation therapy (RT) among elderly patients in Japan. METHODS: Data from the Head and Neck Cancer Registry of Japan were extracted and analyzed. Patients with locally advanced squamous cell carcinoma of the oropharynx, hypopharynx, or larynx who received definitive CRT or RT between 2011 and 2014 were included. RESULTS: CRT was administered to 78% of the 1057 patients aged ≥ 70 years and 67% of the 555 patients aged ≥ 75 years. For the patients aged ≥ 75 years, the overall survival (OS) rate was significantly better in the CRT group than in the RT group (P < 0.05), while the progression-free survival (PFS) rate was not significantly different (P > 0.05). The add-on effect of CRT was significantly poor in elderly patients (P < 0.05), and it was not a significant factor in the multivariate analysis for patients aged ≥ 75 years. After propensity score matching, there were no significant differences in the OS and PFS rates between the patients aged ≥ 70 years and those aged ≥ 75 years (all, P > 0.05). CONCLUSION: Although aggressive CRT is administered to elderly patients in Japan, its effectiveness is uncertain. Further prospective randomized trials are needed to verify whether CRT is superior to RT alone for elderly patients.
• Treatment outcomes of radiotherapy with concurrent weekly cisplatin in older patients with locally advanced head and neck squamous cell carcinoma.

  Yusuke Uchinami, Koichi Yasuda, Satoshi Kano, Manami Otsuka, Seijiro Hamada, Takayoshi Suzuki, Nayuta Tsushima, Shuhei Takahashi, Yoshihiro Fujita, Tomohiko Miyazaki, Hajime Higaki, Jun Taguchi, Yasushi Shimizu, Tomohiro Sakashita, Akihiro Homma, Hidefumi Aoyama

  Discover. Oncology 14 (1) 226 - 226 2023/12/08 [Refereed][Not invited]
   

  BACKGROUND: Tri-weekly cisplatin and radiotherapy (CDDP + RT) is a standard of care for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) but is sometimes challenging to complete in older patients. Weekly CDDP + RT has shown mild toxicity compared to tri-weekly CDDP + RT for LA-HNSCC and is a promising option for older adults. We aimed to report the treatment outcomes and prognostic factors in patients with LA-HNSCC treated with weekly CDDP + RT. METHODS: We analyzed patients aged ≥ 70 years who started weekly CDDP + RT for LA-HNSCC between July 2006 and October 2022. LA-HNSCC includes cancer in the oropharynx, hypopharynx, or larynx with a clinical stage of 3 or 4 without distant metastases based on the Union for International Cancer Control staging system 8th edition. The radiation dose of 70 Gy was delivered in 35 fractions by 3-dimensional conformal radiotherapy, intensity-modulated radiotherapy, or proton beam therapy. The primary endpoint was the 3-year overall survival (OS), and the secondary endpoints were the 3-year progression-free survival (PFS) and 3-year cause-specific survival (CSS). The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to evaluate statistical significance. A Cox proportional hazards model was used for the multivariate analysis of prognostic factors. RESULTS: The median age of the 49 patients was 72 (range: 70-78) years. The median CDDP dose was 200 (40-280) mg/ m2, and 47 patients completed scheduled radiotherapy. Forty-eight patients (98.0%) had a performance status of ≥ 1 at the initial visit. The 3-year OS, PFS, and CSS were 80.9% (95% confidence interval [CI]: 64.8-90.7), 68.3% (95% CI 51.8-81.2), and 85.0% (95% CI 68.7-93.4), respectively. In the multivariate analysis, the cumulative CDDP dose (< 200 or ≥ 200 mg/m2) was a significant factor for OS (hazard ratio: 0.29 [95% CI 0.08-0.97], p = 0.044). There was one case of early mortality. Grade 3 or higher late adverse events were observed in four patients (8.2%). CONCLUSIONS: Weekly CDDP + RT in older patients led to good survival outcomes with an acceptable rate of adverse events. CDDP should be administered at a dose of at least 200 mg/m2 in older patients. Trial registration Retrospectively registered.
• Real-time tumor-tracking radiotherapy with SyncTraX for primary liver tumors requiring isocenter shift†.

  Yusuke Uchinami, Naoki Miyamoto, Daisuke Abo, Ryo Morita, Koji Ogawa, Tatsuhiko Kakisaka, Ryusuke Suzuki, Tomohiko Miyazaki, Hiroshi Taguchi, Norio Katoh, Hidefumi Aoyama

  Journal of radiation research 2023/11/22 [Refereed][Not invited]
   

  The SyncTraX series enables real-time tumor-tracking radiotherapy through the real-time recognition of a fiducial marker using fluoroscopic images. In this system, the isocenter should be located within approximately 5-7.5 cm from the marker, depending on the version, owing to the limited field of view. If the marker is placed away from the tumor, the isocenter should be shifted toward the marker. This study aimed to investigate stereotactic body radiotherapy (SBRT) outcomes of primary liver tumors treated with SyncTraX in cases where the isocenter was shifted marginally or outside the planning target volume (PTV). Twelve patients with 13 liver tumors were included in the analysis. Their isocenter was shifted toward the marker and was placed marginally or outside the PTV. The prescribed doses were generally 40 Gy in four fractions or 48 Gy in eight fractions. The overall survival (OS) and local control (LC) rates were calculated using the Kaplan-Meier method. All patients completed the scheduled SBRT. The median distance between the fiducial marker and PTV centroid was 56.0 (interquartile range [IQR]: 52.7-66.7) mm. By shifting the isocenter toward the marker, the median distance between the marker and isocenter decreased to 34.0 (IQR: 33.4-39.7) mm. With a median follow-up period of 25.3 (range: 6.9-70.0) months, the 2-year OS and LC rates were 100.0% (95% confidence interval: 100-100). An isocenter shift makes SBRT with SyncTraX feasible in cases where the fiducial marker is distant from the tumor.
• Daily fraction dose-adjusted radiotherapy policy to avoid prolonging the overall treatment time for early glottic squamous cell carcinoma: a single-institutional retrospective study.

  Yasuhiro Dekura, Koichi Yasuda, Hideki Minatogawa, Yusuke Uchinami, Nayuta Tsushima, Takayoshi Suzuki, Satoshi Kano, Takashi Mori, Kentaro Nishioka, Keiji Kobashi, Norio Katoh, Akihiro Homma, Hidefumi Aoyama

  Journal of radiation research 2023/11/10 [Refereed][Not invited]
   

  The objective of this study was to determine the outcomes of radical radiotherapy for early glottic squamous cell carcinoma (EGSCC) with the policy of increasing the fraction size during radiotherapy when the overall treatment time (OTT) was expected to be prolonged. Patients diagnosed with clinical T1-2N0M0 EGSCC, who were treated with radical radiotherapy between 2008 and 2019 at Hokkaido University Hospital, were included. Patients received 66 Gy in 33 fractions for T1 disease and 70 Gy in 35 fractions for T2 disease as our standard regimen (usual group [UG]). If the OTT was expected to extend for >1 week, the dose fraction size was increased from 2.0 to 2.5 Gy from the beginning or during radiotherapy (adjusted group [AG]). At this time, we performed a statistical analysis between UG and AG. In total, 116 patients were identified, and the treatment schedules of 29 patients were adjusted. The median follow-up was 60.9 months. In the T1 group, the cumulative 5-year local failure rate was 12.0% in the AG and 15.4% in the UG, and in the T2 group, the rate was 40.7% in the AG and 25.3% in the UG. There were no significant differences between the AG and UG. Similarly, no significant differences were observed for overall survival and progression-free survival rates. Our single-institutional retrospective analysis of EGSCC patients suggested that a method of adjusting the radiotherapy schedule to increase fraction size from the beginning or during the course may be effective in maintaining treatment outcomes.
• 胸部食道がん化学放射線療法における重症放射線食道炎に関する後方視的研究

  原田 一顕, 中村 赳晶, 渡辺 亮介, 山村 貴洋, 結城 敏志, 坂本 直哉, 川本 泰之, 小松 嘉人, 打浪 雄介, 田口 大志, 加藤 徳雄, 青山 英史

  北海道医学雑誌 北海道医学会 98 (2) 139 - 140 0367-6102 2023/11
• Predicting the daily gastrointestinal doses of stereotactic body radiation therapy for pancreatic cancer based on the shortest distance between the tumor and the gastrointestinal tract using daily computed tomography images

  Yusuke Uchinami, Takahiro Kanehira, Keiji Nakazato, Yoshihiro Fujita, Fuki Koizumi, Shuhei Takahashi, Manami Otsuka, Koichi Yasuda, Hiroshi Taguchi, Kentaro Nishioka, Naoki Miyamoto, Kohei Yokokawa, Ryusuke Suzuki, Keiji Kobashi, Keita Takahashi, Norio Katoh, Hidefumi Aoyama

  BJR|Open 5 (1) 2023/08 [Refereed][Not invited]
   

  Objectives: We aimed to investigate whether daily computed tomography (CT) images could predict the daily gastroduodenal, small intestine, and large intestine doses of stereotactic body radiation therapy (SBRT) for pancreatic cancer based on the shortest distance between the gross tumor volume (GTV) and gastrointestinal (GI) tract. Methods: Twelve patients with pancreatic cancer received SBRT of 40 Gy in five fractions. We recalculated the reference clinical SBRT plan (PLAN_ref) using daily CT images and calculated the shortest distance from the GTV to each GI tract. The maximum dose delivered to 0.5 cc (D_0.5cc) was evaluated for each planning at-risk volume of the GI tract. Spearman’s correlation test was used to determine the association between the daily change in the shortest distance (Δshortest distance) and the ratio of ΔD_0.5cc dose to D_0.5cc dose in PLAN_ref (ΔD_0.5cc/PLAN_ref) for quantitative analysis. Results: The median shortest distance in PLAN_ref was 0 mm in the gastroduodenum (interquartile range, 0–2.7), 16.7 mm in the small intestine (10.0–23.7), and 16.7 mm in the large intestine (8.3–28.1 mm). The D_0.5cc of PLAN_ref in the gastroduodenum was >30 Gy in all patients, with 10 (83.3%) having the highest dose. A significant association was found between the Δshortest distance and ΔD_0.5cc/ PLAN_ref in the small or large intestine (p < 0.001) but not in the gastroduodenum (p = 0.404). Conclusions: The gastroduodenum had a higher D_0.5cc and predicting the daily dose was difficult. Daily dose calculations of the GI tract are recommended for safe SBRT. Advances in knowledge: This study aimed to predict the daily doses in SBRT for pancreatic cancer from the shortest distance between the GTV and the gastrointestinal tract. Daily changes in the shortest distance can predict the daily dose to the small or large intestines, but not to the gastroduodenum.
• Treatment outcomes of the patient with sinonasal mucosal melanoma: the role of endoscopic resection and postoperative radiotherapy.

  Nayuta Tsushima, Satoshi Kano, Koichi Yasuda, Takayoshi Suzuki, Seijiro Hamada, Yuji Nakamaru, Masanobu Suzuki, Yusuke Uchinami, Hidefumi Aoyama, Akihiro Homma

  International journal of clinical oncology 28 (9) 1218 - 1226 2023/06/17 [Refereed][Not invited]
   

  BACKGROUND: The standard of care for sinonasal mucosal melanoma is surgery and postoperative radiotherapy (PORT). Our treatment strategy comprises endoscopic resection and PORT. We performed combined endoscopic and open resection or applied an external approach alone when sufficient resection was difficult to achieve endoscopically. The objective of this study was to evaluate the validity of our treatment strategy. METHODS: We assessed 30 patients with sinonasal mucosal melanoma who underwent definitive therapy between January 2002 and April 2021, and conducted a retrospective analysis. The median follow-up period was 2.2 years. The primary endpoint was overall survival. The Kaplan-Meier method was used for the calculation of survival rates, the cumulative incidence of distant metastasis, and local recurrence. RESULTS: Twenty-eight patients underwent surgery. The other two patients were treated by definitive proton beam therapy. Twenty-one of 28 (75%) patients underwent resection by endoscopic approach alone. Postoperative radiotherapy was performed for all 28 patients who underwent surgery. Twenty-one patients (70%) experienced recurrence during the observation period. Overall, distant metastasis was observed in 19 patients. Twelve patients died during the observation period, with 10 of the 12 patients (83%) dying of distant metastasis. The overall survival rate at 2 and 5 years was 70% and 46%, respectively. The cumulative incidence rate of distant metastasis at 2 years was 63%, while the 2-year cumulative incidence rate of local recurrence was 6.7%. CONCLUSION: The local disease was controlled by our treatment strategy. To improve treatment outcomes, control of the distant metastasis is needed.
• Clinical results of proton beam radiotherapy for inoperable stage III non-small cell lung cancer: a Japanese national registry study.

  Hitoshi Tatebe, Hideyuki Harada, Keita Mori, Hiromitsu Iwata, Tetsuo Akimoto, Masao Murakami, Takahiro Waki, Takashi Ogino, Masatoshi Nakamura, Hiroshi Taguchi, Haruhiko Nakayama, Miyako Satouchi, Hidefumi Aoyama

  Journal of radiation research 64 (Supplement_1) i8-i15  2023/06/16 [Refereed]
   

  This study presents the first data of a Japanese nationwide multi-institutional cohort and compares them with the findings of systematic literature reviews on radiation therapies and inoperable stage III non-small cell lung cancer (NSCLC) conducted by the Lung Cancer Working Group in the Particle Beam Therapy (PBT) Committee and Subcommittee at Japanese Society for Radiation Oncology. The Lung Cancer Working Group extracted eight reports and compared their data with those of the PBT registry from May 2016 to June 2018. All the analyzed 75 patients aged ≤80 years underwent proton therapy (PT) with concurrent chemotherapy for inoperable stage III NSCLC. The median follow-up period of the surviving patients was 39.5 (range, 1.6-55.6) months. The 2- and 3-year overall survival (OS) and progression-free survival rates were 73.6%/64.7% and 28.9%/25.1%, respectively. During the follow-up period, six patients (8.0%) had adverse events of Grade ≥ 3, excluding abnormal laboratory values. These included esophagitis in four patients, dermatitis in one and pneumonitis in one. Adverse events of Grade ≥ 4 were not observed. The results of these PBT registry data in patients with inoperable stage III NSCLC suggest that the OS rate was at least equivalent to that of radiation therapy using X-rays and that the incidence of severe radiation pneumonitis was low. PT may be an effective treatment to reduce toxicities of healthy tissues, including the lungs and heart, in patients with inoperable stage III NSCLC.
• The superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT) is effective for metastatic lymph nodes in head and neck squamous cell carcinoma.

  Satoshi Kano, Takayoshi Suzuki, Daisuke Yoshida, Nayuta Tsushima, Seijiro Hamada, Koichi Yasuda, Yusuke Uchinami, Hidefumi Aoyama, Akihiro Homma

  International journal of clinical oncology 28 (9) 1121 - 1128 2023/06/08 [Refereed][Not invited]
   

  BACKGROUND: Superselective intra-arterial infusion of cisplatin and concomitant radiotherapy (RADPLAT) is a very promising treatment modality for locally advanced head and neck squamous cell carcinoma. However, there are some concerns regarding its potential for the control of neck lymph node metastasis. The objective of this study was to investigate whether RADPLAT provided inferior regional control compared to intravenous chemoradiotherapy (IV-CRT). METHODS: A total of 172 patients with neck lymph node metastases, 66 of whom underwent RADPLAT and 106 IV-CRT, were enrolled in this study. We retrospectively compared regional control rates between RADPLAT and IV-CRT. Furthermore, to adjust for differences in factors related to patient background between the groups, we conducted inverse probability weighting (IPW) analysis using the propensity score. RESULTS: A comparison between the two groups revealed that the regional control rates were almost equal under unadjusted conditions; however, after adjustment by IPW analysis, the RADPLAT group had a relatively better regional control rate than did the IV-CRT group (1 year regional control rate: 86.6% vs. 79.4%). In addition, the analysis of relative risk factors for regional control in the RADPLAT group showed that the absence of intra-arterial cisplatin infusion into metastatic lymph nodes was the only independent risk factor (Hazard ratio: 4.23, p = 0.04). CONCLUSION: This study showed that the regional control rate in patients treated with RADPLAT was noninferior to that for IV-CRT. Locally advanced head and neck cancers is a good indication for RADPLAT, even if the patients have neck lymph node metastases.
• Particle beam therapy for pelvic recurrence of colorectal cancer: a registry data analysis in Japan and a systematic review

  Shigeyuki Murayama, Shigeru Yamada, Yuichi Hiroshima, Hirotoshi Takiyama, Hiroshi Taguchi, Takuya Kimoto, Makoto Anzai, Yasuhito Hagiwara, Kazuaki Yasui, Keita Mori, Soichiro Ishihara, Hideki Ueno, Shinichi Shimizu, Hidefumi Aoyama, Hiroshi Tsuji, Hideyuki Sakurai

  Journal of Radiation Research 64 (Supplement_1) i25 - i33 0449-3060 2023/04/28 [Refereed][Not invited]
   

  Abstract The aim of this study was to investigate the efficacy and safety of particle beam therapy (PBT) with proton or carbon ion beam for pelvic recurrence of colorectal cancer (PRCC) by comparing the clinical outcomes of a dataset of prospectively enrolled patients for PBT with those from the literature, which were collected by a systematic review of external X-ray radiotherapy (XRT) and PBT. Patients with PRCC treated at 14 domestic facilities between May 2016 and June 2019 and entered the database for prospective observational follow-up were analyzed. The registry data analyzed included 159 PRCC patients treated with PBT of whom 126 (79%) were treated with carbon ion radiation therapy (CIRT). The 3-year overall survival and local control rate were 81.8 and 76.4%, respectively. Among these PRCC patients, 5.7% had Grade 3 or higher toxicity. Systematic search of PubMed and Cochrane databases published from January 2000 to September 2020 resulted in 409 abstracts for the primary selection. Twelve studies fulfilled the inclusion criteria. With one additional publication, 13 studies were selected for qualitative analysis, including 9 on XRT and 4 on PBT. There were nine XRT studies, which included six on 3D conformal radiotherapy and three on stereotactic body radiation therapy, and four PBT studies included three on CIRT and one on proton therapy. A pilot meta-analysis using literatures with median survival time extractable over a 20-month observation period suggested that PBT, especially CIRT, may be a promising treatment option for PRCC not amenable to curative resection.
• Effectiveness of CT-image guidance in proton therapy for liver cancer and the importance of daily dose monitoring for tumors and organs at risk.

  Yoshikazu Maeda, Keiji Kobashi, Yoshitaka Sato, Hiroyasu Tamamura, Kazutaka Yamamoto, Keiichiro Matsushita, Makoto Sasaki, Hitoshi Tatebe, Tomoko Asahi, Sae Matsumoto, Shigeyuki Takamatsu, Koichi Miyazaki, Rintaro Fujimoto, Yusuke Uchinami, Norio Katoh, Hidefumi Aoyama

  Medical physics 50 (6) 3274 - 3288 2023/04/26 [Refereed][Not invited]
   

  BACKGROUND: It is important to have precise image guidance throughout proton therapy in order to take advantage of the therapy's physical selectivity. PURPOSE: We evaluated the effectiveness of computed tomography (CT)-image guidance in proton therapy for patients with hepatocellular carcinoma (HCC) by assessing daily proton dose distributions. The importance of daily CT image-guided registration and daily proton dose monitoring for tumors and organs at risk (OARs) was investigated. METHODS: A retrospective analysis was conducted using 570 sets of daily CT (dCT) images throughout whole treatment fractions for 38 HCC patients who underwent passive scattering proton therapy with either a 66 cobalt gray equivalent (GyE)/10 fractions (n = 19) or 76 GyE/20 fractions (n = 19) protocol. The actual daily delivered dose distributions were estimated by forward calculation using the dCT sets, their corresponding treatment plans, and the recorded daily couch correction information. We then evaluated the daily changes of the dose indices D99% , V30GyE , and Dmax for the tumor volumes, non-tumorous liver, and other OARs, that is, stomach, esophagus, duodenum, colon, respectively. Contours were created for all dCT sets. We validated the efficacy of the dCT-based tumor registrations (hereafter, "tumor registration") by comparing them with the bone registration and diaphragm registration as a simulation of the treatment based on the positioning using the conventional kV X-ray imaging. The dose distributions and the indices of three registrations were obtained by simulation using the same dCT sets. RESULTS: In the 66 GyE/10 fractions, the daily D99% value in both the tumor and diaphragm registrations agreed with the planned value with 3%-6% (SD), and the V30GyE value for the liver agreed within ±3%; the indices in the bone registration showed greater deterioration. Nevertheless, tumor-dose deterioration occurred in all registration methods for two cases due to daily changes of body shape and respiratory condition. In the 76 GyE/20 fractions, in particular for such a treatment that the dose constraints for the OARs have to be cared in the original planning, the daily D99% in the tumor registration was superior to that in the other registration (p < 0.001), indicating the effectiveness of the tumor registration. The dose constraints, set in the plan as the maximum dose for OARs (i.e., duodenum, stomach, colon, and esophagus) were maintained for 16 patients including seven treated with re-planning. For three patients, the daily Dmax increased gradually or changed randomly, resulting in an inter-fractional averaged Dmax higher than the constraints. The dose distribution would have been improved if re-planning had been conducted. The results of these retrospective analyses indicate the importance of daily dose monitoring followed by adaptive re-planning when needed. CONCLUSIONS: The tumor registration in proton treatment for HCC was effective to maintain the daily dose to the tumor and the dose constraints of OARs, particularly in the treatment where the maintenance for the dose constraints needs to be considered throughout the treatment. Nevertheless daily proton dose monitoring with daily CT imaging is important for more reliable and safer treatment.
• Proton beam therapy for muscle-invasive bladder cancer: A systematic review and analysis with Proton-Net, a multicenter prospective patient registry database.

  Masayuki Araya, Hitoshi Ishikawa, Kentaro Nishioka, Kazushi Maruo, Hirofumi Asakura, Takashi Iizumi, Masaru Takagi, Masao Murakami, Haruhito Azuma, Wataru Obara, Hidefumi Aoyama, Hideyuki Sakurai

  Journal of radiation research 2023/04/25 [Refereed][Not invited]
   

  To assess the safety and efficacy of proton beam therapy (PBT) for muscle-invasive bladder cancer (MIBC), we examined the outcomes of 36 patients with MIBC (cT2-4aN0M0) who were enrolled in the Proton-Net prospective registry study and received PBT with concurrent chemotherapy from May 2016 to June 2018. PBT was also compared with X-ray chemoradiotherapy in a systematic review (X-ray (photon) radiotherapy). The radiotherapy consisted of 40-41.4 Gy (relative biological effectiveness (RBE) delivered in 20-23 fractions to the pelvic cavity or the entire bladder using X-rays or proton beams, followed by a boost of 19.8-36.3 Gy (RBE) delivered in 10-14 fractions to all tumor sites in the bladder. Concurrently, radiotherapy was given with intra-arterial or systemic chemotherapy of cisplatin alone or in combination with methotrexate or gemcitabine. Overall survival (OS), progression-free survival (PFS) and local control (LC) rates were 90.8, 71.4 and 84.6%, respectively, after 3 years. Only one case (2.8%) experienced a treatment-related late adverse event of Grade 3 urinary tract obstruction, and no severe gastrointestinal adverse events occurred. According to the findings of the systematic review, the 3-year outcomes of XRT were 57-84.8% in OS, 39-78% in PFS and 51-68% in LC. The weighted mean frequency of adverse events of Grade 3 or higher in the gastrointestinal and genitourinary systems was 6.2 and 2.2%, respectively. More data from long-term follow-up will provide us with the appropriate use of PBT and validate its efficacy for MIBC.
• The need of radiotherapy optimization for glioblastomas considering immune responses.

  Kentaro Nishioka, Shuhei Takahashi, Takashi Mori, Yusuke Uchinami, Shigeru Yamaguchi, Manabu Kinoshita, Masaaki Yamashina, Hajime Higaki, Katsuya Maebayashi, Hidefumi Aoyama

  Japanese journal of radiology 2023/04/18 [Refereed][Invited]
   

  Glioblastoma is the most common of malignant primary brain tumors and one of the tumors with the poorest prognosis for which the overall survival rate has not significantly improved despite recent advances in treatment techniques and therapeutic drugs. Since the emergence of immune checkpoint inhibitors, the immune response to tumors has attracted increasing attention. Treatments affecting the immune system have been attempted for various tumors, including glioblastomas, but little has been shown to be effective. It has been found that the reason for this is that glioblastomas have a high ability to evade attacks from the immune system, and that the lymphocyte depletion associated with treatment can reduce its immune function. Currently, research to elucidate the resistance of glioblastomas to the immune system and development of new immunotherapies are being vigorously carried out. Targeting of radiation therapy for glioblastomas varies among guidelines and clinical trials. Based on early reports, target definitions with wide margins are common, but there are also reports that narrowing the margins does not make a significant difference in treatment outcome. It has also been suggested that a large number of lymphocytes in the blood are irradiated by the irradiation treatment to a wide area in a large number of fractionations, which may reduce the immune function, and the blood is being recognized as an organ at risk. Recently, a randomized phase II trial comparing two types of target definition in radiotherapy for glioblastomas was conducted, and it was reported that the overall survival and progression-free survival were significantly better in a small irradiation field group. We review recent findings on the immune response and the immunotherapy to glioblastomas and the novel role of radiotherapy and propose the need to develop an optimal radiotherapy that takes radiation effects on the immune function into account.
• A Japanese registry study and systematic review of particle therapy for renal cell carcinoma.

  Hitoshi Ishikawa, Takeshi Arimura, Kazushi Maruo, Hidemasa Kawamura, Shingo Toyama, Takashi Ogino, Tomoaki Okimoto, Masao Murakami, Yoshitaka Sato, Kentaro Nishioka, Masayuki Araya, Hisateru Ohba, Kensuke Umehara, Hidefumi Aoyama, Wataru Obara, Haruhito Azuma, Hiroshi Tsuji, Hideyuki Sakurai

  Journal of radiation research 2023/04/12 [Refereed][Not invited]
   

  The feasibility and efficacy of particle beam therapy (PBT) using protons or carbon ions were compared with those of photon-based stereotactic body radiotherapy (SBRT) for primary renal cell carcinoma (RCC) via a systematic review and nationwide registry for PBT (Japanese Society for Radiation Oncology [JASTRO] particle therapy committee). Between July 2016 and May 2019, 20 patients with non-metastatic RCC who were treated at six Japanese institutes (using protons at three, using carbon ions at the other three) were registered in the nationwide database and followed up prospectively. The 20 patients comprised 15 men and had a median age of 67 (range: 57-88) years. The total radiation dose was 66-79.6 Gy (relative biological effectiveness [RBE]). Over a median follow up of 31 months, the 3-year rates of overall survival (OS) and local control (LC) were 100% and 94.4%, respectively. No grade ≥ 3 toxicities were observed. Based on a random effects model, a meta-analysis including the present results revealed 3-year OS rates after SBRT and PBT of 75.3% (95% CI: 57.3-86.6) and 94.3% (95% CI: 86.8-97.6), respectively (P = 0.005), but the difference in LC rates between the two methods was not observed (P = 0.63). PBT is expected to have similar if not better treatment results compared with SBRT for primary renal cancer. In particular, PBT was shown to be effective even for large RCC and could provide a therapeutic option when SBRT is not indicated.
• Proton beam therapy for gliomas: a multicenter prospective registry study from all proton beam facilities in Japan

  Takashi Mori, Masashi Mizumoto, Katsuya Maebayashi, Kentaro Nishioka, Yoshiki Arakawa, Kazuhiko Kurozumi, Koichi Yasuda, Taisuke Sumiya, Hiroyasu Tamamura, Yoshitaka Sato, Takahiro Waki, Masaru Takagi, Yu Takada, Tomoaki Okimoto, Masao Murakami, Yasuhiro Kikuchi, Kazufumi Okada, Yoichi M Ito, Tetsuo Akimoto, Hidefumi Aoyama

  Journal of Radiation Research 0449-3060 2023/04/07 [Refereed][Not invited]
   

  Abstract We reviewed the outcomes of glioma patients enrolled in a prospective observational registry study of proton beam therapy (PBT) in Japan. The inclusion criteria were glioma patients registered in the Electronic Data Capture system, the Proton-net, between May 2016 and July 2019. Data on patient characteristics, treatments, late adverse events, survival status, recurrence and secondary tumors were extracted and statistically analyzed. The primary endpoint was the overall survival (OS) rate, and the secondary endpoints were the progression-free survival (PFS) rate and cumulative local recurrence rate (cLRR). Of the 65 primary brain tumor patients registered, 29 glioma patients from eight of 19 PBT facilities met the inclusion criteria. There were 19 glioblastoma patients, eight of other malignant gliomas, and two of low-grade gliomas. For glioblastomas, with a median follow-up period of 16 months, the median survival time was 21.2 months and the OS at 1, 2, 3 and 4 years were 77.4%, 44.9%, 23.9% and 23.9%, respectively. The median PFS period was 10.1 months, the 1, 2, 3 and 4-year PFS were 32.4%, 19.4%, 9.7% and 9.7%, respectively. The 1, 2, 3 and 4-year cLRR were 56.1%, 68.8%, 78.4 and 78.4%, respectively. Grade 3 brain necrosis was observed in two patients. No secondary tumor was observed. This is the first report on the current status of PBT for gliomas in Japan. For glioblastomas, the outcomes of PBT are estimated to be equivalent to historical data of photon therapy. The results of a prospective comparative evaluation of PBT and photon therapy are awaited.
• Evaluation of short-term gastrointestinal motion and its impact on dosimetric parameters in stereotactic body radiation therapy for pancreatic cancer

  Yusuke Uchinami, Takahiro Kanehira, Yoshihiro Fujita, Naoki Miyamoto, Kohei Yokokawa, Fuki Koizumi, Motoyasu Shido, Shuhei Takahashi, Manami Otsuka, Koichi Yasuda, Hiroshi Taguchi, Keiji Nakazato, Keiji Kobashi, Norio Katoh, Hidefumi Aoyama

  Clinical and Translational Radiation Oncology 39 100576 - 100576 2405-6308 2023/03 [Refereed]
  
• 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 [Not refereed]
   

  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.
• Study of hepatic toxicity in small liver tumors after photon or proton therapy based on factors predicting the benefits of proton.

  Yusuke Uchinami, Norio Katoh, Daisuke Abo, Ryo Morita, Hiroshi Taguchi, Yoshihiro Fujita, Takahiro Kanehira, Ryusuke Suzuki, Naoki Miyamoto, Seishin Takao, Taeko Matsuura, Takuya Sho, Koji Ogawa, Tatsuya Orimo, Tatsuhiko Kakisaka, Keiji Kobashi, Hidefumi Aoyama

  The British journal of radiology 96 (1144) 20220720 - 20220720 2023/01/12 [Refereed]
   

  OBJECTIVES: In a previous study of hepatic toxicity, the following three factors were identified to predict the benefits of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) with a maximum diameter of ≤5 cm and Child-pugh grade A (CP-A): number of tumors (one vs ≥2), the location of tumors (hepatic hilum or others), and the sum of the diameters of lesions. The aim of this study is to analyze the association between these three factors and hepatic toxicity. METHODS: We retrospectively reviewed patients of CP-A treated with PBT or photon stereotactic body radiotherapy (X-ray radiotherapy, XRT) for HCC ≤5 cm. For normal liver dose, the V5, V10, V20 (volumes receiving 5, 10, and 20 Gy at least), and the mean dose was evaluated. The albumin-bilirubin (ALBI) and CP score changes from the baseline were evaluated at 3 and 6 months after treatment. RESULTS: In 89 patients (XRT: 48, PBT: 41), those with two or three (2-3) predictive factors were higher normal liver doses than with zero or one (0-1) factor. In the PBT group, the ALBI score worsened more in patients with 2-3 factors than those with 0-1 factor, at 3 months (median 0.26 vs 0.02, p = 0.032) and at 6 months (median: 0.35 vs 0.10, p = 0.009). The ALBI score change in the XRT group and CP score change in either modality were not significantly different in the number of predictive factors. CONCLUSIONS: The predictive factor numbers predicted the ALBI score change in PBT but not in XRT. ADVANCES IN KNOWLEDGE: This study suggest that the number of predictive factors previously identified (0-1 vs 2-3) were significantly associated with dosimetric parameters of the normal liver in both modalities. In the proton group, the number of predictive factors was associated with a worsening ALBI score at 3 and 6 months, but these associations were not found in the photon SBRT group.
• 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.
• Prostatic urinary tract visualization with super-resolution deep learning models.

  Takaaki Yoshimura, Kentaro Nishioka, Takayuki Hashimoto, Takashi Mori, Shoki Kogame, Kazuya Seki, Hiroyuki Sugimori, Hiroko Yamashina, Yusuke Nomura, Fumi Kato, Kohsuke Kudo, Shinichi Shimizu, Hidefumi Aoyama

  PloS one 18 (1) e0280076  2023 

  In urethra-sparing radiation therapy, prostatic urinary tract visualization is important in decreasing the urinary side effect. A methodology has been developed to visualize the prostatic urinary tract using post-urination magnetic resonance imaging (PU-MRI) without a urethral catheter. This study investigated whether the combination of PU-MRI and super-resolution (SR) deep learning models improves the visibility of the prostatic urinary tract. We enrolled 30 patients who had previously undergone real-time-image-gated spot scanning proton therapy by insertion of fiducial markers. PU-MRI was performed using a non-contrast high-resolution two-dimensional T2-weighted turbo spin-echo imaging sequence. Four different SR deep learning models were used: the enhanced deep SR network (EDSR), widely activated SR network (WDSR), SR generative adversarial network (SRGAN), and residual dense network (RDN). The complex wavelet structural similarity index measure (CW-SSIM) was used to quantitatively assess the performance of the proposed SR images compared to PU-MRI. Two radiation oncologists used a 1-to-5 scale to subjectively evaluate the visibility of the prostatic urinary tract. Cohen's weighted kappa (k) was used as a measure of agreement of inter-operator reliability. The mean CW-SSIM in EDSR, WDSR, SRGAN, and RDN was 99.86%, 99.89%, 99.30%, and 99.67%, respectively. The mean prostatic urinary tract visibility scores of the radiation oncologists were 3.70 and 3.53 for PU-MRI (k = 0.93), 3.67 and 2.70 for EDSR (k = 0.89), 3.70 and 2.73 for WDSR (k = 0.88), 3.67 and 2.73 for SRGAN (k = 0.88), and 4.37 and 3.73 for RDN (k = 0.93), respectively. The results suggest that SR images using RDN are similar to the original images, and the SR deep learning models subjectively improve the visibility of the prostatic urinary tract.
• Establishing quality indicators to comprehensively assess quality assurance and patient safety in radiotherapy and their relationship with an institution's background.

  Norifumi Mizuno, Hiroyuki Okamoto, Toshiyuki Minemura, Shinji Kawamura, Naoki Tohyama, Masahiko Kurooka, Ryu Kawamorita, Masaru Nakamura, Yoshinori Ito, Yoshiyuki Shioyama, Hidefumi Aoyama, Hiroshi Igaki

  Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 179 109452 - 109452 2022/12/23 [Refereed][Not invited]
   

  BACKGROUND AND PURPOSE: Quality indicators (QIs) for radiotherapy have been proposed by several groups, but no study has been conducted to correlate the implementation of indicators specific to patient safety over the course of the clinical process with an institution's background. An initial large-scale survey was conducted to understand the implementation status of QIs established for quality assurance and patient safety in radiotherapy and the relationship between implementation status and an institutions' background. MATERIALS AND METHOD: Overall, 68 QIs that were established by this research team after a pilot survey were used to assess structures and processes for quality assurance and patient safety. Data on the implementation of QIs and the institutions' backgrounds were obtained from designated cancer care hospitals in Japan. RESULTS: Overall, 284 institutions (72%) responded and had a median QI achievement rate of 60.8%. QIs with low implementation rates, such as the implementation of an error reporting system and establishment of a quality assurance department, were identified. The QI achievement rate and scale of the institution were positively correlated, and the achievement rate of all QIs was significantly higher (p < 0.001) in institutions capable of advanced treatments, such as intensity-modulated radiotherapy, and those with a quality assurance department. CONCLUSION: A large-scale survey on QIs revealed their implementation and relationship with a facility's background. QIs that require improvement were identified, and that these QIs might be effective in providing advanced medical care to many patients.
• Deformed dose restoration to account for tumor deformation and position changes for adaptive proton therapy.

  Koichi Miyazaki, Yusuke Fujii, Takahiro Yamada, Takahiro Kanehira, Naoki Miyamoto, Taeko Matsuura, Koichi Yasuda, Yusuke Uchinami, Manami Otsuka, Hidefumi Aoyama, Seishin Takao

  Medical physics 50 (2) 675 - 687 2022/12/11 [Refereed]
   

  BACKGROUND: Online adaptation during intensity-modulated proton therapy (IMPT) can minimize the effect of inter-fractional anatomical changes, but remains challenging because of the complex workflow. One approach for fast and automated online IMPT adaptation is dose restoration, which restores the initial dose distribution on the updated anatomy. However, this method may fail in cases where tumor deformation or position changes occur. PURPOSE: To develop a fast and robust IMPT online adaptation method named "deformed dose restoration (DDR)" that can adjust for inter-fractional tumor deformation and position changes. METHODS: THE DDR METHOD COMPRISES TWO STEPS: : (1) calculation of the deformed dose distribution, and (2) restoration of the deformed dose distribution. First, the deformable image registration (DIR) between the initial clinical target volume (CTV) and the new CTV were performed to calculate the vector field. To ensure robustness for setup and range uncertainty and the ability to restore the deformed dose distribution, an expanded CTV-based registration to maintain the dose gradient outside the CTV was developed. The deformed dose distribution was obtained by applying the vector field to the initial dose distribution. Then, the voxel-by-voxel dose difference optimization was performed to calculate beam parameters that restore the deformed dose distribution on the updated anatomy. The optimization function was the sum of total dose differences and dose differences of each field to restore the initial dose overlap of each field. This method only requires target contouring, which eliminates the need for organs at risk (OARs) contouring. Six clinical cases wherein the tumor deformation and/or position changed on repeated CTs were selected. DDR feasibility was evaluated by comparing the results with those from three other strategies, namely, not adapted (continuing the initial plan), adapted by previous dose restoration, and fully optimized. RESULTS: In all cases, continuing the initial plan was largely distorted on the repeated CTs and the dose-volume histogram (DVH) metrics for the target were reduced due to the tumor deformation or position changes. On the other hand, DDR improved DVH metrics for the target to the same level as the initial dose distribution. Dose increase was seen for some OARs because tumor growth had reduced the relative distance between CTVs and OARs. Robustness evaluation for setup and range uncertainty (3 mm/3.5%) showed that deviation in DVH-bandwidth for CTV D95% from the initial plan was 0.4 ± 0.5% (Mean ± S.D.) for DDR. The calculation time was 8.1 ± 6.4 min. CONCLUSIONS: An online adaptation algorithm was developed that improved the treatment quality for inter-fractional anatomical changes and retained robustness for intra-fractional setup and range uncertainty. The main advantage of this method is that it only requires target contouring alone and saves the time for OARs contouring. The fast and robust adaptation method for tumor deformation and position changes described here can reduce the need for offline adaptation and improve treatment efficiency. This article is protected by copyright. All rights reserved.
• Technical Note: Performance evaluation of volumetric imaging based on motion modeling by principal component analysis

  Suzuka Asano, Keishi Oseki, Seishin Takao, Koichi Miyazaki, Kohei Yokokawa, Taeko Matsuura, Hiroshi Taguchi, Norio Katoh, Hidefumi Aoyama, Kikuo Umegaki, Naoki Miyamoto

  Medical Physics 0094-2405 2022/12/03 [Refereed][Not invited]
  
• Detailed analysis of failure patterns using deformable image registration in hypopharyngeal cancer patients treated with sequential boost intensity-modulated radiotherapy.

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

  Journal of medical imaging and radiation oncology 67 (1) 98 - 110 2022/11/14 [Refereed]
   

  INTRODUCTION: Sequential boost intensity-modulated radiotherapy (SQB-IMRT) uses two different planning CTs (pCTs) and treatment plans. SQB-IMRT is a form of adaptive radiotherapy that allows for responses to changes in the shape of the tumour and organs at risk (OAR). On the other hand, dose accumulation with the two plans can be difficult to evaluate. The purpose of this study was to analyse patterns of loco-regional failure using deformable image registration (DIR) in hypopharyngeal cancer patients treated with SQB-IMRT. METHODS: Between 2013 and 2019, 102 patients with hypopharyngeal cancer were treated with definitive SQB-IMRT at our institution. Dose accumulation with the 1st and 2nd plans was performed, and the dose to the loco-regional recurrent tumour volume was calculated using the DIR workflow. Failure was classified as follows: (i) in-field (≥95% of the recurrent tumour volume received 95% of the prescribed dose); (ii) marginal (20-95%); or (iii) out-of-field (<20%). RESULTS: After a median follow-up period of 25 months, loco-regional failure occurred in 34 patients. Dose-volume histogram analysis showed that all loco-regional failures occurred in the field within 95% of the prescribed dose, with no marginal or out-of-field recurrences observed. CONCLUSION: The dosimetric analysis using DIR showed that all loco-regional failures were within the high-dose region. More aggressive treatment may be required for gross tumours.
• Reduced-dose WBRT combined with SRS for 1–4 brain metastases aiming at minimizing neurocognitive function deterioration without compromising brain tumor control

  Toshimichi Nakano, Hidefumi Aoyama, Shunsuke Onodera, Hiroshi Igaki, Yasuo Matsumoto, Ayae Kanemoto, Shigetoshi Shimamoto, Masayuki Matsuo, Hidekazu Tanaka, Natsuo Oya, Tomohiko Matsuyama, Atsushi Ohta, Katsuya Maruyama, Takahiro Tanaka, Nobutaka Kitamura, Kohei Akazawa, Katsuya Maebayashi

  Clinical and Translational Radiation Oncology 37 116 - 129 2405-6308 2022/11 [Refereed][Not invited]
  
• Hyperfractionated intensity-modulated proton therapy for pharyngeal cancer with variable relative biological effectiveness: A simulation study.

  Koki Kasamatsu, Taeko Matsuura, Koichi Yasuda, Koichi Miyazaki, Seishin Takao, Masaya Tamura, Manami Otsuka, Yusuke Uchinami, Hidefumi Aoyama

  Medical physics 49 (12) 7815 - 7825 2022/10/27 [Refereed]
   

  BACKGROUND: The relative biological effectiveness (RBE) of proton is considered to be dependent on biological parameters and fractional dose. While hyperfractionated photon therapy was effective in the treatment of patients with head and neck cancers, its effect in intensity-modulated proton therapy (IMPT) under the variable RBE has not been investigated in detail. PURPOSE: To study the effect of variable RBE on hyperfractionated IMPT for the treatment of pharyngeal cancer. We investigated the biologically effective dose (BED) to determine the theoretical effective hyperfractionated schedule. METHODS: The treatment plans of three pharyngeal cancer patients were used to define the ΔBED for the clinical target volume (CTV) and soft tissue (acute and late reaction) as the difference between the BED for the altered schedule with variable RBE and conventional schedule with constant RBE. The ΔBED with several combinations of parameters (treatment days, number of fractions, and prescribed dose) was comprehensively calculated. Of the candidate schedules, the one that commonly gave a higher ΔBED for CTV was selected as the resultant schedule. The BED volume histogram was used to compare the influence of variable RBE and fractionation. RESULTS: In the conventional schedule, compared with the constant RBE, the variable RBE resulted in a mean 2.6 and 2.7 Gy reduction of BEDmean for the CTV and soft tissue (acute reaction) of the three plans, respectively. Moreover, the BEDmean for soft tissue (late reaction) increased by 7.4 Gy, indicating a potential risk of increased RBE. Comprehensive calculation of the ΔBED resulted in the hyperfractionated schedule of 80.52 Gy (RBE = 1.1)/66 fractions in 6.5 weeks. When variable RBE was used, compared with the conventional schedule, the hyperfractionated schedule increased the BEDmean for CTV by 7.6 Gy; however, this was associated with a 7.8 Gy increase for soft tissue (acute reaction). The BEDmean for soft tissue (late reaction) decreased by 2.4 Gy. CONCLUSION: The results indicated a potential effect of the variable RBE on IMPT for pharyngeal cancer but with the possibility that hyperfractionation could outweigh this effect. Although biological uncertainties require conservative use of the resultant schedule, hyperfractionation is expected to be an effective strategy in IMPT for pharyngeal cancer.
• Long-term consequences of residual lesions after chemoradiotherapy in patients with germinoma at onset.

  Shigeru Yamaguchi, Michinari Okamoto, Yukitomo Ishi, Ryosuke Sawaya, Hiroaki Motegi, Minako Sugiyama, Taisuke Harada, Noriyuki Fujima, Takashi Mori, Takayuki Hashimoto, Emi Takakuwa, Atsushi Manabe, Kohsuke Kudo, Hidefumi Aoyama, Miki Fujimura

  Journal of neurosurgery. Pediatrics 1 - 8 2022/09/09 [Refereed][Not invited]
   

  OBJECTIVE: In patients with intracranial germ cell tumors, residual lesions are sometimes observed after completion of primary chemoradiotherapy. Although salvage resection of these end-of-treatment residual lesions is recommended for patients with nongerminomatous germ cell tumors, the necessity of early salvage resection for those with germinoma is not clear. The aim of this study was to investigate the frequency of residual germinoma lesions after primary chemoradiotherapy, as well as their management, long-term consequences, and prognosis. METHODS: The authors retrospectively reviewed patients who were primarily treated for germinoma between 2002 and 2021. Residual lesions were evaluated with MRI with and without contrast enhancement within 2 weeks after chemoradiotherapy. The decision to perform salvage resection of residual lesions was at the discretion of the treating physicians. The change in appearance of residual lesions was assessed with serial MRI. Overall survival (OS), progression-free survival (PFS), and recurrence pattern were also investigated. RESULTS: Sixty-nine patients were treated with chemoradiotherapy for germinoma, with a mean follow-up period of 108 months. Residual lesions were radiologically observed in 30 patients (43.5%). Among these, 5 patients (3 with pineal lesions and 2 with basal ganglia lesions) underwent salvage resection. Pathological examination revealed teratomatous components in 3 patients, whereas no tumoral components were identified in 2 patients. One patient with a basal ganglia lesion showed worsening of hemiparesis postoperatively. The remaining 25 patients received watchful observation without surgical intervention. Chronological periodic radiological change in residual lesions was evaluated in 21 patients. One year after primary treatment, the size of the residual lesions was stable and had decreased in 10 and 11 patients, respectively. None of the lesions increased in size. The 10-year PFS and OS rates were 96.7% and 97.3% in patients without residual lesions (n = 39), and 87.1% and 100% in patients with residual lesions (n = 30), respectively. Presence of residual lesions had no significant effect on PFS or OS. All recurrences occurred at distant sites or via dissemination without progression of the primary tumor site, regardless of the presence of residual lesion. CONCLUSIONS: End-of-treatment residual lesions are not rare in patients with germinoma, and these residual lesions seldom show progression. Because of the potential risk of surgical complications, the indication for early salvage surgery for residual lesions should be carefully determined. Watchful observation is recommended for the majority of these cases.
• 汎用リニアックを用いた膵定位放射線治療における呼気止め分割CBCT

  一宇 佑太, 山田 亮太, 安渡 大輔, 田村 弘詞, 若林 倭, 加藤 徳雄, 青山 英史

  日本放射線技術学会雑誌 (公社)日本放射線技術学会 78 (9) 1057 - 1057 0369-4305 2022/09
• Graded Prognostic Assessment (GPA) for Patients With Lung Cancer and Brain Metastases: Initial Report of the Small Cell Lung Cancer GPA and Update of the Non-Small Cell Lung Cancer GPA Including the Effect of Programmed Death Ligand 1 and Other Prognostic Factors

  Paul W. Sperduto, Brian De, Jing Li, David Carpenter, John Kirkpatrick, Michael Milligan, Helen A. Shih, Tugce Kutuk, Rupesh Kotecha, Hajime Higaki, Manami Otsuka, Hidefumi Aoyama, Malie Bourgoin, David Roberge, Salah Dajani, Sean Sachdev, Jordan Gainey, John M. Buatti, William Breen, Paul D. Brown, Lisa Ni, Steve Braunstein, Matthew Gallitto, Tony J. C. Wang, Ryan Shanley, Emil Lou, Jay Shiao, Laurie E. Gaspar, Satoshi Tanabe, Toshimichi Nakano, Yi An, Veronica Chiang, Liang Zeng, Hany Soliman, Hesham Elhalawani, Daniel Cagney, Evan Thomas, Drexell H. Boggs, Manmeet S. Ahluwalia, Minesh P. Mehta

  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 114 (1) 60 - 74 0360-3016 2022/09 [Refereed][Not invited]
   

  Purpose: Patients with lung cancer and brain metastases represent a markedly heterogeneous population. Accurate prognosis is essential to optimally individualize care. In prior publications, we described the graded prognostic assessment (GPA), but a GPA for patients with small cell lung cancer (SCLC) has never been reported, and in non-small cell lung cancer (NSCLC), the effect of programmed death ligand 1 (PD-L1) was unknown. The 3-fold purpose of this work is to provide the initial report of an SCLC GPA, to evaluate the effect of PD-L1 on survival in patients with NSCLC, and to update the Lung GPA accordingly.Methods and Materials: A multivariable analysis of prognostic factors and treatments associated with survival was performed on 4183 patients with lung cancer (3002 adenocarcinoma, 611 nonadenocarcinoma, 570 SCLC) with newly diagnosed brain metastases between January 1, 2015, and December 31, 2020, using a multi-institutional retrospective database. Significant variables were used to update the Lung GPA.Results: Overall median survival for lung adenocarcinoma, SCLC, and nonadenocarcinoma was 17, 10, and 8 months, respectively, but varied widely by GPA from 2 to 52 months. In SCLC, the significant prognostic factors were age, performance status, extracranial metastases, and number of brain metastases. In NSCLC, the distribution of molecular markers among patients with lung adenocarcinoma and known primary tumor molecular status revealed alterations/expression in PD-L1 50% to 100%, PD-L1 1% to 49%, epidermal growth factor receptor, and anaplastic lymphoma kinase in 32%, 31%, 30%, and 7%, respectively. Median survival of patients with lung adenocarcinoma and brain metastases with 0, 1% to 49%, and >= 50% PD-L1 expression was 17, 19, and 24 months, respectively (P < .01), confirming PD-L1 is a prognostic factor. Previously identified prognostic factors for NSCLC (epidermal growth factor receptor and anaplastic lymphoma kinase status, performance status, age, number of brain metastases, and extracranial metastases) were reaffirmed. These factors were incorporated into the updated Lung GPA with robust separation between subgroups for all histologies.Conclusions: Survival for patients with lung cancer and brain metastases has improved but varies widely. The initial report of a GPA for SCLC is presented. For patients with NSCLC-adenocarcinoma and brain metastases, PD-L1 is a newly identified significant prognostic factor, and the previously identified factors were reaffirmed. The updated indices establish unique criteria for SCLC, NSCLC-nonadenocarcinoma, and NSCLC-adenocarcinoma (incorporating PD-L1). The updated Lung GPA, available for free at brainmetgpa.com, provides an accurate tool to estimate survival, individualize treatment, and stratify clinical trials. (C) 2022 Elsevier Inc. All rights reserved.
• 放射線治療を中心としたがん治療について-最近の変化と将来- 膠芽腫に対する免疫反応を考慮した照射野最適化の必要性

  西岡 健太郎, 高橋 周平, 森 崇, 打浪 雄介, 山口 秀, 木下 学, 山品 将祥, 前林 勝也, 青山 英史

  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 58回 S345 - S345 0048-0428 2022/08
• 放射線治療を中心としたがん治療について-最近の変化と将来- 膠芽腫に対する免疫反応を考慮した照射野最適化の必要性

  西岡 健太郎, 高橋 周平, 森 崇, 打浪 雄介, 山口 秀, 木下 学, 山品 将祥, 前林 勝也, 青山 英史

  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 58回 S345 - S345 0048-0428 2022/08
• 【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
• A study on predicting cases that would benefit from proton beam therapy in primary liver tumors of less than or equal to 5 cm based on the estimated incidence of hepatic toxicity

  Yusuke Uchinami, Norio Katoh, Ryusuke Suzuki, Takahiro Kanehira, Masaya Tamura, Seishin Takao, Taeko Matsuura, Naoki Miyamoto, Yoshihiro Fujita, Fuki Koizumi, Hiroshi Taguchi, Koichi Yasuda, Kentaro Nishioka, Isao Yokota, Keiji Kobashi, Hidefumi Aoyama

  Clinical and Translational Radiation Oncology 35 70 - 75 2405-6308 2022/07 [Refereed][Not invited]
  
• [The Hokkaido Medical Personnel Training Plan Connecting Humans and Medicine]

  Tsuyoshi Saito, Akihiro Sakurai, Hidefumi Aoyama, Ichiro Kinoshita, Takeo Sarashina, Tamami Hamada, Ken Iseki, Kumi Mikuni

  Gan To Kagaku Ryoho . 49 (5) 509 - 515 2022/05
• 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 

  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)
• HyperArcを用いた多発性脳転移腫瘍に対する脳定位放射線治療中の各標的の位置ずれに関する検討

  山田 亮太, 吉村 高明, 若林 倭, 金平 孝博, 森 崇, 西岡 健太郎, 青山 英史

  日本放射線技術学会総会学術大会予稿集 (公社)日本放射線技術学会 78回 161 - 162 1884-7846 2022/03
• Dosimetric advantages of daily adaptive strategy in IMPT for high-risk prostate cancer.

  Hiroshi Tamura, Keiji Kobashi, Kentaro Nishioka, Takaaki Yoshimura, Takayuki Hashimoto, Shinichi Shimizu, Yoichi M Ito, Yoshikazu Maeda, Makoto Sasaki, Kazutaka Yamamoto, Hiroyasu Tamamura, Hidefumi Aoyama, Hiroki Shirato

  Journal of applied clinical medical physics 23 (4) e13531  2022/01/19 [Refereed][Not invited]
   

  PURPOSE: To evaluate the dosimetric advantages of daily adaptive radiotherapy (DART) in intensity-modulated proton therapy (IMPT) for high-risk prostate cancer by comparing estimated doses of the conventional non-adaptive radiotherapy (NART) that irradiates according to an original treatment plan through the entire treatment and the DART that uses an adaptive treatment plan generated by using daily CT images acquired before each treatment. METHODS: Twenty-three patients with prostate cancer were included. A treatment plan with 63 Gy (relative biological effectiveness (RBE)) in 21 fractions was generated using treatment planning computed tomography (CT) images assuming that all patients had high-risk prostate cancer for which the clinical target volume (CTV) needs to include prostate and the seminal vesicle (SV) in our treatment protocol. Twenty-one adaptive treatment plans for each patient (total 483 data sets) were generated using daily CT images, and dose distributions were calculated. Using a 3 mm set-up uncertainty in the robust optimization, the doses to the CTV, prostate, SV, rectum, and bladder were compared. RESULTS: Estimated accumulated doses of NART and DART in the 23 patients were 60.81 ± 3.47 Gy (RBE) and 63.24 ± 1.04 Gy (RBE) for CTV D99 (p < 0.01), 62.99 ± 1.28 Gy (RBE) and 63.43 ± 1.33 Gy (RBE) for the prostate D99 (p = 0.2529), and 59.07 ± 5.19 Gy (RBE) and 63.17 ± 1.04 Gy (RBE) for SV D99 (p < 0.001). No significant differences were observed between NART and DART in the estimated accumulated dose for the rectum and bladder. CONCLUSION: Compared with the NART, DART was shown to be a useful approach that can maintain the dose coverage to the target without increasing the dose to the organs at risk (OAR) using the 3 mm set-up uncertainty in the robust optimization in patients with high-risk prostate cancer.
• Impact of a spatially dependent dose delivery time structure on the biological effectiveness of scanning proton therapy.

  Koki Kasamatsu, Sodai Tanaka, Koichi Miyazaki, Seishin Takao, Naoki Miyamoto, Shusuke Hirayama, Kentaro Nishioka, Takayuki Hashimoto, Hidefumi Aoyama, Kikuo Umegaki, Taeko Matsuura

  Medical physics 49 (1) 702 - 713 2022/01 [Refereed][Not invited]
   

  PURPOSE: In the scanning beam delivery of protons, different portions of the target are irradiated with different linear energy transfer protons with various time intervals and irradiation times. This research aimed to evaluate the spatially dependent biological effectiveness of protracted irradiation in scanning proton therapy. METHODS: One and two parallel opposed fields plans were created in water phantom with the prescribed dose of 2 Gy. Three scenarios (instantaneous, continuous, and layered scans) were used with the corresponding beam delivery models. The biological dose (physical dose × relative biological effectiveness) was calculated using the linear quadratic model and the theory of dual radiation action to quantitatively evaluate the dose delivery time effect. In addition, simulations using clinical plans (postoperative seminoma and prostate tumor cases) were conducted to assess the impact of the effects on the dose volume histogram parameters and homogeneity coefficient (HC) in targets. RESULTS: In a single-field plan of water phantom, when the treatment time was 19 min, the layered-scan scenario showed a decrease of <0.2% (almost 3.3%) in the biological dose from the plan on the distal (proximal) side because of the high (low) dose rate. This is in contrast to the continuous scenario, where the biological dose was almost uniformly decreased over the target by approximately 3.3%. The simulation with clinical geometry showed that the decrease rates in D99% were 0.9% and 1.5% for every 10 min of treatment time prolongation for postoperative seminoma and prostate tumor cases, respectively, whereas the increase rates in HC were 0.7% and 0.2%. CONCLUSIONS: In protracted irradiation in scanning proton therapy, the spatially dependent dose delivery time structure in scanning beam delivery can be an important factor for accurate evaluation of biological effectiveness.
• Evaluation of Visualizing the Prostatic Urinary Tract in MRI With a Super Resolution Deep Learning Model for Urethra Sparing Radiotherapy

  T. Yoshimura, K. Nishioka, T. Hashimoto, S. Kogame, K. Seki, H. Sugimori, H. Yamashina, F. Kato, H. Aoyama, K. Kudo, S. Shimizu

  International Journal of Radiation Oncology*Biology*Physics 111 (3) e121 - e122 0360-3016 2021/11
• A randomized phase III study of short-course radiotherapy combined with Temozolomide in elderly patients with newly diagnosed glioblastoma; Japan clinical oncology group study JCOG1910 (AgedGlio-PIII).

  Yoshiki Arakawa, Keita Sasaki, Yohei Mineharu, Megumi Uto, Takashi Mizowaki, Junki Mizusawa, Yuta Sekino, Tomohiro Ono, Hidefumi Aoyama, Kaishi Satomi, Koichi Ichimura, Manabu Kinoshita, Makoto Ohno, Yoshinori Ito, Ryo Nishikawa, Haruhiko Fukuda, Yasumasa Nishimura, Yoshitaka Narita

  BMC cancer 21 (1) 1105 - 1105 2021/10/15 [Refereed]
   

  BACKGROUND: The current standard treatment for elderly patients with newly diagnosed glioblastoma is surgery followed by short-course radiotherapy with temozolomide. In recent studies, 40 Gy in 15 fractions vs. 60 Gy in 30 fractions, 34 Gy in 10 fractions vs. 60 Gy in 30 fractions, and 40 Gy in 15 fractions vs. 25 Gy in 5 fractions have been reported as non-inferior. The addition of temozolomide increased the survival benefit of radiotherapy with 40 Gy in 15 fractions. However, the optimal regimen for radiotherapy plus concomitant temozolomide remains unresolved. METHODS: This multi-institutional randomized phase III trial was commenced to confirm the non-inferiority of radiotherapy comprising 25 Gy in 5 fractions with concomitant (150 mg/m2/day, 5 days) and adjuvant temozolomide over 40 Gy in 15 fractions with concomitant (75 mg/m2/day, every day from first to last day of radiation) and adjuvant temozolomide in terms of overall survival (OS) in elderly patients with newly diagnosed glioblastoma. A total of 270 patients will be accrued from 51 Japanese institutions in 4 years and follow-up will last 2 years. Patients 71 years of age or older, or 71-75 years old with resection of less than 90% of the contrast-enhanced region, will be registered and randomly assigned to each group with 1:1 allocation. The primary endpoint is OS, and the secondary endpoints are progression-free survival, frequency of adverse events, proportion of Karnofsky performance status preservation, and proportion of health-related quality of life preservation. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in April 2020. Ethics approval was granted by the National Cancer Center Hospital Certified Review Board. Patient enrollment began in August 2020. DISCUSSION: If the primary endpoint is met, short-course radiotherapy comprising 25 Gy in 5 fractions with concomitant and adjuvant temozolomide will be a standard of care for elderly patients with newly diagnosed glioblastoma. TRIAL REGISTRATION: Registry number: jRCTs031200099 . Date of Registration: 27/Aug/2020. Date of First Participant Enrollment: 4/Sep/2020.
• A treatment planning study of urethra-sparing intensity-modulated proton therapy for localized prostate cancer.

  Takaaki Yoshimura, Kentaro Nishioka, Takayuki Hashimoto, Kazuya Seki, Shouki Kogame, Sodai Tanaka, Takahiro Kanehira, Masaya Tamura, Seishin Takao, Taeko Matsuura, Keiji Kobashi, Fumi Kato, Hidefumi Aoyama, Shinichi Shimizu

  Physics and imaging in radiation oncology 20 23 - 29 2021/10 [Refereed]
   

  Background and Purpose: Urethra-sparing radiation therapy for localized prostate cancer can reduce the risk of radiation-induced genitourinary toxicity by intentionally underdosing the periurethral transitional zone. We aimed to compare the clinical impact of a urethra-sparing intensity-modulated proton therapy (US-IMPT) plan with that of conventional clinical plans without urethral dose reduction. Materials and Methods: This study included 13 patients who had undergone proton beam therapy. The prescribed dose was 63 GyE in 21 fractions for 99% of the clinical target volume. To compare the clinical impact of the US-IMPT plan with that of the conventional clinical plan, tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated with a generalized equivalent uniform dose-based Lyman-Kutcher model using dose volume histograms. The endpoints of these model parameters for the rectum, bladder, and urethra were fistula, contraction, and urethral stricture, respectively. Results: The mean NTCP value for the urethra in US-IMPT was significantly lower than that in the conventional clinical plan (0.6% vs. 1.2%, p < 0.05). There were no statistically significant differences between the conventional and US-IMPT plans regarding the mean minimum dose for the urethra with a 3-mm margin, TCP value, and NTCP value for the rectum and bladder. Additionally, the target dose coverage of all plans in the robustness analysis was within the clinically acceptable range. Conclusions: Compared with the conventional clinically applied plans, US-IMPT plans have potential clinical advantages and may reduce the risk of genitourinary toxicities, while maintaining the same TCP and NTCP in the rectum and bladder.
• 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)
• 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
• Treatment outcomes of stereotactic body radiation therapy using a real-time tumor-tracking radiotherapy system for hepatocellular carcinomas.

  Yusuke Uchinami, Norio Katoh, Daisuke Abo, Hiroshi Taguchi, Koichi Yasuda, Kentaro Nishioka, Takeshi Soyama, Ryo Morita, Naoki Miyamoto, Ryusuke Suzuki, Takuya Sho, Masato Nakai, Koji Ogawa, Tatsuhiko Kakisaka, Tatsuya Orimo, Toshiya Kamiyama, Shinichi Shimizu, Hidefumi Aoyama

  Hepatology research : the official journal of the Japan Society of Hepatology 51 (8) 870 - 879 2021/08 [Refereed]
   

  AIM: To report the outcomes of stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system for hepatocellular carcinoma patients. METHODS: From January 2005 to July 2018, 63 patients with 74 lesions with a maximum diameter ≤52 mm were treated by stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system. No patient with a Child-Pugh Score ≥9 was included, and 85.6% had a score of 5 or 6. Using the biological effective dose (BED) with an α/β ratio of 10 (BED10 ), the median dose in BED10 at the reference point was 76.8 Gy (range 60-122.5 Gy). Overall survival (OS) and local control rates were assessed using the Kaplan-Meier method. RESULTS: With a median follow-up period of 24.6 months (range 0.9-118.4 months), the 1-year and 2-year OS rates were 86.8% (95% confidence interval [95% CI] 75.8-93.3) and 71.1% (57.8-81.6), respectively. The 2-year OS was 89.6% in patients with the baseline modified albumin-bilirubin (mALBI) grade =1, and 61.7% in patients with grade ≥2a. In the multivariate analysis, the mALBI grade (=1 vs. ≥2a) was a significant factor for OS (p = 0.028, 95% CI 1.11-6.18). The 1-year and 2-year local control rates were 100% (100-100%) and 92.0% (77.5-97.5%). The local control rates were significantly higher in the BED10 ≥100 Gy group than in the BED10 <100 Gy group (2-year 100% vs. 86.5%, p = 0.049) at the reference point. CONCLUSION: This retrospective study of stereotactic body radiotherapy using real-time tumor-tracking radiotherapy for hepatocellular carcinoma showed favorable outcomes with lower incidence of toxicities, especially in patients treated with BED10 ≥100 Gy to the reference point.
• Predictors of the need for prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients treated with concurrent chemoradiotherapy.

  Satoshi Kano, Nayuta Tsushima, Takayoshi Suzuki, Seijiro Hamada, Taizo Yokokawa, Hiroshi Idogawa, Koichi Yasuda, Hideki Minatogawa, Yasuhiro Dekura, Hidefumi Aoyama, Akihiro Homma

  International journal of clinical oncology 26 (7) 1179 - 1187 2021/07 [Refereed][Not invited]
   

  BACKGROUND: We investigated whether prophylactic percutaneous endoscopic gastrostomy (PEG) is used effectively for patients treated with definitive concurrent chemoradiotherapy (CCRT) and the predictors of the need for PEG. METHODS: 326 patients with laryngeal, oropharyngeal or hypopharyngeal cancers were retrospectively reviewed. RESULTS: The PEG tube use group had more favorable results than the total parenteral nutrition and nasogastric tube groups in terms of rate of serum albumin loss, incidence of severe fever and aspiration pneumonia, CCRT completion rate and hospitalization period. However, it was inferior to oral intake. Analysis of the relative risk of requiring enteral or parenteral nutrition revealed that performance status (PS) 2, primary site (supraglottis, oropharynx, or hypopharynx), N3 disease, and cisplatin were predictors of the need for nutritional support. CONCLUSIONS: Prophylactic PEG is effective for patients treated with definitive CCRT and is especially required for patients with PS2 or oropharyngeal cancer.
• A comparative study of high-dose-rate brachytherapy boost combined with external beam radiation therapy versus external beam radiation therapy alone for high-risk prostate cancer.

  Tomoya Oshikane, Motoki Kaidu, Eisuke Abe, Atsushi Ohta, Hirotake Saito, Toshimichi Nakano, Moe Honda, Satoshi Tanabe, Satoru Utsunomiya, Ryuta Sasamoto, Fumio Ishizaki, Takashi Kasahara, Tsutomu Nishiyama, Yoshihiko Tomita, Hidefumi Aoyama, Hiroyuki Ishikawa

  Journal of radiation research 62 (3) 525 - 532 2021/05/12 [Refereed][Not invited]
   

  We aimed to compare the outcomes of high-dose-rate brachytherapy (HDR-BT) boost and external beam radiation therapy (EBRT) alone for high-risk prostate cancer. This was a single-center, retrospective and observational study. Consecutive patients who underwent initial radical treatment by HDR-BT boost or EBRT alone from June 2009 to May 2016 at the Niigata University Medical and Dental Hospital, Japan were included. A total of 96 patients underwent HDR-BT boost, and 61 underwent EBRT alone. The prescription dose of HDR-BT boost was set to 18 Gy twice a day with EBRT 39 Gy/13 fractions. The dose for EBRT alone was mostly 70 Gy/28 fractions. The high-risk group received >6 months of prior androgen deprivation therapy. Overall survival, biochemical-free survival, local control and distant metastasis-free survival rates at 5 years were analyzed. The incidence of urological and gastrointestinal late adverse events of Grade 2 and above was also summarized. In the National Comprehensive Cancer Network (NCCN) high-risk calssification, HDR-BT boost had a significantly higher biochemical-free survival rate at 5 years (98.9% versus 90.7%, P = 0.04). Urethral strictures were more common in the HDR-BT boost group. We will continuously observe the progress of the study patients and determine the longer term results.
• Salvage surgery improves the treatment outcome of patients with residual/recurrent maxillary sinus cancer after superselective intra-arterial cisplatin infusion with concomitant radiation therapy.

  Nayuta Tsushima, Satoshi Kano, Takayoshi Suzuki, Hiroshi Idogawa, Daisuke Yoshida, Koichi Yasuda, Manami Otsuka, Hidefumi Aoyama, Akihiro Homma

  European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 279 (2) 899 - 905 2021/04/18 [Refereed][Not invited]
   

  PURPOSE: We have performed superselective intra-arterial cisplatin infusion with concomitant radiotherapy (RADPLAT) for patients with maxillary sinus cancer. The promising treatment outcomes of this non-surgical treatment were reported in past studies. However, few clinical studies have been conducted to evaluate the outcome of salvage surgery following RADPLAT. The purpose of this study was to analyze the treatment outcomes of salvage surgery for patients with recurrent maxillary sinus cancer after RADPLAT. METHODS: We assessed 45 patients who had recurrence following RADPLAT between 1999 and 2017, and conducted a retrospective analysis. We excluded patients who did not complete RADPLAT. Patients were not considered to have completed RADPLAT if they underwent intra-arterial cisplatin less than three times or received a total radiation dose of less than 60 Gy. The primary endpoint was overall survival. The median follow-up period for surviving patients after recurrence was 5.1 years. RESULTS: Twenty-five of the 45 (56%) patients underwent salvage surgery. The 5-year overall survival rate was 68% in patients who underwent salvage surgery, while all patients who did not undergo salvage surgery died during the observation period. Fifteen of 24 (63%) patients with local recurrence underwent salvage surgery. Eight patients did not undergo salvage surgery because of unresectable disease; five of the eight patients had unresectable posterior extension. All nine patients with nodal recurrence underwent neck dissection. CONCLUSION: Treatment outcomes of salvage surgery following RADPLAT were favorable enough for it to be generally recommended. To reduce unresectable recurrence, the posterior section should be eradicated by RADPLAT.
• Visualizing the urethra by magnetic resonance imaging without usage of a catheter for radiotherapy of prostate cancer.

  Takaaki Yoshimura, Kentaro Nishioka, Takayuki Hashimoto, Taro Fujiwara, Kinya Ishizaka, Hiroyuki Sugimori, Shoki Kogame, Kazuya Seki, Hiroshi Tamura, Sodai Tanaka, Yuto Matsuo, Yasuhiro Dekura, Fumi Kato, Hidefumi Aoyama, Shinichi Shimizu

  Physics and imaging in radiation oncology 18 1 - 4 2021/04 [Refereed][Not invited]
   

  The urethra position may shift due to the presence/absence of the catheter. Our proposed post-urination-magnetic resonance imaging (PU-MRI) technique is possible to identify the urethra without catheter. We aimed to verify the inter-operator difference in contouring the urethra by PU-MRI. The mean values of the evaluation indices of dice similarity coefficient, mean slice-wise Hausdorff distance, and center coordinates were 0.93, 0.17 mm, and 0.36 mm for computed tomography, and 0.75, 0.44 mm, and 1.00 mm for PU-MRI. Therefore, PU-MRI might be useful for identifying the prostatic urinary tract without using a urethral catheter. Clinical trial registration: Hokkaido University Hospital for Clinical Research (018-0221).
• Analysis of acute-phase toxicities of intensity-modulated proton therapy using a model-based approach in pharyngeal cancer patients.

  Koichi Yasuda, Hideki Minatogawa, Yasuhiro Dekura, Seishin Takao, Masaya Tamura, Nayuta Tsushima, Takayoshi Suzuki, Satoshi Kano, Takatsugu Mizumachi, Takashi Mori, Kentaro Nishioka, Motoyasu Shido, Norio Katoh, Hiroshi Taguchi, Noriyuki Fujima, Rikiya Onimaru, Isao Yokota, Keiji Kobashi, Shinichi Shimizu, Akihiro Homma, Hiroki Shirato, Hidefumi Aoyama

  Journal of radiation research 62 (2) 329 - 337 2021/03/10 [Refereed][Not invited]
   

  Pharyngeal cancer patients treated with intensity-modulated proton therapy (IMPT) using a model-based approach were retrospectively reviewed, and acute toxicities were analyzed. From June 2016 to March 2019, 15 pharyngeal (7 naso-, 5 oro- and 3 hypo-pharyngeal) cancer patients received IMPT with robust optimization. Simulation plans for IMPT and intensity-modulated X-ray therapy (IMXT) were generated before treatment. We also reviewed 127 pharyngeal cancer patients with IMXT in the same treatment period. In the simulation planning comparison, all of the normal-tissue complication probability values for dysphagia, dysgeusia, tube-feeding dependence and xerostomia were lower for IMPT than for IMXT in the 15 patients. After completing IMPT, 13 patients completed the evaluation, and 12 of these patients had a complete response. The proportions of patients who experienced grade 2 or worse acute toxicities in the IMPT and IMXT cohorts were 21.4 and 56.5% for dysphagia (P < 0.05), 46.7 and 76.3% for dysgeusia (P < 0.05), 73.3 and 62.8% for xerostomia (P = 0.43), 73.3 and 90.6% for mucositis (P = 0.08) and 66.7 and 76.4% for dermatitis (P = 0.42), respectively. Multivariate analysis revealed that IMPT was independently associated with a lower rate of grade 2 or worse dysphagia and dysgeusia. After propensity score matching, 12 pairs of IMPT and IMXT patients were selected. Dysphagia was also statistically lower in IMPT than in IMXT (P < 0.05). IMPT using a model-based approach may have clinical benefits for acute dysphagia.
• 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
• Detecting MLC modeling errors using radiomics‐based machine learning in patient‐specific QA with an EPID for intensity‐modulated radiation therapy

  Madoka Sakai, Hisashi Nakano, Daisuke Kawahara, Satoshi Tanabe, Takeshi Takizawa, Akihiro Narita, Takumi Yamada, Hironori Sakai, Masataka Ueda, Ryuta Sasamoto, Motoki Kaidu, Hidefumi Aoyama, Hiroyuki Ishikawa, Satoru Utsunomiya

  Medical Physics 48 (3) 991 - 1002 0094-2405 2021/03 [Refereed][Not invited]
   

  PURPOSE: We sought to develop machine learning models to detect multileaf collimator (MLC) modeling errors with the use of radiomic features of fluence maps measured in patient-specific quality assurance (QA) for intensity-modulated radiation therapy (IMRT) with an electric portal imaging device (EPID). METHODS: Fluence maps measured with EPID for 38 beams from 19 clinical IMRT plans were assessed. Plans with various degrees of error in MLC modeling parameters [i.e., MLC transmission factor (TF) and dosimetric leaf gap (DLG)] and plans with an MLC positional error for comparison were created. For a total of 152 error plans for each type of error, we calculated fluence difference maps for each beam by subtracting the calculated maps from the measured maps. A total of 837 radiomic features were extracted from each fluence difference map, and we determined the number of features used for the training dataset in the machine learning models by using random forest regression. Machine learning models using the five typical algorithms [decision tree, k-nearest neighbor (kNN), support vector machine (SVM), logistic regression, and random forest] for binary classification between the error-free plan and the plan with the corresponding error for each type of error were developed. We used part of the total dataset to perform fourfold cross-validation to tune the models, and we used the remaining test dataset to evaluate the performance of the developed models. A gamma analysis was also performed between the measured and calculated fluence maps with the criteria of 3%/2 and 2%/2 mm for all of the types of error. RESULTS: The radiomic features and its optimal number were similar for the models for the TF and the DLG error detection, which was different from the MLC positional error. The highest sensitivity was obtained as 0.913 for the TF error with SVM and logistic regression, 0.978 for the DLG error with kNN and SVM, and 1.000 for the MLC positional error with kNN, SVM, and random forest. The highest specificity was obtained as 1.000 for the TF error with a decision tree, SVM, and logistic regression, 1.000 for the DLG error with a decision tree, logistic regression, and random forest, and 0.909 for the MLC positional error with a decision tree and logistic regression. The gamma analysis showed the poorest performance in which sensitivities were 0.737 for the TF error and the DLG error and 0.882 for the MLC positional error for 3%/2 mm. The addition of another type of error to fluence maps significantly reduced the sensitivity for the TF and the DLG error, whereas no effect was observed for the MLC positional error detection. CONCLUSIONS: Compared to the conventional gamma analysis, the radiomics-based machine learning models showed higher sensitivity and specificity in detecting a single type of the MLC modeling error and the MLC positional error. Although the developed models need further improvement for detecting multiple types of error, radiomics-based IMRT QA was shown to be a promising approach for detecting the MLC modeling error.
• 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 

  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.
• Potential benefits of adaptive intensity‐modulated proton therapy in nasopharyngeal carcinomas

  Hideki Minatogawa, Koichi Yasuda, Yasuhiro Dekura, Seishin Takao, Taeko Matsuura, Takaaki Yoshimura, Ryusuke Suzuki, Isao Yokota, Noriyuki Fujima, Rikiya Onimaru, Shinichi Shimizu, Hidefumi Aoyama, Hiroki Shirato

  Journal of Applied Clinical Medical Physics 22 (1) 174 - 183 1526-9914 2021/01 [Refereed][Not invited]
   

  Purpose To investigate potential advantages of adaptive intensity-modulated proton beam therapy (A-IMPT) by comparing it to adaptive intensity-modulated X-ray therapy (A-IMXT) for nasopharyngeal carcinomas (NPC).Methods Ten patients with NPC treated with A-IMXT (step and shoot approach) and concomitant chemotherapy between 2014 and 2016 were selected. In the actual treatment, 46 Gy in 23 fractions (46Gy/23Fx.) was prescribed using the initial plan and 24Gy/12Fx was prescribed using an adapted plan thereafter. New treatment planning of A-IMPT was made for the same patients using equivalent dose fractionation schedule and dose constraints. The dose volume statistics based on deformable images and dose accumulation was used in the comparison of A-IMXT with A-IMPT.Results The means of the D-mean of the right parotid gland (P < 0.001), right TM joint (P < 0.001), left TM joint (P < 0.001), oral cavity (P < 0.001), supraglottic larynx (P = 0.001), glottic larynx (P < 0.001), , middle PCM (P = 0.0371), interior PCM (P < 0.001), cricopharyngeal muscle (P = 0.03643), and thyroid gland (P = 0.00216), in A-IMPT are lower than those of A-IMXT, with statistical significance. The means of, D-0.03cc, and D-mean of each sub portion of auditory apparatus and D-30% for Eustachian tube and D-0.5cc for mastoid volume in A-IMPT are significantly lower than those of A-IMXT. The mean doses to the oral cavity, supraglottic larynx, and glottic larynx were all reduced by more than 20 Gy (RBE = 1.1).Conclusions An adaptive approach is suggested to enhance the potential benefit of IMPT compared to IMXT to reduce adverse effects for patients with NPC.
• Effect of setup error in the single‐isocenter technique on stereotactic radiosurgery for multiple brain metastases

  Hisashi Nakano, Satoshi Tanabe, Satoru Utsunomiya, Takumi Yamada, Ryuta Sasamoto, Toshimichi Nakano, Hirotake Saito, Takeshi Takizawa, Hironori Sakai, Atsushi Ohta, Eisuke Abe, Motoki Kaidu, Hidefumi Aoyama

  Journal of Applied Clinical Medical Physics 21 (12) 155 - 165 1526-9914 2020/12 [Refereed][Not invited]
  
• Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.

  Paul W Sperduto, Shane Mesko, Jing Li, Daniel Cagney, Ayal Aizer, Nancy U Lin, Eric Nesbit, Tim J Kruser, Jason Chan, Steve Braunstein, Jessica Lee, John P Kirkpatrick, Will Breen, Paul D Brown, Diana Shi, Helen A Shih, Hany Soliman, Arjun Sahgal, Ryan Shanley, William A Sperduto, Emil Lou, Ashlyn Everett, Drexell H Boggs, Laura Masucci, David Roberge, Jill Remick, Kristin Plichta, John M Buatti, Supriya Jain, Laurie E Gaspar, Cheng-Chia Wu, Tony J C Wang, John Bryant, Michael Chuong, Yi An, Veronica Chiang, Toshimichi Nakano, Hidefumi Aoyama, Minesh P Mehta

  Journal of clinical oncology : official journal of the American Society of Clinical Oncology 38 (32) 3773 - 3784 2020/11/10 [Refereed][Not invited]
   

  PURPOSE: Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. METHODS: A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. RESULTS: Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. CONCLUSION: Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).
• 動体追跡陽子線照射における気管支内視鏡的放射線治療用マーカー留置術の検討

  伊藤 祥太郎, 品川 尚文, 高島 雄太, 國崎 守, 古田 恵, 水柿 秀紀, 朝比奈 肇, 菊地 英毅, 菊地 順子, 榊原 純, 加藤 徳雄, 田口 大志, 青山 英史, 今野 哲

  気管支学 (NPO)日本呼吸器内視鏡学会 42 (6) 576 - 576 0287-2137 2020/11
• 動体追跡陽子線照射における気管支内視鏡的放射線治療用マーカー留置術の検討

  伊藤 祥太郎, 品川 尚文, 高島 雄太, 國崎 守, 古田 恵, 水柿 秀紀, 朝比奈 肇, 菊地 英毅, 菊地 順子, 榊原 純, 加藤 徳雄, 田口 大志, 青山 英史, 今野 哲

  気管支学 (NPO)日本呼吸器内視鏡学会 42 (6) 576 - 576 0287-2137 2020/11
• Efficacy and Safety of the Radiotherapy for Liver Cancer: Assessment of Local Controllability and its Role in Multidisciplinary Therapy.

  Marina Ohkoshi-Yamada, Kenya Kamimura, Osamu Shibata, Shinichi Morita, Motoki Kaidu, Toshimichi Nakano, Katsuya Maruyama, Atsushi Ota, Hirotake Saito, Nobuko Yamana, Tomoya Oshikane, Yukiyo Goto, Natsumi Yoshimura, Satoshi Tanabe, Hisashi Nakano, Madoka Sakai, Yuto Tanaka, Yohei Koseki, Yoshihisa Arao, Hiroyuki Abe, Toru Setsu, Akira Sakamaki, Takeshi Yokoo, Hiroteru Kamimura, Hidefumi Aoyama, Shuji Terai

  Cancers 12 (10) 2020/10/13 [Refereed][Not invited]
   

  This study investigated the efficacy and safety of radiotherapy as part of multidisciplinary therapy for advanced hepatocellular carcinoma (HCC). Clinical data of 49 HCC patients treated with radiotherapy were assessed retrospectively. The efficacy of radiotherapy was assessed by progression-free survival, disease control rate, and overall survival. Safety was assessed by symptoms and hematological assay, and changes in hepatic reserve function were determined by Child-Pugh score and albumin-bilirubin (ALBI) score. Forty patients underwent curative radiotherapy, and nine patients with portal vein tumor thrombus (PVTT) underwent palliative radiotherapy as part of multidisciplinary therapy. Local disease control for curative therapy was 80.0% and stereotactic body radiotherapy was 86.7% which was greater than that of conventional radiotherapy (60.0%). Patients with PVTT had a median observation period of 651 days and 75% three-year survival when treated with multitherapy, including radiotherapy for palliative intent, transcatheter arterial chemoembolization, and administration of molecular targeted agents. No adverse events higher than grade 3 and no changes in the Child-Pugh score and ALBI score were seen. Radiotherapy is safe and effective for HCC treatment and can be a part of multidisciplinary therapy.
• 膵癌に対するS-1併用術前化学放射線療法(S-1併用NACRT)の治療成績

  小泉 富基, 加藤 徳雄, 中村 透, 川本 泰之, 田口 大志, 打浪 雄介, 清水 伸一, 青山 英史

  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 56回 S103 - S103 0048-0428 2020/10
• 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
• Screening and follow-up of chronic liver diseases with understanding their etiology in clinics and hospitals.

  Masahiro Ogawa, Atsunori Tsuchiya, Takayuki Watanabe, Toru Setsu, Naruhiro Kimura, Masato Matsuda, Yoshiki Hoshiyama, Hiroaki Saito, Tsutomu Kanazawa, Motoi Shiotani, Tatsuhiko Sato, Takuya Yagi, Koji Igarashi, Norihiko Yoshimura, Masaaki Takamura, Hidefumi Aoyama, Shuji Terai

  JGH open : an open access journal of gastroenterology and hepatology 4 (5) 827 - 837 2020/10 [Refereed][Not invited]
   

  Background and Aim: Considering the increasing prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), the development of an effective screening and follow-up system that enables the recognition of etiological changes by primary physicians in clinics and specialists in hospitals is required. Methods: Chronic hepatitis B (HBV) and C (HCV), NASH, and alcoholic steatohepatitis (ASH) patients who were assayed for Mac-2-binding protein glycosylation isomer (M2BPGi) (n = 272) and underwent magnetic resonance elastography (MRE) (n = 119) were enrolled. Patients who underwent MRE were also tested by ultrasound elastography (USE) (n = 80) and for M2BPGi (n = 97), autotaxin (ATX) (n = 62), and platelet count (n = 119), and their fibrosis-4 (FIB-4) index was calculated (n = 119). Results: FIB-4 index >2, excluding HBV-infected patients, M2BPGi >0.5, ATX >0.5, and platelet count <20 × 104/μL were the benchmark indices, and we took into consideration other risk factors, such as diabetes mellitus and age, to recommend further examinations, such as USE, based on the local situation to avoid overlooking hepatocellular carcinoma (HCC) in the clinic. During specialty care in the hospital, MRE exhibited high diagnostic ability for fibrosis stages >F3 or F4; it could efficiently predict collateral circulation with high sensitivity, which can replace USE. We also identified etiological features and found that collateral circulation in NASH/ASH patients tended to exceed high-risk levels; moreover, these patients exhibited more variation in HCC-associated liver stiffness than the HBV and HCV patients. Conclusions: Using appropriate markers and tools, we can establish a stepwise, practical, noninvasive, and etiology-based screening and follow-up system in primary and specialty care.
• Estrogen/progesterone receptor and HER2 discordance between primary tumor and brain metastases in breast cancer and its effect on treatment and survival.

  Paul W Sperduto, Shane Mesko, Jing Li, Daniel Cagney, Ayal Aizer, Nancy U Lin, Eric Nesbit, Tim J Kruser, Jason Chan, Steve Braunstein, Jessica Lee, John P Kirkpatrick, Will Breen, Paul D Brown, Diana Shi, Helen A Shih, Hany Soliman, Arjun Sahgal, Ryan Shanley, William Sperduto, Emil Lou, Ashlyn Everett, Drexell Hunter Boggs, Laura Masucci, David Roberge, Jill Remick, Kristin Plichta, John M Buatti, Supriya Jain, Laurie E Gaspar, Cheng-Chia Wu, Tony J C Wang, John Bryant, Michael Chuong, James Yu, Veronica Chiang, Toshimichi Nakano, Hidefumi Aoyama, Minesh P Mehta

  Neuro-oncology 22 (9) 1359 - 1367 2020/09/29 [Refereed][Not invited]
   

  BACKGROUND: Breast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM). METHODS: A retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the BCBM. RESULTS: The overall receptor discordance rate was 132/316 (42%), and the subtype discordance rate was 100/316 (32%). Hormone receptors (HR, either ER or PR) were gained in 40/160 (25%) patients with HR-negative primary tumors. HER2 was gained in 22/173 (13%) patients with HER2-negative primary tumors. Subsequent treatment was not adjusted for most patients who gained receptors-nonetheless, median survival (MS) improved but did not reach statistical significance (HR, 17-28 mo, P = 0.12; HER2, 15-19 mo, P = 0.39). MS for patients who lost receptors was worse (HR, 27-18 mo, P = 0.02; HER2, 30-18 mo, P = 0.08). CONCLUSIONS: Receptor discordance between primary tumor and BCBM is common, adversely affects survival if receptors are lost, and represents a missed opportunity for use of effective treatments if receptors are gained. Receptor analysis of BCBM is indicated when clinically appropriate. Treatment should be adjusted accordingly. KEY POINTS: 1. Receptor discordance alters subtype in 32% of BCBM patients.2. The frequency of receptor gain for HR and HER2 was 25% and 13%, respectively.3. If receptors are lost, survival suffers. If receptors are gained, consider targeted treatment.
• High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term androgen deprivation therapy for very high-risk prostate cancer.

  Takashi Kasahara, Fumio Ishizaki, Akira Kazama, Eri Yuki, Kazutoshi Yamana, Ryo Maruyama, Tomoya Oshikane, Motoki Kaidu, Hidefumi Aoyama, Vladimir Bilim, Tsutomu Nishiyama, Yoshihiko Tomita

  International journal of urology : official journal of the Japanese Urological Association 27 (9) 800 - 806 2020/09 [Refereed][Not invited]
   

  OBJECTIVE: To estimate the outcomes of high-dose-rate brachytherapy combined with hypofractionated external beam radiotherapy in prostate cancer patients classified as very high risk by the National Comprehensive Cancer Network. METHODS: Between June 2009 and September 2015, 66 patients meeting the criteria for very high-risk disease received high-dose-rate brachytherapy (2 fractions of 9 Gy) as a boost of external beam radiotherapy (13 fractions of 3 Gy). Androgen deprivation therapy was administered for approximately 3 years. Biochemical failure was assessed using the Phoenix definition. RESULTS: The median follow-up period was 53 months from the completion of radiotherapy. The 5-year biochemical failure-free, distant metastasis-free, prostate cancer-specific and overall survival rates were 88.7, 89.2, 98.5 and 97.0%, respectively. The independent contribution of each component of the very high-risk criteria was assessed in multivariable models. Primary Gleason pattern 5 was associated with increased risks of biochemical failure (P = 0.017) and distant metastasis (P = 0.049), whereas clinical stage ≥T3b or >4 biopsy cores with Gleason score 8-10 had no significant impact on the two outcomes. Grade 3 genitourinary toxicities were observed in two (3.0%) patients, whereas no grade ≥3 gastrointestinal toxicities occurred. CONCLUSIONS: The present study shows that this multimodal approach provides potentially excellent cancer control and acceptable associated morbidity for very high-risk disease. Patients with primary Gleason pattern 5 are at a higher risk of poor outcomes, indicating the need for more aggressive approaches in these cases.
• 上・中・下咽頭癌に対する陽子線治療の初期経験

  安田 耕一, 湊川 英樹, 出倉 康裕, 対馬 那由多, 鈴木 崇祥, 加納 里志, 鬼丸 力也, 清水 伸一, 本間 明宏, 青山 英史

  頭頸部癌 (一社)日本頭頸部癌学会 46 (2) 161 - 161 1349-5747 2020/07
• 頭頸部粘膜悪性黒色腫に対する術後陽子線治療30GyE/5回の初期経験

  湊川 英樹, 安田 耕一, 出倉 康裕, 鈴木 正宣, 中丸 裕爾, 中薗 彬, 鈴木 崇祥, 対馬 那由多, 加納 里志, 鬼丸 力也, 清水 伸一, 本間 明宏, 青山 英史

  頭頸部癌 (一社)日本頭頸部癌学会 46 (2) 188 - 188 1349-5747 2020/07
• 動体追跡陽子線照射における気管支内視鏡的放射線治療用マーカー留置術の検討

  伊藤 祥太郎, 品川 尚文, 高島 雄太, 國崎 守, 古田 恵, 水柿 秀紀, 朝比奈 肇, 菊地 英毅, 菊地 順子, 榊原 純, 加藤 徳雄, 田口 大志, 青山 英史, 今野 哲

  気管支学 (NPO)日本呼吸器内視鏡学会 42 (Suppl.) S277 - S277 0287-2137 2020/06
• Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today.

  Paul W Sperduto, Shane Mesko, Jing Li, Daniel Cagney, Ayal Aizer, Nancy U Lin, Eric Nesbit, Tim J Kruser, Jason Chan, Steve Braunstein, Jessica Lee, John P Kirkpatrick, Will Breen, Paul D Brown, Diana Shi, Helen A Shih, Hany Soliman, Arjun Sahgal, Ryan Shanley, William Sperduto, Emil Lou, Ashlyn Everett, Drexell Hunter Boggs, Laura Masucci, David Roberge, Jill Remick, Kristin Plichta, John M Buatti, Supriya Jain, Laurie E Gaspar, Cheng-Chia Wu, Tony J C Wang, John Bryant, Michael Chuong, James Yu, Veronica Chiang, Toshimichi Nakano, Hidefumi Aoyama, Minesh P Mehta

  International journal of radiation oncology, biology, physics 107 (2) 334 - 343 2020/06/01 [Refereed][Not invited]
   

  PURPOSE: Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. METHODS AND MATERIALS: A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively. RESULTS: Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01). CONCLUSIONS: MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
• Dosimetric comparison of analytic anisotropic algorithm and Acuros XB algorithm in VMAT plans for high-grade glioma.

  Takeshi Takizawa, Satoshi Tanabe, Satoru Utsunomiya, Hisashi Nakano, Takumi Yamada, Hironori Sakai, Atsushi Ohta, Hirotake Saito, Toshimichi Nakano, Eisuke Abe, Motoki Kaidu, Hidefumi Aoyama

  Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) 73 73 - 82 2020/05 [Refereed][Not invited]
   

  PURPOSE: To investigate the dosimetric impact between the anisotropic analytical algorithm (AAA) and the Acuros XB (AXB) algorithm in volumetric-modulated arc therapy (VMAT) plans for high-grade glioma (HGG). METHODS: We used a heterogeneous phantom to quantify the agreement between the measured and calculated doses from the AAA and from the AXB. We then analyzed 14 patients with HGG treated by VMAT, using the AAA. We newly created AXB plans for each corresponding AAA plan under the following conditions: (1) re-calculation for the same number of monitor units with an identical beam and leaf setup, and (2) re-optimization under the same conditions of dose constraints. The dose coverage for the planning target volume (PTV) was evaluated by dividing the coverage into the skull, air, and soft-tissue regions. RESULTS: Compared to the results obtained with the AAA, the AXB results were in good agreement with the measured profiles. The dose differences in the PTV between the AAA and re-calculated AXB plans were large in the skull region contained in the target. The dose difference in the PTV in both types of plan was significantly correlated with the volume of the skull contained in the target (r = 0.71, p = 0.0042). A re-optimized AXB plan's dose difference was lower vs. the re-calculated AXB plan's. CONCLUSIONS: We observed dose differences between the AAA and AXB plans, in particular in the cases in which the skull region of the target was large. Considering the phantom measurement results, the AXB algorithm should be used in VMAT plans for HGG.
• マージンベース解析に基づいた多発脳転移に対する単一アイソセンタ照射法における回転誤差が生じた際の最大距離

  中野 永, 棚邊 哲史, 山田 巧, 宇都宮 悟, 滝澤 健司, 坂井 裕則, 青山 英史

  日本放射線技術学会総会学術大会予稿集 76回 242 - 242 1884-7846 2020/03
• Quantitative 3D Shape Analysis of CT Images of Thymoma: A Comparison With Histological Types.

  Motohiko Yamazaki, Kanako Oyanagi, Hajime Umezu, Takuya Yagi, Hiroyuki Ishikawa, Norihiko Yoshimura, Hidefumi Aoyama

  AJR. American journal of roentgenology 214 (2) 341 - 347 2020/02 [Refereed][Not invited]
   

  OBJECTIVE. The purpose of this study is to differentiate between low- and high-risk types of thymoma using quantitative 3D shape analysis of CT images. MATERIALS AND METHODS. This retrospective study included 44 patients with a pathologic diagnosis of thymoma. Two radiologists semiautomatically contoured CT images of the tumors and evaluated 3D shape parameters-namely, quantitative indicators of surface smoothness, including sphericity, ellipsoidality, and discrete compactness. The visual CT findings that were analyzed included longest diameter, shape (round-oval, lobulated, or irregular), calcification, cystic or necrotic changes, and enhancement pattern (homogeneous or heterogeneous). The difference and discriminating performance between low-risk (types A, AB, and B1) and high-risk (types B2 and B3) thymomas were statistically assessed. Interobserver agreement was determined using the concordance correlation coefficient. RESULTS. Twenty-three low-risk and 21 high-risk thymomas were identified on the basis of pathologic findings. The median values of sphericity and ellipsoidality were significantly higher for low-risk thymomas than for high-risk thymomas (for sphericity, 0.566 vs 0.517; for ellipsoidality, 0.941 vs 0.875; p < 0.05 for both). The AUC values of sphericity and ellipsoidality were 0.704 and 0.712, respectively. The best cutoff values were 0.528 and 0.919 for sphericity and ellipsoidality, respectively. Risk assessment combining these cutoff values and the mode of tumor detection (incidental detection or detection based on the presence of symptoms) improved the AUC value to 0.856 (sensitivity, 81.0% [17 of 21 patients]; specificity, 82.6% [19 of 23 patients]). All 3D shape parameters showed almost perfect interobserver agreement (concordance correlation coefficient, > 0.90). The visual CT findings were not significantly different between low- and high-risk thymomas (p > 0.05 for all). CONCLUSION. Quantitative 3D shape analysis has excellent reproducibility, and combining this technique with information on the detection mode helps differentiate low- from high-risk thymomas.
• The neurocognitive function change criteria after whole-brain radiation therapy for brain metastasis, in reference to health-related quality of life changes: a prospective observation study.

  Toshimichi Nakano, Hidefumi Aoyama, Hirotake Saito, Satoshi Tanabe, Kensuke Tanaka, Katsuya Maruyama, Tomoya Oshikane, Atsushi Ohta, Eisuke Abe, Motoki Kaidu

  BMC cancer 20 (1) 66 - 66 2020/01/29 [Refereed][Not invited]
   

  BACKGROUND: We sought to construct the optimal neurocognitive function (NCF) change criteria sensitive to health-related quality of life (HR-QOL) in patients who have undergone whole-brain radiation therapy (WBRT) for brain metastasis. METHODS: We categorized the patients by the changes of NCF into groups of improvement versus deterioration if at least one domain showed changes that exceeded the cut-off while other domains remained stable. The remaining patients were categorized as stable, and the patients who showed both significant improvement and deterioration were categorized as 'both.' We examined the clinical meaning of NCF changes using the cut-off values 1.0, 1.5, and 2.0 SD based on the percentage of patients whose HR-QOL changes were ≥ 10 points. RESULTS: Baseline, 4-month and 8-month data were available in 78, 41 (compliance; 85%), and 29 (81%) patients, respectively. At 4 months, improvement/stable/deterioration/both was seen in 15%/12%/41%/32% of the patients when 1.0 SD was used; 19%/22%/37%/22% with 1.5 SD, and 17%/37%/37%/9% with 2.0 SD. The HR-QOL scores on the QLQ-C30 functional scale were significantly worse in the deterioration group versus the others with 1.0 SD (p = 0.013) and 1.5 SD (p = 0.015). With 1.5 SD, the HR-QOL scores on the QLQ-BN20 was significantly better in the improvement group versus the others (p = 0.033). However, when 'both' was included in 'improvement' or 'deterioration,' no significant difference in HR-QOL was detected. CONCLUSIONS: The NCF cut-off of 1.5 SD and the exclusion of 'both' patients from the 'deterioration' and 'improvement' groups best reflects HR-QOL changes.
• 消化器癌脳転移に対する定位照射の治療成績

  斎藤 紘丈, 中野 智成, 押金 智哉, 太田 篤, 阿部 英輔, 海津 元樹, 青山 英史

  定位的放射線治療 日本定位放射線治療学会 24 73 - 79 1342-9930 2020/01 

  定位放射線治療を受けた消化器癌(胃、小腸、大腸、肝臓、胆、膵)からの脳転移患者の治療成績について検討した。25名の消化器癌脳転移患者が当科を受診し、生存期間中央値は5.1ヵ月であった。25名のうち定位照射を施行されたのは5人(男性4人、女性1人、中央値77歳)で、原発巣は肝臓4人、直腸1人であった。初診時の病期はstage Iが1人、stage IIIが4人、不明が1人であり、4人が脳転移診断時に頭蓋外転移をすでに有していた。治療方針は定位照射単独が3人、定位+全脳照射が1人、定位+全脳照射+手術が1人であった。定位照射の線量分割は22Gy/1回が5病変、28Gy/4回が2病変、32Gy/4回が2病変、30.4Gy/4回が1病変であった。定位照射後の一次治療効果判定はPDが3人、制御が1人、体幹部転移の増大のため未評価が1人であった。適切な画像フォローアップおよび体幹部転移のコントロールを改善することが予後改善につながる可能性があると考えられた。
• 多発脳転移に対する単一アイソセンタ照射法における患者セットアップの並進誤差が線量不確かさに及ぼす影響

  中野 永, 棚邊 哲史, 宇都宮 悟, 中野 智成, 斎藤 紘丈, 滝澤 健司, 山田 巧, 坂井 裕則, 太田 篤, 阿部 英輔, 海津 元樹, 青山 英史

  定位的放射線治療 日本定位放射線治療学会 24 81 - 89 1342-9930 2020/01 

  複数の脳転移に対する単一アイソセンタVMAT(SIVMAT)の患者セットアップの並進誤差が線量の不確かさに及ぼす影響を評価した。治療計画装置上において、30×30×30cm3の仮想水等価ファントム上で、二つの模擬腫瘍肉眼腫瘍体積(GTV)を作成した。並進誤差が増加するにつれて、各GTVと計画標的体積(PTV)の線量カバレッジは低下し、GTVとPTVの直径が小さい場合、線量カバレッジはより低下した。各GTVおよびPTVの線量カバレッジは、GTVおよびPTVの体積が小さいほど、並進誤差が大きくなるにつれて低下した。GTVの直径が0.5cm、1.0cm、1.5cm、2.0cmの場合、至適PTVマージンはそれぞれ8.6mm、6.1mm、3.6mm、1.0mmであった。また、GTVの体積が1.0cm3、5.0cm3、10.0cm3、14.0cm3の場合、至適PTVマージンはそれぞれ7.0mm、3.4mm、1.8mm、1.0mmであった。1.0mm PTVマージンを設定した場合、PTV線量カバレッジの低下率5%以内を満たすためには、2.0cm以上の直径または14.0cm3以上の体積をもつGTVが必要であった。
• Rab27b contributes to radioresistance and exerts a paracrine effect via epiregulin in glioblastoma

  Soichiro Nishioka, Ping-Hsiu Wu, Toshiaki Yakabe, Amato J Giaccia, Quynh-Thu Le, Hidefumi Aoyama, Shinichi Shimizu, Hiroki Shirato, Yasuhito Onodera, Jin-Min Nam

  Neuro-Oncology Advances 2 (1) 2020/01/01
• The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study.

  Hirotake Saito, Ryusuke Shodo, Keisuke Yamazaki, Kouji Katsura, Yushi Ueki, Toshimichi Nakano, Tomoya Oshikane, Nobuko Yamana, Satoshi Tanabe, Satoru Utsunomiya, Atsushi Ohta, Eisuke Abe, Motoki Kaidu, Ryuta Sasamoto, Hidefumi Aoyama

  Clinical and translational radiation oncology 20 13 - 18 2020/01 [Refereed][Not invited]
   

  Background and purpose: Concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). As Candida spp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients. Patients and methods: We retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC. Results: We identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22-6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029). Conclusion: Candida infection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.
• Reconstruction of knee extensor with patellar tendon autograft following intraoperative radiotherapy.

  Hiroyuki Kawashima, Akira Ogose, Takashi Ariizumi, Tetsuro Yamagishi, Naoki Oike, Hidefumi Aoyama, Hiroshi Hatano, Naoto Endo

  The Knee 27 (1) 257 - 262 2020/01 [Refereed][Not invited]
   

  BACKGROUND: Patellar tendon autograft after intraoperative extracorporeal radiotherapy has been used for reconstruction of the extensor mechanism following limb-sparing wide tumor resection around the knee. The purpose of this study was to determine the clinical outcome of this reconstruction technique. METHODS: We retrospectively reviewed six consecutive patients with peripatellar tendon and proximal tibial sarcoma who underwent reconstruction of the knee extensor mechanism. The resection area was planned to be contained with the patellar tendon in order to obtain a wide margin. First, the patella was osteotomized at the midline, and the inferior half of patella, patellar tendon, and tibial tuberosity were excised en bloc. The resected segments were devitalized with intraoperative extracorporeal radiotherapy and reimplanted into the original site. A follow-up evaluation included an assessment of the range of motion, extensor lag, the International Society of Limb Salvage score, and complications. RESULTS: Six patients were followed up for 121-270 months. One patient underwent an additional reconstruction with total knee arthroplasty due to a collapse of the tibial subchondral bone. A supracondylar fracture of the femur occurred in two patients, and a delayed union of the osteosynthesis site of the tibial shaft was observed in one patient. At the latest follow up, extensor lag had a median of five degrees, and International Society of Limb Salvage scores had a median of 83%. No local recurrence or rupture of the patellar tendon was observed. CONCLUSIONS: Reconstruction of the knee extensor mechanism using a patellar tendon treated with intraoperative radiotherapy is a reliable and successful method.
• The impact of EGFR-TKI use on clinical outcomes of lung adenocarcinoma patients with brain metastases after Gamma Knife radiosurgery: a propensity score-matched analysis based on extended JLGK0901 dataset (JLGK0901-EGFR-TKI).

  Shoji Yomo, Toru Serizawa, Masaaki Yamamoto, Yoshinori Higuchi, Yasunori Sato, Takashi Shuto, Atsuya Akabane, Hidefumi Jokura, Jun Kawagishi, Hidefumi Aoyama

  Journal of neuro-oncology 145 (1) 151 - 157 2019/10 [Refereed][Not invited]
   

  PURPOSE: Recent advances in targeted therapy have prolonged overall survival (OS) for patients with lung cancer. The impact of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) on brain metastases (BM) treated with stereotactic radiosurgery (SRS) has not, however, been fully elucidated. We investigated the influence of post-SRS EGFR-TKI use on the efficacy and toxicity of SRS for BM from lung adenocarcinoma. METHODS: We used the updated dataset of the Japanese Leksell Gamma Knife (JLGK) 0901 study, which proved the efficacy of Gamma Knife SRS in patients with BM. Propensity score matching (PSM) analysis was employed to determine the impact of concurrent or post-SRS EGFR-TKI use on OS, neurological death, intracranial disease recurrence and SRS-related adverse events. RESULTS: Among 1194 patients registered in the JLGK0901 study, 608 eligible lung adenocarcinoma patients were identified and 238 (39%) had received EGFR-TKI concurrently or during the post-SRS clinical course. After PSM, there were 200 patient pairs with/without post-SRS EGFR-TKI use. EGFR-TKI use was associated with longer OS (median 25.5 vs. 11.0 months, HR 0.60, 95% CI 0.48-0.75, p < 0.001), although the long-term OS curves eventually crossed. Distant intracranial recurrence was more likely in patients receiving EGFR-TKI (HR 1.45, 95% CI 1.12-1.89, p = 0.005). Neurological death, local recurrence and SRS-related adverse event rates did not differ significantly between the two groups. CONCLUSIONS: Although patients receiving EGFR-TKI concurrently or after SRS had significantly longer OS, the local treatment efficacy and toxicity of SRS did not differ between patients with/without EGFR-TKI use.
• 【二次出版】ANL Secondary Publication 日本人頭頸部扁平上皮癌に対する高用量シスプラチン併用化学放射線療法の多施設共同第I/II相試験

  松山 洋, 山崎 恵介, 岡部 隆一, 植木 雄志, 正道 隆介, 尾股 丈, 佐藤 雄一郎, 太田 久幸, 高橋 剛史, 富田 雅彦, 横山 侑輔, 富樫 孝文, 青山 英史, 阿部 英輔, 西條 康夫, 勝良 剛詞, 曽我 麻里恵, 杉田 公, 松本 康男, 土田 恵美子, 堀井 新

  日本耳鼻咽喉科学会会報 (一社)日本耳鼻咽喉科学会 122 (9) 1269 - 1270 0030-6622 2019/09
• Stereotactic radiosurgery in elderly patients with brain metastases: comparison with non-elderly patients using database of a multi-institutional prospective observational study (JLGK0901-Elderly).

  Yoshinori Higuchi, Masaaki Yamamoto, Toru Serizawa, Yasunori Sato, Takashi Shuto, Atsuya Akabane, Hidefumi Jokura, Shoji Yomo, Osamu Nagano, Jun Kawagishi, Kazuhiro Yamanaka, Hidefumi Aoyama

  Journal of neuro-oncology 144 (2) 393 - 402 2019/09 [Refereed][Not invited]
   

  PURPOSE: Stereotactic radiosurgery (SRS) has been increasingly used for elderly patients with brain metastases (BMs). However, no studies based on a large sample size have been reported. To compare SRS treatment results between elderly and non-elderly patients, we performed a subset study of elderly patients using our prospectively-accumulated multi-institution study database (JLGK0901 Study, Lancet Oncol 15:387-395, 2014). METHODS: During the 2009-2011 period, 1194 eligible patients undergoing gamma knife SRS alone for newly diagnosed BMs were enrolled in this study from 23 gamma knife facilities in Japan. Observation was discontinued at the end of 2013. The 1194 patients were divided into the two age groups, 693 elderly ( ≥ 65 years) and 501 non-elderly ( < 65 years) patients. Our study protocol neither set an upper age limit nor required dose de-escalation. RESULTS: Median post-SRS survival time was significantly shorter in the elderly than in the non-elderly patient group (10.3 vs 14.3 months, HR 1.380, 95% CI 1.218-1.563, p < 0.0001). However, regarding all secondary endpoints including neurological death, neurological deterioration, SRS-related complications, leukoencephalopathy, local recurrence, newly-developed tumors, meningeal dissemination, salvage SRS, whole brain radiotherapy and surgery and decreased mini-mental state examination scores, the elderly patient group was not inferior to the non-elderly patient group. In the 693 elderly patients, there was no post-SRS median survival time difference between those with 5-10 versus 2-4 tumors (10.8 vs 8.9 months, HR 0.936, 95% CI 0.744-1.167, p = 0.5601). CONCLUSIONS: We conclude that elderly BM patients are not unfavorable candidates for SRS alone treatment.
• Estimating survival in patients with gastrointestinal cancers and brain metastases: An update of the graded prognostic assessment for gastrointestinal cancers (GI-GPA).

  Paul W Sperduto, Penny Fang, Jing Li, William Breen, Paul D Brown, Daniel Cagney, Ayal Aizer, James B Yu, Veronica Chiang, Supriya Jain, Laurie E Gaspar, Sten Myrehaug, Arjun Sahgal, Steve Braunstein, Penny Sneed, Brent Cameron, Albert Attia, Jason Molitoris, Cheng-Chia Wu, Tony J C Wang, Natalie A Lockney, Kathryn Beal, Jessica Parkhurst, John M Buatti, Ryan Shanley, Emil Lou, Daniel D Tandberg, John P Kirkpatrick, Diana Shi, Helen A Shih, Michael Chuong, Hirotake Saito, Hidefumi Aoyama, Laura Masucci, David Roberge, Minesh P Mehta

  Clinical and translational radiation oncology 18 39 - 45 2019/09 [Refereed][Not invited]
   

  Background: Patients with gastrointestinal cancers and brain metastases (BM) represent a unique and heterogeneous population. Our group previously published the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) for patients with GI cancers (GI-GPA) (1985-2007, n = 209). The purpose of this study is to update the GI-GPA based on a larger contemporary database. Methods: An IRB-approved consortium database analysis was performed using a multi-institutional (18), multi-national (3) cohort of 792 patients with gastrointestinal (GI) cancers, with newly-diagnosed BM diagnosed between 1/1/2006 and 12/31/2017. Survival was measured from date of first treatment for BM. Multiple Cox regression was used to select and weight prognostic factors in proportion to their hazard ratios. These factors were incorporated into the updated GI-GPA. Results: Median survival (MS) varied widely by primary site and other prognostic factors. Four significant factors (KPS, age, extracranial metastases and number of BM) were used to formulate the updated GI-GPA. Overall MS for this cohort remains poor; 8 months. MS by GPA was 3, 7, 11 and 17 months for GPA 0-1, 1.5-2, 2.5-3.0 and 3.5-4.0, respectively. >30% present in the worst prognostic group (GI-GPA of ≤1.0). Conclusions: Brain metastases are not uncommon in GI cancer patients and MS varies widely among them. This updated GI-GPA index improves our ability to estimate survival for these patients and will be useful for therapy selection, end-of-life decision-making and stratification for future clinical trials. A user-friendly, free, on-line app to calculate the GPA score and estimate survival for an individual patient is available at brainmetgpa.com.
• Dramatic response of BRAF V600E-mutant epithelioid glioblastoma to combination therapy with BRAF and MEK inhibitor: establishment and xenograft of a cell line to predict clinical efficacy.

  Yu Kanemaru, Manabu Natsumeda, Masayasu Okada, Rie Saito, Daiki Kobayashi, Takeyoshi Eda, Jun Watanabe, Shoji Saito, Yoshihiro Tsukamoto, Makoto Oishi, Hirotake Saito, Masayuki Nagahashi, Takahiro Sasaki, Rintaro Hashizume, Hidefumi Aoyama, Toshifumi Wakai, Akiyoshi Kakita, Yukihiko Fujii

  Acta neuropathologica communications 7 (1) 119 - 119 2019/07/25 [Refereed][Not invited]
   

  Epithelioid glioblastoma is a rare aggressive variant of glioblastoma (GBM) characterized by a dismal prognosis of about 6 months and frequent leptomeningeal dissemination. A recent study has revealed that 50% of epithelioid GBMs harbor three genetic alterations - BRAF V600E mutation, TERT promoter mutations, and homozygous deletions of CDKN2A/2B. Emerging evidence support the effectiveness of targeted therapies for brain tumors with BRAF V600E mutation. Here we describe a dramatic radiographical response to combined therapy with BRAF and MEK inhibitors in a patient with epithelioid GBM harboring BRAF V600E mutation, characterized by thick spinal dissemination. From relapsed tumor procured at autopsy, we established a cell line retaining the BRAF V600E mutation, TERT promoter mutation and CDKN2A/2B loss. Intracranial implantation of these cells into mice resulted in tumors closely resembling the original, characterized by epithelioid tumor cells and dissemination, and invasion into the perivascular spaces. We then confirmed the efficacy of treatment with BRAF and MEK inhibitor both in vitro and in vivo. Epithelioid GBM with BRAF V600E mutation can be considered a good treatment indication for precision medicine, and this patient-derived cell line should be useful for prediction of the tumor response and clarification of its biological characteristics.
• Survival and prognostic factors in patients with gastrointestinal cancers and brain metastases: have we made progress?

  Paul W Sperduto, Penny Fang, Jing Li, William Breen, Paul D Brown, Daniel Cagney, Ayal Aizer, James Yu, Veronica Chiang, Supriya Jain, Laurie E Gaspar, Sten Myrehaug, Arjun Sahgal, Steve Braunstein, Penny Sneed, Brent Cameron, Albert Attia, Jason Molitoris, Cheng-Chia Wu, Tony J C Wang, Natalie Lockney, Kathryn Beal, Jessica Parkhurst, John M Buatti, Ryan Shanley, Emil Lou, Daniel D Tandberg, John P Kirkpatrick, Diana Shi, Helen A Shih, Michael Chuong, Hirotake Saito, Hidefumi Aoyama, Laura Masucci, David Roberge, Minesh P Mehta

  Translational research : the journal of laboratory and clinical medicine 208 63 - 72 2019/06 [Refereed][Not invited]
   

  The literature describing the prognosis of patients with gastrointestinal (GI) cancers and brain metastases (BM) is sparse. Our group previously published a prognostic index, the Graded Prognostic Assessment (GPA) for GI cancer patients with BM, based on 209 patients diagnosed from 1985-2005. The purpose of this analysis is to identify prognostic factors for GI cancer patients with newly diagnosed BM in a larger contemporary cohort. A multi-institutional retrospective IRB-approved database of 792 GI cancer patients with new BM diagnosed from 1/1/2006 to 12/31/2016 was created. Demographic data, clinical parameters, and treatment were correlated with survival and time from primary diagnosis to BM (TPDBM). Kaplan-Meier median survival (MS) estimates were calculated and compared with log-rank tests. The MS from time of first treatment for BM for the prior and current cohorts were 5 and 8 months, respectively (P < 0.001). Eight prognostic factors (age, stage, primary site, resection of primary tumor, Karnofsky Performance Status (KPS), extracranial metastases, number of BM and Hgb were found to be significant for survival, in contrast to only one (KPS) in the prior cohort. In this cohort, the most common primary sites were rectum (24%) and esophagus (23%). Median TPDBM was 22 months. Notably, 37% (267/716) presented with poor prognosis (GPA 0-1.0). Although little improvement in overall survival in this cohort has been achieved in recent decades, survival varies widely and multiple new prognostic factors were identified. Future work will translate these factors into a prognostic index to facilitate clinical decision-making and stratification of future clinical trials.
• Detectability of the choroid plexus of the third ventricle with magnetic resonance ventriculography.

  Ken Sato, Masanori Awaji, Shoichi Inagawa, Yuichiro Yoneoka, Junichi Yoshimura, Norihiko Yoshimura, Hidefumi Aoyama

  Japanese journal of radiology 37 (6) 449 - 457 2019/06 [Refereed][Not invited]
   

  PURPOSE: To clarify the detectability of the choroid plexus of the third ventricle (ChPl3V) with magnetic resonance ventriculography (MRVn) employing a steady-state free precession (SSFP) sequence in comparison to surgical endoscopic movies as a golden standard, as we encountered some clinical cases of total agenesis of corpus callosum (ACC) where we could not recognize the choroid plexus of the third ventricle and found no previous article addressing this problem. MATERIALS AND METHODS: This retrospective study included consecutive patients from 2010 to 2016 for whom endoscopic evaluation of the third ventricle was conducted. The anterior portion of the right and left streaks of ChPl3V was evaluated in 8 patients on 16 sites, while the posterior portion of both streaks of ChPl3V was evaluated in 13 patients on 26 sites. Sensitivity of MRVn to visualize ChPl3V with endoscopic movies as the golden standard was calculated. RESULTS: Sensitivity of MRVn in visualizing the anterior portion of ChPl3V was 0.813, and that for the posterior portion 0.692. The anterior portion of ChPl3V was visualized in all cases where no tumor contacted the foramen of Monro. CONCLUSION: MRVn visualizes the anterior portion of ChPl3V with significant sensitivity and the posterior portion with lower one.
• The impact of the three degrees-of-freedom fiducial marker-based setup compared to soft tissue-based setup in hypofractionated intensity-modulated radiotherapy for prostate cancer.

  Satoshi Tanabe, Satoru Utsunomiya, Eisuke Abe, Hiraku Sato, Atsushi Ohta, Hironori Sakai, Takumi Yamada, Motoki Kaidu, Hidefumi Aoyama

  Journal of applied clinical medical physics 20 (6) 53 - 59 2019/06 [Refereed][Not invited]
   

  PURPOSE: We evaluated the setup accuracy of a three-degree-of-freedom fiducial marker (3DOF-FM)-based setup compared to a soft tissue (ST)-based setup in hypofractionated intensity-modulated radiotherapy (IMRT) for prostate cancer. MATERIALS AND METHODS: We analyzed the setup accuracy for 17 consecutive prostate cancer patients with three implanted FMs who underwent hypofractionated IMRT. The 3DOF-ST-based setup using cone-beam computed tomography (CT) was performed after a six DOF-bony structure (BS)-based setup using an ExacTrac x-ray system. The 3DOF-FM-based matching using the ExacTrac x-ray system was done during the BS- and ST-based setups. We determined the mean absolute differences and the correlation between the FM- and ST-based translational shifts relative to the BS-based setup position. The rotational mean shifts detected by the ExacTrac x-ray system were also evaluated. RESULTS: The mean differences in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) dimensions were 0.69, 0.0, and 0.30 mm, respectively. The Pearson correlation coefficients for both shifts were 0.92 for AP, 0.91 for SI, and 0.68 for LR. The percentages of shift agreements within 2 mm were 85% for AP, 93% for SI, and 99% for LR. The absolute values of rotational shifts were 0.1° for AP, 0.3°, and 1.2° for LR. CONCLUSIONS: The setup accuracy of the 3DOF-FM-based setup has the potential to be interchangeable with a ST-based setup. Our data are likely to be useful in clinical practice along with the popularization of the hypofractionated IMRT in prostate cancer.
• 当院の前立腺癌照射法別治療成績の各リスク分類・因子における比較検討 外照射併用HDR-BT vs. IMRT単独

  押金 智哉, 海津 元樹, 阿部 英輔, 丸山 克也, 太田 篤, 斎藤 紘丈, 中野 智成, 後藤 侑世, 青山 英史, 棚邊 哲史, 宇都宮 悟, 笹本 龍太

  臨床放射線 金原出版(株) 64 (6) 831 - 840 0009-9252 2019/05 

  当院における前立腺癌の放射線治療成績を三次元原体照射(3D-CRT)併用高線量率組織内照射(HDR-BT)と強度変調放射線治療(IMRT)について遡及的にまとめ、各リスク分類やリスク因子別に検討し、どのような症例が3D-CRT併用HDR-BTの良い適応となるのかを探索した。HDR-BTまたはIMRTを施行した前立腺癌の初発根治治療目的の連続症例を対象とした。症例の内訳はHDR-BT 230例、IMRT 140例である。HDR-BT群とIMRT群における5年時点での全生存率、生化学的非再発生存率、局所制御率は各94.7%/95.2%、95.2%/93.7%、98.4%/95.2%であり、両群間に有意差はなかった。CAPRA分類が高リスクの症例ではHDR-BTの局所制御率がIMRTよりも有意に高く、CAPRA中リスクの症例では全生存率、生化学的非再発生存率、局所制御率に有意差はなかった。D'Amico分類での高リスク症例、NCCN分類での高リスク以上の症例でも、両者には有意差がなかった。このほか、年齢、Tステージ、グリソンスコア、PSA、生検陽性本数で解析を行った結果、両群の差が統計学的有意となる因子は5年時点では見いだせなかった。
• Complementary Relation Between the Improvement of Dose Delivery Technique and PTV Margin Reduction in Dose-Escalated Radiation Therapy for Prostate Cancer.

  Satoru Utsunomiya, Jun Yamamoto, Satoshi Tanabe, Mayu Oishi, Aruha Satsuma, Motoki Kaidu, Eisuke Abe, Atsushi Ohta, Naotaka Kushima, Hidefumi Aoyama

  Practical radiation oncology 9 (3) 172 - 178 2019/05 [Refereed][Not invited]
   

  PURPOSE: The purpose of this study is to demonstrate quantitatively the complementary relationship between the introduction of intensity modulated radiation therapy (IMRT) and planning target volume (PTV) margin reduction with an image guided technique in reducing the risk of rectal toxicity in dose-escalating prostate radiation therapy. METHODS AND MATERIALS: Three-dimensional conformal radiation therapy (CRT) and IMRT plans were generated for 10 patients with prostate cancer based on 2 PTV margin protocols (10/8 mm and 6/5 mm) and 2 dose prescriptions (70 Gy and 78 Gy). The normal tissue complication probability (NTCP) for each of the 8 scenarios was calculated using the Lyman-Kutcher-Burman model to estimate the risk of rectal and bladder late toxicity. The conformity and homogeneity indices of PTVs were calculated for each plan. RESULTS: The IMRT plans showed superiority in conformity and inferiority in homogeneity over 3-dimensional CRT plans. The rectal NTCPs were increased 3.5 to 4.1 times when the prescribed total dose was changed from 70 Gy to 78 Gy and the dose delivery and the image guided radiation therapy techniques remained unchanged. PTV margin reduction was shown to reduce the value of rectal NTCP significantly. Overall, implementing the IMRT technique alone could reduce the NTCP values only by 2.1% to 7.3% from those of 3-dimensional CRT. The introduction of both IMRT and PTV margin reduction was found to be necessary for rectal NTCP to remain <5% in the dose escalation from 70 to 78 Gy. CONCLUSIONS: The complementary relationship between the introduction of IMRT and PTV margin reduction was proven. We found that both approaches need to be implemented to safely deliver a curative dose in dose-escalating prostate radiation therapy.
• Clues to improve the cost-effectiveness of radiotherapy for brain metastases from non-small cell lung cancer: cost reduction, patient selection, and better understanding of neurocognitive deterioration.

  Hirotake Saito, Toshimichi Nakano, Hidefumi Aoyama

  Annals of palliative medicine 8 (2) 199 - 202 2019/04 [Refereed][Invited]
  
• 当院における肝癌に対する放射線治療の検討

  柴田 理, 上村 顕也, 木村 成宏, 薛 徹, 横尾 健, 坂牧 僚, 上村 博輝, 土屋 淳紀, 高村 昌昭, 丸山 克也, 太田 篤, 海津 元樹, 青山 英史, 寺井 崇二

  日本消化器病学会雑誌 (一財)日本消化器病学会 116 (臨増総会) A456 - A456 0446-6586 2019/03
• 脳腫瘍の診断から治療まで 放射線治療(Diagnostic and Therapeutic Indications of Brain Tumor Radiation Therapy)

  青山 英史

  日本放射線技術学会総会学術大会予稿集 75回 85 - 86 1884-7846 2019/03
• 多発脳転移に対するSingle-isocenter照射法の線量分布にセットアップの回転誤差が及ぼす影響

  中野 永, 棚邊 哲史, 宇都宮 悟, 滝澤 健司, 山田 巧, 坂井 裕則, 青山 英史

  日本放射線技術学会総会学術大会予稿集 75回 229 - 230 1884-7846 2019/03
• Assessment of a simple method of heart weight estimation by postmortem computed tomography.

  Rei Ogawa, Naoya Takahashi, Takeshi Higuchi, Hiroyuki Shibuya, Motohiko Yamazaki, Norihiko Yoshimura, Hisakazu Takatsuka, Hidefumi Aoyama

  Forensic science international 296 22 - 27 2019/03 [Refereed][Not invited]
   

  BACKGROUND: Measurement of heart weight is important when investigating cause of death, but there is presently no satisfactory method of heart weight estimation by postmortem computed tomography (PMCT). METHOD: We investigated 33 consecutive cases that underwent both PMCT and autopsy between February 2008 and June 2014. Heart and left ventricular (LV) weights were calculated by PMCT morphometry. We used a simple method to estimate LV weight: We assumed that LV was an ellipsoid and multiplied its volume on PMCT with myocardial specific gravity. We then compared the various heart and LV weights using linear regression. The calculated and estimated LV weights on PMCT were also compared. RESULTS: It was not possible to predict heart weight at autopsy from PMCT (R2 = 0.53). However, heart weight at autopsy could be accurately predicted from LV weight calculated by PMCT (R2 = 0.77). In addition, there was a strong correlation between the estimated and calculated LV weights by PMCT (R2 = 0.92). Heart weight at autopsy could also be accurately predicted using the PMCT-estimated LV weight (R2 = 0.72). CONCLUSION: Heart weight at autopsy could be accurately predicted using a simple method in which LV volume was assumed to be an ellipsoid on PMCT.
• Selection criteria for 3D conformal radiotherapy versus volumetric-modulated arc therapy in high-grade glioma based on normal tissue complication probability of brain.

  Satoshi Tanabe, Haruna Takahashi, Hirotake Saito, Atsushi Ohta, Toshimichi Nakano, Ryuta Sasamoto, Miki Shioi, Satoru Utsunomiya, Eisuke Abe, Motoki Kaidu, Hidefumi Aoyama

  Journal of radiation research 60 (2) 249 - 256 2019/03/01 [Refereed][Not invited]
   

  There are no quantitative selection criteria for identifying high-grade glioma (HGG) patients who are suited for volumetric-modulated arc therapy (VMAT). This study aimed to develop selection criteria that can be used for the selection of the optimal treatment modality in HGG. We analyzed 20 patients with HGG treated by 3D conformal radiotherapy (3DCRT). First, VMAT plans were created for each patient retrospectively. For each plan, the normal tissue complication probability (NTCP) for normal brain was calculated. We then divided the patients based on the NTCPs of the 3DCRT plans for normal brain, using the threshold of 5%. We compared the NTCPs of the two plans and the gross tumor volumes (GTVs) of the two groups. For the GTVs, we used receiver operating characteristic curves to identify the cut-off value for predicting NTCP < 5%. We determined the respective correlations between the GTV and the GTV's largest cross-sectional diameter and largest cross-sectional area. In the NTCP ≥ 5% group, the NTCPs for the VMAT plans were significantly lower than those for the 3DCRT plans (P = 0.0011). The NTCP ≥ 5% group's GTV was significantly larger than that of the NTCP < 5% group (P = 0.0016), and the cut-off value of the GTV was 130.5 cm3. The GTV was strongly correlated with the GTV's largest cross-sectional diameter (R2 = 0.82) and largest cross-sectional area (R2 = 0.94), which produced the cut-off values of 7.5 cm and 41 cm2, respectively. It was concluded that VMAT is more appropriate than 3DCRT in cases in which the GTV is ≥130.5 cm3.
• 悪性神経膠腫のVMAT治療計画における2つの線量計算アルゴリズム Analytic Anisotropic AlgorithmとAcuros XBの違いが線量分布へ与える影響

  滝澤 健司, 棚邊 哲史, 宇都宮 悟, 久島 尚隆, 中野 永, 太田 篤, 斎藤 紘丈, 中野 智成, 阿部 英輔, 海津 元樹, 青山 英史

  定位的放射線治療 日本定位放射線治療学会 23 43 - 54 1342-9930 2019/01 

  悪性神経膠腫に対する強度変調回転放射線治療(VMAT)の治療計画におけるAnalytical Anisotropic Algorithm(AAA)とAcuros XB(AXB)の線量分布の違いを明らかにし、AXBの臨床的意義を明らかにすることを目的とした。悪性神経膠腫に対してVMATが施行された連続16症例を対象とした。計画標的体積(PTV)60のD95%およびV95%はAXB治療計画の方が有意に低く、各々効果量は大きかった。CTV60のD95%およびV95%は各々AXB治療計画の方が有意に低く、D95%の効果量は中等度で、V95%の効果量は小さかった。PTV60_skullのD95%およびV95%はAXB治療計画の方が有意に低く、各々効果量は大きかった。一方、PTV60_airについては、D95%はAXB治療計画の方が有意に高かったが、V95%の有意差は認められず、各々効果量は小さかった。また、頭蓋骨体積とPTV60、PTV50の各々の線量差に対する相関係数は0.66、0.71と高い正の相関が認められ、PTV内の頭蓋骨体積の割合が大きいほど線量差は大きくなった。
• Present clinical practices of stereotactic irradiation for metastatic brain tumors in Japan: results of questionnaire survey of the Japanese Radiation Oncology Study Group (JROSG) working subgroup for neurological tumors.

  Ken Harada, Hiroshi Igaki, Eisuke Abe, Takuro Ariga, Nobuyuki Hayashi, Ayae Kanemoto, Takafumi Komiyama, Yasuo Matsumoto, Toshimichi Nakano, Rikiya Onimaru, Hirotake Saito, Minako Sumi, Masao Tago, Kensuke Tanaka, Katsuya Maebayashi, Hidefumi Aoyama

  International journal of clinical oncology 23 (6) 1015 - 1022 2018/12 [Refereed][Not invited]
   

  BACKGROUND: To determine the current practice of stereotactic irradiation (STI) for brain metastases in Japan by a questionnaire survey. METHODS: A questionnaire was distributed to 313 institutions performing STI with one of the following machines: Gamma Knife (GK), CyberKnife (CK), Novalis (Nov), or other linear accelerator (LINAC)-based systems (OLS). The participation was voluntary. RESULTS: There were 163 responding institutions. The total number of STI treatments between April 2013 and March 2014 was 10,684. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) were performed in 8624 (80.7%) and 2060 (19.3%) cases, respectively. Whole-brain radiation therapy (WBRT) was performed for a total of 3515 cases. For a case model of a 1.5-cm solitary brain metastasis in a non-eloquent area, the most common GTV-PTV margin was 2 mm (22 of 114 institutions), and an institutional standard fraction was 1 (75 of 114 institutions). The doses for the model case also varied from 13.0 to 26.0 Gy (Median 20 Gy) when converted to SRS (α/β = 10). A prescription point was at the PTV margin the most. The median dose constraints which were converted to SRS (α/β = 3) to organs at risk were 12.2, 12.7, and 13.7 Gy for optic nerves, cavernous sinus, and brainstem, respectively. CONCLUSIONS: STI for brain metastases in current practice varied significantly among institutions. These different strategies relied mostly on the type of treatment machine used. It is thus necessary to establish a common guideline to express dose prescriptions and plan qualities for different STI machines.
• Multiinstitutional prospective observational study of stereotactic radiosurgery for patients with multiple brain metastases from non-small cell lung cancer (JLGK0901 study-NSCLC).

  Takashi Shuto, Atsuya Akabane, Masaaki Yamamoto, Toru Serizawa, Yoshinori Higuchi, Yasunori Sato, Jun Kawagishi, Kazuhiro Yamanaka, Hidefumi Jokura, Shoji Yomo, Osamu Nagano, Hidefumi Aoyama

  Journal of neurosurgery 129 (Suppl1) 86 - 94 2018/12/01 [Refereed][Not invited]
   

  OBJECTIVEPrevious Japanese Leksell Gamma Knife Society studies (JLGK0901) demonstrated the noninferiority of stereotactic radiosurgery (SRS) alone as the initial treatment for patients with 5-10 brain metastases (BMs) compared with those with 2-4 BMs in terms of overall survival and most secondary endpoints. The authors studied the aforementioned treatment outcomes in a subset of patients with BMs from non-small cell lung cancer (NSCLC).METHODSPatients with initially diagnosed BMs treated with SRS alone were enrolled in this prospective observational study. Major inclusion criteria were the existence of up to 10 tumors with a maximum diameter of less than 3 cm each, a cumulative tumor volume of less than 15 cm3, and no leptomeningeal dissemination in patients with a Karnofsky Performance Scale score of 70% or better.RESULTSAmong 1194 eligible patients, 784 with NSCLC were categorized into 3 groups: group A (1 tumor, n = 299), group B (2-4 tumors, n = 342), and group C (5-10 tumors, n = 143). The median survival times were 13.9 months in group A, 12.3 months in group B, and 12.8 months in group C. The survival curves of groups B and C were very similar (hazard ratio [HR] 1.037; 95% CI 0.842-1.277; p < 0.0001, noninferiority test). The crude and cumulative incidence rates of neurological death, deterioration of neurological function, newly appearing lesions, and leptomeningeal dissemination did not differ significantly between groups B and C. SRS-induced complications occurred in 145 (12.1%) patients during the median post-SRS period of 9.3 months (IQR 4.1-17.4 months), including 46, 54, 29, 11, and 5 patients with a Common Terminology Criteria for Adverse Events v3.0 grade 1, 2, 3, 4, or 5 complication, respectively. The cumulative incidence rates of adverse effects in groups A, B, and C 60 months after SRS were 13.5%, 10.0%, and 12.6%, respectively (group B vs C: HR 1.344; 95% CI 0.768-2.352; p = 0.299). The 60-month post-SRS rates of neurocognitive function preservation were 85.7% or higher, and no significant differences among the 3 groups were found.CONCLUSIONSIn this subset analysis of patients with NSCLC, the noninferiority of SRS alone for the treatment of 5-10 versus 2-4 BMs was confirmed again in terms of overall survival and secondary endpoints. In particular, the incidence of neither post-SRS complications nor neurocognitive function preservation differed significantly between groups B and C. These findings further strengthen the already-reported noninferiority hypothesis of SRS alone for the treatment of patients with 5-10 BMs.
• Clinical commissioning of a new patient positioning system, SyncTraX FX4, for intracranial stereotactic radiotherapy.

  Satoshi Tanabe, Osamu Umetsu, Toshikazu Sasage, Satoru Utsunomiya, Ryota Kuwabara, Toshiki Kuribayashi, Hiromasa Takatou, Gen Kawaguchi, Hidefumi Aoyama

  Journal of applied clinical medical physics 19 (6) 149 - 158 2018/11 [Refereed][Not invited]
   

  BACKGROUND & AIMS: A new real-time tracking radiotherapy (RTRT) system, the SyncTraX FX4 (Shimadzu, Kyoto, Japan), consisting of four X-ray tubes and four ceiling-mounted flat panel detectors (FPDs) combined with a linear accelerator, was installed at Uonuma Kikan Hospital (Niigata, Japan) for the first time worldwide. In addition to RTRT, the SyncTraX FX4 system enables bony structure-based patient verification. Here we provide the first report of this system's clinical commissioning for intracranial stereotactic radiotherapy (SRT). MATERIALS & METHODS: A total of five tests were performed for the commissioning: evaluations of (1) the system's image quality; (2) the imaging and treatment coordinate coincidence; and (3) the localization accuracy of cone-beam computed tomography (CBCT) and SyncTraX FX4; (4) the measurement of air kerma; (5) an end-to-end test. RESULTS & DISCUSSION: The tests revealed the following. (1) All image quality evaluation items satisfied each acceptable criterion in all FPDs. (2) The maximum offsets among the centers were ≤0.40 mm in all combinations of the FPD and X-ray tubes (preset). (3) The isocenter localization discrepancies between CBCT and preset #3 in the SyncTraX FX4 system were 0.29 ± 0.084 mm for anterior-posterior, -0.19 ± 0.13 mm for superior-inferior, 0.076 ± 0.11 mm for left-right, -0.11 ± 0.066° for rotation, -0.14 ± 0.064° for pitch, and 0.072±0.058° for roll direction. the Pearson's product-moment correlation coefficient between the two systems was >0.98 in all directions. (4) The mean air kerma value for preset #3 was 0.11 ± 0.0002 mGy in predefined settings (80 kV, 200 mA, 50 msec). (5) For 16 combinations of gantry and couch angles, median offset value in all presets was 0.31 mm (range 0.14-0.57 mm). CONCLUSION: Our results demonstrate a competent performance of the SyncTraX FX4 system in terms of the localization accuracy for intracranial SRT.
• Multicenter phase I/II study of chemoradiotherapy with high-dose CDDP for head and neck squamous cell carcinoma in Japan.

  Hiroshi Matsuyama, Keisuke Yamazaki, Ryuichi Okabe, Yushi Ueki, Ryusuke Shodo, Jo Omata, Yuichiro Sato, Hisayuki Ota, Takeshi Takahashi, Masahiko Tomita, Yusuke Yokoyama, Takafumi Togashi, Hidefumi Aoyama, Eisuke Abe, Yasuo Saijo, Kouji Katsura, Marie Soga, Tadashi Sugita, Yasuo Matsumoto, Emiko Tsuchida, Arata Horii

  Auris, nasus, larynx 45 (5) 1086 - 1092 2018/10 [Refereed][Not invited]
   

  OBJECTIVE: Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese. METHODS: Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events. RESULTS: A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event. CONCLUSION: The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).
• Correction to: The sternalis muscle: radiologic findings on MDCT.

  Motoi Shiotani, Takeshi Higuchi, Norihiko Yoshimura, Takao Kiguchi, Naoya Takahashi, Haruo Maeda, Hidefumi Aoyama

  Japanese journal of radiology 36 (4) 312 - 312 2018/04 

  In the original publication of the article, the seventh author name was incorrectly published as Hidehumi Aoyama. The correct author name should read as Hidefumi Aoyama.
• 肺動脈塞栓として初期治療を受け、18F FDG-PET/CTで鑑別できた肺動脈肉腫の1例

  山田 美佳, 佐藤 卓, 石川 浩志, 堀井 陽祐, 八木 琢也, 山崎 元彦, 塩谷 基, 吉村 宣彦, 青山 英史, 佐藤 征二郎, 小池 輝元, 土田 正則, 名村 理, 大橋 瑠子, 梅津 哉

  Japanese Journal of Radiology (公社)日本医学放射線学会 36 (Suppl.) 7 - 7 1867-1071 2018/02
• 悪性神経膠腫における寡分割照射を考慮した3DCRT/VMATの正常脳組織障害確率の比較

  高橋 春奈, 棚邊 哲史, 斎藤 紘丈, 中野 智成, 太田 篤, 海津 元樹, 青山 英史, 宇都宮 悟

  Japanese Journal of Radiology (公社)日本医学放射線学会 36 (Suppl.) 8 - 8 1867-1071 2018/02
• 前立腺癌に対する高線量率組織内照射 5年経過例の尿道狭窄の検討

  丸山 克也, 海津 元樹, 阿部 英輔, 田中 研介, 太田 篤, 塩井 美希, 斎藤 紘丈, 中野 智成, 青山 英史, 笹本 龍太

  Japanese Journal of Radiology (公社)日本医学放射線学会 36 (Suppl.) 11 - 11 1867-1071 2018/02
• HRCT texture analysis for pure or part-solid ground-glass nodules: distinguishability of adenocarcinoma in situ or minimally invasive adenocarcinoma from invasive adenocarcinoma.

  Takuya Yagi, Motohiko Yamazaki, Riuko Ohashi, Rei Ogawa, Hiroyuki Ishikawa, Norihiko Yoshimura, Masanori Tsuchida, Yoichi Ajioka, Hidefumi Aoyama

  Japanese journal of radiology 36 (2) 113 - 121 2018/02 [Refereed][Not invited]
   

  PURPOSE: To distinguish between adenocarcinoma in situ (AIS)-minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) showing pure or part-solid ground-glass nodules (GGNs) by high-resolution computed tomography (HRCT) texture analysis. MATERIALS AND METHODS: This retrospective study included 101 consecutive patients with 115 pure or part-solid GGNs ≤ 3 cm diameter, which were surgically resected and pathologically diagnosed with AIS, MIA, or IAC (48 AIS-MIA and 67 IAC) between April 2011 and March 2015. Each tumor was manually segmented on axial CT images, and the following texture features were calculated: volume, mass, mean CT value, variance, skewness, kurtosis, entropy, uniformity, and percentile CT numbers (10th, 25th, 50th, 75th, 90th, 95th percentiles). The differences between AIS-MIA and IAC were statistically evaluated using univariate, multivariate, and receiver operating characteristic analysis. RESULTS: Compared with IAC, AIS-MIA had significantly greater skewness, kurtosis, and uniformity, whereas in the other parameters, AIS-MIA demonstrated significantly lower values than those of IAC. Multivariate analysis revealed that independent differentiators were the 90th percentile CT numbers (P < 0.001) and entropy (P = 0.005) with an excellent accuracy (area under the curve, 0.90). CONCLUSIONS: The 90th percentile CT numbers and entropy can accurately distinguish AIS-MIA from IAC.
• Definitive chemoradiotherapy with low-dose continuous 5-fluorouracil reduces hematological toxicity without compromising survival in esophageal squamous cell carcinoma patients.

  Hirotake Saito, Atsushi Ohta, Eisuke Abe, Motoki Kaidu, Miki Shioi, Toshimichi Nakano, Tomoya Oshikane, Kensuke Tanaka, Katsuya Maruyama, Naotaka Kushima, Satoshi Tanabe, Satoru Utsunomiya, Ryuta Sasamoto, Hidefumi Aoyama

  Clinical and translational radiation oncology 9 12 - 17 2018/02 [Refereed][Not invited]
   

  Background and purpose: To compare chemoradiotherapy (CRT) with low-dose continuous 5-fluorouracil (5FU) to CRT with 5FU+cisplatin (CDDP) for esophageal squamous cell carcinoma (ESCC) in a retrospective cohort study. Methods and materials: We reviewed the cases of Stage I-IV ESCC patients who underwent definitive CRT in 2000-2014. Concomitant chemotherapy was one of the three regimens: (1) high-dose intermittent 5FU and CDDP (standard-dose FP: SDFP), (2) low-dose continuous 5FU and CDDP (LDFP), or (3) low-dose continuous 5FU (LD5FU). The general selection criteria for chemotherapy were: SDFP for patients aged <70 yrs; LDFP for those aged 70-74 yrs; LD5FU for those aged ≥75 yrs or with performance status (PS) ≥3. Propensity scores were derived with chemotherapy (LD5FU vs. 5FU+CDDP) as the dependent variable. Results: In a multivariate analysis, chemotherapy (LD5FU vs. SDFP, p = .24; LDFP vs. SDFP, p = .52) did not affect the overall survival (OS). LD5FU caused significantly less grade 3-4 leukopenia (9%) compared to SDFP (47%) and LDFP (44%) (p < .001). In a propensity-matched analysis, LD5FU affected neither OS (HR 1.06; 95%CI 0.55-2.05; p = .87) nor progression-free survival (HR 0.95, 95%CI 0.50-1.81; p = .87). Conclusion: CRT with low-dose continuous 5FU may be a less toxic option for elderly ESCC patients.
• 悪性神経膠腫における正常脳の正常組織障害発生確率を用いた強度変調回転放射線療法の適応基準の検討

  高橋 春奈, 棚邊 哲史, 斎藤 紘丈, 太田 篤, 中野 智成, 笹本 龍太, 宇都宮 悟, 阿部 英輔, 梅津 元樹, 青山 英史

  定位的放射線治療 日本定位放射線治療学会 22 125 - 133 1342-9930 2018/01 

  悪性神経膠腫において強度変調回転放射線療法(VMAT)がより有効である症例の選別基準の方法を構築することを目的として、VMATと三次元原体照射法(3DCRT)の治療計画を放射線誘発性脳壊死のリスク指標とした正常組織障害発生確率(NTCP)を用いて比較した。3DCRTで放射線治療が施行された20例を対象とした。PTVinitialについては、Conformity index(CI)に関してVMATが3DCRTよりも有意に向上しており、PTVboostについてもCIはVMATが有意に向上した。正常脳の平均線量については両治療計画間に有意差は認められなかった。3DCRTにおける正常脳のNTCP 5%未満の群においては、3DCRTとVMATのNTCPの中央値は各々1.2%、0.8%であり有意差は認められなかった。しかし、3DCRTにおける正常脳NTCP 5%以上の群においてはそれぞれ9.6%、4.0%であり、VMATで有意に減少した。また、肉眼的標的体積はNTCP 5%以上の群で大きく、カットオフ値は130.5ccであった。
• Clinical trial design for local therapies for brain metastases: a guideline by the Response Assessment in Neuro-Oncology Brain Metastases working group.

  Brian M Alexander, Paul D Brown, Manmeet S Ahluwalia, Hidefumi Aoyama, Brigitta G Baumert, Susan M Chang, Laurie E Gaspar, Steven N Kalkanis, David R Macdonald, Minesh P Mehta, Riccardo Soffietti, John H Suh, Martin J van den Bent, Michael A Vogelbaum, Jeffrey S Wefel, Eudocia Q Lee, Patrick Y Wen

  The Lancet. Oncology 19 (1) e33-e42  2018/01 [Refereed][Not invited]
   

  The goals of therapeutic and biomarker development form the foundation of clinical trial design, and change considerably from early-phase to late-phase trials. From these goals, decisions on specific clinical trial design elements, such as endpoint selection and statistical approaches, are formed. Whereas early-phase trials might focus on finding a therapeutic signal to make decisions on further development, late-phase trials focus on the confirmation of therapeutic impact by considering clinically meaningful endpoints. In this guideline from the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group, we highlight issues related to, and provide recommendations for, the design of clinical trials on local therapies for CNS metastases from solid tumours. We discuss endpoint selection criteria, the analysis appropriate for early-phase and late-phase trials, the association between tumour-specific and clinically meaningful endpoints, and possible issues related to the estimation of local control in the context of competing risks. In light of these discussions, we make specific recommendations on the clinical trial design of local therapies for brain metastases.
• Special prosthetic device for head and neck radiotherapy based on scientific evidence

  Kouji Katsura, Satoru Utsunomiya, Naotaka Kushima, Eisuke Abe, Hidefumi Aoyama, Takafumi Hayashi

  Annals of oncology 28 (suppl_9) 36 - 36 0923-7534 2017/10 [Not refereed][Not invited]
  
• A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores.

  Masaaki Yamamoto, Toru Serizawa, Yoshinori Higuchi, Yasunori Sato, Jun Kawagishi, Kazuhiro Yamanaka, Takashi Shuto, Atsuya Akabane, Hidefumi Jokura, Shoji Yomo, Osamu Nagano, Hidefumi Aoyama

  International journal of radiation oncology, biology, physics 99 (1) 31 - 40 2017/09/01 [Refereed][Not invited]
   

  PURPOSE: The JLGK0901 study showed the noninferiority of stereotactic radiosurgery (SRS) alone as initial treatment of 5 to 10 brain metastases (BMs) compared with 2 to 4 BMs in terms of overall survival and most secondary endpoints (Lancet Oncol 2014;15:387-95). However, observation periods were not long enough to allow confirmation of the long-term safety of SRS alone in patients with 5 to 10 BMs. METHODS AND MATERIALS: This was a prospective observational study of Gamma Knife SRS-treated patients with 1 to 10 newly diagnosed BMs enrolled at 23 facilities between March 1, 2009, and February 15, 2012. RESULTS: The 1194 eligible patients were categorized into the following groups: group A, 1 tumor (n=455); group B, 2 to 4 tumors (n=531); and group C, 5 to 10 tumors (n=208). Cumulative rates of Mini-Mental State Examination (MMSE) score maintenance (MMSE score decrease <3 from baseline) determined with a competing risk analysis of groups A, B, and C were 93%, 91%, and 92%, respectively, at the 12th month after SRS; 91%, 89%, and 91%, respectively, at the 24th month; 89%, 88%, and 89%, respectively, at the 36th month; and 87%, 86%, and 89%, respectively, at the 48th month (hazard ratio [HR] of group A vs group B, 0.719; 95% confidence interval [CI], 0.437-1.172; P=.18; HR of group B vs group C, 1.280; 95% CI, 0.696-2.508; P=.43). During observations ranging from 0.3 to 67.5 months (median, 12.0 months; interquartile range, 5.8-26.5 months), as of December 2014, 145 patients (12.1%) had SRS-induced complications. Cumulative complication incidences by competing risk analysis for groups A, B, and C were 7%, 8%, and 6%, respectively, at the 12th month after SRS; 10%, 11%, and 11%, respectively, at the 24th month; 11%, 11%, and 12%, respectively, at the 36th month; and 12%, 12%, and 13%, respectively, at the 48th month (HR of group A vs group B, 0.850; 95% CI, 0.592-1.220; P=.38; HR of group B vs group C, 1.052; 95% CI, 0.666-1.662, P=.83). Leukoencephalopathy occurred in 12 of the 1074 patients (1.1%) with follow-up magnetic resonance imaging and was detected after salvage whole-brain radiation therapy in 11 of these 12 patients. In these 11 patients, leukoencephalopathy was detected by magnetic resonance imaging 5.2 to 21.2 months (median, 11.0 months; interquartile range, 7.0-14.4 months) after whole-brain radiation therapy. CONCLUSIONS: Neither MMSE score maintenance nor post-SRS complication incidence differed among groups A, B, and C. This longer-term follow-up study further supports the already-reported noninferiority hypothesis of SRS alone for patients with 5 to 10 BMs versus 2 to 4 BMs.
• 脳転移治療における個別最適化

  青山 英史

  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 53回 S439 - S439 0048-0428 2017/08
• The Changing Role of Whole-Brain Radiotherapy: Demise or Time for Selective Usage?

  Minesh P Mehta, Hidefumi Aoyama, Vinai Gondi

  JAMA oncology 3 (8) 1021 - 1022 2017/08/01 [Invited]
  
• Coronary computed tomography angiography using 128-slice dual-source computed tomography in patients with severe calcification.

  Suguru Sato, Yosuke Horii, Norihiko Yoshimura, Takuya Yagi, Hidefumi Aoyama

  Japanese journal of radiology 35 (8) 432 - 439 2017/08 [Refereed][Not invited]
   

  PURPOSE: To compare coronary computed tomography angiography (CTA) and coronary angiography (CAG) with regard to luminal graphic definition of calcified segments using 128-slice dual-source computed tomography (DSCT), specifically for patients with an Agatston score >400. MATERIALS AND METHODS: Of 1148 consecutive patients who underwent coronary CTA using a 128-slice DSCT, 132 subjects had severe calcification with an Agatston score >400. Thirty-nine of the 132 patients who had undergone CAG within 3 months before or after coronary CTA were included. We investigated the distribution of calcification, and we visually evaluated significant stenosis in the calcified and all segments. Results were compared with CAG. RESULTS: The target group in this study had a very high mean Agatston score of 1771 ± 1724. Results for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 247 calcified vs all 325 segments were as follows: sensitivity 93.2 vs 92.2%, specificity 83.9 vs 87.5%, PPV 70.8 vs 69.6%, and NPV 96.7 vs 97.3%, respectively. CONCLUSION: 128-slice DSCT has potential for evaluation of calcified segments in the lumen, even in patients whose Agatston score exceeds 400.
• Five-year quality of life assessment after carbon ion radiotherapy for prostate cancer.

  Katsuya Maruyama, Hiroshi Tsuji, Takuma Nomiya, Hiroyuki Katoh, Hitoshi Ishikawa, Tadashi Kamada, Masaru Wakatsuki, Koichiro Akakura, Jun Shimazaki, Hidefumi Aoyama, Hirohiko Tsujii

  Journal of radiation research 58 (2) 260 - 266 2017/03/01 [Refereed][Not invited]
   

  The aim of this study was to prospectively assess 5-year health-related quality of life (HRQOL) of patients treated with carbon ion radiotherapy (C-ion RT) for clinically localized prostate cancer. A total of 417 patients received carbon ion radiotherapy at a total dose of 63-66 Gray-equivalents (GyE) in 20 fractions over 5 weeks, and neoadjuvant and adjuvant androgen deprivation therapy (ADT) were administered for intermediate and high-risk patients. A HRQOL assessment was performed at five time points (immediately before the initiation of C-ion RT, immediately after, and at 12, 36 and 60 months after completion of C-ion RT) using Functional Assessment of Cancer Therapy (FACT) questionnaires. FACT-G and FACT-P scores were significantly decreased; however, the absolute change after 60 months was minimal. The transient decreases in the Trial Outcome Index (TOI) score returned to their baseline levels. Use of ADT, presence of adverse events, and biochemical failure were related to lower scores. Scores of subdomains of FACT instruments indicated characteristic changes. The pattern of HRQOL change after C-ion RT was similar to that of other modalities. Further controlled studies focusing on a HRQOL in patients with prostate cancer are warranted.
• Respiratory gating and multifield technique radiotherapy for esophageal cancer.

  Atsushi Ohta, Motoki Kaidu, Satoshi Tanabe, Satoru Utsunomiya, Ryuta Sasamoto, Katsuya Maruyama, Kensuke Tanaka, Hirotake Saito, Toshimichi Nakano, Miki Shioi, Haruna Takahashi, Naotaka Kushima, Eisuke Abe, Hidefumi Aoyama

  Japanese journal of radiology 35 (3) 95 - 100 2017/03 [Refereed][Not invited]
   

  PURPOSE: To investigate the effects of a respiratory gating and multifield technique on the dose-volume histogram (DVH) in radiotherapy for esophageal cancer. METHODS AND MATERIALS: Twenty patients who underwent four-dimensional computed tomography for esophageal cancer were included. We retrospectively created the four treatment plans for each patient, with or without the respiratory gating and multifield technique: No gating-2-field, No gating-4-field, Gating-2-field, and Gating-4-field plans. We compared the DVH parameters of the lung and heart in the No gating-2-field plan with the other three plans. RESULT: In the comparison of the parameters in the No gating-2-field plan, there are significant differences in the Lung V5Gy, V20Gy, mean dose with all three plans and the Heart V25Gy-V40Gy with Gating-2-field plan, V35Gy, V40Gy, mean dose with No Gating-4-field plan and V30Gy-V40Gy, and mean dose with Gating-4-field plan. The lung parameters were smaller in the Gating-2-field plan and larger in the No gating-4-field and Gating-4-field plans. The heart parameters were all larger in the No gating-2-field plan. CONCLUSION: The lung parameters were reduced by the respiratory gating technique and increased by the multifield technique. The heart parameters were reduced by both techniques. It is important to select the optimal technique according to the risk of complications.
• 若年者に発症し副結節をともなった硬化性血管腫の1例

  押金 智哉, 山崎 元彦, 石川 浩志, 八木 琢也, 吉村 宣彦, 青山 英史, 北原 哲彦, 佐藤 征二郎, 小池 輝元, 土田 正則, 大橋 瑠子, 梅津 哉

  Japanese Journal of Radiology (公社)日本医学放射線学会 35 (Suppl.) 8 - 8 1867-1071 2017/02
• Toward the clarification of the role of whole-brain radiation therapy for brain metastases from non-small cell lung cancer: a comment about the QUARTZ trial

  Hirotake Saito, Toshimichi Nakano, Miki Shioi, Hidefumi Aoyama

  Translational Cancer Research 5 (S7) S1465 - S1468 2218-676X 2016/12 [Not refereed]
  
• Factors Affecting the Baseline and Post-Treatment Scores on the Hopkins Verbal Learning Test-Revised Japanese Version before and after Whole-Brain Radiation Therapy.

  Hirotake Saito, Kensuke Tanaka, Ayae Kanemoto, Toshimichi Nakano, Eisuke Abe, Hidefumi Aoyama

  International journal of molecular sciences 17 (11) 2016/11/03 [Refereed][Not invited]
   

  Our objectives were to (1) investigate the feasibility of the use of the Japanese version of the Hopkins Verbal Learning Test-Revised (HVLT-R); (2) identify the clinical factors influencing the HVLT-R scores of patients undergoing whole-brain radiation therapy (WBRT); and (3) compare the neurocognitive function (NCF) after WBRT in different dose fractionation schedules. We administered the HVLT-R (Japanese version) before (baseline) and at four and eight months after WBRT in 45 patients who received either therapeutic (35Gy-in-14, n = 16; 30Gy-in-10, n = 18) or prophylactic (25Gy-in-10, n = 11) WBRT. Sixteen patients dropped out before the eight-month examination, due mostly to death from cancer. The Karnofsky Performance Status (KPS) 80-100 group had significantly higher baseline total recall (TR) scores (p = 0.0053), delayed recall (DR) scores (p = 0.012), and delayed recognition (DRecog) scores (p = 0.0078). The patients aged ≤65 years also had significantly higher TR scores (p = 0.030) and DRecog scores (p = 0.031). The patients who underwent two examinations (worse-prognosis group) had significantly decreased DR scores four months after WBRT compared to the baseline (p = 0.0073), and they were significantly more likely to have declined individual TR scores (p = 0.0017) and DR scores (p = 0.035) at four months. The eight-month HVLT-R scores did not significantly decline regardless of the WBRT dose fractionation. The baseline NCF was determined by age and KPS, and the early decline in NCF is characteristic of the worse-prognosis group.
• 髄芽腫術後2週間以内の全脳脊髄照射及びSJM-96式自家末梢血幹細胞救援併用反復大量化学療法の実現可能性(Feasibility of SJMB-96 based repetitive high-dose chemotherapy with PBSC rescue and CSI within two weeks after surgery for medulloblastoma)

  今村 勝, 久保 暢大, 申 将守, 笠原 靖史, 細貝 亮介, 高地 貴行, 吉田 咲子, 岩渕 晴子, 齋藤 昭彦, 青山 英史, 吉村 淳一, 今井 千速

  日本小児血液・がん学会雑誌 53 (4) 360 - 360 2187-011X 2016/11
• A study on a dental device for the prevention of mucosal dose enhancement caused by backscatter radiation from dental alloy during external beam radiotherapy.

  Kouji Katsura, Satoru Utsunomiya, Eisuke Abe, Hironori Sakai, Naotaka Kushima, Satoshi Tanabe, Takumi Yamada, Takahide Hayakawa, Yoshihiko Yamanoi, Syuhei Kimura, Shinichi Wada, Hidefumi Aoyama, Takafumi Hayashi

  Journal of radiation research 57 (6) 709 - 713 2016/11 

  The changes in dose distribution caused by backscatter radiation from a common commercial dental alloy (Au-Ag-Pd dental alloy; DA) were investigated to identify the optimal material and thicknesses of a dental device (DD) for effective prevention of mucositis. To this end, 1 cm3 of DA was irradiated with a 6-MV X-ray beam (100 MU) in a field size of 10 × 10 cm2 using a Novalis TX linear accelerator. Ethylene vinyl acetate copolymer, polyolefin elastomer, and polyethylene terephthalate (PET) were selected as DD materials. The depth dose along the central axis was determined with respect to the presence/absence of DA and DDs at thicknesses of 1-10 mm using a parallel-plate ionization chamber. The dose in the absence of DDs showed the lowest value at a distance of 5 mm from the DA surface and gradually increased with distance between the measurement point and the DA surface for distances of ≥5 mm. Except for PET, no significant difference between the DA dose curves for the presence and absence of DDs was observed. In the dose curve, PET showed a slightly higher dose for DA with DD than for DA without DD for thicknesses of ≥4 mm. The findings herein suggest that the optimal DD material for preventing local dose enhancement of the mucosa caused by DA backscatter radiation should have a relatively low atomic number and physical density and that optimal DD thickness should be chosen considering backscatter radiation and percentage depth dose.
• Two-fraction high-dose-rate brachytherapy within a single day combined with external beam radiotherapy for prostate cancer: single institution experience and outcomes.

  Junyang Liu, Motoki Kaidu, Ryuta Sasamoto, Fumio Ayukawa, Nobuko Yamana, Hiraku Sato, Kensuke Tanaka, Gen Kawaguchi, Atsushi Ohta, Katsuya Maruyama, Eisuke Abe, Takashi Kasahara, Tsutomu Nishiyama, Yoshihiko Tomita, Hidefumi Aoyama

  Journal of radiation research 57 (3) 280 - 7 2016/06 

  We investigated the outcomes of treatment for patients with localized prostate cancer (PCa) treated with 3D conformal radiation therapy (3D-CRT) followed by two-fraction high-dose-rate brachytherapy within a single day (2-fr.-HDR-BT/day) at a single institution. A total of 156 consecutive Asian males (median age, 67 years) were enrolled. To compare our findings with those of other studies, we analyzed our results using the D'Amico classification, assigning the patients to low- ( N =: 5; 3.2%), intermediate- ( N =: 36; 23.1%) and high-risk ( N =: 115; 73.7%) groups (Stage T3 PCa patients were classified as high-risk). One patient in the D'Amico low-risk group (20%), 13 intermediate-risk patients (36.1%) and 99 high-risk patients (86.1%) underwent androgen deprivation therapy. We administered a prescription dose of 39 Gy in 13 fractions of 3D-CRT combined with 18 Gy of HDR-BT in two 9-Gy fractions delivered within a single day. We did not distinguish between risk groups in determining the prescription dose. The median follow-up period was 38 months. Of the 156 patients, one died from primary disease and five died from other diseases. The 3-year overall survival (OS) rates were 100%, 100% and 93.7%, and the 3-year 'biochemical no evidence of disease (bNED)' rates were 100%, 100% and 96.9% for the D'Amico low-, intermediate- and high-risk groups, respectively. No patient developed ≥ Grade 3 early toxicity. The Grade 3 late genitourinary toxicity rate was 2.6%, and no ≥ Grade 3 late gastrointestinal toxicity occurred. The efficacy and safety of this study were satisfactory, and longer-term follow-up is necessary.
• Effects of casein phosphopeptide-amorphous calcium phosphate with sodium fluoride on root surface conditions in head and neck radiotherapy patients

  Kouji Katsura, Marie Soga, Eisuke Abe, Hiroshi Matsuyama, Hidefumi Aoyama, Takafumi Hayashi

  ORAL RADIOLOGY Springer 32 (2) 105 - 110 0911-6028 2016/05 [Refereed][Not invited]
   

  Objectives This study evaluated the effects of combined topical sodium fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste application on root surface conditions in cancer patients undergoing head and neck radiotherapy.Patients and methods Nineteen patients undergoing conventional external radiotherapy in head and neck cancer were enrolled and divided into CPP-ACP (topical sodium fluoride/daily CPP-ACP paste application) and Non-CPP-ACP (topical fluoride application alone) groups. Chronological root surface texture changes were prospectively investigated for 1 year.Results The mean radiation dose of the parotid gland did not differ significantly between the CPP-ACP and Non-CPP-ACP groups. From baseline to 6 and 6-12 months, the CPP-ACP group had significantly better root surface textures than those in the Non-CPP-ACP group (p = 0.001 and p < 0.001, respectively). The hard surface numbers in the CPP-ACP group increased from 347 to 350 in 12 months. The respective soft lesion incidence rates from baseline to 6, 6-12, and baseline to 12 months were significantly lower in the CPP-ACP group than those in the Non-CPP-ACP group (per patient: p = 0.038, p = 0.038, and p = 0.029; per root surface: p = 0.026, p < 0.001, and p < 0.001).Conclusions The present results suggest that dental management with a combination of topical sodium fluoride and CPP-ACP paste application can control root surface caries more effectively than topical sodium fluoride alone in patients undergoing head and neck radiotherapy.
• 【放射線治療-最近の動向と展望】原発性・転移性脳腫瘍への放射線治療

  中野 智成, 高橋 春奈, 棚邊 哲史, 斎藤 紘丈, 青山 英史

  カレントテラピー (株)ライフメディコム 34 (5) 424 - 430 0287-8445 2016/05
• Acute coronary syndrome: evaluation of detection capability using non-electrocardiogram-gated parenchymal phase CT imaging.

  Motohiko Yamazaki, Takeshi Higuchi, Toshikazu Shimokoshi, Takao Kiguchi, Yosuke Horii, Norihiko Yoshimura, Hidefumi Aoyama

  Japanese journal of radiology 34 (5) 331 - 8 2016/05 

  PURPOSE: To evaluate the capability to detect acute coronary syndrome (ACS) by using non-electrocardiogram-gated parenchymal phase CT imaging. MATERIALS AND METHODS: Of 962 consecutive patients who underwent emergent coronary angiography for suspected ACS, 32 with ACS who underwent CT ≤24 h before angiography and 15 without ACS who underwent CT ≤24 h before or after angiography were included. Parenchymal phase was acquired at 100-s scan delay. The presence of a myocardial perfusion defect (MPD) on the left ventricle (a decrease of >20 HU) and its capability to detect ACS were evaluated. Results were compared with laboratory findings. RESULTS: MPD was detected in 29 of 32 ACSs. The sensitivity, specificity, and positive and negative predictive values were 91 % (29/32), 93 % (14/15), 97 % (29/30), and 82 % (14/17), respectively. The sensitivities of ST- and non-ST-elevation ACSs were 89 % (16/18) and 93 % (13/14), respectively, without significant difference (P > 0.99). Of the CT-detectable ACS, non-ST-elevation on the electrocardiogram and a normal creatine kinase-myocardial band were observed in 41 % (12/29) and 24 % (7/29), respectively. CONCLUSION: ACS is highly detectable even using conventional parenchymal phase CT imaging. Therefore, even when CT is non-gating, radiologists should carefully evaluate the heart to avoid overlooking ACS.
• 前立腺癌に対する体外照射を併用した高線量率小線源療法 4年間の経験(HIGH-DOSE-RATE BRACHYTHERAPY WITH EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE CANCER: 4-YEAR EXPERIECE)

  劉 君陽, 海津 元樹, 鮎川 文夫, 小日向 美華, 山名 展子, 佐藤 啓, 田中 研介, 川口 弦, 太田 篤, 丸山 克也, 阿部 英輔, 青山 英史, 笹本 龍太

  Japanese Journal of Radiology (公社)日本医学放射線学会 34 (Suppl.) 5 - 5 1867-1071 2016/02
• A case of pancreatic neuroendocrine tumors.

  Masato Moriyama, Yoshifumi Matsumoto, Qiliang Zhou, Kanako Yamana, Yohei Ikeda, Fumio Ayukawa, Eisuke Abe, Seijiro Sato, Kabuto Takano, Motoki Kaidu, Hidefumi Aoyama, Yasuo Saijo

  International cancer conference journal 5 (1) 1 - 4 2016/01 

  Pancreatic neuroendocrine tumors (pNETs) are an uncommon malignancy arising from the neuroendocrine cells of pancreas. Most cases of pNETs present with metastatic disease, but there are few reports in the literature describing pNETs metastasis to the lung and mediastinal lymph nodes [1]. Moreover, although a multimodal treatment including surgical resection and chemotherapy is acceptable for management of pNETs, advanced pNETs still remain a difficult therapeutic challenge [2, 3]. Radiotherapy or combined chemoradiotherapy has not been standard in the treatment of pNETs. An 80-year-old female was admitted to our hospital with cough and anorexia. She had been diagnosed and resected pNETs 8 years ago. Mass shadow was pointed out with chest X-ray, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed. Pathological examination revealed neuroendocrine tumors, so the lung mass was considered as metastasis of pNETs. Then, we discussed her treatment at Cancer Board, and radiotherapy was chosen. We hope this case suggests that radiotherapy will be one of the treatment options for metastatic pNETs.
• CT measurement of splenic volume changes as a result of hypovolemic shock.

  Takao Kiguchi, Takeshi Higuchi, Naoya Takahashi, Toshikazu Shimokoshi, Motohiko Yamazaki, Norihiko Yoshimura, Hidefumi Aoyama

  Japanese journal of radiology 33 (10) 645 - 9 2015/10 

  PURPOSE: To evaluate the changes in splenic volume during hypovolemic shock and after recovery by use of multidetector computed tomography (MDCT). MATERIALS AND METHODS: We investigated 22 cases who underwent MDCT during hypovolemic shock up to 3 h after presentation, compared the splenic volume with that after recovery, and evaluated the volume difference. We compared the volume ratio (recovery/shock) for two age groups: under 60 years (n = 10) and 60 years and over (n = 12). For cases (n = 10) undergoing CT examination twice after treatment, we compared the volume ratios by using the initial recovery CT and the second CT images. RESULTS: The average spleen volume in shock was 63 cm(3); under normal conditions it was 132 cm(3) (P < 0.001). The average volume ratio for groups under 60 years old was 2.34; for groups 60 years and over it was 2.05 (P = 0.051). The average volume ratio obtained by use of the initial post-recovery CT was 2.11; the ratio obtained by use of the second post-recovery CT was 2.16 (P = 0.386). CONCLUSIONS: Our results revealed that splenic volume was reduced during hypovolemic shock and rapidly increased after recovery. Splenic contraction is an important CT finding in shock.
• Superiority of a soft tissue-based setup using cone-beam computed tomography over a bony structure-based setup in intensity-modulated radiotherapy for prostate cancer.

  Hiraku Sato, Eisuke Abe, Satoru Utsunomiya, Motoki Kaidu, Nobuko Yamana, Kensuke Tanaka, Atsushi Ohta, Mika Obinata, Junyang Liu, Gen Kawaguchi, Katsuya Maruyama, Fumio Ayukawa, Hidefumi Aoyama

  Journal of applied clinical medical physics 16 (5) 239–245  2015/09/08 

  The purpose of this study was to test the superiority of a soft tissue-based setup using cone-beam computed tomography (CBCT) to a bony structure-based setup using the ExacTrac system in intensity-modulated radiotherapy (IMRT) for prostate cancer. We studied 20 patients with localized prostate cancer who received IMRT between November 2010 and February 2012. After the initial setup, the pelvic bony structure-based setup and ExacTrac system were applied. After that, CBCT and a soft tissue-based setup were used. A shift in the isocenter between the ExacTrac-based and CBCT-based setup was recorded in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) axes. The shift was considered an interfractional prostate shift. Post-treatment CBCT was also taken once a week to measure the intrafractional prostate shift, based on the coordinates of the isocenter between pre- and post-treatment CBCT. The planning target volume (PTV) margins were determined using van Herk's method. We measured the elapsed time required for soft tissue matching and the entire treatment time using CBCT. The means ± standard deviation (SD) of the inter- and intrafractional shifts were 0.9 ± 2.8 mm and -0.3 ± 1.4 mm in the AP, 0.9 ± 2.2 mm and -0.1 ± 1.2 mm in the SI, and 0.1 ± 0.7 mm and -0.1 ± 0.7 mm in the LR directions. The PTV margins in the cases of bony structure-based and soft tissue-based setups were 7.3 mm and 2.7 mm in the AP, 5.8 mm and 2.3 mm in the SI, and 1.9 mm and 1.2 mm in the LR directions. Even though the median elapsed time using CBCT was expanded in 5.9 min, the PTV margins were significantly reduced. We found the calculated PTV margins in the soft tissue-based setup using CBCT were small, and this arrangement was superior to the bony structure-based setup in prostate IMRT.
• 全脳脊髄照射を要する小児脳腫瘍における術後2週間以内のG-CSF単独自家末梢血幹細胞採取

  細貝 亮介, 高地 貴行, 吉田 咲子, 岩渕 晴子, 今村 勝, 申 将守, 笠原 靖史, 齋藤 昭彦, 佐野 正和, 西山 健一, 阿部 英輔, 青山 英史, 吉村 淳一, 今井 千速

  日本小児血液・がん学会雑誌 (一社)日本小児血液・がん学会 52 (2) 133 - 138 2187-011X 2015/08 

  悪性脳腫瘍に対する全脳脊髄照射(CSI)では頭蓋骨及び全脊椎の骨髄組織が障害されるため、CSI後の強力な化学療法では骨髄抑制が著しく遷延し、結果的に治療全体の強度が低下することが大きな問題である。そこで我々は、CSI及び強力な化学療法を要する悪性脳腫瘍に対しG-CSF単独の末梢血幹細胞(PBSC)採取を試み、化学療法に自家末梢血幹細胞移植(aPBSCT)を併用することとした。早期にCSIを開始するため、術後2週以内の採取完了を目指した。初発未治療例6例では中央値12.6×10^6/kg(3.9-21.6×10^6/kg)のCD34陽性細胞採取が可能だったが、うち2例では複数回のaPBSCTに十分な細胞数に達しなかった。再発例の2例では少なくとも1回の移植に必要な量は採取できた。これら4例ではaPBSCT併用化学療法1コース終了後に再度PBSC採取を行い十分量が確保できた(13.7-42.1×10^6/kg)。術後2週以内のPBSC採取では白血球数が増加しやすい傾向にあったが、重篤な有害事象はみられなかった。全例で予定した複数回aPBSCTを実施でき、骨髄抑制の遷延をきたすことなく規定の間隔で化学療法を完遂できた。術後2週以内のG-CSF単独PBSC採取は安全に実施できたものの少数例の経験であり、術後早期にCSIを要する悪性脳腫瘍の集学的治療における有効性に関しては更なる検討を要する。(著者抄録)
• Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: correlations with the apparent diffusion coefficient and cell density.

  Akiko Tasaki, Mina O Asatani, Hajime Umezu, Katsunori Kashima, Takayuki Enomoto, Norihiko Yoshimura, Hidefumi Aoyama

  Abdominal imaging 40 (6) 1742 - 52 2015/08 

  The purpose of this study is to investigate the utility of the apparent diffusion coefficient (ADC) in differentiating benign and malignant uterine smooth muscle tumors classified by signal intensity (SI) on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), and to determine the correlation between ADC and tumor cell density. This retrospective study reviewed 168 lesions in 134 cases with pathologically confirmed uterine smooth muscle tumors, including 6 leiomyosarcomas and 3 smooth muscle tumors of uncertain malignant potential, and preoperative magnetic resonance imaging examinations performed between October 2009 and November 2012. T2WI and DWI were also performed for each subject. Tumors were then classified according to SI on T2WI and DWI relative to myometrial SI. The correlation between ADC and tumor cell density was also determined. In Group 1 (high on both T2WI/DWI), mean ADC was significantly lower for leiomyosarcoma (0.91 × 10(-3) mm(2)/s) than for leiomyoma (1.30 × 10(-3) mm(2)/s; p < 0.05) and mean cell density significantly higher for leiomyosarcoma (42.9%) than for leiomyoma (22.4%; p < 0.05). A strong negative correlation was seen between ADC and tumor cell density in Group 1 (Spearman, R = -0.72; p < 0.05). ADC may help to differentiate benign from malignant uterine smooth muscle tumors, particularly tumors with high SI on T2WI and DWI.
• Development of a video image-based QA system for the positional accuracy of dynamic tumor tracking irradiation in the Vero4DRT system.

  Kazuyu Ebe, Satoru Sugimoto, Satoru Utsunomiya, Hiroshi Kagamu, Hidefumi Aoyama, Laurence Court, Katsuichi Tokuyama, Ryuta Baba, Yoshisada Ogihara, Kosuke Ichikawa, Joji Toyama

  Medical physics 42 (8) 4745 - 54 2015/08 

  PURPOSE: To develop and evaluate a new video image-based QA system, including in-house software, that can display a tracking state visually and quantify the positional accuracy of dynamic tumor tracking irradiation in the Vero4DRT system. METHODS: Sixteen trajectories in six patients with pulmonary cancer were obtained with the ExacTrac in the Vero4DRT system. Motion data in the cranio-caudal direction (Y direction) were used as the input for a programmable motion table (Quasar). A target phantom was placed on the motion table, which was placed on the 2D ionization chamber array (MatriXX). Then, the 4D modeling procedure was performed on the target phantom during a reproduction of the patient's tumor motion. A substitute target with the patient's tumor motion was irradiated with 6-MV x-rays under the surrogate infrared system. The 2D dose images obtained from the MatriXX (33 frames/s; 40 s) were exported to in-house video-image analyzing software. The absolute differences in the Y direction between the center of the exposed target and the center of the exposed field were calculated. Positional errors were observed. The authors' QA results were compared to 4D modeling function errors and gimbal motion errors obtained from log analyses in the ExacTrac to verify the accuracy of their QA system. The patients' tumor motions were evaluated in the wave forms, and the peak-to-peak distances were also measured to verify their reproducibility. RESULTS: Thirteen of sixteen trajectories (81.3%) were successfully reproduced with Quasar. The peak-to-peak distances ranged from 2.7 to 29.0 mm. Three trajectories (18.7%) were not successfully reproduced due to the limited motions of the Quasar. Thus, 13 of 16 trajectories were summarized. The mean number of video images used for analysis was 1156. The positional errors (absolute mean difference + 2 standard deviation) ranged from 0.54 to 1.55 mm. The error values differed by less than 1 mm from 4D modeling function errors and gimbal motion errors in the ExacTrac log analyses (n = 13). CONCLUSIONS: The newly developed video image-based QA system, including in-house software, can analyze more than a thousand images (33 frames/s). Positional errors are approximately equivalent to those in ExacTrac log analyses. This system is useful for the visual illustration of the progress of the tracking state and for the quantification of positional accuracy during dynamic tumor tracking irradiation in the Vero4DRT system.
• Stereotactic Radiosurgery With or Without Whole-Brain Radiotherapy for Brain Metastases: Secondary Analysis of the JROSG 99-1 Randomized Clinical Trial.

  Hidefumi Aoyama, Masao Tago, Hiroki Shirato

  JAMA oncology 1 (4) 457 - 64 2015/07 

  IMPORTANCE: It remains uncertain whether treatment with stereotactic radiosurgery (SRS) alone can be safely applied to all patient populations with 1 to 4 brain metastases (BMs) exhibiting heterogeneous prognoses. OBJECTIVE: To investigate the feasibility of SRS alone for patients with different prognoses determined by the diagnosis-specific Graded Prognostic Assessment (DS-GPA). DESIGN, SETTING, AND PARTICIPANTS: A secondary analysis (performed in September 2014) of the Japanese Radiation Oncology Study Group (JROSG) 99-1, a phase 3 randomized trial, comparing SRS alone and whole-brain radiotherapy (WBRT) + SRS conducted in 1999 to 2003. Among a total of 132 patients, 88 with non-small-cell lung cancer (NSCLC) and 1 to 4 BMs were included and poststratified by DS-GPA scores to avoid potential bias from BMs from different primary cancer types. The median follow-up time was 8.05 months. INTERVENTIONS: The WBRT schedule was 30 Gy in 10 fractions over 2 to 2.5 weeks. The mean SRS dose was 21.9 Gy in SRS alone and 16.6 Gy in WBRT + SRS. MAIN OUTCOMES AND MEASURES: The primary end point was overall survival (OS), and the secondary end points included brain tumor recurrence (BTR), salvage treatment, and radiation toxic effects. RESULTS: Forty-seven patients had a favorable prognosis, with DS-GPA scores of 2.5 to 4.0 (26 SRS-alone and 21 WBRT + SRS [DS-GPA 2.5-4.0 group]), and 41 had an unfavorable prognosis, with DS-GPA scores of 0.5 to 2.0 (19 SRS-alone and 22 WBRT + SRS [DS-GPA 0.5-2.0 group]). Significantly better OS was observed in the DS-GPA 2.5-4.0 group in WBRT + SRS vs the SRS alone, with a median survival time of 16.7 (95% CI, 7.5-72.9) months vs 10.6 (95% CI, 7.7-15.5) months (P = .04) (hazard ratio [HR], 1.92; 95% CI, 1.01-3.78). However, no such difference was observed in the DS-GPA 0.5-2.0 group (HR, 1.05; 95% CI, 0.55-1.99) (P = .86). This benefit could be explained by the differing BTR rates, in that the prevention against BTR by WBRT had a more significant impact in the DS-GPA 2.5-4.0 group (HR, 8.31; 95% CI, 3.05-29.13) (P < .001) vs the DS-GPA 0.5-2.0 group (HR, 3.57; 95% CI, 1.02-16.49) (P = .04). CONCLUSIONS AND RELEVANCE: Despite the current trend of using SRS alone, the important role of WBRT for patients with BMs from NSCLC with a favorable prognosis should be considered. Our findings should be validated through appropriately designed prospective studies. TRIAL REGISTRATION: umin.ac.jp/ctr Identifier: C000000412.
• Response assessment criteria for brain metastases: proposal from the RANO group.

  Nancy U Lin, Eudocia Q Lee, Hidefumi Aoyama, Igor J Barani, Daniel P Barboriak, Brigitta G Baumert, Martin Bendszus, Paul D Brown, D Ross Camidge, Susan M Chang, Janet Dancey, Elisabeth G E de Vries, Laurie E Gaspar, Gordon J Harris, F Stephen Hodi, Steven N Kalkanis, Mark E Linskey, David R Macdonald, Kim Margolin, Minesh P Mehta, David Schiff, Riccardo Soffietti, John H Suh, Martin J van den Bent, Michael A Vogelbaum, Patrick Y Wen

  The Lancet. Oncology 16 (6) e270-8  2015/06 

  CNS metastases are the most common cause of malignant brain tumours in adults. Historically, patients with brain metastases have been excluded from most clinical trials, but their inclusion is now becoming more common. The medical literature is difficult to interpret because of substantial variation in the response and progression criteria used across clinical trials. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group is an international, multidisciplinary effort to develop standard response and progression criteria for use in clinical trials of treatment for brain metastases. Previous efforts have focused on aspects of trial design, such as patient population, variations in existing response and progression criteria, and challenges when incorporating neurological, neuro-cognitive, and quality-of-life endpoints into trials of patients with brain metastases. Here, we present our recommendations for standard response and progression criteria for the assessment of brain metastases in clinical trials. The proposed criteria will hopefully facilitate the development of novel approaches to this difficult problem by providing more uniformity in the assessment of CNS metastases across trials.
• Factors predicting aggressiveness of non-hypervascular hepatic nodules detected on hepatobiliary phase of gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid magnetic resonance imaging.

  Tsutomu Kanefuji, Toru Takano, Takeshi Suda, Kouhei Akazawa, Takeshi Yokoo, Hiroteru Kamimura, Kenya Kamimura, Atsunori Tsuchiya, Masaaki Takamura, Hirokazu Kawai, Satoshi Yamagiwa, Hidefumi Aoyama, Minoru Nomoto, Shuji Terai

  World journal of gastroenterology 21 (15) 4583 - 91 2015/04/21 

  AIM: To establish a prognostic formula that distinguishes non-hypervascular hepatic nodules (NHNs) with higher aggressiveness from less hazardous one. METHODS: Seventy-three NHNs were detected in gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid magnetic resonance imaging (Gd-EOB-DTPA-MRI) study and confirmed to change 2 mm or more in size and/or to gain hypervascularity. All images were interpreted independently by an experienced, board-certified abdominal radiologist and hepatologist; both knew that the patients were at risk for hepatocellular carcinoma development but were blinded to the clinical information. A formula predicting NHN destiny was developed using a generalized estimating equation model with thirteen explanatory variables: age, gender, background liver diseases, Child-Pugh class, NHN diameter, T1-weighted imaging/T2-weighted imaging detectability, fat deposition, lower signal intensity in arterial phase, lower signal intensity in equilibrium phase, α-fetoprotein, des-γ-carboxy prothrombin, α-fetoprotein-L3, and coexistence of classical hepatocellular carcinoma. The accuracy of the formula was validated in bootstrap samples that were created by resampling of 1000 iterations. RESULTS: During a median follow-up period of 504 d, 73 NHNs with a median diameter of 9 mm (interquartile range: 8-12 mm) grew or shrank by 68.5% (fifty nodules) or 20.5% (fifteen nodules), respectively, whereas hypervascularity developed in 38.4% (twenty eight nodules). In the fifteen shrank nodules, twelve nodules disappeared, while 11.0% (eight nodules) were stable in size but acquired vascularity. A generalized estimating equation analysis selected five explanatories from the thirteen variables as significant factors to predict NHN progression. The estimated regression coefficients were 0.36 for age, 6.51 for lower signal intensity in arterial phase, 8.70 or 6.03 for positivity of hepatitis B virus or hepatitis C virus, 9.37 for des-γ-carboxy prothrombin, and -4.05 for fat deposition. A formula incorporating the five coefficients revealed sensitivity, specificity, and accuracy of 88.0%, 86.7%, and 87.7% in the formulating cohort, whereas these of 87.2% ± 5.7%, 83.8% ± 13.6%, and 87.3% ± 4.5% in the bootstrap samples. CONCLUSION: These data suggest that the formula helps Gd-EOB-DTPA-MRI detect a trend toward hepatocyte transformation by predicting NHN destiny.
• Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis.

  Arjun Sahgal, Hidefumi Aoyama, Martin Kocher, Binod Neupane, Sandra Collette, Masao Tago, Prakesh Shaw, Joseph Beyene, Eric L Chang

  International journal of radiation oncology, biology, physics 91 (4) 710 - 7 2015/03/15 [Refereed][Not invited]
   

  PURPOSE: To perform an individual patient data (IPD) meta-analysis of randomized controlled trials evaluating stereotactic radiosurgery (SRS) with or without whole-brain radiation therapy (WBRT) for patients presenting with 1 to 4 brain metastases. METHOD AND MATERIALS: Three trials were identified through a literature search, and IPD were obtained. Outcomes of interest were survival, local failure, and distant brain failure. The treatment effect was estimated after adjustments for age, recursive partitioning analysis (RPA) score, number of brain metastases, and treatment arm. RESULTS: A total of 364 of the pooled 389 patients met eligibility criteria, of whom 51% were treated with SRS alone and 49% were treated with SRS plus WBRT. For survival, age was a significant effect modifier (P=.04) favoring SRS alone in patients ≤50 years of age, and no significant differences were observed in older patients. Hazard ratios (HRs) for patients 35, 40, 45, and 50 years of age were 0.46 (95% confidence interval [CI] = 0.24-0.90), 0.52 (95% CI = 0.29-0.92), 0.58 (95% CI = 0.35-0.95), and 0.64 (95% CI = 0.42-0.99), respectively. Patients with a single metastasis had significantly better survival than those who had 2 to 4 metastases. For distant brain failure, age was a significant effect modifier (P=.043), with similar rates in the 2 arms for patients ≤50 of age; otherwise, the risk was reduced with WBRT for patients >50 years of age. Patients with a single metastasis also had a significantly lower risk of distant brain failure than patients who had 2 to 4 metastases. Local control significantly favored additional WBRT in all age groups. CONCLUSIONS: For patients ≤50 years of age, SRS alone favored survival, in addition, the initial omission of WBRT did not impact distant brain relapse rates. SRS alone may be the preferred treatment for this age group.
• 心停止をきたした冠動脈起始異常の1例

  斎藤 紘丈, 堀 祐郎, 吉村 宣彦, 青山 英史, 星名 哲, 鈴木 博, 斎藤 昭彦

  Japanese Journal of Radiology (公社)日本医学放射線学会 33 (Suppl.) 4 - 4 1867-1071 2015/02
• The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer.

  Gen Kawaguchi, Ryuta Sasamoto, Eisuke Abe, Atsushi Ohta, Hiraku Sato, Kensuke Tanaka, Katsuya Maruyama, Motoki Kaizu, Fumio Ayukawa, Nobuko Yamana, Junyang Liu, Manabu Takeuchi, Masaaki Kobayashi, Hidefumi Aoyama

  Radiation oncology (London, England) 10 31 - 31 2015/01/31 

  BACKGROUND: To evaluate the risks and benefits of endoscopic submucosal dissection (ESD) in addition to chemoradiotherapy (CRT) for the treatment of superficial esophageal squamous cell carcinoma (SESCC). METHODS AND MATERIALS: We retrospectively reviewed the treatment outcomes of 47 patients with SESCC treated between October 2000 and December 2011. Sixteen patients with invasion into the submucosal layer (T1b) or the muscularis mucosa (m3) with positive vascular invasion were treated with CRT after ESD (ESD-CRT group). The lymph node area was irradiated to a total dose of 40-44 Gy and a boost radiation was administered if PET-positive lymph nodes or positive margins were observed. The remaining 31 patients received definitive CRT only (dCRT group). RESULTS: The radiation field was significantly larger in the ESD-CRT group; the "long T" was used in 11 patients (35.4%) in the dCRT group and 15 (93.7%) in the ESD-CRT group (p = 0.0001). The total radiation dose was smaller in the ESD-CRT group; 40 Gy was used in 10 patients (62.5%) in the ESD-CRT group and all but one patient in the dCRT group received ≥60 Gy (p = 0.00001). The 3-year overall survival rates in the dCRT and ESD-CRT groups were 63.2% and 90.0% respectively (p = 0.118). Recurrence developed in nine patients (29.0%) in the dCRT group and one (6.3%) in the ESD-CRT group. Local recurrence was observed in six patients (19%) in the dCRT group and none in the ESD-CRT-group (p = 0.029). Pericardial effusion (≥Grade 3) occurred in three patients (9.7%) in the dCRT group and none in the ESD-CRT group. CONCLUSIONS: ESD followed by CRT is an effective and safe approach for SESCC at m3 or T1b. This combination of ESD and CRT improves the local control rate, and it could decrease the number of cardiac toxicities due to a radiation-dose reduction relative to CRT alone.
• Can Fiducial Marker-Based Setup Using ExacTrac Be An Alternative to Soft Tissue-Based Setup Using Cone-Beam CT for Prostate IMRT?

  Tanabe, S., Utsunomiya, S., Abe, E., Satou, H., Sakai, H., Yamada, T., Aoyama, H.

  Medical Physics 42 (6) 2015
• A multi-institutional prospective observational study of stereotactic radiosurgery (SRS) for patients with multiple brain metastases (BMs): Updated results of the JLGK0901 Study-Long-term results of irradiation-related complications and neurocognitive function (NCF)

  Yamamoto, Masaaki, Serizawa, Toru, Higuchi, Yoshinori, Sato, Yasunori, Kawagishi, Jun, Yamanaka, Kazuhiro, Shuto, Takashi, Akabane, Atsuya, Jokura, Hidefumi, Yomo, Shoji, Nagano, Osamu, Aoyama, Hidefumi

  Journal of Clinical Oncology 33 (15) 2015
• A combination of preoperative CT findings and postoperative serum CEA levels improves recurrence prediction for stage I lung adenocarcinoma.

  Motohiko Yamazaki, Hiroyuki Ishikawa, Ryosuke Kunii, Akiko Tasaki, Suguru Sato, Yohei Ikeda, Norihiko Yoshimura, Takehisa Hashimoto, Masanori Tsuchida, Hidefumi Aoyama

  European journal of radiology 84 (1) 178 - 184 2015/01 

  OBJECTIVES: To assess the prognostic value of combined evaluation of preoperative CT findings and pre/postoperative serum carcinoembryonic antigen (CEA) levels for pathological stage I lung adenocarcinoma. METHODS: This retrospective study included 250 consecutive patients who underwent complete resection for ≤ 3-cm pathological stage I (T1-2aN0M0) adenocarcinomas (132 men, 118 women; mean age, 67.8 years). Radiologists evaluated following CT findings: maximum tumor diameter, percentage of solid component (%solid), air bronchogram, spiculation, adjacency of bullae or interstitial pneumonia (IP) around the tumor, notch, and pleural indent. These CT findings, pre/postoperative CEA levels, age, gender, and Brinkman index were assessed by Cox proportional hazards model to determine the best prognostic model. Prognostic accuracy was examined using the area under the receiver operating characteristic curve (AUC). RESULTS: Median follow-up period was 73.2 months. In multivariate analysis, high %solid, adjacency of bullae or IP around the tumor, and high postoperative CEA levels comprised the best combination for predicting recurrence (P<0.05). A combination of these three findings had a greater accuracy in predicting 5-year disease-free survival than did %solid alone (AUC=0.853 versus 0.792; P=0.023), with a sensitivity of 85.7% and a specificity of 74.3% at the optimal threshold. The best cut-off values of %solid and postoperative CEA levels for predicting high-risk patients were ≥ 48% and ≥ 3.7 ng/mL, respectively. CONCLUSION: Compared to %solid alone, combined evaluation of %solid, adjacency of bullae or IP change around the tumor, and postoperative CEA levels improves recurrence prediction for stage I lung adenocarcinoma.
• Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms.

  Yohei Ikeda, Norihiko Yoshimura, Yoshiro Hori, Yosuke Horii, Hiroyuki Ishikawa, Motohiko Yamazaki, Yoshiyuki Noto, Hidefumi Aoyama

  European journal of radiology 83 (12) 2260 - 2267 2014/12 

  PURPOSE: The aim of this study was to determine if lung perfusion blood volume (lung PBV) with non-occlusive pulmonary embolism (PE) differs quantitatively and visually from that with occlusive PE and to investigate if lung PBV with non-occlusive PE remains the same as that without PE. MATERIALS AND METHODS: Totally, 108 patients suspected of having acute PE underwent pulmonary dual-energy computed tomography angiography (DECTA) between April 2011 and January 2012. Presence of PE on DECTA was evaluated by one radiologist. Two radiologists visually evaluated the PE distribution (segmental or subsegmental) and its nature (occlusive or non-occlusive) on DECTA and classified perfusion in lung PBV as "decreased," "slightly decreased," and "preserved". Two radiologists used a lung PBV application to set a region of interest (ROI) in the center of the lesion and measured HU values of an iodine map. In the same slice as the ROI of the lesion and close to the lesion, another ROI was set in the normal perfusion area without PE, and HUs were measured. The proportion of lesions was compared between the occlusive and non-occlusive groups. HUs were compared among the occlusive, non-occlusive, and corresponding normal groups. RESULTS: Twenty-five patients had 80 segmental or subsegmental lesions. There were 37 and 43 lesions in the occlusive and non-occlusive groups, respectively. The proportion of decreased lesions was 73.0% (27/37) in the occlusive group, while that of preserved lesions in the non-occlusive group was 76.7% (33/43). There was a significant difference in the proportion of lesions (P<0.001) between the two groups. HUs of the iodine map were significantly higher in the non-occlusive group than in the occlusive group (33.8 ± 8.2 HU vs. 11.9 ± 6.1 HU, P<0.001). There was no significant difference in HUs for the entire lesion between the non-occlusive (33.8 ± 8.2 HU) and corresponding normal group (34.5 ± 6.8 HU; P=0.294). CONCLUSION: Iodine perfusion tended to be visually and quantitatively preserved in lungs with nonocclusive PE. Lung PBV is required to evaluate pulmonary blood flow.
• The value of 4-month neurocognitive function as an endpoint in brain metastases trials.

  Shunsuke Onodera, Hidefumi Aoyama, Khin Khin Tha, Naoki Hashimoto, Atsuhito Toyomaki, Satoshi Terae, Hiroki Shirato

  Journal of neuro-oncology 120 (2) 311 - 9 2014/11 

  To investigate whether the neurocognitive function at 4 months could be a relevant primary endpoint in clinical trials dealing with brain metastases, we created a Japanese neurocognitive battery and examined the changes in patients' neurocognitive function for 1 year after their brain radiotherapy. In this prospective pilot study, we enrolled 27 patients (20 patients who received whole-brain radiation therapy [WBRT] and seven who received stereotactic irradiation [STI] alone) between March 2009 and December 2010. The follow-up neurocognitive data at 4, 8 and 12 months were available in 22 (17 WBRT, 5 STI), 19 patients (14 WBRT, 5 STI) and 13 patients (9 WBRT, 4 STI), respectively. Among the patients who received WBRT, significant deterioration in delayed memory compared to the baseline (p = 0.04) was observed at 4 months, and at 8 months, significant improvements were observed in immediate memory compared to the baseline (p = 0.008) and 4-months scores (p = 0.005). At 12 months, however, the immediate memory scores had returned to the baseline. Similar trends were observed in other functions (delayed memory, attention and executive functions). In these patients, the correlations between 4-months scores of neurocognitive functions and 12-months scores were significant in immediate memory (γ = 0.68, p = 0.004), delayed memory (γ = 0.738, p = 0.023) and attention (γ = 0.817, p = 0.007). Among the patients who received STI, no significant changes were observed in any functions. These results suggest that 4-months changes in neurocognitive functions were transient but could also be a premonitory index for predicting the neurocognitive function 1 year or later after brain radiation therapy.
• Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study.

  Masaaki Yamamoto, Toru Serizawa, Takashi Shuto, Atsuya Akabane, Yoshinori Higuchi, Jun Kawagishi, Kazuhiro Yamanaka, Yasunori Sato, Hidefumi Jokura, Shoji Yomo, Osamu Nagano, Hiroyuki Kenai, Akihito Moriki, Satoshi Suzuki, Yoshihisa Kida, Yoshiyasu Iwai, Motohiro Hayashi, Hiroaki Onishi, Masazumi Gondo, Mitsuya Sato, Tomohide Akimitsu, Kenji Kubo, Yasuhiro Kikuchi, Toru Shibasaki, Tomoaki Goto, Masami Takanashi, Yoshimasa Mori, Kintomo Takakura, Naokatsu Saeki, Etsuo Kunieda, Hidefumi Aoyama, Suketaka Momoshima, Kazuhiro Tsuchiya

  The Lancet. Oncology 15 (4) 387 - 95 2014/04 

  BACKGROUND: We aimed to examine whether stereotactic radiosurgery without whole-brain radiotherapy (WBRT) as the initial treatment for patients with five to ten brain metastases is non-inferior to that for patients with two to four brain metastases in terms of overall survival. METHODS: This prospective observational study enrolled patients with one to ten newly diagnosed brain metastases (largest tumour <10 mL in volume and <3 cm in longest diameter; total cumulative volume ≤15 mL) and a Karnofsky performance status score of 70 or higher from 23 facilities in Japan. Standard stereotactic radiosurgery procedures were used in all patients; tumour volumes smaller than 4 mL were irradiated with 22 Gy at the lesion periphery and those that were 4-10 mL with 20 Gy. The primary endpoint was overall survival, for which the non-inferiority margin for the comparison of outcomes in patients with two to four brain metastases with those of patients with five to ten brain metastases was set as the value of the upper 95% CI for a hazard ratio (HR) of 1·30, and all data were analysed by intention to treat. The study was finalised on Dec 31, 2012, for analysis of the primary endpoint; however, monitoring of stereotactic radiosurgery-induced complications and neurocognitive function assessment will continue for the censored subset until the end of 2014. This study is registered with the University Medical Information Network Clinical Trial Registry, number 000001812. FINDINGS: We enrolled 1194 eligible patients between March 1, 2009, and Feb 15, 2012. Median overall survival after stereotactic radiosurgery was 13·9 months [95% CI 12·0-15·6] in the 455 patients with one tumour, 10·8 months [9·4-12·4] in the 531 patients with two to four tumours, and 10·8 months [9·1-12·7] in the 208 patients with five to ten tumours. Overall survival did not differ between the patients with two to four tumours and those with five to ten (HR 0·97, 95% CI 0·81-1·18 [less than non-inferiority margin], p=0·78; pnon-inferiority<0·0001). Stereotactic radiosurgery-induced adverse events occurred in 101 (8%) patients; nine (2%) patients with one tumour had one or more grade 3-4 event compared with 13 (2%) patients with two to four tumours and six (3%) patients with five to ten tumours. The proportion of patients who had one or more treatment-related adverse event of any grade did not differ significantly between the two groups of patients with multiple tumours (50 [9%] patients with two to four tumours vs 18 [9%] with five to ten; p=0·89). Four patients died, mainly of complications relating to stereotactic radiosurgery (two with one tumour and one each in the other two groups). INTERPRETATION: Our results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases. FUNDING: Japan Brain Foundation.
• 肺塞栓症におけるLung PBVの血流低下域についての検討

  池田 洋平, 佐藤 卓, 山崎 元彦, 堀 祐郎, 石川 浩志, 吉村 宣彦, 青山 英史

  Japanese Journal of Radiology (公社)日本医学放射線学会 32 (Suppl.) 1 - 1 1867-1071 2014/02
• Relationship between CT features and high preoperative serum carcinoembryonic antigen levels in early-stage lung adenocarcinoma

  Yamazaki, M., Ishikawa, H., Kunii, R., Tasaki, A., Sato, S., Ikeda, Y., Yoshimura, N., Aoyama, H.

  Clinical Radiology 69 (6) 2014
• Salvage endoscopic submucosal dissection in patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma.

  Manabu Takeuchi, Masaaki Kobayashi, Satoru Hashimoto, Ken-Ichi Mizuno, Gen Kawaguchi, Ryuta Sasamoto, Hidefumi Aoyama, Yutaka Aoyagi

  Scandinavian journal of gastroenterology 48 (9) 1095 - 101 2013/09 

  OBJECTIVE: For locoregional failure after chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma (ESCC), salvage esophagectomy and endoscopic mucosal resection have disadvantages, such as a high morbidity rate and a high local recurrence rate, respectively. The aim of this study was to clarify the efficacy of salvage endoscopic submucosal dissection (ESD) for locoregional failure of CRT. METHODS: A total of 19 lesions in 19 patients were treated with salvage ESD; 15 lesions were local recurrences at the primary site and 4 lesions were residual. All lesions were intramucosal or submucosal tumors without metastases. A case-control study was retrospectively evaluated to clarify whether the clinical outcomes of salvage ESD were equivalent to those of control primary ESD. RESULTS: No significant differences were observed between salvage ESD and primary ESD in short-term outcomes, including procedure time. For salvage ESD, the complete en bloc resection rate was 94.7% (18 of 19), and no severe complications were observed. At a median follow up of 54.6 (range: 5-98) months after salvage ESD, the local recurrence rate was 0%. However, three patients (15.8%) died due to lymph node and distant metastases and six patients (31.5%) died from other diseases, including radiation pneumonitis, pyothorax or respiratory failure with no recurrence of ESCC. The 3-year overall survival rate for all 19 patients was 74%. CONCLUSIONS: ESD represents an acceptable treatment option for recurrent or residual ESCC because of its improvement in local control, when local failure after CRT is limited to the submucosal layer without metastases.
• Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group.

  Nancy U Lin, Eudocia Q Lee, Hidefumi Aoyama, Igor J Barani, Brigitta G Baumert, Paul D Brown, D Ross Camidge, Susan M Chang, Janet Dancey, Laurie E Gaspar, Gordon J Harris, F Stephen Hodi, Steven N Kalkanis, Kathleen R Lamborn, Mark E Linskey, David R Macdonald, Kim Margolin, Minesh P Mehta, David Schiff, Riccardo Soffietti, John H Suh, Martin J van den Bent, Michael A Vogelbaum, Jeffrey S Wefel, Patrick Y Wen

  The Lancet. Oncology 14 (10) e396-406  2013/09 

  Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials.
• Challenges relating to solid tumour brain metastases in clinical trials, part 2: neurocognitive, neurological, and quality-of-life outcomes. A report from the RANO group.

  Nancy U Lin, Jeffrey S Wefel, Eudocia Q Lee, David Schiff, Martin J van den Bent, Riccardo Soffietti, John H Suh, Michael A Vogelbaum, Minesh P Mehta, Janet Dancey, Mark E Linskey, D Ross Camidge, Hidefumi Aoyama, Paul D Brown, Susan M Chang, Steven N Kalkanis, Igor J Barani, Brigitta G Baumert, Laurie E Gaspar, F Stephen Hodi, David R Macdonald, Patrick Y Wen

  The Lancet. Oncology 14 (10) e407-16  2013/09 

  Neurocognitive function, neurological symptoms, functional independence, and health-related quality of life are major concerns for patients with brain metastases. The inclusion of these endpoints in trials of brain metastases and the methods by which these measures are assessed vary substantially. If functional independence or health-related quality of life are planned as key study outcomes, then the reliability and validity of these endpoints can be crucial because methodological issues might affect the interpretation and acceptance of findings. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, and collaborative effort to improve the design of clinical trials in patients with brain tumours. In this report, the second in a two-part series, we review clinical trials of brain metastases in relation to measures of clinical benefit and provide a framework for the design and conduct of future trials.
• Clinical results after the multidisciplinary treatment of spinal arteriovenous fistulas.

  Shoichi Inagawa, Shuhei Yamashita, Hisaya Hiramatsu, Mika Kamiya, Tokutaro Tanaka, Harumi Sakahara, Hidefumi Aoyama

  Japanese journal of radiology 31 (7) 455 - 64 2013/07 

  PURPOSE: We retrospectively evaluated the clinical outcome after multidisciplinary treatment of spinal arteriovenous fistulas (AVFs) in terms of the Aminoff-Logue grading scale (ALS) to depict the outcome in a perspective pertinent to the quality of everyday living. MATERIALS AND METHODS: Twenty-six spinal AVFs in 25 patients were angiographically diagnosed from April 1998 through April 2012 and treated by endovascular embolization or surgery. When both treatment procedures seemed feasible, embolization was undertaken as the initial treatment. Motor and gait disturbance at follow-up was retrospectively graded according to ALS. RESULTS: All lesions were localized at the thoracolumbar or sacral levels and include six epidural AVFs with intradural venous reflux, 14 dural AVFs, and six perimedullary AVFs. Embolization was performed as the initial treatment for 17 lesions, while open surgery was performed for the others as well as for residual or recurrent lesions after embolization. All lesions were completely occluded except three perimedullary AVFs. At clinical follow-up of 1-153 months (mean 53.3), amelioration of gait disturbance with reduction of ALS scores was noted for 13 lesions and amelioration of micturition for 13 lesions as well. CONCLUSION: Clinical functional status was improved for half of the lesions after the multidisciplinary treatment.
• 限局性の前立腺癌に対する高線量率組織内照射療法による急性期有害事象の検討

  海津 元樹, 丸山 克也, 小日向 美華, 山名 展子, 西山 勉, 笠原 隆, 佐藤 啓, 田中 研介, 川口 弦, 阿部 英輔, 笹本 龍太, 青山 英史

  臨床放射線 金原出版(株) 58 (5) 717 - 723 0009-9252 2013/05 

  2009年6月〜2011年4月に前立腺癌に対し、外照射と高線量率組織内照射の組み合わせで根治的な放射線治療を施行した64例を対象に、急性期の有害事象、主に尿路障害および消化管障害の発生頻度について調査した。対象はリンパ節および遠隔転移のない前立腺癌でUICC分類T1〜T3までの症例とした。Common Terminology Criteria Version4.0(CTCAE Ver4.0)でグレード(G)1以上の尿路障害は55例みられた。そのうちG2以上は8例で、内訳はG2頻尿3例、G2尿路痛2例、G2尿閉2例、G3前立腺痛1例であった。G1以上の消化管障害は34例で、G2以上は2例存在し、いずれも下痢症状であった。消化管以外の有害事象としてG2腰痛2例、G3意識消失発作2例、G1足背浮腫1例がみられた。意識消失発作はいずれも迷走神経反射によるもので、補液、硫酸アトロピン投与で軽快した。なお、アプリケータ抜去直後数日間は血尿が全例必発となり、出血量に応じ一時的な血圧低下が起こる症例もみられた。これらの項目は侵襲的な操作に伴い起こる有害事象のため集計から除いた。
• 子宮頸癌の放射線治療

  鮎川 文夫, 海津 元樹, 阿部 英輔, 笹本 龍太, 土田 恵美子, 杉田 公, 松本 康男, 伊藤 猛, 青山 英史

  日本医学放射線学会学術集会抄録集 (公社)日本医学放射線学会 72回 S295 - S295 0048-0428 2013/02
• Symptomatic outcomes in relation to tumor expansion after fractionated stereotactic radiation therapy for vestibular schwannomas: single-institutional long-term experience.

  Hidefumi Aoyama, Shunsuke Onodera, Norihito Takeichi, Rikiya Onimaru, Shunsuke Terasaka, Yutaka Sawamura, Hiroki Shirato

  International journal of radiation oncology, biology, physics 85 (2) 329 - 34 2013/02/01 

  PURPOSE: The effect of transient tumor expansion after conventionally fractionated stereotactic radiation therapy (SRT) on the symptomatic outcomes is not well-known. METHODS AND MATERIALS: This study enrolled 201 consecutive patients who received SRT for vestibular schwannoma. A conventional fractionation schedule was applied in 194 patients (97%), and 142 (71%) received a total dose of 50 Gy. The median follow-up time was 72 months. RESULTS: The maximum diameter was 9 mm or less in 13 patients, 10-19 mm in 79 patients, 20-29 mm in 87 patients, and 30 mm or greater in 22 patients. At presentation, tumor size of 20 mm or greater was significantly associated with loss of serviceable hearing and trigeminal neuropathy. After SRT, tumor expansion was observed in 42 patients (21%). By tumor size, tumor expansion was observed in 0%, 11.4%, 25.6%, and 50% of patients with tumors of 9 mm or less, 10-19 mm, 20-29 mm, and 30 mm or greater, respectively, in diameter. The tumor expansion was significantly associated with an increased risk of hydrocephalus requiring shunt placement (P=.004), loss of serviceable hearing (P=.0064), and worsening of facial (P<.0001) and trigeminal nerve (P<.0001) functions. Spontaneous tumor shrinkage was observed in 29 of those 42 patients, mostly within 2 years after the expansion, and the majority of the worsened symptoms except for hearing resolved once the tumor had shrunk. As a result, salvage surgical resection for symptomatic relief was required in only 5% of patients. CONCLUSIONS: Fractionated SRT could be safely applied even for medium- to large-sized (≥20 mm) tumors. However, greater knowledge of the risks and consequences, including transient symptomatic worsening, and the time span of expansion will be required for the follow-up of patients after SRT to avoid unnecessary surgical intervention.
• Comment.

  Hidefumi Aoyama

  Neurosurgery 71 (4) 851 - 851 2012/10
• 新潟大学における、前立腺癌高線量率組織内照射療法の初期治療経験

  笠原 隆, 西山 勉, 笹本 龍太, 海津 元樹, 丸山 克也, 小日向 美華, 青山 英史, 高橋 公太

  泌尿器外科 医学図書出版(株) 25 (8) 1663 - 1666 0914-6180 2012/08 

  当院では、2009年より前立腺癌に対する放射線外照射併用による高線量率組織内照射療法(HDRBT)を開始した。初期経験(58例)における治療成績およびQOLの変化について検討した。周術期合併症(grade 2)が8例で認められた。追跡期間中央値20ヵ月にて、再発は1例のみであった。QOLに関しては、包括的尺度の一部および排尿機能においてHDRBT施行後早期より有意に低下したが、いずれも時間経過とともに改善する傾向が認められた。(著者抄録)
• [Short course radiotherapy in elderly patients with high-grade glioma].

  Hiroshi Aoki, Manabu Natsumeda, Eisuke Abe, Takeo Uzuka, Tsutomu Kobayashi, Hidefumi Aoyama, Yukihiko Fujii

  No shinkei geka. Neurological surgery 40 (7) 593 - 8 0301-2603 2012/07 

  PURPOSE: There is no standard therapy for elderly patients with high-grade glioma. We have adopted short course radiotherapy for such patients since 2005. The efficacy of this therapy was assessed retrospectively. METHODS: This study reviewed 16 newly diagnosed high-grade glioma patients aged 75 years or older who were treated with short course radiotherapy (focal radiation in daily fraction of 3 Gy given 5 days per week, for a total dose of 39 Gy). RESULTS: All patients received 100% of the planed radiation dose. No patients received prior or concomitant chemotherapy. Thirteen patients had died and median follow-up period was 9 months at the time of analysis. The median age at surgery was 79 years (range 75-86). The estimated median overall survival was 9.6 months. The median Karnofsky Performance Status on admission was 60% (range 40-90) and at discharge was 60% (range 40-80). The median length of hospital stay was 38 days (range 19-61). There is no severe adverse events related to radiation therapy. The rate of discharge to home was 69%. CONCLUSION: Short course radiotherapy can reduce the treatment time and adverse events of conventional radiotherapy without decrement in survival. This therapy seems to be a considerable treatment option for elderly patients with high-grade glioma.
• Where is the most common site of DVT? Evaluation by CT venography.

  Norihiko Yoshimura, Yoshiro Hori, Yosuke Horii, Toru Takano, Hiroyuki Ishikawa, Hidefumi Aoyama

  Japanese journal of radiology 30 (5) 393 - 7 2012/06 

  PURPOSE: Our aim was to clarify the common site of deep venous thrombosis (DVT) in patients suspected of having pulmonary embolism using computed tomography pulmonary angiography with computed tomography venography (CTV). MATERIALS AND METHODS: We evaluated 215 patients. For all studies, 100 ml of 370 mg I/ml nonionic contrast material was administered. CTV were scanned with helical acquisition starting at 3 min in four-slice multidetector-row computed tomography (MDCT) or 5 min in 64-MDCT after the start of contrast material injection. The site of DVT was divided into iliac vein, femoral vein, popliteal vein, or calf vein. Calf vein was divided into muscular (soleal and gastrocnemius) and nonmuscular (anterior/posterior tibial and peroneal) veins. The 2 × 2 chi-square test was used. RESULTS: One hundred and thirty-seven patients showed DVT; the muscular calf vein was more prevalent than other veins (P < 0.01). CONCLUSIONS: Our study showed that the most common site of DVT was the muscular calf vein.
• The sternalis muscle: Radiologic findings on MDCT

  Motoi Shiotani, Takeshi Higuchi, Norihiko Yoshimura, Takao Kiguchi, Naoya Takahashi, Haruo Maeda, Hidefumi Aoyama

  Japanese Journal of Radiology 36 (4) 312  1867-108X 2012/04/01 [Refereed][Not invited]
   

  In the original publication of the article, the seventh author name was incorrectly published as Hidehumi Aoyama. The correct author name should read as Hidefumi Aoyama.
• 自然に縮小した肺癌の2例

  山崎 元彦, 石川 浩志, 國井 亮祐, 麻谷 美奈, 青山 英史, 篠原 博彦, 橋本 毅久, 土田 正則, 大橋 瑠子, 梅津 哉

  Japanese Journal of Radiology (公社)日本医学放射線学会 30 (Suppl.I) 1 - 1 1867-1071 2012/02
• 限局期前立腺癌に対する外照射併用高線量率組織内照射の初期経験

  丸山 克也, 笹本 龍太, 川口 弦, 福田 貴徳, 阿部 英輔, 海津 元樹, 青山 英史, 笠原 隆, 西山 勉, 高橋 公太

  Japanese Journal of Radiology (公社)日本医学放射線学会 30 (Suppl.I) 6 - 6 1867-1071 2012/02
• 前立腺癌強度変調放射線治療(IMRT)におけるkV-CBCTを用いたorgan motionの検討

  佐藤 啓, 阿部 英輔, 笹本 龍太, 海津 元樹, 山名 展子, 川口 弦, 小日向 美華, 田中 研介, 青山 英史

  日本医学放射線学会学術集会抄録集 (公社)日本医学放射線学会 71回 S286 - S286 0048-0428 2012/02
• 前立腺癌高線量率組織内照射療法における急性期有害事象の検討

  海津 元樹, 丸山 克也, 小日向 美華, 山名 展子, 佐藤 啓, 田中 研介, 阿部 英輔, 笹本 龍太, 青山 英史

  日本医学放射線学会学術集会抄録集 (公社)日本医学放射線学会 71回 S289 - S289 0048-0428 2012/02
• The role of whole brain radiation therapy for the management of brain metastases in the era of stereotactic radiosurgery.

  Eisuke Abe, Hidefumi Aoyama

  Current oncology reports 14 (1) 79 - 84 2012/02 

  The goals of treatment for brain metastases (BMs) include preservation of function and improvement of survival. Although whole brain radiotherapy (WBRT) has been a mainstay in the treatment of BMs, stereotactic radiosurgery (SRS) monotherapy has been increasingly used because of concern about the deterioration of neurocognitive function as a late adverse effect of WBRT. The results of four randomized controlled trials comparing focal treatment alone versus focal treatment combined with WBRT have shown, however, that SRS monotherapy significantly increases the risk of brain tumor recurrence (BTR) and that this increased risk of BTR may cause deterioration of neurocognitive function. We suggest identifying patients according to their risk of BTR when selecting treatment. Patients who have solitary BM with the absence of extracranial metastases may be indicated for SRS monotherapy given the lower risk of BTR compared with those having multiple BMs or extracranial metastases.
• Reoxygenation of glioblastoma multiforme treated with fractionated radiotherapy concomitant with temozolomide: changes defined by 18F-fluoromisonidazole positron emission tomography: two case reports.

  Takuhito Narita, Hidefumi Aoyama, Kenji Hirata, Shunsuke Onodera, Tohru Shiga, Hiroyuki Kobayashi, Junichi Murata, Shunsuke Terasaka, Shinya Tanaka, Kiyohiro Houkin

  Japanese journal of clinical oncology 42 (2) 120 - 3 2012/02 

  Two glioblastoma multiforme patients underwent (18)F-FMISO (fluoromisonidazole) positron emission tomography study to access the tumor oxygenation status before and immediately after fractionated radiotherapy concomitant with temozolomide chemotherapy. In both cases, a prominent (18)F-FMISO tumor accumulation observed in the first study was notably decreased in the second study, which was supposed to be a reoxygenation of the tumor. As far as we investigated, this is the first report of the changes of oxygenation status in glioblastoma multiforme treated through radiation therapy with temozolomide.
• Impact of [11C]methionine positron emission tomography for target definition of glioblastoma multiforme in radiation therapy planning.

  Masayuki Matsuo, Kazuhiro Miwa, Osamu Tanaka, Jun Shinoda, Hironori Nishibori, Yusuke Tsuge, Hirohito Yano, Toru Iwama, Shinya Hayashi, Hiroaki Hoshi, Jitsuhiro Yamada, Masayuki Kanematsu, Hidefumi Aoyama

  International journal of radiation oncology, biology, physics 82 (1) 83 - 9 2012/01/01 

  PURPOSE: The purpose of this work was to define the optimal margins for gadolinium-enhanced T(1)-weighted magnetic resonance imaging (Gd-MRI) and T(2)-weighted MRI (T(2)-MRI) for delineating target volumes in planning radiation therapy for postoperative patients with newly diagnosed glioblastoma multiforme (GBM) by comparison to carbon-11-labeled methionine positron emission tomography ([(11)C]MET-PET) findings. METHODS AND MATERIALS: Computed tomography (CT), MRI, and [(11)C]MET-PET were separately performed for radiation therapy planning for 32 patients newly diagnosed with GBM within 2 weeks after undergoing surgery. The extent of Gd-MRI (Gd-enhanced clinical target volume [CTV-Gd]) uptake and that of T(2)-MRI of the CTV (CTV-T(2)) were compared with the extent of [(11)C]MET-PET (CTV--[(11)C]MET-PET) uptake by using CT--MRI or CT--[(11)C]MET-PET fusion imaging. We defined CTV-Gd (x mm) and CTV-T(2) (x mm) as the x-mm margins (where x = 0, 2, 5, 10, and 20 mm) outside the CTV-Gd and the CTV-T(2), respectively. We evaluated the relationship between CTV-Gd (x mm) and CTV-- [(11)C]MET-PET and the relationship between CTV-T(2) (x mm) and CTV-- [(11)C]MET-PET. RESULTS: The sensitivity of CTV-Gd (20 mm) (86.4%) was significantly higher than that of the other CTV-Gd. The sensitivity of CTV-T(2) (20 mm) (96.4%) was significantly higher than that of the other CTV-T(2) (x = 0, 2, 5, 10 mm). The highest sensitivity and lowest specificity was found with CTV-T(2) (x = 20 mm). CONCLUSIONS: It is necessary to use a margin of at least 2 cm for CTV-T(2) for the initial target planning of radiation therapy. However, there is a limit to this setting in defining the optimal margin for Gd-MRI and T(2)-MRI for the precise delineation of target volumes in radiation therapy planning for postoperative patients with GBM.
• 脳転移の治療 定位照射単独か、全脳照射併用か?

  青山 英史

  肺癌 (NPO)日本肺癌学会 51 (5) 363 - 363 0386-9628 2011/10
• Radiation therapy for brain metastases in breast cancer patients.

  Hidefumi Aoyama

  Breast cancer (Tokyo, Japan) 18 (4) 244 - 51 2011/10 

  Most randomized comparison trials (RCTs) investigating treatments for brain metastases (BM) have included BM from any origin; as a result, more than half (52.4-77.0%) of the BM in these trials originated from the lungs (mostly non-small-cell lung cancer, NSCLC), with the breasts being the origin in only 6.8-19.0% of cases. In addition, patients with poor systemic status (KPS < 70) were not included in these trials. Hence, before we can apply RCT-based information to the daily clinical treatment of BM from breast cancers, it will be crucial to differentiate the characteristics of BM originating from NSCLC and BM originating from breast cancer. Although stereotactic radiosurgery (SRS) is widely used in Japan, level-1 evidence suggests that the benefit of using SRS in addition to whole-brain radiation therapy (WBRT) has been proven only for patients with a single BM. Treatment with SRS alone, which is widely used in Japan, seems attractive because it could avoid the risk of long-term adverse effects of WBRT. However, level-1 evidence suggests that the omission of WBRT results in a high frequency of brain tumor recurrence (BTR). In an RCT between SRS-alone and SRS + WBRT conducted in Japan, we found that patients who had a single BM and no extracranial metastases had a low risk of developing BTR after initial brain management (low-risk group) compared with those who had 2 or more BM and extracranial metastases (high-risk group). In order to meet the criteria of "low-risk" BTR, patients also should have good systemic status (KPS ≧ 70). Epidemiologic data suggest that the prognosis is twice as likely to be poor in patients with BM from breast cancer (RPA III = KPS < 70) than in patients with BM from NSCLC (40 vs. 20%); in addition, the probability of brain-only metastases in patients with breast cancer is less than half that in patients with NSCLC (20-25 vs. 60-75%). Considering these findings, we should be aware that most patients with BM from breast cancer are not good candidates for SRS alone, and, therefore, the role of WBRT is still important in the era of modern radiation techniques.
• Relationship between heart rate and optimal reconstruction phase in dual-source CT coronary angiography.

  Yosuke Horii, Norihiko Yoshimura, Yoshiro Hori, Toru Takano, Shoichi Inagawa, Kohei Akazawa, Hidefumi Aoyama

  Academic radiology 18 (6) 726 - 30 2011/06 

  RATIONALE AND OBJECTIVES: To evaluate reconstruction image quality at the systolic and diastolic cardiac phases and determine the optimal phase for reconstruction according to heart rate when using dual-source computed tomography (CT) with 75 ms temporal resolution. MATERIALS AND METHODS: We retrospectively reviewed the CT datasets of 35 patients with regular heartbeats who underwent coronary CT angiography. Images were reconstructed in 2% steps between 32 and 78% of the beat-to-beat interval. Two experienced radiologists determined the reconstruction interval with the fewest motion artifacts and the motion score of each vessel for the systolic and diastolic phases. Subgroup analysis was performed in patients having heart rates of <70, 70-80, and >80 beats per minute (bpm). RESULTS: In the subgroup with heart rates of <70 bpm, the diastolic phase reconstruction image quality was significantly better than for the systolic phase (P < .01). In the 70-80 bpm and >80 bpm subgroups, no significant difference was observed. In the diastolic phase, the image quality of the <70 bpm subgroup was significantly better than for the >80 bpm subgroup (P < .05). In all systolic phase subgroups and other diastolic phase subgroups, no significant difference was observed. CONCLUSIONS: Using a DSCT scanner with 75 ms temporal resolution, reconstruction at the diastolic phases should be used for patients with heart rates <70 bpm. For heart rates >70 bpm, larger studies are necessary to determine whether reconstruction at the systolic, diastolic, or both phases should be used.
• Long-term outcomes of fractionated stereotactic radiotherapy for intracranial skull base benign meningiomas in single institution.

  Shunsuke Onodera, Hidefumi Aoyama, Norio Katoh, Hiroshi Taguchi, Kouichi Yasuda, Daisuke Yoshida, Ken Surtherland, Ryusuke Suzuki, Masayori Ishikawa, Bengua Gerard, Shunsuke Terasaka, Hiroki Shirato

  Japanese journal of clinical oncology 41 (4) 462 - 8 2011/04 

  OBJECTIVE: To investigate the outcome of linac-based fractionated stereotactic radiotherapy over the last 10 years for intracranial skull base benign meningiomas in patients who were inoperable, who had residual tumors with some components of high mitotic index after surgery and who experienced relapse of the tumor. METHODS: Twenty-seven patients with intracranial skull base benign meningiomas treated with fractionated stereotactic radiotherapy were retrospectively reviewed. Twenty-seven cases were diagnosed as benign meningiomas on pathological (17 cases) or radiological (10 cases) examination. The median follow-up time was 90 months after initial treatment and 63 months after fractionated stereotactic radiotherapy. The median biological equivalent dose calculated using an α/β ratio of 2.0 Gy was 82.0 Gy (range, 60-106 Gy). RESULTS: The 5-year overall survival was 95.7 (95% confidence interval: 87.3-100)% after initial treatment and 96.2 (88.8-100)% after fractionated stereotactic radiotherapy. The 5-year overall survival and local control rate of patients who received fractionated stereotactic radiotherapy alone were both 100%. The 5-year progression-free survival and local control rate after fractionated stereotactic radiotherapy were all 100% with a tumor volume of <9.1 cc and 68.2 (37.2-99.2) and 75.8 (45.2-100)% for the tumors 9.1 cc, respectively. The difference was significant in progression-free survival (P = 0.022) and local control rate (P = 0.044). The local control rate was significantly worse in patients who received fractionated stereotactic radiotherapy for relapsed tumors (P = 0.01). No late radiation damage was observed in the follow-up period. CONCLUSIONS: The long-term outcome suggests that fractionated stereotactic radiotherapy is a safe and effective treatment for intracranial skull base benign meningioma, especially for those who have tumors <9.1 cc or would receive fractionated stereotactic radiotherapy with or without surgery as the initial treatment.
• Correlation between the site of pulmonary embolism and the extent of deep vein thrombosis: evaluation by computed tomography pulmonary angiography and computed tomography venography.

  Yosuke Horii, Norihiko Yoshimura, Yoshiro Hori, Satoshi Takaki, Toru Takano, Shoichi Inagawa, Hidefumi Aoyama

  Japanese journal of radiology 29 (3) 171 - 6 2011/04 

  PURPOSE: The aim of this study was to evaluate the relation between the sites of pulmonary embolism (PE) and deep vein thrombosis (DVT) by computed tomography pulmonary angiography (CTPA) and CT venography (CTV) of the pelvis and lower extremities. MATERIALS AND METHODS: We retrospectively reevaluated CTPA-CTV data sets for 227 consecutive patients suspected of having a PE. The PEs were divided into proximal (located at the lobar artery or proximal to it) and distal groups. DVTs were divided into proximal (located above the knee) and distal groups. Cohen's kappa statistic and chi-squared tests were performed. RESULTS: The incidence of PE was significantly higher in patients with a proximal DVT than with a distal DVT (P < 0.01). In patients with a proximal DVT, the incidence of proximal PE was significantly higher than that of distal PE (P < 0.05). In patients with a proximal DVT, the incidence of PE was significantly higher in patients with a right-side DVT than with a left-side DVT (P < 0.05). CONCLUSION: Proximal PEs were correlated with proximal DVTs. Patients with a proximal DVT tended to have a PE, especially with a right-proximal DVT. Hence, the presence of a right-proximal DVT has the potential for serious complications, and carefully diagnosis is required for PE and DVT.
• 聴神経鞘腫の定位放射線治療 一過性腫瘍増大と症状変化の関連

  青山 英史, 小野寺 俊輔, 白土 博樹

  日本医学放射線学会学術集会抄録集 70回 S298 - S298 0048-0428 2011/02
• 新潟大学における前立腺癌高線量率組織内照射療法 線量分布改善のための工夫

  笠原 隆, 西山 勉, 笹本 龍太, 丸山 克也, 青山 英史, 高橋 公太

  日本癌治療学会誌 (一社)日本癌治療学会 45 (2) 946 - 946 0021-4671 2010/09
• 高精度放射線治療の臨床的意義に関する一考察

  青山 英史

  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 46回 S498 - S498 0048-0428 2010/08
• Clinical outcomes of stereotactic brain and/or body radiotherapy for patients with oligometastatic lesions.

  Tetsuya Inoue, Norio Katoh, Hidefumi Aoyama, Rikiya Onimaru, Hiroshi Taguchi, Shunsuke Onodera, Satoshi Yamaguchi, Hiroki Shirato

  Japanese journal of clinical oncology 40 (8) 788 - 94 2010/08 

  OBJECTIVE: Several recent studies have shown that oligometastatic disease has curative potential, although it was previously considered to signal a patient's last stage of life. Stereotactic body radiotherapy has been available for extra-cranial metastases in addition to stereotactic cranial radiotherapy for brain metastases. The aim of the present study was to retrospectively evaluate the clinical outcomes of stereotactic radiotherapy for patients with oligometastatic lesions. METHODS: Between 1999 and 2008, 41 patients with five or fewer detectable metastases were treated with stereotactic radiotherapy at our institution. The treated oligometastatic lesions were in the brain, lung and adrenal glands. RESULTS: With a median follow-up period of 20 months, the 3-year overall survival, progression-free survival, local control and distant control rates were 39%, 20%, 80% and 35%, respectively, and the respective 5-year rates were 28%, 20%, 80% and 35%. The median survival time was 24 months. According to interval to recurrence, the 3- and 5-year overall survival rates were 19% and 10%, respectively, for patients with <12 months (n = 18), compared with 53% and 40% for those with > or =12 months (n = 23) (P = 0.006). CONCLUSIONS: Precise stereotactic radiotherapy was effective in controlling oligometastatic lesions for patients with a median survival time of 24 months. Interval to recurrence may impact the overall survival rate and should be included in the stratification criteria in a prospective randomized trial to investigate the benefits of stereotactic radiotherapy for patients with oligometastases.
• 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 28 (Supplement 1) 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 28 (Supplement 1) 14  1867-1071 2010/07/25 [Not refereed][Not invited]
  
• Remote Desktopアプリケーションを用いた遠隔放射線治療計画システム(第一報)

  鈴木 恵士郎, 島 勝美, 西尾 正道, 青山 英史, 白土 博樹, 影井 兼司, 八重樫 祐司, 平澤 之規, 宮坂 和男, 宮本 英樹

  Japanese Journal of Radiology (公社)日本医学放射線学会 28 (Suppl.I) 8 - 8 1867-1071 2010/07
• 放射線がん治療における免疫系の役割と治療への応用

  武島 嗣英, 茶本 健司, 北村 秀光, 西村 孝司, 青山 英史, 白土 博樹

  Japanese Journal of Radiology (公社)日本医学放射線学会 28 (Suppl.I) 8 - 8 1867-1071 2010/07
• 放射線がん治療における免疫系の役割と治療への応用

  武島 嗣英, 茶本 健司, 北村 秀光, 西村 孝司, 青山 英史, 白土 博樹

  Japanese Journal of Radiology (公社)日本医学放射線学会 28 (Suppl.I) 8 - 8 1867-1071 2010/07
• An Internationally Compatible, Japanese Neurocognitive Function Test Battery for the Assessment of Radiation-induced Brain Injury

  S. Onodera, H. Aoyama, N. Hashimoto, A. Toyomaki, N. Nishikawa, K. K. Tha, K. Ogisu, S. Terae, H. Shirato

  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 78 (3) S293 - S293 0360-3016 2010 [Refereed][Not invited]
  
• 導入化学療法と低線量放射線治療でジャーミノーマの治療は可能か

  澤村 豊, 鴨嶋 雄大, 白土 博樹, 青山 英史

  小児がん (NPO)日本小児がん学会 46 (プログラム・総会号) 353 - 353 0389-4525 2009/11
• 画像誘導放射線治療

  白土博樹, 青山英史, 石川正純, 清水伸一, 鬼丸力也, 溝脇尚志

  日本癌治療学会誌 (一社)日本癌治療学会 44 (2) 256 - 256 0021-4671 2009/09/14 [Not refereed][Not invited]
  
• 動体追跡装置におけるコントラスト‐ノイズ比の測定方法の検討

  木村傑, 宮本直樹, 石川正純, SUTHERLAND Kenneth, BENGUA Gerard, 鈴木隆介, 清水伸一, 青山英史, 鬼丸力也, 白土博樹

  医学物理 Supplement 29 (3) 148-149  1345-5362 2009/09 [Not refereed][Not invited]
  
• 動体追跡装置を用いた肺定位照射時の投与線量解析—動体追跡データに基づくDVH解析—

  石川正純, サザランド ケネス, ベングア ジェラード, 鈴木隆介, 宮本直樹, 加藤徳雄, 清水伸一, 鬼丸力也, 青山英史, 白土博樹

  日本放射線腫よう学会誌 21 (Supplement 1) 158  1040-9564 2009/08/19 [Not refereed][Not invited]
  
• 新しい治療 画像誘導放射線治療(image‐guided radiotherapy:IGRT)

  白土博樹, 青山英史, 鬼丸力也, 清水伸一, 石川正純, 西岡健

  治療学 ライフサイエンス出版(株) 43 (7) 781-783 - 783 0386-8109 2009/07/10 [Not refereed][Not invited]
  
• Stereotactic body radiotherapy for small lung lesions clinically diagnosed as primary lung cancer on radiological examination

  INOUE TETSUYA, ONIMARU RIKIYA, SHIMIZU SHIN'ICHI, AOYAMA HIDEFUMI, SHIRATO HIROKI

  臨床放射線 金原出版 54 (5) 625-630 - 630 0009-9252 2009/05/10 [Not refereed][Not invited]
  
• 転移性脳腫瘍への放射線治療後の認知機能の推移

  青山 英史, 加藤 徳雄, 白土 博樹

  Japanese Journal of Radiology (公社)日本医学放射線学会 27 (Suppl.) 12 - 12 1867-1071 2009/04
• 体内臓器同期照射を目的とした次世代動体追跡装置の開発〜透視画像の歪みと位置計算誤差〜

  宮本直樹, SUTHERLAND Kenneth, 石川正純, 鈴木隆介, BENGUA Gerard, 木村傑, 清水伸一, 青山英史, 鬼丸力也, 白土博樹

  医学物理 Supplement 29 (2) 192-193  1345-5362 2009/04 [Not refereed][Not invited]
  
• 体内臓器同期照射を目的とした次世代動体追跡装置の開発〜デジタル画像機器としての定量的評価〜

  木村傑, 石川正純, SUTHERLAND Kenneth, 宮本直樹, BENGUA Gerard, 鈴木隆介, 清水伸一, 青山英史, 鬼丸力也, 白土博樹

  医学物理 Supplement 29 (2) 196-197  1345-5362 2009/04 [Not refereed][Not invited]
  
• 体内臓器同期照射を目的とした次世代動体追跡装置の開発〜複数マーカ追跡への挑戦〜

  石川正純, SUTHERLAND Kenneth, 宮本直樹, BENGUA Gerard, 清水伸一, 青山英史, 鬼丸力也, 木村傑, 白土博樹

  医学物理 Supplement 29 (2) 194-195  1345-5362 2009/04 [Not refereed][Not invited]
  
• Can the Real-time Tumor-tracking Radiotherapy Give the Planned Dose to the Tumor? DVH Analysis Based on Measured Real-time Tracking Data

  M. Ishikawa, K. L. Sutherland, G. Bengua, R. Suzuki, N. Miyamoto, N. Katoh, S. Shimizu, R. Onimaru, H. Aoyama, H. Shirato

  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 75 (3) S590 - S591 0360-3016 2009 [Refereed][Not invited]
  
• 【脊髄腫瘍の最新動向】脊髄腫瘍に対する放射線治療の役割

  小野寺 俊輔, 青山 英史

  脊椎脊髄ジャーナル (株)三輪書店 22 (1) 85 - 91 0914-4412 2009/01
• Radiation therapy for intracranial germ cell tumors.

  Hidefumi Aoyama

  Progress in neurological surgery 23 96 - 105 2009 

  Although radiation therapy (RT) is essential to the management of intracranial germ cell tumors, the ideal radiation dose and field remain controversial. For the treatment of germinoma, whole central nervous system radiation, which was once the standard RT field, is being replaced by whole ventricle (WV) field radiation for localized disease. The use of induction chemotherapy has been expected to further reduce the RT field and dose; however, use of a localized field smaller than the WV field has resulted in a higher recurrence rate. Therefore, the WV field should be considered appropriate even after induction chemotherapy. With regard to the radiation dose to the primary tumor site, it can be reduced to 40-45 Gy in RT alone. The further reduction of the radiation dose when using a combination of chemotherapy and RT is yet to be determined. Unlike germinomas, nongerminomatous germ cell tumors, with the exception of mature teratomas, are refractory to conventional RT. The whole central nervous system field should thus be used for all but immature teratomas. Given that local progression is the primary pattern of recurrence even after effective induction chemotherapy, RT dose increase through the use of modern techniques, including stereotactic irradiation and intensity-modulated RT, should be investigated.
• 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 44th 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]
  
• SOF線量計によるIr‐192高線量率密封小線源治療時のin‐vivoリアルタイム線量測定

  石川正純, 平塚純一, 長瀬尚巳, GERARD Bengua, KENNETH Sutherland, 加藤徳雄, 清水伸一, 鬼丸力也, 青山英史, 白土博樹

  日本放射線腫よう学会誌 20 (Supplement 1) 251  1040-9564 2008/09/22 [Not refereed][Not invited]
  
• LG-DRR patient setup verification for routine clinical application

  KENNETH SUTHERLAND, ISHIKAWA MASAZUMI, GERARD BENGUA, ONIMARU RIKIYA, SHIMIZU SHIN'ICHI, AOYAMA HIDEFUMI, FUJITA KATSUHISA, YAMASAKI SATOI, SHIRATO HIROKI

  日本放射線腫よう学会誌 20 (Supplement 1) 264  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 - 566 0285-0524 2008/04/25 [Not refereed][Not invited]
  
• Image guided radiotherapy (IGRT) and intensity modulated radiotherapy (IMRT)

  ONIMARU RIKIYA, FUJINO MASAHARU, KATO NORIO, TAGUCHI HIROSHI, KINOSHITA RUMIKO, SERIZAWA ITSUKO, INOUE TETSUYA, HASEGAWA MASAKAZU, AOYAMA HIDEFUMI, OSAKA YASUHIRO, SHIRATO HIROKI

  臨床放射線 金原出版(株) 52 (8) 961 - 966 0009-9252 2007/08 [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.
• Hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumor.

  Norio Katoh, Hiroki Shirato, Hidefumi Aoyama, Rikiya Onimaru, Keishiro Suzuki, Kazutoshi Hida, Kazuo Miyasaka, Yoshinobu Iwasaki

  Journal of neuro-oncology 78 (1) 63 - 9 0167-594X 2006/05 

  PURPOSE: To retrospectively analyze the outcome of post-operative radiotherapy for spinal cord glioma with the emphasis on the hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumors. MATERIALS AND METHODS: Forty-one patients with spinal cord glioma received post-operative radiotherapy between 1979 and 2003. The median age was 34 years (range, 10-66 years). Median follow-up was 49 months (range, 5-291 months). There were 12 low-grade astrocytic tumors, 11 high-grade astrocytic tumors, 16 low-grade ependymal tumors and 2 high-grade ependymal tumors. Among 11 patients with high-grade astrocytic tumors, 5 with anaplastic astrocytoma and 1 with glioblastoma received hypofractionated radiotherapy boost for dose escalation. The median total dose of the conventional radiotherapy was 45.5 Gy in 19 fractions (range, 30.0-60.0 Gy). The median normalized total dose (using daily dose of 2.0 Gy and an alpha/ per thousandbeta ratio of 2.0) of the hypofractionated radiotherapy boost was 131 Gy2 (range, 85-249). RESULTS: The Kaplan-Meier survival rates at 10 years from the date of the first surgery were 64% for the entire group, 47% for the astrocytic tumors and 84% for the ependymal tumors, respectively (P=0.009). Among 11 patients with high-grade astrocytic tumors, the actuarial survival rate at 10 years was 35%. The actuarial survival rates at 10 years were 67% for those who received hypofractionated radiotherapy boost for dose escalation, and 20% for those who did not (P=0.47). DISCUSSION: The results for ependymal tumors and low-grade astrocytic tumors were comparable to those reported in the literature. Hypofractionated radiotherapy boost for dose escalation may help to prolong the survival of patients with high-grade astrocytic tumors.
• 甲状腺未分化癌の放射線およびドセタキセル治療

  高田 尚幸, 古井 秀典, 大野 正博, 田口 大志, 青山 英史, 中駄 邦博, 高橋 弘昌

  北海道医学雑誌 北海道医学会 80 (6) 619 - 619 0367-6102 2005/11
• 放射線治療効果の向上を目指した新手法開発とその臨床応用 動体追跡照射装置を用いた放射線治療

  鬼丸 力也, 白土 博樹, 藤野 賢治, 田口 大志, 加藤 徳雄, 大坂 康博, 清水 伸一, 青山 英史, 鈴木 恵士郎

  日本放射線影響学会大会講演要旨集 (一社)日本放射線影響学会 48回 75 - 75 1347-8680 2005/11 [Not refereed][Not invited]
  
• 当科における頭頸部高線量率放射線治療

  大森 桂一, 西岡 健, 土屋 和彦, 青山 英史, 木下 留美, 西岡 井子, 鈴木 恵士郎, 白土 博樹

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 17 (Suppl.1) 126 - 126 1040-9564 2005/10
• 【脳腫瘍の診断と治療 最新の研究動向】脳腫瘍の治療 放射線療法 定位放射線照射療法(リニアック)

  白土 博樹, 青山 英史, 鈴木 恵士郎, 宮坂 和男

  日本臨床 (株)日本臨床社 63 (増刊9 脳腫瘍の診断と治療) 419 - 424 0047-1852 2005/09
• [Stereotactic irradiation (Linac) for brain tumors].

  Hiroki Shirato, Hidefumi Aoyama, Keishiro Suzuki, Kazuo Miyasaka

  Nihon rinsho. Japanese journal of clinical medicine 63 Suppl 9 419 - 24 0047-1852 2005/09
• 聴神経腫瘍に対する定位分割照射の治療成績

  坂本 徹, 白土 博樹, 澤村 豊, 鈴木 恵士郎, 青山 英史, 加藤 徳雄

  定位的放射線治療 日本定位放射線治療学会 9 37 - 44 1342-9930 2005/08 

  定位分割照射を行った聴神経腫瘍165例(男62例・女103例,中央値54歳)の成績を報告した.平均腫瘍径は照射前17.0mm,平均観察期間42ヵ月後13.9mmであった.2〜7年の累積腫瘍制御率は91.8%で,腫瘍増大を9例に認め,うち3例に手術,2例に追加照射を行った.累積腫瘍縮小率は3年で54%,7年で61.6%であった.腫瘍径25mm以上の31例では7年の累積腫瘍制御率90.5%,縮小率78.1%であった.腫瘍の性状別にみると,cystic typeは腫瘍制御率100%,縮小率88.6%で,solid typeは各々86.8%,56.6%と,縮小率に有意差を認めた.聴力検査の結果は,照射前が平均48.7dBで,照射1年後に10dB,5年で20.1dBの低下を認め,7年の累積聴力温存率は71.5%,保存率は56.3%であった.腫瘍縮小群は非縮小群に比較して聴力温存率が高い傾向であった.合併障害は三叉神経障害,めまいが9%,顔面神経麻痺が3%にみられたがいずれも一過性で,照射後にシャント手術を必要としたのは18例であった
• 化学放射線同時併用療法後の喉頭全摘術における合併症の検討

  古田 康, 本間 明宏, 折舘 伸彦, 樋口 栄作, 鈴木 章之, 西岡 健, 青山 英史, 鈴木 恵士郎, 白土 博樹, 福田 諭

  頭頸部癌 (一社)日本頭頸部癌学会 31 (2) 220 - 220 1349-5747 2005/05 [Not refereed][Not invited]
  
• Long-term results of ethmoid squamous cell or undifferentiated carcinoma treated with radiotherapy with or without surgery

  Daichi Uchida, Hiroki Shirato, Rikiya Onimaru, Hideho Endou, Hidefumi Aoyama, Kazuhiko Tsuchiya, Takeshi Nishioka, Akihiro Homma, Yasushi Furuta, Satoshi Fukuda, Kazuo Miyasaka

  Cancer Journal 11 (2) 152 - 156 1528-9117 2005/03 [Refereed][Not invited]
   

  PURPOSE: Ethmoidal malignant tumors, for which intensity-modulated radiotherapy is expected to improve outcome, consist of heterogeneous pathological types. Reports about their outcome are influenced by the inclusion of favorable histology, such as adenocarcinoma and adenoid cystic carcinoma. We investigated the long-term treatment outcome of squamous cell carcinoma and undifferentiated carcinoma of the ethmoid sinus. MATERIALS AND METHODS: Between August 1976 and April 2002, 25 patients (20 squamous cell carcinomas and five undifferentiated carcinomas) received radical radiotherapy or preoperative radiotherapy in our institution. One (4%) had stage T2 disease, seven (28%) had stage T3, three (12%) had stage T4a, and 14 (56%) had stage T4b. Surgery was performed in 13 patients. Radiation dose varied from 50.4 Gy in 16 fractions (50.4 Gy/16 Fr) to 65 Gy in 26 fractions with or without stereotactic boost irradiation. Eleven patients received chemotherapy consisting mainly of platinum-based compounds. RESULTS: The 3- and 5-year overall survival rates for all 25 patients were 34% (95% confidence interval [CI]: 14%-54%) and 24% (CI: 6%-42%), respectively. The 3- or 5-year local progression-free rates for all patients were 48.9% and 36.7%, respectively. Visual acuity of a single eye was impaired in three patients and was lost in five patients as a result of tumor progression, but no patient had visual impairment or loss due to radiotherapy. CONCLUSION: Ethmoid squamous cell carcinoma or undifferentiated carcinoma was diagnosed at advanced T stages and was treated with radiotherapy; these patients had a poorer outcome than patients with adenocarcinoma or adenoid cystic carcinoma. Prospective trials using advanced technology should be carefully compared with historical controls because pathological types can considerably influence the treatment results. Copyright © 2005 Jones and Bartlett Publishers, Inc.
• 頭頸部腫瘍における放射線治療前FDG-PETの検討 SUVの意義について

  鈴木 恵士郎, 西岡 健, 青山 英史, 土屋 和彦, 白土 博樹, 宮坂 和男, 加藤 千恵次, 志賀 哲, 中駄 邦博, 玉木 長良

  日本医学放射線学会学術集会抄録集 (公社)日本医学放射線学会 64回 S298 - S299 0048-0428 2005/02
• 画像診断技術の進歩と放射線治療 脳動静脈奇形の定位照射を例として

  青山 英史, 加藤 徳雄, 土屋 和彦, 藤野 賢治, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 64 (8) 577 - 577 0048-0428 2004/11
• Stereotactic irradiation for intracranial arteriovenous malformation using stereotactic radiosurgery or hypofractionated stereotactic radiotherapy.

  Ta-Chen Chang, Hiroki Shirato, Hidefumi Aoyama, Satoshi Ushikoshi, Norio Kato, Satoshi Kuroda, Tatsuya Ishikawa, Kiyohiro Houkin, Yoshinobu Iwasaki, Kazuo Miyasaka

  International journal of radiation oncology, biology, physics 60 (3) 861 - 70 0360-3016 2004/11/01 

  PURPOSE: To investigate the appropriateness of the treatment policy of stereotactic irradiation using both hypofractionated stereotactic radiotherapy (HSRT) and stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) located in an eloquent region or for large AVMs and using SRS alone for the other AVMs. METHODS AND MATERIALS: Included in this study were 75 AVMs in 72 patients, with a mean follow-up of 52 months. Of the 75 AVMs, 33 were located in eloquent regions or were >2.5 cm in maximal diameter and were given 25-35 Gy (mean, 32.4 Gy) in four daily fractions at a single isocenter if the patient agreed to prolonged wearing of the stereotactic frame for 5 days. The other 42 AVMs were treated with SRS at a dose of 15-25 Gy (mean, 24.1 Gy) at the isocenter. The 75 AVMs were classified according to the Spetzler-Martin grading system; 21, 23, 28, 2, and 1 AVM were Grade I, II, III, IV, V, and VI, respectively. RESULTS: The overall actuarial rate of obliteration was 43% (95% confidence interval [CI], 30-56%) at 3 years, 72% (95% CI, 58-86%) at 5 years, and 78% (95% CI, 63-93%) at 6 years. The actuarial obliteration rate at 5 years was 79% for the 42 AVMs <2.0 cm and 66% for the 33 AVMs >2 cm. The 5- and 6-year actuarial obliteration rate was 61% (95% CI, 39-83%) and 71% (95% CI, 47-95%), respectively, after HSRT and 81% (95% CI, 66-96%) and 81% (95% CI, 66-96%), respectively, after SRS; the difference was not statistically significant. Radiation-induced necrosis was observed in 4 subjects in the SRS group and 1 subject in the HSRT group. Cyst formation occurred in 3 patients in the SRS group and no patient in the HSRT group. A permanent symptomatic complication was observed in 3 cases (4.2%), and 1 of the 3 was fatal. All 3 patients were in the SRS group. The annual intracranial hemorrhage rate was 5.5-5.6% for all patients. CONCLUSION: Our treatment policy using SRS and HSRT was as effective as the policy involving SRS alone. The HSRT schedule was suggested to have a lower frequency of radiation necrosis and cyst formation than the high-dose SRS schedule. The benefit of HSRT compared with lower dose SRS has not yet been determined.
• 肺癌放射線治療におけるFDG-PETでの標的体積の抽出法の観察者間差

  藤野 賢治, 加藤 徳雄, 白土 博樹, 青山 英史, 渡辺 良晴, 熊谷 まなみ, 西岡 健, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 16 (Suppl.1) 108 - 108 1040-9564 2004/10
• Randomized phase II trial of concomitant chemoradiotherapy using weekly carboplatin or daily low-dose cisplatin for squamous cell carcinoma of the head and neck

  A Homma, H Shirato, Y Furuta, T Nishioka, N Oridate, K Tsuchiya, T Nagahashi, H Aoyama, Y Inuyama, S Fukuda

  CANCER JOURNAL 10 (5) 326 - 332 1528-9117 2004/09 [Refereed][Not invited]
   

  Purpose This randomized, phase II study aimed to compare concomitant chemoradiotherapy using weekly carboplatin or daily low-dose cisplatin as a treatment for squamous cell carcinoma of the head and neck. Patients and Methods One hundred nineteen patients with moderate- to advanced-stage disease were eligible for the study. Fifty-three patients had stage II disease, 28 had stage III, and the remaining 38 had stage IV disease. Primary tumor sites included the larynx (N = 63), oropharynx (N = 30), hypopharynx (N = 23), and oral cavity (N = 3). Each patient received either a weekly carboplatin dose (100 mg/m(2)) in one arm or daily cisplatin (4 mg/m(2)) in the other arm for the initial 4 weeks of radiotherapy. The radiotherapy dose of 65 Gy was given in 26 fractions over 45 days, dependent on a good tumor response at 40 Gy. Forty-nine (81.7%) of 60 patients treated with carboplatin and 41 (69.5%) of 59 patients treated with cisplatin received the full dose of radiotherapy. Surgical resection was optionally used for the remaining patients. Results The median follow-up time was 63 months. The local control rate at 5 years was 56.2% for the carboplatin-treated arm and 35.5% for the cisplatin-treated arm, respectively. The 5-year overall survival rate did not significantly differ between treatments: 71.4% for carboplatin and 66.0% for cisplatin. Hematologic toxicity was more frequent in the carboplatin-treated arm. No difference was observed in surgical complications or in radiation-related adverse effects. Dicussion These findings suggest that weekly carboplatin treatment is preferable to daily low-dose cisplatin. This could be because the total dose of cisplatin was too low to be effective.
• Impact of margin for target volume in low-dose involved field radiotherapy after induction chemotherapy for intracranial germinoma.

  Hiroki Shirato, Hidefumi Aoyama, Jun Ikeda, Kenji Fujieda, Norio Kato, Nobuaki Ishi, Kazuo Miyasaka, Yoshinobu Iwasaki, Yutaka Sawamura

  International journal of radiation oncology, biology, physics 60 (1) 214 - 7 0360-3016 2004/09/01 

  PURPOSE: We previously published a report stating that germinomas with elevated serum beta human chorionic gonadotropin (HCG-beta) had a poor relapse rate, but these findings have not been supported by a multi-institutional trial. The margin for initial gross tumor volume (GTV) before surgery and chemotherapy of the same materials was investigated by retrospective review. METHODS AND MATERIAL: The 27 patients reported on in the previous paper were analyzed. The two-dimensional margin from the initial GTV to 90% of the prescribed dose of 24 Gy was 2.0 cm for a solitary lesion in the protocol. This margin was measured retrospectively without knowledge of the serum HCG-beta level. The whole ventricle field was used for patients with multifocal disease and whole central nervous system field was used for disseminated disease, respectively. RESULTS: Six relapses were seen in 18 patients with solitary tumors, and were treated with the minimum margin of 1.5 cm or less to the initial GTV. Five of the 6 had initially elevated serum HCG-beta at the median of 7.4 mIU/mL, ranging from 0.7-233 mIU/mL. No relapses were seen in the 9 patients who were treated with whole ventricle or whole central nervous system field. CONCLUSIONS: An inadequate margin and elevated serum HCG-beta were equally determined to be candidates that caused the poor local control. The whole ventricle is recommended as the smallest target volume for germinoma with or without elevated HCG-beta after induction chemotherapy.
• 頬粘膜腫瘍の放射線治療成績

  大森 桂一, 中村 博行, 山崎 裕, 小野 貢伸, 青山 英史, 土屋 和彦, 西岡 健, 白土 博樹, 本間 明宏, 古田 康, 中村 太保

  頭頸部腫瘍 (一社)日本頭頸部癌学会 30 (2) 195 - 195 0911-4335 2004/05 [Not refereed][Not invited]
  
• 化学療法併用放射線療法後に喉頭全摘術後の瘻孔発生率は高まるか? 過去10年間の喉頭全摘症例の検討

  古田 康, 本間 明宏, 永橋 立望, 樋口 栄作, 鈴木 章之, 折舘 伸彦, 福田 諭, 西岡 健, 青山 英史, 白土 博樹

  頭頸部腫瘍 (一社)日本頭頸部癌学会 30 (2) 270 - 270 0911-4335 2004/05 [Not refereed][Not invited]
  
• 頭頸部癌に対するDocetaxelと放射線同時併用療法の有用性の検討

  樋口 榮作, 本間 明宏, 永橋 立望, 折舘 伸彦, 古田 康, 鈴木 章之, 西岡 健, 土屋 和彦, 青山 英史, 滝沢 昌彦, 白土 博樹, 福田 諭

  頭頸部腫瘍 (一社)日本頭頸部癌学会 30 (2) 194 - 194 0911-4335 2004/05 [Not refereed][Not invited]
  
• Clinical significance of 3D reconstruction of arteriovenous malformation using digital subtraction angiography and its modification with CT information in stereotactic radiosurgery.

  Xiao-Qing Zhang, Hiroki Shirato, Hidefumi Aoyama, Satoshi Ushikoshi, Takeshi Nishioka, Da-Zhen Zhang, Kazuo Miyasaka

  International journal of radiation oncology, biology, physics 57 (5) 1392 - 9 0360-3016 2003/12/01 

  PURPOSE: A three-dimensional (3D) reconstruction method of arteriovenous malformation (AVM) nidus from digital subtraction angiography (DSA) in combination with CT and/or MRI was developed, and its usefulness was evaluated in this study. MATERIALS AND METHODS: The contour of the AVM nidus was delineated on two orthogonal projected DSA images. First, the volume and center of the AVM nidus were calculated in a classic DSA plan using three maximal lengths of the nidus in three perpendicular directions, assuming that the nidus had a prolate ellipsoid shape. Second, in the 3D-DSA plan, the contours of the AVM nidus on the two orthogonal projected DSA images were segmented to be compatible with the slice thickness of the CT image. Assuming that each segment of the nidus has an ellipsoid pillar shape, the volume and center of each segment were calculated. The volume and 3D shape of the nidus were calculated by 3D reconstruction in the 3D-DSA plan. Third, in the CT-DSA plan, the contour based on the segmented DSA was superimposed on the corresponding transaxial CT image slice by slice. The cylindrical shape of the nidus in the transaxial image was modified using the enhanced CT images in the CT-DSA plan. These three planning methods were compared using dose-volume statistics from real patients' data. Eighteen patients with intracranial AVMs in different brain locations who had been treated by radiosurgery were the subjects of this study. To examine the visibility (validity) of the nidus on the CT image, the "nidus" was delineated on an enhanced CT image without DSA superposition in the CT plan and compared with the CT-DSA plan. RESULTS: The variance in the distance between coordinates determined by the CT plan and those determined by the classic DSA plan was significantly larger than the variance in the CT-DSA plan (p < 0.0001 for lateral, AP, and craniocaudal directions). The difference in the variance was not reduced by the addition of MRI (p < 0.0001 for each direction). The mean volume +/- SD of the nidus calculated was 5.9 +/- 8.0 cm(3) in the classic DSA plan, 4.0 +/- 5.6 cm(3) in the 3D-DSA plan, and 3.6 +/- 5.2 cm(3) in the CT-DSA plan. The 3D-DSA plan significantly reduced the mean nidus volume 31.8% +/- 12.7% from the classic DSA plan (p = 0.0054). The CT-DSA plan further significantly reduced the volume 9.8% +/- 8.8% from the 3D-DSA plan (p = 0.0021). The mean overlapping volume of the nidus between the CT plan and CT-DSA plan was 2.6 +/- 4.3 cm(3) (range 0.17-18.9), corresponding to 63.7% +/- 19.2% (range 11.4-85.3%) of the volume in the CT-DSA plan. CONCLUSIONS: The superposition of the segmented DSA information on CT was shown to be an important tool to determine the precise shape of the nidus and is suggested to be useful to reduce partial occlusion of the AVM or radiation complications in radiosurgery.
• 定位放射線照射における投与線量の解釈

  直居 豊, 伊藤 佳菜, 渡辺 太志, 笹井 啓資, 青山 英史, 白土 博樹, 永田 靖, 平岡 真寛, 藤川 章

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 68 - 68 1040-9564 2003/10
• 前立腺癌への動体追跡装置を用いた強度変調放射線治療75 Gy/30 fの初期経験

  大坂 康博, 喜多村 圭, 青山 英史, 土屋 和彦, 西岡 健, 白土 博樹, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 86 - 86 1040-9564 2003/10
• JROSG99-1第III相試験中間報告 1〜4個脳転移に対する定位単独と定位+全脳照射の比較

  青山 英史, 白土 博樹, 中川 恵一, 多湖 正夫

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 87 - 87 1040-9564 2003/10
• 金マーカー埋入義歯を用いた透視セットアップ照射

  大森 桂一, 土屋 和彦, 笈田 将皇, 渡辺 良晴, 青山 英史, 西岡 健, 白土 博樹

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 121 - 121 1040-9564 2003/10
• 長径2.5cm以上の聴神経鞘腫に対する定位放射線治療

  坂井 亙, 白土 博樹, 青山 英史, 坂本 徹, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 148 - 148 1040-9564 2003/10
• 動体追跡システムを用いたIMRTの基礎的検討(1) 移動による線量分布への影響

  笈田 将皇, 渡辺 良晴, 白土 博樹, 青山 英史, 土屋 和彦, 清水 祐介, 藤田 勝久

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 154 - 154 1040-9564 2003/10
• 動体追跡システムを用いたIMRTの基礎的検討(2) 移動によるIMRTの線量分布への影響

  渡辺 良晴, 笈田 将皇, 白土 博樹, 青山 英史, 土屋 和彦, 清水 祐介, 藤田 勝久

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 15 (Suppl.1) 155 - 155 1040-9564 2003/10
• Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption.

  Yutaka Sawamura, Hiroki Shirato, Touru Sakamoto, Hidefumi Aoyama, Keishiro Suzuki, Rikiya Onimaru, Toyohiko Isu, Satoshi Fukuda, Kazuo Miyasaka

  Journal of neurosurgery 99 (4) 685 - 92 0022-3085 2003/10 

  OBJECT: The goal of this study was to investigate outcomes in patients with vestibular schwannoma (VS) who were treated with fractionated stereotactic radiotherapy (SRT). METHODS: One hundred one patients with VS were treated with fractionated SRT at a radiation level of 40 to 50 Gy administered in 20 to 25 fractions over a 5- to 6-week period. The median tumor size in these patients was 19 mm (range 3-40 mm), and 27 tumors were larger than 25 mm. Patients were consistently followed up using magnetic resonance imaging every 6 months for 5 years in principle. The median follow-up period was 45 months. The actuarial 5-year rate of tumor control (no growth > 2 mm and no requirement for salvage surgery) was 91.4% (95% confidence interval 85.2-97.6%). Three patients with progressive tumors underwent salvage tumor resection. The actuarial 5-year rate of useful hearing preservation (Gardner-Robertson Class I or II) was 71%. The observed complications of fractionated SRT included transient facial nerve palsy (4% of patients), trigeminal neuropathy (14% of patients), and balance disturbance (17% of patients). No new permanent facial weakness occurred after fractionated SRT. Eleven patients (11%) who had progressive communicating hydrocephalus (cerebrospinal fluid malabsorption) and no evidence of tumor growth after fractionated SRT required a shunt. The symptoms of this type of hydrocephalus were similar to those of normal-pressure hydrocephalus and occurred 4 to 20 months (median 12 months) after fractionated SRT. The mean size (+/- standard deviation) of tumors causing symptomatic hydrocephalus (25.5 +/- 7.8 mm) was significantly larger than that of other tumors (18.2 +/- 8.7 mm) (p = 0.011). Only four of the 72 patients with tumors smaller than 25 mm in maximum diameter received a shunt. CONCLUSIONS: Fractionated SRT resulted in an excellent tumor control rate, even for relatively large tumors, and produced a high rate of hearing preservation that was comparable to the best results of single-fraction radiosurgery. The progression of communicating hydrocephalus should be monitored closely, particularly in patients harboring a large VS.
• 小児大脳PNET(primitive neuroectodermal tumor)に対するICE(IFX/CDDP/VP-16)化学療法を用いた集学的治療

  池田 潤, 小林 浩之, 石井 伸明, 澤村 豊, 岩崎 喜信, 青山 英史, 白土 博樹

  日本癌治療学会誌 (一社)日本癌治療学会 38 (2) 510 - 510 0021-4671 2003/09
• 画像診断の進歩と放射線治療 治療計画と効果判定にどのように役立っているか 放射線脳壊死と腫瘍再発の鑑別におけるL-[methyl-11C]-methionine PET(Met-PET)

  加藤 徳雄, 中駄 邦博, 青山 英史, 竹井 俊樹, 白土 博樹, 玉木 長良, 宮坂 和男

  断層映像研究会雑誌 断層映像研究会 30 (2〜3) 73 - 73 0914-8663 2003/09
• Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.

  Kazutoshi Hida, Hiroki Shirato, Toyohiko Isu, Toshitaka Seki, Rikiya Onimaru, Hidefumi Aoyama, Satoshi Ushikoshi, Kazuo Miyasaka, Yoshinobu Iwasaki

  Journal of neurosurgery 99 (1 Suppl) 34 - 8 0022-3085 2003/07 

  OBJECT: Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. METHODS: Candidates for this study were patients who experienced symptoms due to an intramedullary AVM but were ineligible for embolization or surgery. Of 21 patients with spinal AVMs, 10 cases in a 10-year period met this criterion. Angiography and contrast-enhanced computerized tomography scanning were used for treatment planning in all cases. Fractionated radiotherapy was performed using a linear accelerator, extracranial immobilization system, and frequent orthogonal linacographic verification. The starting radiation dose was 32 Gy in two, 36 Gy in three, and 40 Gy in two patients, in a regimen involving 1.8 to 2-Gy daily fractions; this was recently changed to a hypofractionation schedule of 30 Gy (in eight sessions) in one and 20 Gy (in four sessions) in two patients. RESULTS: The follow-up period ranged from 26 to 124 months (median of 49 months). There were no hemorrhages nor any adverse reactions attributable to irradiation. Of the seven patients who consented to undergo follow-up angiography, the nidus size decreased in five, but complete obliteration did not occur in any patient. CONCLUSIONS: Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
• 【脳腫瘍のキーワード】Linac surgery

  青山 英史, 白土 博樹

  Clinical Neuroscience (株)中外医学社 21 (5) 570 - 571 0289-0585 2003/05
• 放射線脳壊死と脳腫瘍の鑑別におけるL-[methyl-11C]-methionine PET(MET)

  加藤 徳雄, 中駄 邦博, 青山 英史, 竹井 俊樹, 白土 博樹, 玉木 長良, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 63 (2) S238 - S238 0048-0428 2003/02
• Long-term follow-up results with audiological assessment after fractionated stereotactic radiotherapy for vestibular schwannomas

  Y Sawamura, H Shirato, T Sakamoto, H Aoyama, S Fukuda, K Miyasaka

  ACOUSTIC NEUROMA 10 127 - 128 2003 [Refereed][Not invited]
   

  We investigated the appropriate management of patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (fSRT).
• 頭部疾患の定位放射線照射と画像診断 良性腫瘍(聴神経鞘腫を中心に)

  青山 英史, 白土 博樹

  臨床画像 (株)メジカルビュー社 19 (1) 110 - 115 0911-1069 2003/01
• :REPORT OF 2001st AND 2002nd JASTRO THEME STUDY

  NAOI Yutaka, AKAMATSU Masayuki, ITOH Kana, WATANABE Futoshi, SASAI Keisuke, AOYAMA Hidefumi, SHIRATO Hiroki, NAGATA Yasushi, HIRAOKA Masahiro, FUJIKAWA Akira

  J Jpn Soc Ther Radiol Oncol Japanese Society for Therapeutic Radiology and Oncology 15 (4) 297 - 306 1040-9564 2003
• Cervical and intracranial atherosclerosis and silent brain infarction in Japanese patients with coronary artery disease.

  Kazumi Uekita, Naoyuki Hasebe, Naoki Funayama, Hidefumi Aoyama, Kenji Kuroda, Hitoshi Aizawa, Ryo Kataoka, Kenjiro Kikuchi

  Cerebrovascular diseases (Basel, Switzerland) 16 (1) 61 - 8 1015-9770 2003 

  PURPOSE: To investigate the prevalence of cervical and intracranial atherosclerosis and silent brain infarction in patients with coronary artery disease (CAD). METHODS: Cervical and intracranial atherosclerotic lesions on magnetic resonance angiography (MRA) and silent brain infarctions on magnetic resonance imaging (MRI) were investigated in comparison with the findings of coronary angiography in 133 consecutive patients with CAD. RESULTS: The mean severity scores of cervical and intracranial MRA lesions were significantly higher in the three-vessel CAD (0.40 and 0.53, respectively) than in the zero-vessel CAD group (0.04 and 0.11). The mean scores of the maximal size and multiplicity of MRI lesion were also significantly greater in the two-vessel (1.00 and 1.44) and three-vessel CAD (0.94 and 1.26) than in the zero-vessel CAD group (0.27 and 0.50). The incidence of MRA lesion was markedly higher in patients with brain MRI lesion than in those without (51.1 vs. 6.5%). CONCLUSIONS: Serious coronary artery lesions were commonly accompanied by latent atherosclerotic lesions in the cervical and intracranial arteries besides silent brain infarction in patients with CAD.
• 神経下垂体部germinoma治療後における下垂体後葉ホルモン(抗利尿ホルモン)補充必要量についての検討

  池田 潤, 石井 伸明, 澤村 豊, 岩崎 喜信, 青山 英史, 白土 博樹

  日本内分泌学会雑誌 (一社)日本内分泌学会 78 (Suppl.) 68 - 69 0029-0661 2002/12 

  神経下垂体部に発生したgerminoma43例を治療方針別に放射線照射主体(A群)23例,化学療法主体(B群)20例に分け,初期治療終了後の抗利尿ホルモン(デスモプレシン)の1日必要投与量を比較検討した.A群では化学療法は加えず,B群では化学療法終了後に放射線治療を行った.A群の放射線照射線量は40-50Gy,一日必要デスモプレシン量は0.105+/-0.077mLで,B群では各々24-30Gy,0.065+/-0.037mLであり,B群で有意にデスモプレシン使用量が少なかった.B群において治療終了後にデスモプレシン使用量の減少例はあったが,不要例はなかった.以上より,化学療法を用いて放射線治療線量を減じるプロトコールによりデスモプレシン必要補充量を少なく抑えることが可能と考えられた
• 【良性疾患の放射線治療】脳動静脈奇形

  張 大鎮, 青山 英史, 白土 博樹

  臨床放射線 金原出版(株) 47 (別冊) 84 - 95 0009-9252 2002/11 

  脳動静脈奇形の放射線治療における照射ターゲットの設定には,定位的血管造影の撮影とCT,MRI,MRA画像の重ね合わせで各々の特長を生かす.標的体積と照射の線量分布を一致させる方法として強度変調照射或いは多中心を用いたconformalityの向上により複雑な形態に対して照射野を一致することが可能となった.適切な線量の選択,大きなサイズ,重要部位の治療における少分割照射の可能性についても解説した
• Calculation of rotational setup error using the real-time tracking radiation therapy (RTRT) system and its application to the treatment of spinal schwannoma.

  Rikiya Onimaru, Hiroki Shirato, Hidefumi Aoyama, Kei Kitakura, Toshitaka Seki, Kazutoshi Hida, Katsuhisa Fujita, Kenji Kagei, Takeshi Nishioka, Tatsuya Kunieda, Yoshinobu Iwasaki, Kazuo Miyasaka

  International journal of radiation oncology, biology, physics 54 (3) 939 - 47 0360-3016 2002/11/01 

  PURPOSE: The efficacy of a prototypic fluoroscopic real-time tracking radiation therapy (RTRT) system using three gold markers (2 mm in diameter) for estimating translational error, rotational setup error, and the dose to normal structures was tested in 5 patients with spinal schwannoma and a phantom. METHODS AND MATERIALS: Translational error was calculated by comparing the actual position of the marker closest to the tumor to its planned position, and the rotational setup error was calculated using the three markers around the target. Theoretically, the actual coordinates can be adjusted to the planning coordinates by sequential rotation of gamma degrees around the z axis, beta degrees around the y axis, and alpha degrees around the x axis, in this order. We measured the accuracy of the rotational calculation using a phantom. Five patients with spinal schwannoma located at a minimum of 1-5 mm from the spinal cord were treated with RTRT. Three markers were inserted percutaneously into the paravertebral deep muscle in 3 patients and surgically into two consecutive vertebral bones in two other patients. RESULTS: In the phantom study, the discrepancies between the actual and calculated rotational error were -0.1 +/- 0.5 degrees. The random error of rotation was 5.9, 4.6, and 3.1 degrees for alpha, beta, and gamma, respectively. The systematic error was 7.1, 6.6, and 3.0 degrees for alpha, beta, and gamma, respectively. The mean rotational setup error (0.2 +/- 2.2, -1.3 +/- 2.9, and -1.3 +/- 1.7 degrees for alpha, beta, and gamma, respectively) in 2 patients for whom surgical marker implantation was used was significantly smaller than that in 3 patients for whom percutaneous insertion was used (6.0 +/- 8.2, 2.7 +/- 5.9, and -2.1 +/- 4.6 degrees for alpha, beta, and gamma). Random translational setup error was significantly reduced by the RTRT setup (p < 0.0001). Systematic setup error was significantly reduced by the RTRT setup only in patients who received surgical implantation of the marker (p < 0.0001). The maximum dose to the spinal cord was estimated to be 40.6-50.3 Gy after consideration of the rotational setup error, vs. a planned maximum dose of 22.4-51.6 Gy. CONCLUSION: The RTRT system employing three internal fiducial markers is useful to reduce translational setup error and to estimate the dose to the normal structures in consideration of the rotational setup error. Surgical implantation of the marker to the vertebral bone was shown to be sufficiently rigid for the calculation of the rotational setup error. Fractionated radiotherapy for spinal schwannoma using the RTRT system may well be an alternative or supplement to surgical treatment.
• Three-dimensional conformal radiotherapy for astrocytic tumors involving the eloquent area in children and young adults.

  Taiga Nishihori, Hiroki Shirato, Hidefumi Aoyama, Rikiya Onimaru, Takashi Komae, Nobuaki Ishii, Jun Ikeda, Kazuo Miyasaka, Yutaka Sawamura, Yoshinobu Iwasaki

  Journal of neuro-oncology 60 (2) 177 - 83 0167-594X 2002/11 

  PURPOSE: Although a gross total removal of astrocytic tumors offers a favorable prognosis, it is often difficult to achieve in the eloquent area of the brain. This study was conducted to investigate the possible gain of three-dimensional conformal radiotherapy (3DCRT) for astrocytic tumors located in the eloquent area in children and young adults. MATERIALS AND METHODS: Twenty patients with astrocytic tumors received the radiotherapy. The median age was 17 years, ranging from 4 to 30 years. Fourteen low-grade tumors (seven pilocytic and seven diffuse), and six high-grade tumors (five anaplastic, one malignant pilocytic) were included. Tumors were located at the thalamus/hypothalamus in 12 cases, optic tract in one case, and the deep cerebral/cerebellar hemisphere in seven cases. A specific fixation device was used for 3DCRT. Forty-six Gy for low-grade tumors and 54 Gy for high-grade astrocytomas with 1.8-2.0 Gy per fraction were in principle employed as the standard regimen. Nominal radiotherapy fields ranged from 2.0 x 2.0 to 15.0 x 11.0 cm2. The median follow-up period was 42 months, ranging from 3 to 108 months. RESULTS: The actuarial survival rate at 5 years was 68% +/- 13% for all patients. The actuarial survival rate for low-grade glioma was 79% +/- 14% at 5 years and 50% +/- 20% at 3 years for high-grade glioma. The actual progression-free survival rate was 83% +/- 11% at 5 years for low-grade glioma and 50% +/- 20% for high-grade glioma. A complete response was obtained in three (21%) of 14 patients with low-grade astrocytic tumors. Two patients with low-grade tumors and four of six with high-grade tumors died due to tumor progression with infield relapse but not marginal relapse. Twelve survivors with low-grade tumors showed no signs of relapse and no neurological, hormonal, or cognitive deterioration after radiotherapy and were able to attend their school or continue with a full-time job. CONCLUSIONS: 3DCRT is safe and effective for low-grade astrocytic tumors located in the eloquent area in children and young adults.
• C-11メチオニンPETによる放射線性壊死と再発脳腫瘍の鑑別

  中駄 邦博, 竹井 俊樹, 加藤 千恵次, 山本 文泰, 塚本 正仁, 青山 英史, 久下 祐司, 塚本 江利子, 玉木 長良, 鈴木 幸太郎, 表 英彦

  核医学 (一社)日本核医学会 39 (3) 398 - 398 0022-7854 2002/09
• 脳腫瘍に対する放射線治療戦略 全脳画像の治療計画への利用

  白土 博樹, 青山 英史, 石井 伸明, 池田 潤, 澤村 豊, 鎌田 恭輔, 宮坂 和男, 岩埼 喜信

  日本癌治療学会誌 (一社)日本癌治療学会 37 (2) 221 - 221 0021-4671 2002/09
• 新たに診断されたCNS胚細胞腫に対する減容量放射線照射を行う前の導入補助化学療法の長期追跡結果(Long-Term Follow-up Results of Induction Chemotherapy Followed by Reduced-Volume Irradiation for Newly Diagnosed CNS Germinoma)

  澤村 豊, 白土 博樹, 池田 潤, 青山 英史

  日本癌治療学会誌 37 (2) 222 - 222 0021-4671 2002/09
• Image fusion between 18FDG-PET and MRI/CT for radiotherapy planning of oropharyngeal and nasopharyngeal carcinomas.

  Takeshi Nishioka, Tohru Shiga, Hiroki Shirato, Eriko Tsukamoto, Kazuhiko Tsuchiya, Takashi Kato, Keiichi Ohmori, Akira Yamazaki, Hidefumi Aoyama, Seiko Hashimoto, Ta-Chen Chang, Kazuo Miyasaka

  International journal of radiation oncology, biology, physics 53 (4) 1051 - 7 0360-3016 2002/07/15 

  PURPOSE: Accurate diagnosis of tumor extent is important in three-dimensional conformal radiotherapy. This study reports the use of image fusion between (18)F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) and magnetic resonance imaging/computed tomography (MRI/CT) for better targets delineation in radiotherapy planning of head-and-neck cancers. METHODS AND MATERIALS: The subjects consisted of 12 patients with oropharyngeal carcinoma and 9 patients with nasopharyngeal carcinoma (NPC) who were treated with radical radiotherapy between July 1999 and February 2001. Image fusion between 18FDG-PET and MRI/CT was performed using an automatic multimodality image registration algorithm, which used the brain as an internal reference for registration. Gross tumor volume (GTV) was determined based on clinical examination and 18FDG uptake on the fusion images. Clinical target volume (CTV) was determined following the usual pattern of lymph node spread for each disease entity along with the clinical presentation of each patient. RESULTS: Except for 3 cases with superficial tumors, all the other primary tumors were detected by 18FDG-PET. The GTV volumes for primary tumors were not changed by image fusion in 19 cases (89%), increased by 49% in one NPC, and decreased by 45% in another NPC. Normal tissue sparing was more easily performed based on clearer GTV and CTV determination on the fusion images. In particular, parotid sparing became possible in 15 patients (71%) whose upper neck areas near the parotid glands were tumor-free by 18FDG-PET. Within a mean follow-up period of 18 months, no recurrence occurred in the areas defined as CTV, which was treated prophylactically, except for 1 patient who experienced nodal recurrence in the CTV and simultaneous primary site recurrence. CONCLUSION: This preliminary study showed that image fusion between 18FDG-PET and MRI/CT was useful in GTV and CTV determination in conformal RT, thus sparing normal tissues.
• 直線加速器を用いた定位放射線照射

  白土 博樹, 青山 英史, 飛騨 一利, 澤村 豊, 宮坂 和男, 岩崎 喜信

  Neurological Surgery (株)医学書院 30 (6) 579 - 591 0301-2603 2002/06
• [Stereotactic irradiation using linear accelerator].

  Hiroki Shirato, Hidefumi Aoyama, Kazutoshi Hida, Yutaka Sawamura, Kazuo Miyasaka, Yoshinobu Iwasaki

  No shinkei geka. Neurological surgery 30 (6) 579 - 91 0301-2603 2002/06
• Anisotrophic diffusion-weighted MRIを用いた錐体路情報の定位照射治療計画への統合

  青山 英史, 鎌田 恭輔, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 62 (3) S116 - S116 0048-0428 2002/03
• Registration accuracy and possible migration of internal fiducial gold marker implanted in prostate and liver treated with real-time tumor-tracking radiation therapy (RTRT).

  Kei Kitamura, Hiroki Shirato, Shinichi Shimizu, Nobuo Shinohara, Toru Harabayashi, Tadashi Shimizu, Yoshihisa Kodama, Hideho Endo, Rikiya Onimaru, Seiko Nishioka, Hidefumi Aoyama, Kazuhiko Tsuchiya, Kazuo Miyasaka

  Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 62 (3) 275 - 81 0167-8140 2002/03 

  BACKGROUND AND PURPOSE: We have developed a linear accelerator synchronized with a fluoroscopic real-time tumor-tracking system to reduce errors due to setup and organ motion. In the real-time tumor-tracking radiation therapy (RTRT) system, the accuracy of tumor tracking depends on the registration of the marker's coordinates. The registration accuracy and possible migration of the internal fiducial gold marker implanted into prostate and liver was investigated. MATERIALS AND METHODS: Internal fiducial gold markers were implanted in 14 patients with prostate cancer and four patients with liver tumors. Computed tomography (CT) was carried out as a part of treatment planning in the 18 patients. A total of 72 follow-up CT scans were taken. We calculated the relative relationship between the coordinates of the center of mass (CM) of the organs and those of the marker. The discrepancy in the CM coordinates during a follow-up CT compared to those recorded during the planning CT was used to study possible marker migration. RESULTS: The standard deviation (SD) of interobserver variations in the CM coordinates was within 2.0 and 0.4 mm for the organ and the marker, respectively, in seven observers. Assuming that organs do not shrink, grow, or rotate, the maximum SD of migration error in each direction was estimated to be less than 2.5 and 2.0 mm for liver and prostate, respectively. There was no correlation between the marker position and the time after implantation. CONCLUSION: The degree of possible migration of the internal fiducial marker was within the limits of accuracy of the CT measurement. Most of the marker movement can be attributed to the measurement uncertainty, which also influences registration in actual treatment planning. Thus, even with the gold marker and RTRT system, a planning target volume margin should be used to account for registration uncertainty.
• 動体追跡照射装置を用いた前立腺癌のConformal Set-up

  上垣 慎二, 白土 博樹, 喜多村 圭, 鬼丸 力也, 青山 英史, 米坂 祥朗, 井上 明大, 小前 隆, 土屋 和彦, 西岡 健

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 62 (1) 47 - 47 0048-0428 2002/01
• 動体追跡照射中における肺腫瘍の三次元的運動の解析

  喜多村 圭, 白土 博樹, 鬼丸 力也, 土屋 和彦, 西岡 井子, 西岡 健, 青山 英史, 宮坂 和男, Seppenwoolde Yvette

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 62 (1) 46 - 46 0048-0428 2002/01
• 頭蓋内原発胚細胞腫瘍に対する放射線治療の問題点 長期生存例における放射線誘発二次腫瘍と脳血管障害の発生について

  池田 潤, 澤村 豊, 石井 伸明, 岩崎 喜信, 青山 英史, 白土 博樹

  小児がん (NPO)日本小児がん学会 38 (3) 374 - 374 0389-4525 2001/12
• 肺定位照射における吸気・呼気・自由呼吸時と呼気時のみのCTでのDVH parameterの検討

  鬼丸力也, 白土博樹, 喜多村圭, 清水伸一, 西岡健, 青山英史, 土屋和彦, 西岡井子, 宮坂和男

  日本放射線腫よう学会誌 (公社)日本放射線腫瘍学会 13 (Supplement 1) 114 - 114 1040-9564 2001/11 [Not refereed][Not invited]
  
• Cisplatin抵抗性頭蓋内胚細胞腫瘍に対するgemcitabine/taxotere併用化学療法

  池田 潤, 石井 伸明, 澤村 豊, 岩崎 喜信, 青山 英史, 白土 博樹

  日本癌治療学会誌 (一社)日本癌治療学会 36 (2) 590 - 590 0021-4671 2001/10
• 小児後頭蓋窩悪性腫瘍に対する化学放射線療法

  池田 潤, 石井 伸明, 澤村 豊, 岩崎 喜信, 青山 英史, 白土 博樹

  小児の脳神経 (一社)日本小児神経外科学会 26 (4) 267 - 267 0387-8023 2001/08
• 頭蓋内原発胚芽腫に対する集学的治療 特にHCG-β陽性群のあつかいについて

  石井 伸明, 池田 潤, 澤村 豊, 岩崎 喜信, 青山 英史, 白土 博樹

  小児の脳神経 (一社)日本小児神経外科学会 26 (4) 316 - 316 0387-8023 2001/08
• 脊髄動静脈奇形・脊髄神経鞘腫に対する定位照射での画像レジストレーションと位置精度

  鬼丸力也, 白土博樹, 喜多村圭, 清水伸一, 青山英史, 影井兼司, 土屋和彦, 西岡健, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (6) 319 - 319 0048-0428 2001/05/25 [Not refereed][Not invited]
  
• 原発性・転移性肝腫ように対する動体追跡放射線治療の経験

  喜多村圭, 白土博樹, 清水伸一, 橋本井子, 土屋和彦, 鬼丸力也, 青山英史, 影井兼司, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (4) 190 - 190 0048-0428 2001/03/25 [Not refereed][Not invited]
  
• 動体追跡照射装置による照射中の肺癌の動態解析

  清水伸一, 白土博樹, 喜多村圭, 青山英史, 鬼丸力也, 土屋和彦, 橋本井子, 宮坂和男, VAN HERK M

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (4) 191 - 191 0048-0428 2001/03/25 [Not refereed][Not invited]
  
• 放射線治療におけるVirtualとRealのRegistration技術に関する考察

  白土博樹, 鬼丸力也, 清水伸一, 橋本井子, 土屋和彦, 喜多村圭, 青山英史, 宮坂和男, 伊福部達

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (4) 192 - 192 0048-0428 2001/03/25 [Not refereed][Not invited]
  
• Stage B期の前立腺癌に対する局所放射線治療

  喜多村圭, 白土博樹, 清水伸一, 橋本井子, 土屋和彦, 鬼丸力也, 青山英史, 影井兼司, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (4) 193 - 193 0048-0428 2001/03/25 [Not refereed][Not invited]
  
• 線量率可変式全身照射用装置の使用経験

  井上 明大, 影井 兼司, 橋本 井子, 西岡 健, 喜多村 圭, 青山 英史, 鬼丸 力也, 土屋 和彦, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (4) 190 - 190 0048-0428 2001/03
• 頭頸部腫瘍の治療計画におけるFDGPETの利用

  西岡 健, 山崎 彰, 土屋 和彦, 青山 英史, 白土 博樹, 志賀 徹, 加藤 貴志, 塚本 江利子, 玉木 長良

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (4) 189 - 189 0048-0428 2001/03
• 前立腺癌に対するIntensity modulated radiotherapy(IMRT) 動体追跡・内分泌療法併用によるprospective studyの初期成績

  喜多村 圭, 白土 博樹, 清水 伸一, 鬼丸 力也, 西岡 井子, 西岡 健, 影井 兼司, 土屋 和彦, 青山 英史, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (2) S128 - S129 0048-0428 2001/02
• FDGPETを用いた頭頸部癌の放射線治療計画

  西岡 健, 白土 博樹, 土屋 和彦, 山崎 彰, 志賀 哲, 塚本 江利子, 青山 英史, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 61 (2) S138 - S138 0048-0428 2001/02
• 頭蓋内原発胚芽腫に対する集学的治療

  池田 潤, 石井 伸明, 澤村 豊, 岩崎 喜信, 青山 英史, 白土 博樹

  小児がん (NPO)日本小児がん学会 37 (3) 370 - 370 0389-4525 2000/11
• Physical aspects of a real-time tumor-tracking system for gated radiotherapy.

  H Shirato, S Shimizu, T Kunieda, K Kitamura, M van Herk, K Kagei, T Nishioka, S Hashimoto, K Fujita, H Aoyama, K Tsuchiya, K Kudo, K Miyasaka

  International journal of radiation oncology, biology, physics 48 (4) 1187 - 95 0360-3016 2000/11/01 [Refereed][Not invited]
   

  PURPOSE: To reduce uncertainty due to setup error and organ motion during radiotherapy of tumors in or near the lung, by means of real-time tumor tracking and gating of a linear accelerator. METHODS AND MATERIALS: The real-time tumor-tracking system consists of four sets of diagnostic X-ray television systems (two of which offer an unobstructed view of the patient at any time), an image processor unit, a gating control unit, and an image display unit. The system recognizes the position of a 2.0-mm gold marker in the human body 30 times per second using two X-ray television systems. The marker is inserted in or near the tumor using image guided implantation. The linear accelerator is gated to irradiate the tumor only when the marker is within a given tolerance from its planned coordinates relative to the isocenter. The accuracy of the system and the additional dose due to the diagnostic X-ray were examined in a phantom, and the geometric performance of the system was evaluated in 4 patients. RESULTS: The phantom experiment demonstrated that the geometric accuracy of the tumor-tracking system is better than 1.5 mm for moving targets up to a speed of 40 mm/s. The dose due to the diagnostic X-ray monitoring ranged from 0.01% to 1% of the target dose for a 2.0-Gy irradiation of a chest phantom. In 4 patients with lung cancer, the range of the coordinates of the tumor marker during irradiation was 2.5-5.3 mm, which would have been 9.6-38.4 mm without tracking. CONCLUSION: We successfully implemented and applied a tumor-tracking and gating system. The system significantly improves the accuracy of irradiation of targets in motion at the expense of an acceptable amount of diagnostic X-ray exposure.
• 視床部星細胞腫に対する放射線治療

  池田 潤, 澤村 豊, 石井 伸明, 青山 英史, 白土 博樹

  日本脳神経外科学会総会抄録集 (一社)日本脳神経外科学会 59回 235 - 235 1347-9059 2000/10
• 頭蓋内原発胚細胞腫瘍患者の長期生存例における放射線誘発脳血管障害の発生

  池田 潤, 澤村 豊, 石井 伸明, 青山 英史, 白土 博樹

  日本脳神経外科学会総会抄録集 (一社)日本脳神経外科学会 59回 91 - 91 1347-9059 2000/10
• High-speed magnetic resonance imaging for four-dimensional treatment planning of conformal radiotherapy of moving body tumors

  S Shimizu, H Shirato, H Aoyama, S Hashimoto, T Nishioka, A Yamazaki, K Kagei, K Miyasaka

  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 48 (2) 471 - 474 0360-3016 2000/09 [Refereed][Not invited]
   

  Purpose: High-speed magnetic resonance imaging (MRI) was applied to the determination of the planning target volume (PTV) of moving hepatobiliary tumors. Methods and Materials: Three moving tumors, including two metastatic hepatic tumors and one bile duct tumor, were examined using high-speed MRI and reference fiducial markers before external radiotherapy. Patients were examined for 30 seconds under conditions of normal breathing during the examination. The coordinates of the center of the tumor contours were shown on sagittal and coronal images displayed on the monitor. Results: The maximum length of movement was 10.6 +/- 7.0 mm in a craniocaudal direction; 5.2 +/- 1.8 mm in a lateral direction; and 4.6 +/- 1.6 mm in a ventrodorsal direction. When the PTV was determined using MRI at exhalation phase with a 10-mm safety margin, clinical target volume (CTV) was not covered in 19% of all images in the 3 patients. With MRI at inhalation phase with a 10-mm safety margin, CTV was not covered in 36% of all images. Conclusion: Four-dimensional treatment planning using high speed MRI, and integrating time and spatial information, has the potential to determine the planning target volume of moving body tumors more precisely than does conventional CT planning. (C) 2000 Elsevier Science Inc.
• 前立腺癌への局所放射線治療の効果と副作用

  喜多村圭, 鈴木恵士郎, 白土博樹, 西岡健, 影井兼司, 青山英史, 清水伸一, 篠原信雄, 出村孝義

  泌尿器外科 医学図書出版(株) 13 (8) 1133 - 1133 0914-6180 2000/08/15 [Not refereed][Not invited]
  
• The role of radiotherapy in treating squamous cell carcinoma of the external auditory canal, especially in early stages of disease

  Noriko Hashi, Hiroki Shirato, Tokuhiko Omatsu, Kenji Kagei, Takeshi Nishioka, Seiko Hashimoto, Hidefumi Aoyama, Satoshi Fukuda, Yukio Inuyama, Kazuo Miyasaka

  Radiotherapy and Oncology 56 (2) 221 - 225 0167-8140 2000/08/01 [Refereed][Not invited]
   

  Purpose: Our intent was to investigate the role of radiotherapy in treating external auditory canal squamous cell carcinoma, especially in early stages of disease. Materials and methods: The treatment results for 20 patients treated between 1980 and 1998 were retrospectively analyzed. Radiotherapy was used as an initial treatment without surgery in eight patients and with surgery in 12 patients. The patients treated by radiotherapy alone received 65 Gy in 26 fractions over 6.5 weeks. The patients treated with radiotherapy perioperatively received 30-75 Gy in 12-30 fractions. The follow-up period for survivors including patients died of intercurrent disease ranged from 7 to 205 months (mean: 71 months). Results: The 5-year survival rate calculated by the Kaplan-Meier method for all patients was 59%. According to Stell classification (Laryncol. Otol. 99 (1985) 847), the 5-year survival rates for eight patients with T1 disease and eight with T2 disease were 100 and 38%, respectively. In the eight patients with T1 disease, disease control was 100%. Local control with hearing preservation was achieved in five patients with T1 disease by radiotherapy alone. No late complications related to radiotherapy were observed. Conclusions: A precise diagnosis of the disease in terms of whether or not it has invaded the bone is important in order to predict the treatment outcome. Radiotherapy with or without surgery is the treatment of choice for patients with T1-stage disease. Surgery with radiotherapy is recommended as standard care for tumors with bony invasion. Copyright (C) 2000 Elsevier Science Ireland Ltd.
• AstrocytomaおよびOligodendrogliomaへの放射線照射の治療経験

  小前隆, 青山英史, 西岡健, 橋本井子, 山崎彰, 清水伸一, 喜多村圭, 宮坂和男, 沢村豊

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (8) 465 - 465 0048-0428 2000/07/25 [Not refereed][Not invited]
  
• 体幹部定位放線照射における4次元治療計画と動体追跡放射線照射

  白土博樹, 清水伸一, 清水匡, 喜多村圭, 青山英史, 西岡健, 影井兼司, 橋本井子, 宮坂和男

  定位的放射線治療 日本定位放射線治療学会 4 131-136 - 136 1342-9930 2000/07/25 [Not refereed][Not invited]
   

  体幹部病巣の定位放射線照射の為に,病巣をリアルタイムに追跡して,計画部位に位置した瞬間のみ照射可能な装置を開発し,臨床経験を得た.腫瘍ないしその近傍に1〜2mmの金マーカーを刺入した上で,CTプランを行う.腫瘍と金マーカーの位置関係を直線加速器の動体追跡照射装置に伝送する.治療室に備えられた2組のX線透視装置を用いて,この金マーカーの三次元位置座標を計算し,isocenterに対応した座標を用いて患者セットアップを行う.その後,治療用X線の照射中,30回/秒の割合で透視し,リアルタイムに金マーカー位置を計算し,計画位置に金マーカーが透視した場合のみ,治療用X線が照射される.ファントム実験では,静的なものに対して1mm以下の精度で座標を計測できた.動くファントムを用いた実験では,秒速40mmまで追跡可能であった
• 下咽頭癌のCT simulationにおける頚部リンパ節転移領域の解析

  山崎彰, 西岡健, 橋本井子, 喜多村圭, 土屋和彦, 青山英史, 清水伸一, 影井兼司, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (8) 466 - 466 0048-0428 2000/07/25 [Not refereed][Not invited]
  
• 頭頚部早期悪性リンパ腫に対するBiweekly CHOPと放射線治療

  西岡健, 山崎彰, 橋本井子, 喜多村圭, 土屋和彦, 青山英史, 清水伸一, 宮坂和男, 北原利博

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (8) 466 - 466 0048-0428 2000/07/25 [Not refereed][Not invited]
  
• 動体追跡放射線照射装置を用いた前立腺癌・ぼうこう癌への高精度conformal radiotherapyの経験

  喜多村圭, 清水伸一, 森孝之, 土屋和彦, 山崎彰, 青山英史, 橋本井子, 西岡健, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (3) 110 - 110 0048-0428 2000/02/25 [Not refereed][Not invited]
  
• Pilocytic astrocytomaへの3次元conformal放射線治療の経験

  森孝之, 青山英史, 清水伸一, 喜多村圭, 土屋和彦, 山崎彰, 橋本井子, 西岡健, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (3) 108 - 108 0048-0428 2000/02/25 [Not refereed][Not invited]
  
• 前立腺癌に対する局所放射線治療の長期成績と副作用の検討

  喜多村圭, 清水伸一, 森孝之, 土屋和彦, 山崎彰, 青山英史, 橋本井子, 西岡健, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (3) 110 - 110 0048-0428 2000/02/25 [Not refereed][Not invited]
  
• 上咽頭腫ようの局所残存および再発病変に対する3次元小容積照射

  西岡健, 山崎彰, 橋本井子, 喜多村圭, 土屋和彦, 清水伸一, 青山英史, 白土博樹, 宮坂和男

  日本医学放射線学会雑誌 60 (2) S239  0048-0428 2000/02/20 [Not refereed][Not invited]
  
• 前立腺癌へのintensity modulated radiotherapy(IMRT)におけるreal‐time tumor‐tracking systemの有用性

  喜多村圭, 白土博樹, 清水伸一, 土屋和彦, 山崎彰, 青山英史, 橋本井子, 西岡健, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (2) S235-S236 - S236 0048-0428 2000/02/20 [Not refereed][Not invited]
  
• Glioblastoma細胞の放射線感受性におけるp53遺伝子の役割 温度感受性p53変異細胞株を用いた検討

  土屋和彦, 多田光宏, 白土博樹, 西岡健, 橋本井子, 青山英史, 喜多村圭, 清水伸一, 宮坂和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (2) S148-S149 - S149 0048-0428 2000/02/20 [Not refereed][Not invited]
  
• MRI治療計画装置を用いた頭蓋部病変三次元治療計画 複数観察者間の標的体積の検討

  青山 英史, 土屋 和彦, 橋本 井子, 西岡 健, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (2) S218 - S218 0048-0428 2000/02
• 上咽頭腫瘍の局所残存及び再発病変に対する三次元小容積照射

  西岡 健, 山崎 彰, 橋本 井子, 喜多村 圭, 土屋 和彦, 清水 伸一, 青山 英史, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 60 (2) S239 - S239 0048-0428 2000/02 [Not refereed][Not invited]
  
• Stereotactic radiotherapy and real-time tumour-tracking radiotherapy.

  SHIRATO HIROKI, AOYAMA EIJI, KITAMURA KEI, SHIMIZU SHIN'ICHI

  臨床放射線 44 (13) 1609-1615  0009-9252 1999/12/10 [Not refereed][Not invited]
  
• Reconstruction of medical treatment and radiotherapy. The latest radiotherapy. Real-tome tumor-tracking irradiation method and stereotactic radioirradiation.

  SHIRATO HIROKI, NISHIOKA TAKESHI, KAGEI KENJI, HASHIMOTO SEIKO, AOYAMA HIDEFUMI, KITAMURA KEI, SHIMIZU SHIN'ICHI, KUNIEDA TATSUYA, GOTO MASAHARU

  月刊新医療 (株)エムイー振興協会 26 (12) 61-63 - 63 0910-7991 1999/12/01 [Not refereed][Not invited]
  
• 定位放射線照射,三次元原体照射による治療が有効であったpilocytic,fibrillary astrocytomaの4例

  森 孝之, 青山 英史, 白土 博樹, 西岡 健, 橋本 井子, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 295 - 295 1040-9564 1999/11
• 血管造影装置を配備した密封小線源治療施設における血管内小線源治療システムの開発と基礎的研究

  橋本 井子, 西岡 健, 土屋 和彦, 清水 伸一, 喜多村 圭, 山崎 彰, 青山 英史, 清水 匡, 白土 博樹, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 311 - 311 1040-9564 1999/11 [Not refereed][Not invited]
  
• 肺腫瘍45病変に対する定位的放射線治療の臨床成績

  清水 伸一, 白土 博樹, 喜多村 圭, 青山 英史, 橋本 井子, 西岡 健, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 206 - 206 1040-9564 1999/11 [Not refereed][Not invited]
  
• 頭蓋内,頭蓋底病変におけるMRI-planningの有用性 CT,MRIで定義されたGTVの複数観察者比較検討

  青山 英史, 土屋 和彦, 橋本 井子, 西岡 健, 山崎 彰, 喜多村 圭, 清水 伸一, 白土 博樹, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 240 - 240 1040-9564 1999/11 [Not refereed][Not invited]
  
• 前立腺癌に対する局所放射線治療後の晩期直腸出血に関する検討

  喜多村 圭, 鈴木 恵士郎, 土屋 和彦, 山崎 彰, 清水 伸一, 青山 英史, 橋本 井子, 西岡 健, 白土 博樹, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 149 - 149 1040-9564 1999/11 [Not refereed][Not invited]
  
• Glioblastoma細胞の放射線感受性におけるp53遺伝子の役割 温度感受性p53変異細胞株を用いた検討

  土屋 和彦, 多田 光宏, 白土 博樹, 西岡 健, 橋本 井子, 青山 英史, 喜多村 圭, 清水 伸一, 山崎 彰, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 169 - 169 1040-9564 1999/11 [Not refereed][Not invited]
  
• 動体追跡照射装置の開発と初期臨床効果

  白土 博樹, 清水 伸一, 喜多村 圭, 清水 匡, 青山 英史, 山崎 彰, 橋本 井子, 西岡 健, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 207 - 207 1040-9564 1999/11 [Not refereed][Not invited]
  
• 頭頸部癌の至適臨床的標的体積決定のためのリンパ節転移分布の解析 下咽頭癌

  山崎 彰, 西岡 健, 白土 博樹, 橋本 井子, 喜多村 圭, 青山 英史, 清水 伸一, 土屋 和彦, 宮坂 和男

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 11 (Suppl.1) 190 - 190 1040-9564 1999/11 [Not refereed][Not invited]
  
• 【脳のイメージングupdate 解剖から治療まで】放射線治療 脳の定位放射線照射

  白土 博樹, 青山 英史

  臨床放射線 金原出版(株) 44 (11) 1478 - 1488 0009-9252 1999/10
• 【Radiotherapy Today '99 放射線治療の最新動向】ライナックによる定位放射線照射の現状と展望

  青山 英史, 白土 博樹

  INNERVISION (株)インナービジョン 14 (10) 89 - 92 0913-8919 1999/09
• 放射線治療計画用MRシステムの開発

  渡辺 良晴, 白土 博樹, 浅田 和佳, 前田 常雄, 影井 兼司, 西岡 健, 青山 英史, 橋本 井子, 清水 伸一, 南雲 淳也, 藤田 勝久, 古家 輝夫, 山口 恵, 宮坂 和男

  メディックス (株)日立製作所ヘルスケアビジネスユニット 31 12 - 17 0385-2245 1999/09 [Not refereed][Not invited]
  
• 【放射線治療の新潮流】MRI画像の放射線治療計画への応用

  青山 英史, 渡辺 良晴, 古屋 輝夫, 橋本 井子, 影井 兼司, 西岡 健, 白土 博樹, 宮坂 和男

  映像情報Medical 産業開発機構(株) 31 (16) 895 - 898 1346-1354 1999/08
• 【放射線治療の新潮流】 2軸X線透視装置を用いた三次元的患者セットアップシステムの開発

  清水 伸一, 白土 博樹, 青山 英史, 宮坂 和男, 国枝 達也

  映像情報Medical 産業開発機構(株) 31 (16) 879 - 884 1346-1354 1999/08 [Not refereed][Not invited]
  
• 【MRIの到達点】北大における治療計画用MRIの概要と臨床応用

  青山 英史, 宮坂 和男, 白土 博樹, 渡辺 良晴, 古屋 輝夫, 影井 兼司

  新医療 (株)エムイー振興協会 26 (6) 109 - 112 0910-7991 1999/06
• 脳動静脈奇形に対する定位照射後の出血に関わる因子の検討

  青山 英史, 白土 博樹, 西岡 健, 影井 兼司, 橋本 井子, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (6) 278 - 278 0048-0428 1999/05
• MR治療計画システムの開発

  影井 兼司, 西岡 健, 橋本 井子, 青山 英史, 清水 伸一, 土屋 和彦, 橋 徳子, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (6) 282 - 282 0048-0428 1999/05 [Not refereed][Not invited]
  
• Stereotactic Irradiation-from Three-dimensional to Four-dimensional Stereotaxy.

  SHIRATO HIROKI, AOYAMA HIDEFUMI, SHIMIZU SHIN'ICHI

  癌の臨床 45 (4) 293-294  0021-4949 1999/04/01 [Not refereed][Not invited]
  
• Three-dimensional movement of a liver tumor detected by high-speed magnetic resonance imaging

  S Shimizu, B Shirato, B Xo, K Kagei, T Nishioka, S Hashimoto, K Tsuchiya, H Aoyama, K Miyasaka

  RADIOTHERAPY AND ONCOLOGY 50 (3) 367 - 370 0167-8140 1999/03 [Refereed][Not invited]
   

  Objective: Three-dimensional (3D) movement of a spherical liver tumor during respiration was investigated with magnetic resonance imaging (MRI) using a high-speed sequence. Methods: A marker was placed on the surface of the patient as a reference of distance. Repetition time (TR) was 7.7 ms, echo time (TE) was 4.2 ms, flip angle was 20 degrees, section thickness was 8 mm, and a 256 X 128 matrix was used. The acquisition time was 1.0 s followed by an interval of 0.5 s. The 20 tumor contours extracted during 30 s were superimposed on sagittal and coronal MR images. Results: The maximum value of tumor edge location was 3.9 cm in the cranio-caudal direction, 2.3 cm in the ventro-dorsal direction, and 3.1 cm in the lateral direction. The mean length of tumor displacement observed was 2.1 cm in the cranio-caudal direction, 0.8 cm in the ventro-dorsal and 0.9 cm in the left-right direction, respectively. The locus of the center of the tumor contour in the sagittal cross section was inclined at 23 degrees and in the coronal cross section was inclined at 18 degrees to the cranio-caudal axis of body. Conclusion: In conclusion, 3D movement of a spherical liver tumor was detected using rapid MRI sequential examinations. Magnetic resonance imaging has a potential to improve the accuracy of the planning target volume of a liver tumor. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.
• 脳転移に対する定位放射線照射

  白土 博樹, 長谷川 正俊, 直居 豊, 林 靖之, 池田 裕子, 青山 英史, 柴山 千秋

  日本放射線腫瘍学会誌 (公社)日本放射線腫瘍学会 10 (Suppl.2) 34 - 37 1040-9564 1999/03 

  定位放射線照射の転移性脳腫瘍への適応基準は,思ったほど施設間差がなく,同治療法が的確に普及しつつあることを示唆した.一方,線量分布の急峻さから,辺縁線量の指示は大きくばらついていた.アンケートに現れなかった要素に違いがあり,実際の線量はあまり違っていない可能性もある
• 脳少分割定位照射の合併症に関する検討

  青山 英史, 白土 博樹, 西岡 健, 影井 兼司, 橋本 井子, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (2) S234 - S234 0048-0428 1999/02
• 血管造影装置を配備した密封小線源治療施設における血管内小線源治療システムの開発

  西岡 健, 清水 匡, 土屋 和彦, 清水 伸一, 山崎 彰, 青山 英史, 橋本 井子, 影井 兼司, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (2) S191 - S191 0048-0428 1999/02 [Not refereed][Not invited]
  
• 放射線治療計画専用MRIの開発及びその臨床応用

  影井 兼司, 土屋 和彦, 清水 伸一, 山崎 彰, 青山 英史, 橋本 井子, 西岡 健, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (2) S188 - S188 0048-0428 1999/02 [Not refereed][Not invited]
  
• 2軸X線透視装置を用いた三次元的患者セットアップシステムの開発

  清水 伸一, 白土 博樹, 西岡 健, 影井 兼司, 橋本 井子, 青山 英史, 山崎 彰, 土屋 和彦, 宮坂 和男, 国枝 達也

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (2) S189 - S189 0048-0428 1999/02 [Not refereed][Not invited]
  
• Spinal cord compressionに対する放射線治療開始時期と効果 緊急照射に対する遠隔放射線治療支援システムTHERAPISの利用

  橋本 井子, 白土 博樹, 西岡 健, 影井 兼司, 清水 伸一, 山崎 彰, 青山 英史, 土屋 和彦, 瀬川 広志, 小笠原 弘

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 59 (2) S67 - S68 0048-0428 1999/02 [Not refereed][Not invited]
  
• 5Fr.バルーンカテーテルを用いたCTAP,CTAの試み

  堀尾 圭司, 鬼丸 力也, 土屋 和彦, 青山 英史, 市村 亘, 清水 匡, 宮坂 和男

  IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 14 (1) 94 - 94 1340-4520 1999/01
• 中咽頭腫瘍の予後因子の検討

  土屋 和彦, 西岡 健, 影井 兼司, 橋本 井子, 清水 伸一, 山崎 彰, 青山 英史, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 58 (14) 855 - 855 0048-0428 1998/12 [Not refereed][Not invited]
  
• 子宮頸癌の術後放射線治療

  山崎 彰, 西岡 健, 影井 兼司, 橋本 井子, 清水 伸一, 土屋 和彦, 青山 英史, 白土 博樹, 宮坂 和男

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 58 (14) 859 - 859 0048-0428 1998/12 [Not refereed][Not invited]
  
• 舌腫瘍の超音波所見

  土屋 和彦, 橋本 井子, 青山 英史, 朱 強, 唐 少珊, 白土 博樹, 北原 利博, 影井 兼司, 清水 匡, 宮坂 和男

  超音波医学 (公社)日本超音波医学会 25 (9) 967 - 967 1346-1176 1998/09
• 頭蓋内胚細胞腫に対する照射前化学療法と限局照射野を用いた低線量放射線治療

  白土 博樹, 喜多村 圭, 青山 英史, 宮坂 和男, 澤村 豊, 池田 潤

  小児がん (NPO)日本小児がん学会 35 (3) 439 - 439 0389-4525 1998/09
• 放射線治療の最前線 定位的放射線照射の現況

  青山 英史, 白土 博樹

  映像情報Medical 産業開発機構(株) 29 (16) 946 - 950 1346-1354 1997/08
• 組織診断のついた頭蓋内germinomaに対する放射線治療の成績 NJRTOG多施設研究からの報告

  青山 英史

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 57 (7) 446 - 446 0048-0428 1997/06
• Non-germinomatous germ-cell tumorの治療成績

  青山 英史

  日本医学放射線学会雑誌 (公社)日本医学放射線学会 57 (2) S103 - S103 0048-0428 1997/02

Conference Activities & Talks

• Brain metastases, Radiation, and Neuro-cognition  [Invited]

  青山英史

  The 8th GCB Biomedical Science and Engineering Symposium  2022/03
• RANO Criteria for Brain Metastases and Leptomeningeal Metastases  [Invited]

  Hidefumi Aoyama

  World Federation of Neuro-Oncology Societies (WFNOS 2022), Seoul,  2022/03
• VMAT を用いた新たな照射法の紹介：SI-VMAT と HA-WBRT±SIB  [Invited]

  青山英史

  第39回日本脳腫瘍学会学術集会  2021/12
• 転移性脳腫瘍の放射線治療：照射法選択の「私の」思考過程  [Invited]

  青山英史

  第33回埼玉県放射線腫瘍研究会  2021/09
• 痛くない！早い！高性能！ピンポイント放射線治療の最前線  [Invited]

  青山英史

  北海道がんプロ北大医・市民公開講座×北海道大学病院腫瘍センター市民公開講座, 「脳腫瘍特集」  2021/08
• 転移性脳腫瘍の放射線治療：照射法選択の「私の」思考過程  [Invited]

  青山英史

  第6回たちばな放射線治療講演会  2021/05
• 頭蓋内良性疾患の放射線治療  [Invited]

  青山英史

  The 80th Annual Meeting of the Japan Radiology Society  2021/04

MISC

• Effect of the Bite-Block on Target Displacement by Patient Motion during Stereotactic Brain Radiation Therapy

  山田亮太, 安渡大輔, 若林倭, 田村弘詞, 一宇佑太, 孫田惠一, 青山英史  北海道放射線技術雑誌(Web)  94-  2023
• 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
• がん治療における緩和的放射線治療の評価と普及啓発のための研究 放射線治療を含むがん治療の経済毒性と両立支援に関する研究

  青山英史, 白土博樹, 西岡健太郎, 岩崎由加子, 高橋健夫, 原田英幸, 立石清一郎, 内海暢子, 浅川勇雄  がん治療における緩和的放射線治療の評価と普及啓発のための研究 令和3年度 総括・分担研究報告書(Web)  2022
• 脳定位放射線治療時のCBCTにおけるmAs値の最適化

  山田亮太, 若林倭, 一宇佑太, 安渡大輔, 田村弘詞, 孫田惠一, 青山英史  北海道放射線技術雑誌(Web)  93-  2022
• 逐次近似法を用いた低線量CTの治療計画への影響評価

  川崎佳菜, 一宇佑太, 田村弘詞, 孫田惠一, 松尾勇斗, 青山英史  北海道放射線技術雑誌(Web)  93-  2022
• Dosimetric evaluation of log-based simplified Monte Carlo dose calculation for efficient patient-specific QA in spot-scanning proton therapy

  MATSUMOTO Takuya, MIYAZAKI Koichi, MIYAZAKI Koichi, MIYAZAKI Koichi, MATSUO Yuto, TAKAO Seishin, TAKAO Seishin, YAMADA Takahiro, TAKAYANAGI Taisuke, HIRAYAMA Shusuke, MATSUURA Taeko, MATSUURA Taeko, AOYAMA Hidefumi  日本医学物理学会学術大会報文集  123rd-  2022
• 局所進行上咽頭癌におけるadaptive radiotherapyに関する検討

  打浪雄介, 安田耕一, 藤田祥博, 高橋周平, 大塚愛美, 田口純, 清水康, 加納里志, 本間明宏, 青山英史  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  35th-  2022
• 強度変調放射線治療(IMRT)を行った下咽頭癌における再発症例の検討

  大塚愛美, 安田耕一, 湊川英樹, 出倉康裕, 青山英史, 清水伸一, 鈴木隆介, 宮本直樹, 清水伸一, 鈴木崇祥, 対馬那由多, 加納里志, 田口純, 清水康, 本間明宏, 清水伸一  Japanese Journal of Radiology  40-  (Supplement)  2022
• HyperArcを用いた多発性脳転移腫瘍に対する脳定位放射線治療中の各標的の位置ずれに関する検討

  山田亮太, 吉村高明, 吉村高明, 若林倭, 金平孝博, 森崇, 西岡健太郎, 青山英史  日本放射線技術学会総会学術大会予稿集  78th-  2022
• SMARCB1欠損篩骨洞癌に対する強度変調陽子線治療 症例報告と文献レビュー

  宮崎 智彦, 安田 耕一, 志藤 元泰, 小泉 富基, 藤田 祥博, 高橋 周平, 湊川 英樹, 大塚 愛美, 加藤 徳雄, 清水 伸一, 青山 英史  北海道放射線医学雑誌  1-  1  -6  2021/03  

  近年、腫瘍抑制遺伝子の一つであるSMARCB1を欠損した腫瘍の存在が頭頸部領域でも知られるようになったが、希少な亜型であるため臨床上の特徴についてはまだ不明な点が多い。今回、SMARCB1欠損を伴う篩骨洞癌に対して強度変調陽子線治療(IMPT)を施行した1例を報告する。患者は40代女性で、左眼の視力低下をきっかけに副鼻腔腫瘍を指摘され当院に紹介となった。各種画像検査にて前頭蓋底と左視神経への浸潤が疑われた。腫瘍生検でSMARCB1欠損を認め、SMARCB1欠損篩骨洞癌、cT4bN0M0、stageIVB(UICC 8th)の診断となった。治療はIMPT単独の方針となり、65Gy(RBE)/26frの治療が実施された。治療効果は良好で、治療後3年6ヵ月経過した時点において完全寛解を維持している。過去の文献からは2年生存率は58%と推定された。SMARCB1欠損副鼻腔癌に対する放射線治療の報告は限られており、陽子線治療症例については我々の調べる限りでは今回が最初の報告となる。(著者抄録)
• 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  2021/03
• 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
• 肝細胞癌陽子線治療前MRIにおけるばらつきの小さいADC値指標の検討:治療効果予測に向けた前段階の研究

  藤田祥博, 加藤徳雄, 田口大志, 打浪雄介, 西岡健太郎, 森崇, 湊川英樹, 安田耕一, 清水伸一, 青山英史  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  34th-  2021
• Conversion surgery for locally advanced unresectable pancreatic cancer treated with proton beam therapy combined with S-1 chemotherapy: a case report and literature review

  小泉富基, 加藤徳雄, 中村透, 川本泰之, 高尾聖心, 阿保大介, 清水伸一, 清水伸一, 青山英史  臨床放射線  66-  (8)  2021
• Reduced-Dose Whole Brain Radiation Therapy Combined With Stereotactic Irradiation For Solitary Or Oligo Brain Metastases Aiming At Minimizing Deterioration Of Neurocognitive Function Without Compromising Intracranial Tumor Control: Preliminary Results

  T. Nakano, H. Aoyama, S. Onodera, Y. Matsumo, S. Shimamoto, H. Igaki, M. Matsuo, N. Oya, A. Ohta, H. Saito, K. Maruyama, A. Kanemoto, T. Sakurai, T. Tanaka, N. Kitamura, K. Akazawa, K. Maebayashi  International Journal of Radiation Oncology*Biology*Physics  108-  (3)  e692  -e693  2020/11
• 筋層浸潤性膀胱癌に対する膀胱温存治療後患者のHealth-related quality of life

  大澤 崇宏, 安部 崇重, 西岡 健太郎, 菊地 央, 松本 隆児, 橋本 孝之, 清水 伸一, 青山 英史, 村井 祥代, 篠原 信雄  日本泌尿器内視鏡学会総会  34回-  P  -1  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  2020/11  [Refereed]
  
• 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  2020/11  [Refereed]
  
• 休日による総治療期間延長に対して1回線量増加の方法を組み合わせて放射線治療を行った早期声門癌の検討

  出倉 康裕, 安田 耕一, 湊川 英樹, 対馬 那由多, 鈴木 崇祥, 加納 里志, 鬼丸 力也, 本間 明宏, 青山 英史  頭頸部癌  46-  (2)  179  -179  2020/07
• Stereotactic irradiation for 2-3 cm brain metastases: A multicenter retrospective cohort study.

  平田岳郎, 平田岳郎, 原田堅, 原田堅, 島本茂利, 川口弘毅, 井垣浩, 伊藤有祐, 山田和成, 角原久夫, 前林勝也, 青山英史  日本脳腫瘍学会学術集会プログラム・抄録集  38th-  2020
• 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
• 筋層浸潤性膀胱癌に対する膀胱温存治療後患者のHealth-related quality of life

  大澤崇宏, 安部崇重, 西岡健太郎, 菊地央, 松本隆児, 橋本孝之, 清水伸一, 青山英史, 村井祥代, 篠原信雄  日本泌尿器内視鏡学会(Web)  34th-  P  -1  2020
• 多発脳転移に対する単一アイソセンタ照射法における患者セットアップの並進誤差が線量不確かさに及ぼす影響

  中野 永, 棚邊 哲史, 宇都宮 悟, 中野 智成, 斎藤 紘丈, 滝澤 健司, 山田 巧, 坂井 裕則, 太田 篤, 阿部 英輔, 海津 元樹, 青山 英史  定位的放射線治療  24-  81  -89  2020/01  [Not refereed][Not invited]
  
• 超高リスク前立腺癌に対する内分泌療法併用高線量率組織内照射療法の有効性の検討

  笠原 隆, 山名 一寿, 丸山 亮, 石崎 文雄, 海津 元樹, 青山 英史, 西山 勉, 冨田 善彦  日本癌治療学会学術集会抄録集  57回-  P107  -1  2019/10
• 腎移植後前立腺癌症例に対するBrachytherapyの経験

  石川 晶子, 田崎 正行, 笠原 隆, 海津 元樹, 川口 弦, 原 昇, 齋藤 和英, 青山 英史, 冨田 善彦  泌尿器外科  32-  (臨増)  765  -765  2019/06
• 初発髄芽腫に対する術後2週間以内の全脳脊髄照射及びSJMB‐96式自家末梢血幹細胞救援併用反復大量化学療法:単一施設での治療経験

  今村勝, 石井孝規, 久保暢大, 笠原靖史, 岩渕晴子, 棗田学, 大石誠, 今井千速, 吉村淳一, 青山英史, 藤井幸彦  小児の脳神経  44-  (2)  125  -125  2019/04/30  [Not refereed][Not invited]
  
• 前立腺癌放射線治療後の血中テストステロン値の上昇が治療成績に及ぼす影響

  原 昇, 笠原 隆, 丸山 亮, 山名 一寿, 石崎 文雄, 鳥羽 智貴, 黒木 大生, 海津 元樹, 青山 英史, 冨田 善彦  日本泌尿器科学会総会  107回-  OP  -276  2019/04
• 当院における肝癌に対する放射線治療の検討

  柴田 理, 上村 顕也, 木村 成宏, 薛 徹, 横尾 健, 坂牧 僚, 上村 博輝, 土屋 淳紀, 高村 昌昭, 丸山 克也, 太田 篤, 海津 元樹, 青山 英史, 寺井 崇二  日本消化器病学会雑誌  116-  (臨増総会)  A456  -A456  2019/03  [Not refereed][Not invited]
  
• Initial clinical experience of the new Real-time Tumor-tracking Radiotherapy (RTRT) System : SyncTraX FX4

  川口 弦, 棚邊 哲史, 青山 英史  月刊新医療  44-  (12)  58  -61  2017/12
• A consideration for the individualized treatment selection for the brain metastases according to the predicted prognosis : based on the results of the secondary analyses of JROSG99-1 randomized clinical trial

  青山 英史  臨床放射線  62-  (12)  1625  -1634  2017/11
• 前立腺癌に対する強度変調放射線治療と高線量率組織内照射の治療成績の比較検討

  瀧澤 逸大, 笠原 隆, 丸山 亮, 山名 一寿, 阿部 英輔, 海津 元樹, 青山 英史, 冨田 善彦  日本癌治療学会学術集会抄録集  55回-  P72  -1  2017/10
• 当院での局所進行膵臓癌に対するS‐1併用化学放射線療法について

  松本吉史, 周啓亮, 森山雅人, 滝沢一泰, 若井俊文, 青山英史, 西條康夫  日本癌治療学会学術集会(Web)  55th-  ROMBUNNO.P53‐5 (WEB ONLY)  -5  2017/10  [Not refereed][Not invited]
  
• 新潟大学における前立腺癌に対する強度変調放射線治療(IMRT)の治療成績

  瀧澤 逸大, 笠原 隆, 丸山 亮, 山名 一寿, 阿部 英輔, 青山 英史, 冨田 善彦  泌尿器外科  30-  (臨増)  906  -906  2017/05
• 局所進行性前立腺癌(臨床病期C)に対する、外照射併用高線量率組織内照射の治療成績

  笠原 隆, 山名 一寿, 丸山 亮, 瀧澤 逸大, 海津 元樹, 青山 英史, 西山 勉, 冨田 善彦  日本泌尿器科学会総会  105回-  PP19  -11  2017/04
• 多発肺結節を呈したメトトレキセート関連リンパ増殖性疾患の1例

  山名 加菜子, 山崎 元彦, 石川 浩志, 八木 琢也, 吉村 宣彦, 青山 英史, 坂上 拓郎, 北原 哲彦, 佐藤 征二郎, 小池 輝元, 土田 正則, 大橋 瑠子, 梅津 哉  Japanese Journal of Radiology  35-  (Suppl.)  8  -8  2017/02  [Not refereed][Not invited]
  
• 食道癌根治照射での血清炎症マーカーに関する検討

  斎藤 紘丈, 鈴木 邦恵, 山名 展子, 棚邉 哲史, 田中 研介, 太田 篤, 佐藤 啓, 丸山 克也, 劉 君陽, 川口 弦, 宇都宮 悟, 鮎川 文夫, 阿部 英輔, 海津 元樹, 青山 英史, 笹本 龍太  Japanese Journal of Radiology  34-  (Suppl.)  9  -9  2016/02
• 治療計画用CTの空間分解能がMU値計算に与える影響 微小肺結節シミュレーション画像を用いた検討

  重田 尚吾, 笹本 龍太, 大久保 真樹, 早川 岳英, 沼田 彩美, 和田 真一, 宇都宮 悟, 青山 英史, 棚邊 哲史  日本放射線技術学会東北部会雑誌  (25)  176  -176  2016/01
• 外部放射線治療における歯科用合金の後方散乱線と防護装置としてのデンタルデバイスについての検討

  勝良 剛詞, 曽我 麻里恵, 林 孝文, 青山 英史, 阿部 英輔, 宇都宮 悟, 棚邊 哲史, 早川 岳英, 和田 真一, 坂井 裕則  歯科放射線  55-  (増刊)  66  -66  2015/04  [Not refereed][Not invited]
  
• 化学放射線療法で治療したG-CSF産生食道扁平上皮癌の1例

  臼井 賢司, 矢島 和人, 加納 陽介, 石川 卓, 小杉 伸一, 神田 達夫, 畠山 勝義, 笹本 龍太, 青山 英史, 三浦 智史  新潟医学会雑誌  126-  (9)  509  -509  2012/09
• 転移性脳腫瘍症例における全脳照射後の1年以内のQOLの変化について

  小野寺俊輔, 青山英史, 鬼丸力也, 白土博樹  日本医学放射線学会秋季臨床大会抄録集  48th-  S542  -S542  2012/08/28  [Not refereed][Not invited]
  
• 高齢悪性神経膠腫症例に対する少分割照射

  青木 洋, 棗田 学, 阿部 英輔, 宇塚 岳夫, 小林 勉, 青山 英史, 藤井 幸彦  Neurological Surgery  40-  (7)  593  -598  2012/07  [Not refereed][Not invited]
   

  1995年1月〜2004年12月に標準的放射線療法を施行した75歳以上の初発膠芽腫10例、2005年1月〜2011年4月に少分割照射を施行した75歳以上の初発膠芽腫16例を対象に、2005年以降の患者の負担を軽減するために採用した少分割照射の有用性を標準的放射線療法と比較検討した。標準的放射線療法は10例中8例(80%)において放射線治療を完遂し得た。3例は温熱療法を併用し、1例でラニムスチンを用いた化学療法を併用した。フォローアップ期間は3〜20ヵ月、中央値10ヵ月で全例死亡した。入院期間は44〜96日、中央値68日、生存期間は3〜20ヵ月、中央値10ヵ月であった。少分割照射は16例中14例において総照射線量を39Gyに設定し、残り2例において30Gyに設定した。フォローアップ期間は2〜45ヵ月、中央値9.6ヵ月で2011年12月迄に13例(81%)が死亡した。入院期間は19〜61日、中央値38日、生存期間は2〜45ヵ月、中央値9.6ヵ月であった。入院時との比較では改善5例、悪化5例、不変6例であった。両群間において退院時のKarnofsky Performance Status(KPS)はほぼ同様の数値を示し、有意差を認めていない。少分割照射の治療効果として全生存期間が同等で、利点とし治療期間(入院期間)の短縮(30日間)、合併症の軽減(有害事象0%)、ステロイド減少、高い治療完遂率、自宅退院割合の増加、医療費削減、放射線部の負担軽減が挙げられる。欠点として白質脳症、認知機能低下、放射線壊死の増加、長期生存の割合の低下の潜在的可能性がある。
• 全脳照射後の大脳白質障害:拡散テンソルによる経時的変化の検討

  タ キンキン, 寺江聡, 小野寺俊輔, 青山英史, ポピ コサアクタ, 藤間憲幸, 財津有里, 塚原亜希子, 吉田大介, 白土博樹  日本神経放射線学会プログラム・抄録集  41st-  111  2012  [Not refereed][Not invited]
  
• Stereotactic Radiotherapy using Linac System for Vestibular Schwannomas

  Aoyama Hidefumi  新潟医学会雑誌  125-  (9)  463  -468  2011/09  

  新潟大学病院において高精度放射線治療装置の本格的稼働が開始となった. 本システムは優れた画像誘導機能が搭載されており, 非観血的に1mm未満の物理精度を担保した定位照射を行うことが可能である. 聴神経鞘腫への定位照射の有効性は既に広く認識されているが, 我々の検討により腫瘍径1-2cm以下かつ有効聴力が保たれた状態で治療した場合, 99%の腫瘍制御率と5-7割の症例で有効聴力温存が可能であることが示された. 今後, 当県においても, 様々な疾患で有害反応が少ない高精度の放射線治療が展開されるであろう.
• 3 Gd-EOB-DTPA造影MRIの肝細胞相で低信号を示した慢性肝疾患における乏血性結節の経過 : 長期経過観察を含めた検討(I.一般演題,第63回新潟画像医学研究会)

  高野 徹, 山崎 元彦, 佐藤 章子, 青山 英史, 土屋 淳紀, 上村 顕也, 矢野 雅彦, 田村 康, 高村 昌昭, 五十嵐 正人, 山際 訓, 野本 実, 青柳 豊, 加村 毅, 山本 哲史  新潟医学会雑誌  125-  (6)  339  -339  2011/06
• 脳腫瘍の治療 脳腫瘍の放射線療法 定位放射線照射療法(リニアック)

  小野寺俊輔, 青山英史, 白土博樹  日本臨床  68-  406-409  -409  2010/12/20  [Not refereed][Not invited]
  
• Oligometastases症例に対する定位放射線治療の有用性についての検討

  井上哲也, 加藤徳雄, 青山英史, 鬼丸力也, 石川正純, 田口大志, 白土博樹  日本医学放射線学会総会抄録集  69th-  S193-S194  -S194  2010/02/28  [Not refereed][Not invited]
  
• Conventionally Fractionated Stereotactic Radiotherapy for Vestibular Schwannoma: A Single Institutional Long-term Outcomes

  H. Aoyama, N. Takeichi, S. Onodera, H. Taguchi, Y. Sawamura, H. Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  78-  (3)  S8  -S9  2010  [Not refereed][Not invited]
  
• 高精度治療技術による低リスク高線量放射線治療に関する臨床研究 少数の転移性臓器転移への臨床研究

  青山英史, 小野寺俊輔  高精度治療技術による低リスク高線量放射線治療に関する臨床研究 平成21年度 総括研究報告書  9  2010  [Not refereed][Not invited]
  
• STEREOTACTIC RADIOTHERAPY FOR INTRACRANIAL NONACOUSTIC SCHWANNOMAS INCLUDING FACIAL NERVE SCHWANNOMA

  Kentaro Nishioka, Daisuke Abo, Hidefumi Aoyama, Yasushi Furuta, Rikiya Onimaru, Shunsuke Onodera, Yutaka Sawamura, Masayori Ishikawa, Satoshi Fukuda, Hiroki Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  75-  (5)  1415  -1419  2009/12  [Not refereed][Not invited]
   

  Purpose: Although the effectiveness of stereotactic radiosurgery for nonacoustic schwannomas is currently being assessed, there have been few studies on the efficacy of stereotactic radiotherapy (SRT) for these tumors. We investigated the long-term outcome of SRT for nonacoustic intracranial nerve schwannomas. Methods and Materials: Seventeen patients were treated between July 1994 and December 2006. Of these patients, 7 had schwannomas located in the jugular foramen, 5 in the trigeminal nerve, 4 in the facial nerve, and I in the oculomotor nerve. Radiotherapy was used as an initial treatment without surgery in 10 patients (59 %) and after initial subtotal resection in the remaining patients. The tumor volume ranged from 0.3 to 31.3 mL (mean, 8.2 mL). The treatment dose was 40 to 54 Gy in 20 to 26 fractions. The median follow-up period was 59.5 months (range, 7.4-122.6 months). Local control was defined as stable or decreased tumor size on follow-up magnetic resonance imaging. Results: Tumor size was decreased in 3 patients, stable in 13, and increased in I after SRT. Regarding neurologic symptoms, 8 patients (47 %) had improvement and 9 patients were unchanged. One patient had an increase in tumor size and received microsurgical resection at 32 months after irradiation. No patient had worsening of pre-existing neurologic symptoms or development of new cranial nerve deficits at the last follow-up. Conclusions: SRT is an effective alternative to surgical resection for patients with nonacoustic intracranial nerve schwannomas with respect to not only long-term local tumor control but also neuro-functional preservation. (C) 2009 Elsevier Inc.
• 対向型PET装置を用いた患者位置確認システムの開発—GEANT4基礎シミュレーション—

  山口哲, 石川正純, 棚邊哲史, BENGUA Gerard, SUTHERLAND Kenneth, 青山英史, 武島嗣英, 白土博樹  医学物理 Supplement  29-  (3)  174-175  2009/09  [Not refereed][Not invited]
  
• 動体追跡放射線治療におけるX線透視条件の最適化

  宮本直樹, SUTHERLAND Kenneth, 石川正純, 鈴木隆介, BENGUA Gerard, 木村傑, 清水伸一, 青山英史, 鬼丸力也, 白土博樹  医学物理 Supplement  29-  (3)  150-151  2009/09  [Not refereed][Not invited]
  
• Oligometastases症例に対する定位放射線治療の有用性についての検討

  井上哲也, 加藤徳雄, 青山英史, 鬼丸力也, 石川正純, 田口大志, 白土博樹  日本放射線腫よう学会誌  21-  (Supplement 1)  159  2009/08/19  [Not refereed][Not invited]
  
• Value of fluorodeoxyglucose positron emission tomography before radiotherapy for head and neck cancer: does the standardized uptake value predict treatment outcome?

  Keishiro Suzuki, Takeshi Nishioka, Akihiro Homma, Kazuhiko Tsuchiya, Motoaki Yasuda, Hidefumi Aoyama, Rikiya Onimaru, Nagara Tamaki, Hiroki Shirato  JAPANESE JOURNAL OF RADIOLOGY  27-  (6)  237  -242  2009/07  [Not refereed][Not invited]
   

  Purpose. The aim of this study was to determine if the standardized uptake value (SUV) of fluorodeoxyglucose positron emission tomography (FDG-PET) for head and neck cancer can predict the outcome of radiotherapy and if the SUV is correlated with histological grade, mitosis, and apoptosis. Materials and methods. The study included 45 head and neck cancer patients who underwent FDG-PET scanning before radiotherapy. The maximum SUV (SUVmax) of their primary lesions were measured. Biopsy was performed in all patients to determine the histological diagnosis. Altogether, 14 biopsy specimens were available for mitotic and apoptotic cell counts. Results. The mean SUVmax of T3 tumors was significantly higher than that of T1 (P = 0.01) and T2 (P = 0.011) tumors. The mean SUVmax of stage II disease was significantly lower than that of stage III (P = 0.028) and stage IV (P = 0.007) disease. There was a tendency toward a better locoregional control rate and disease-free survival for the lower SUV group using a cutoff value of 5.5. For 41 patients with squamous cell carcinoma or undifferentiated carcinoma, SUVmax did not reflect the histological grade. There was no correlation between the SUVmax and the mitotic/apoptotic status. Conclusion. SUVmax may correlate with the T classification and stage, but there was no predictive value for outcome of radiation therapy. Neither histological grading nor mitotic/apoptotic status is correlated with SUVmax.
• Value of fluorodeoxyglucose positron emission tomography before radiotherapy for head and neck cancer: does the standardized uptake value predict treatment outcome?

  Keishiro Suzuki, Takeshi Nishioka, Akihiro Homma, Kazuhiko Tsuchiya, Motoaki Yasuda, Hidefumi Aoyama, Rikiya Onimaru, Nagara Tamaki, Hiroki Shirato  JAPANESE JOURNAL OF RADIOLOGY  27-  (6)  237  -242  2009/07  [Not refereed][Not invited]
   

  Purpose. The aim of this study was to determine if the standardized uptake value (SUV) of fluorodeoxyglucose positron emission tomography (FDG-PET) for head and neck cancer can predict the outcome of radiotherapy and if the SUV is correlated with histological grade, mitosis, and apoptosis. Materials and methods. The study included 45 head and neck cancer patients who underwent FDG-PET scanning before radiotherapy. The maximum SUV (SUVmax) of their primary lesions were measured. Biopsy was performed in all patients to determine the histological diagnosis. Altogether, 14 biopsy specimens were available for mitotic and apoptotic cell counts. Results. The mean SUVmax of T3 tumors was significantly higher than that of T1 (P = 0.01) and T2 (P = 0.011) tumors. The mean SUVmax of stage II disease was significantly lower than that of stage III (P = 0.028) and stage IV (P = 0.007) disease. There was a tendency toward a better locoregional control rate and disease-free survival for the lower SUV group using a cutoff value of 5.5. For 41 patients with squamous cell carcinoma or undifferentiated carcinoma, SUVmax did not reflect the histological grade. There was no correlation between the SUVmax and the mitotic/apoptotic status. Conclusion. SUVmax may correlate with the T classification and stage, but there was no predictive value for outcome of radiation therapy. Neither histological grading nor mitotic/apoptotic status is correlated with SUVmax.
• 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]
  
• A feasibility study of novel plastic scintillation dosimetry with pulse-counting mode

  M. Ishikawa, G. Bengua, K. L. Sutherland, J. Hiratsuka, N. Katoh, S. Shimizu, H. Aoyama, K. Fujita, R. Yamazaki, K. Horita, H. Shirato  PHYSICS IN MEDICINE AND BIOLOGY  54-  (7)  2079  -2092  2009/04  [Not refereed][Not invited]
   

  The purpose of this study was to develop a novel scintillation dosimeter for in vivo dosimetry in Ir-192 brachytherapy via the pulse-counting mode. The new dosimeter was made from a plastic scintillator shaped into a hemisphere of diameter 1 mm and connected to the tip of a plastic optical fiber. The relationship between pulse counts and absorbed dose was derived based on the assumption that scintillation photons from the incident gamma ray are proportional to the absorbed dose. An equation for the conversion of pulse counts to water-equivalent dose was deduced wherein the pulse height spectrum from scintillation photons was assumed to be exponential. To confirm its accuracy, the dose rate distribution in a water phantom was measured by the present dosimeter and this was compared with Monte Carlo simulations, resulting in a discrepancy of less than 1.97%. It was found that the dosimeter has a wide dynamic range of linearity up to an order of magnitude of almost 10(3), including corrections for loss of counts due to pile-up.
• A feasibility study of novel plastic scintillation dosimetry with pulse-counting mode

  M. Ishikawa, G. Bengua, K. L. Sutherland, J. Hiratsuka, N. Katoh, S. Shimizu, H. Aoyama, K. Fujita, R. Yamazaki, K. Horita, H. Shirato  PHYSICS IN MEDICINE AND BIOLOGY  54-  (7)  2079  -2092  2009/04  [Not refereed][Not invited]
   

  The purpose of this study was to develop a novel scintillation dosimeter for in vivo dosimetry in Ir-192 brachytherapy via the pulse-counting mode. The new dosimeter was made from a plastic scintillator shaped into a hemisphere of diameter 1 mm and connected to the tip of a plastic optical fiber. The relationship between pulse counts and absorbed dose was derived based on the assumption that scintillation photons from the incident gamma ray are proportional to the absorbed dose. An equation for the conversion of pulse counts to water-equivalent dose was deduced wherein the pulse height spectrum from scintillation photons was assumed to be exponential. To confirm its accuracy, the dose rate distribution in a water phantom was measured by the present dosimeter and this was compared with Monte Carlo simulations, resulting in a discrepancy of less than 1.97%. It was found that the dosimeter has a wide dynamic range of linearity up to an order of magnitude of almost 10(3), including corrections for loss of counts due to pile-up.
• 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]
  
• 第3部 PET装置開発の展望(28)照射位置確認のためのOpen‐PET装置の開発—画像再構成の基礎シミュレーション—

  山口哲, 石川正純, 棚邊哲史, BENGUA Gerard, SUTHERLAND Kenneth, 青山英史, 武島嗣英, 白土博樹  NIRS−R (Natl Inst Radiol Sci)  (60)  137-138  2009/03  [Not refereed][Not invited]
  
• Stereotactic radiotherapy for intracranial nonacoustic schwannomas including facial nerve schwannoma.

  Int J Radiat Oncol Biol Phys.  75-  (5)  1415  -1419  2009  [Not refereed][Not invited]
  
• Reduction of bed rest time after transfemoral noncardiac angiography from 4 hours to 2 hours: a randomized trial and a one-arm study.

  J Vasc Interv Radiol.  20-  (5)  587  -592  2009  [Not refereed][Not invited]
  
• Reduction of bed rest time after transfemoral noncardiac angiography from 4 hours to 2 hours: a randomized trial and a one-arm study.

  Fumi Kato, Yukihiko Sato, Noriaki Yuasa, Daisuke Abo, Yusuke Sakuhara, Noriko Oyama, Rikiya Onimaru, Hidefumi Aoyama, Hiroki Shirato, Satoshi Terae  J Vasc Interv Radiol.  20-  (5)  587  -592  2009  [Not refereed][Not invited]
   

  PURPOSE: To evaluate the feasibility of shortening the bed rest time from 4 hours to 2 hours after transfemoral noncardiac angiography with a 4-F sheath (outer diameter, 1.93 mm), a 5-F sheath (outer diameter, 2.27 mm), and a 4-F catheter. MATERIALS AND METHODS: Patients were randomized into two groups, receiving either 2 or 4 hours of bed rest after hemostasis by manual compression of the puncture site. The authors evaluated the frequency of bleeding complications. An interim analysis was performed wherein 40 patients were assigned to each group. After the analysis, a single-arm 2-hour bed rest trial was conducted in an additional 115 procedures. RESULTS: In the interim analysis, three of the 40 patients in the 4-hour group and none of the 40 patients in the 2-hour group developed minor bleeding within 2 hours after manual compression (P = .24). After 2 hours of bed rest, no bleeding complication was observed in either group. In the single-arm 2-hour bed rest trial, minor bleeding developed in one of the 115 procedures (0.8%). Through the study, minor bleeding occurred in four of the 195 total procedures (2%), and no major complications developed. The occurrence of a bleeding complication was significantly higher in patients with platelet counts of less than 100 x 10(9)/L than in the other patients (4/67 vs 0/128, P = .01). CONCLUSIONS: Two hours of bed rest is feasible for patients undergoing transfemoral noncardiac angiography by using a 4-5-F sheath and/or a 4-F catheter, especially those with a normal platelet count.
• Fractionated Stereotactic Radiotherapy for Intracranial Meningioma: The Long-term Outcomes in Single Institution

  S. Onodera, H. Aoyama, H. Shirato, K. Tsuchiya, K. Kagei, T. Nishioka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  75-  (3)  S256  -S257  2009  [Not refereed][Not invited]
  
• Late recurrence and salvage therapy of CNS germinomas

  Yuuta Kamoshima, Yutaka Sawamura, Jun Ikeda, Hiroki Shirato, Hidefumi Aoyama  JOURNAL OF NEURO-ONCOLOGY  90-  (2)  205  -211  2008/11  [Not refereed][Not invited]
   

  Central nervous system (CNS) germinoma is a curable tumor and its recurrence rate after initial therapy may be approximately 10% or higher. This study elucidates the time-course of recurrence and results of salvage therapy. Twenty-five patients with recurrent germinoma treated at Hokkaido University Hospital were retrospectively reviewed. The median age at initial treatment was 12 years (range: 8-37). All patients had been tumor-free for at least 6 months after the initial treatment. The median follow-up period was 134 months (range: 44-338). The median age at first recurrence was 18 years and the median time to the first recurrence was 50 months. Among the patients, 9 (36%) had the first recurrence at 60 months or later. The latest recurrence in a patient occurred 230 months after the initial treatment. The results of salvage therapy were estimated in all 25 patients. Seventeen patients (68%) were salvaged and were tumor-free at the final observation. The remaining 8 patients died of disease. At first recurrence, 11 patients were treated using radiation therapy with or without surgery and 7 out of the 11 patients died due to the recurrent tumor. On the other hand, 13 patients who received salvage chemotherapy and radiotherapy were tumor-free at the last follow-up. In conclusion, late recurrence is not a rare event in patients with CNS germinoma. To identify a true cure rate of this disease, a 10-year or longer observation period may be required. As a salvage therapy, platinum-based chemotherapy followed by wide-field low-dose radiation therapy appears to be effective.
• Late recurrence and salvage therapy of CNS germinomas

  Yuuta Kamoshima, Yutaka Sawamura, Jun Ikeda, Hiroki Shirato, Hidefumi Aoyama  JOURNAL OF NEURO-ONCOLOGY  90-  (2)  205  -211  2008/11  [Not refereed][Not invited]
   

  Central nervous system (CNS) germinoma is a curable tumor and its recurrence rate after initial therapy may be approximately 10% or higher. This study elucidates the time-course of recurrence and results of salvage therapy. Twenty-five patients with recurrent germinoma treated at Hokkaido University Hospital were retrospectively reviewed. The median age at initial treatment was 12 years (range: 8-37). All patients had been tumor-free for at least 6 months after the initial treatment. The median follow-up period was 134 months (range: 44-338). The median age at first recurrence was 18 years and the median time to the first recurrence was 50 months. Among the patients, 9 (36%) had the first recurrence at 60 months or later. The latest recurrence in a patient occurred 230 months after the initial treatment. The results of salvage therapy were estimated in all 25 patients. Seventeen patients (68%) were salvaged and were tumor-free at the final observation. The remaining 8 patients died of disease. At first recurrence, 11 patients were treated using radiation therapy with or without surgery and 7 out of the 11 patients died due to the recurrent tumor. On the other hand, 13 patients who received salvage chemotherapy and radiotherapy were tumor-free at the last follow-up. In conclusion, late recurrence is not a rare event in patients with CNS germinoma. To identify a true cure rate of this disease, a 10-year or longer observation period may be required. As a salvage therapy, platinum-based chemotherapy followed by wide-field low-dose radiation therapy appears to be effective.
• 患者位置確認のためのイメージング装置の開発—Open‐PET装置の基礎シミュレーション—

  山口哲, 石川正純, 棚邊哲史, GERARD Bengua, KENNETH Sutherland, 青山英史, 武島嗣英, 白土博樹  日本放射線腫よう学会誌  20-  (Supplement 1)  267  2008/09/22  [Not refereed][Not invited]
  
• De novo formation of cavernoma after radiosurgery for adult cerebral arteriovenous malformation - Case report

  Hiroaki Motegi, Satoshi Kuroda, Nobuaki Ishii, Hidefumi Aoyama, Satoshi Terae, Hiroki Shirato, Yoshinobu Iwasaki  NEUROLOGIA MEDICO-CHIRURGICA  48-  (9)  397  -400  2008/09  [Not refereed][Not invited]
   

  A 47-year-old male underwent stereotactic radiosurgery (25 Gy) for a cerebral arteriovenous malformation located in the right caudate nucleus, using a linear accelerator. Complete obliteration of nidus was confirmed 20 months after radiosurgery. However, a hypointense mass on T-2-weighted magnetic resonance imaging developed in the area adjacent to the nidus after approximately 80 months. The mass gradually increased in size and induced severe perifocal edema over 2 years. The mass was successfully excised. Histological examination revealed that the mass consisted of dilated sinusoid vessels attached to the hematoma capsule, and the hematoma included clots in various stages of organization encapsulated by dense collagenous tissue. The histological diagnosis was cavernoma. De novo formation of cavernoma is well known to occur after radiation surgery for intracranial tumor, especially in pediatric patients, but is rare in adults. Based on the radiological and histological findings in the present case, the radiation-induced cavernoma underwent repeated bleedings resulting in chronic encapsulated expanding hematoma.
• De novo formation of cavernoma after radiosurgery for adult cerebral arteriovenous malformation - Case report

  Hiroaki Motegi, Satoshi Kuroda, Nobuaki Ishii, Hidefumi Aoyama, Satoshi Terae, Hiroki Shirato, Yoshinobu Iwasaki  NEUROLOGIA MEDICO-CHIRURGICA  48-  (9)  397  -400  2008/09  [Not refereed][Not invited]
   

  A 47-year-old male underwent stereotactic radiosurgery (25 Gy) for a cerebral arteriovenous malformation located in the right caudate nucleus, using a linear accelerator. Complete obliteration of nidus was confirmed 20 months after radiosurgery. However, a hypointense mass on T-2-weighted magnetic resonance imaging developed in the area adjacent to the nidus after approximately 80 months. The mass gradually increased in size and induced severe perifocal edema over 2 years. The mass was successfully excised. Histological examination revealed that the mass consisted of dilated sinusoid vessels attached to the hematoma capsule, and the hematoma included clots in various stages of organization encapsulated by dense collagenous tissue. The histological diagnosis was cavernoma. De novo formation of cavernoma is well known to occur after radiation surgery for intracranial tumor, especially in pediatric patients, but is rare in adults. Based on the radiological and histological findings in the present case, the radiation-induced cavernoma underwent repeated bleedings resulting in chronic encapsulated expanding hematoma.
• Low-dose craniospinal irradiation and ifosfamide, cisplatin and etoposide for non-metastatic embryonal tumors in the central nervous system

  Koichi Yasuda, Hiroshi Taguchi, Yutaka Sawamura, Jun Ikeda, Hidefumi Aoyama, Kenji Fujieda, Nobuaki Ishii, Masaaki Kashiwamura, Yoshinobu Iwasaki, Hiroki Shirato  JAPANESE JOURNAL OF CLINICAL ONCOLOGY  38-  (7)  486  -492  2008/07  [Not refereed][Not invited]
   

  Objective: The current study was conducted to evaluate the effects of low-dose craniospinal irradiation (CSI) combined with chemotherapy on non-metastatic embryonal tumors in the central nervous system (CNS), including medulloblastoma and supra-tentorial primitive neuroectodermal tumors (ST-PNET). Methods: All patients were treated according to the following protocol. After surgery, the patients <= 5 years old received 18 Gy and the patients > 5 years old received 24 Gy CSI. The dose to the primary tumor bed was 39.6-54 Gy. Chemotherapy consisted of ifosfamide, cisplatin and etoposide (ICE chemotherapy). Results: Sixteen patients aged 0.5-20.4 (median 6.1) years were enrolled and followed for 11-165 (median 112) months. Both 5-year actuarial overall survival (OAS) and progression-free survival (PFS) were 81% (95% confidence interval (CI): 62-100%) for the 16 patients. Both 5-year OAS and PFS were 82% (CI: 59-100%) for the patients with medulloblastoma and 80% (CI: 45-100%) for the patients with ST-PNET. Both 5-year OAS and PFS were 75% for the eight patients <= 5 years old and 88% for the eight patients > 5 years old. Both 5-year OAS and PFS were 100% for six average-risk patients (3 years or older, total resection and posterior fossa) and 70% for 10 poor-risk patients (others). The median total intellectual quotient at the last follow-up was 85 (ranging from 48 to 103) in 12 patients who were followed for 3-145 (median 49) months. Eight patients received hormone replacement therapy. Conclusion: Low-dose CSI and ICE chemotherapy may have a role as a treatment option for a subset of patients with non-metastatic embryonal tumors in the CNS.
• Low-dose craniospinal irradiation and ifosfamide, cisplatin and etoposide for non-metastatic embryonal tumors in the central nervous system

  Koichi Yasuda, Hiroshi Taguchi, Yutaka Sawamura, Jun Ikeda, Hidefumi Aoyama, Kenji Fujieda, Nobuaki Ishii, Masaaki Kashiwamura, Yoshinobu Iwasaki, Hiroki Shirato  JAPANESE JOURNAL OF CLINICAL ONCOLOGY  38-  (7)  486  -492  2008/07  [Not refereed][Not invited]
   

  Objective: The current study was conducted to evaluate the effects of low-dose craniospinal irradiation (CSI) combined with chemotherapy on non-metastatic embryonal tumors in the central nervous system (CNS), including medulloblastoma and supra-tentorial primitive neuroectodermal tumors (ST-PNET). Methods: All patients were treated according to the following protocol. After surgery, the patients <= 5 years old received 18 Gy and the patients > 5 years old received 24 Gy CSI. The dose to the primary tumor bed was 39.6-54 Gy. Chemotherapy consisted of ifosfamide, cisplatin and etoposide (ICE chemotherapy). Results: Sixteen patients aged 0.5-20.4 (median 6.1) years were enrolled and followed for 11-165 (median 112) months. Both 5-year actuarial overall survival (OAS) and progression-free survival (PFS) were 81% (95% confidence interval (CI): 62-100%) for the 16 patients. Both 5-year OAS and PFS were 82% (CI: 59-100%) for the patients with medulloblastoma and 80% (CI: 45-100%) for the patients with ST-PNET. Both 5-year OAS and PFS were 75% for the eight patients <= 5 years old and 88% for the eight patients > 5 years old. Both 5-year OAS and PFS were 100% for six average-risk patients (3 years or older, total resection and posterior fossa) and 70% for 10 poor-risk patients (others). The median total intellectual quotient at the last follow-up was 85 (ranging from 48 to 103) in 12 patients who were followed for 3-145 (median 49) months. Eight patients received hormone replacement therapy. Conclusion: Low-dose CSI and ICE chemotherapy may have a role as a treatment option for a subset of patients with non-metastatic embryonal tumors in the CNS.
• Stereotactic radiotherapy in comparison to whole brain radiation therapy from a radiation oncological standpoint

  青山 英史  医学のあゆみ  225-  (13)  1352  -1356  2008/06/28
• 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]
  
• 脳AVMの放射線治療後経過観察におけるMR perfusion studyの有用性の検討

  芹澤慈子, 工藤與亮, キン キンタ, 青山英史, 塚原亜希子, 寺江聡, 宮坂和男  Radiat Med  26-  (Suppl.I)  8  -8  2008/04/25  [Not refereed][Not invited]
  
• Development of Molecular Imaging Device for patient setup : Preliminary simulation of Open-PET

  YAMAGUCHI Satoshi, ISHIKAWA Masayori, TANABE Satoshi, BENGUA Gerard, SUTHERLAND Kenneth, AOYAMA Hidefumi, TAKESHIMA Tuguhide, SHIRATO Hiroki  医学物理 : 日本医学物理学会機関誌 = Japanese journal of medical physics : an official journal of Japan Society of Medical Physics  28-  256  -257  2008/04/01  [Not refereed][Not invited]
  
• Three-dimensional intrafractional motion of breast during tangential breast irradiation monitored with high-sampling frequency using a real-time tumor-tracking radiotherapy system

  Rumiko Kinoshita, Shinichi Shimizu, Hiroshi Taguchi, Norio Katoh, Masaharu Fujino, Rikiya Onimaru, Hidefumi Aoyama, Fumi Katoh, Tokuhiko Omatsu, Masayori Ishikawa, Hiroki Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  70-  (3)  931  -934  2008/03  [Not refereed][Not invited]
   

  Purpose: To evaluate the three-dimensional intrafraction motion of the breast during tangential breast irradiation using a real-time tracking radiotherapy (RT) system with a high-sampling frequency. Methods and Materials: A total of 17 patients with breast cancer who had received breast conservation RT were included in this study. A 2.0-mm gold marker was placed on the skin near the nipple of the breast for RT. A fluoroscopic real-time tumor-tracking RT system was used to monitor the marker. The range of motion of each patient was calculated in three directions. Results: The mean standard deviation of the range of respiratory motion was 1.0 +/- 0.6 mm (median, 0.9; 95% confidence interval [CI] of the marker position, 0.4-2.6), 1.3 +/- 0.5 mm (median, 1.1; 95 % CI, 0.5-2.5), and 2.6 +/- 1.4 (median, 2.3; 95 % CI, 1.0-6.9) for the right-left, craniocaudal, and anteroposterior direction, respectively. No correlation was found between the range of motion and the body mass index or respiratory function. The mean +/- standard deviation of the absolute value of the baseline shift in the right-left, craniocaudal, and anteroposterior direction was 0.2 +/- 0.2 mm (range, 0.0-0.8 mm), 0.3 +/- 0.2 mm (range, 0.0-0.7 mm), and 0.8 +/- 0.7 mm (range, 0.1-1.8 mm), respectively. Conclusion: Both the range of motion and the baseline shift were within a few millimeters in each direction. As long as the conventional wedge-pair technique and the proper immobilization are used, the intrafraction three-dimensional change in the breast surface did not much influence the dose distribution. (C) 2008 Elsevier Inc.
• Three-dimensional intrafractional motion of breast during tangential breast irradiation monitored with high-sampling frequency using a real-time tumor-tracking radiotherapy system

  Rumiko Kinoshita, Shinichi Shimizu, Hiroshi Taguchi, Norio Katoh, Masaharu Fujino, Rikiya Onimaru, Hidefumi Aoyama, Fumi Katoh, Tokuhiko Omatsu, Masayori Ishikawa, Hiroki Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  70-  (3)  931  -934  2008/03  [Not refereed][Not invited]
   

  Purpose: To evaluate the three-dimensional intrafraction motion of the breast during tangential breast irradiation using a real-time tracking radiotherapy (RT) system with a high-sampling frequency. Methods and Materials: A total of 17 patients with breast cancer who had received breast conservation RT were included in this study. A 2.0-mm gold marker was placed on the skin near the nipple of the breast for RT. A fluoroscopic real-time tumor-tracking RT system was used to monitor the marker. The range of motion of each patient was calculated in three directions. Results: The mean standard deviation of the range of respiratory motion was 1.0 +/- 0.6 mm (median, 0.9; 95% confidence interval [CI] of the marker position, 0.4-2.6), 1.3 +/- 0.5 mm (median, 1.1; 95 % CI, 0.5-2.5), and 2.6 +/- 1.4 (median, 2.3; 95 % CI, 1.0-6.9) for the right-left, craniocaudal, and anteroposterior direction, respectively. No correlation was found between the range of motion and the body mass index or respiratory function. The mean +/- standard deviation of the absolute value of the baseline shift in the right-left, craniocaudal, and anteroposterior direction was 0.2 +/- 0.2 mm (range, 0.0-0.8 mm), 0.3 +/- 0.2 mm (range, 0.0-0.7 mm), and 0.8 +/- 0.7 mm (range, 0.1-1.8 mm), respectively. Conclusion: Both the range of motion and the baseline shift were within a few millimeters in each direction. As long as the conventional wedge-pair technique and the proper immobilization are used, the intrafraction three-dimensional change in the breast surface did not much influence the dose distribution. (C) 2008 Elsevier Inc.
• The Role of Radiation Therapy for treating Brain Metastases

  AOYAMA Hidefumi  Japanese journal of neurosurgery  16-  (11)  828  -832  2007/11/20  

  For the majority of brain metastatic patients, radiation therapy and surgical resection play an important role considering the limited ability of drug treatment. Especially, whole brain radiotherapy (WBRT) has been a mainstay in the treatment strategy. Local aggressive therapy including surgery and stereotactic radiosurgery (SRS) might also add some benefit but only for some selected patients who have solitary metastasis and good performance status. The Japanese randomized study between WBRT and SRS versus SRS-alone for 1〜4 metastases showed an identical median survival time but a significantly higher frequency of brain tumor recurrence when WBRT was not used. We have to be aware that WBRT is still the standard treatment for the vast majority of patients and SRS should be used only when we consider that the patients might have some beneficial effect.
• Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone

  Hidefumi Aoyama, Masao Tago, Norio Kato, Tatsuya Toyoda, Masahiro Kenjyo, Saeko Hirota, Hiroki Shioura, Taisuke Inomata, Etsuo Kunieda, Kazushige Hayakawa, Keiichi Nakagawa, Gen Kobashi, Hiroki Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  68-  (5)  1388  -1395  2007/08  [Not refereed][Not invited]
   

  Purpose: To determine how the omission of whole brain radiotherapy (WBRT) affects the neurocognitive function of patients with one to four brain metastases who have been treated with stereotactic radiosurgery (SRS). Methods and Materials: In a prospective randomized trial between WBRT+SRS and SRS alone for patients with one to four brain metastases, we assessed the neurocognitive function using the Mini-Mental State Examination (MMSE). Of the 132 enrolled patients, MMSE scores were available for 110. Results: In the baseline MMSE analyses, statistically significant differences were observed for total tumor volume, extent of tumor edema, age, and Karnofsky performance status. Of the 92 patients who underwent the follow-up MMSE, 39 had a baseline MMSE score of <= 27 (17 in the WBRT+SRS group and 22 in the SRS-alone group). Improvements of <= 3 points in the MMSEs of 9 WBRT+SRS patients and 11 SRS-alone patients (p = 0.85) were observed. Of the 82 patients with a baseline MMSE score of >= 27 or whose baseline MMSE score was >= 26 but had improved to = 27 after the initial brain treatment, the 12-,24-, and 36-month actuarial free rate of the 3-point drop in the MMSE was 76.1%, 68.5 %, and 14.7 % in the WBRT+SRS group and 59.3 %, 51.9 %, and 51.9 % in the SRS-alone group, respectively. The average duration until deterioration was 16.5 months in the WBRT+SRS group and 7.6 months in the SRS-alone group (p = 0.05). Conclusion: The results of the present study have revealed that, for most brain metastatic patients, control of the brain tumor is the most important factor for stabilizing neurocognitive function. However, the long-term adverse effects of WBRT on neurocognitive function might not be negligible. (C) 2007 Elsevier Inc.
• Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone

  Hidefumi Aoyama, Masao Tago, Norio Kato, Tatsuya Toyoda, Masahiro Kenjyo, Saeko Hirota, Hiroki Shioura, Taisuke Inomata, Etsuo Kunieda, Kazushige Hayakawa, Keiichi Nakagawa, Gen Kobashi, Hiroki Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  68-  (5)  1388  -1395  2007/08  [Not refereed][Not invited]
   

  Purpose: To determine how the omission of whole brain radiotherapy (WBRT) affects the neurocognitive function of patients with one to four brain metastases who have been treated with stereotactic radiosurgery (SRS). Methods and Materials: In a prospective randomized trial between WBRT+SRS and SRS alone for patients with one to four brain metastases, we assessed the neurocognitive function using the Mini-Mental State Examination (MMSE). Of the 132 enrolled patients, MMSE scores were available for 110. Results: In the baseline MMSE analyses, statistically significant differences were observed for total tumor volume, extent of tumor edema, age, and Karnofsky performance status. Of the 92 patients who underwent the follow-up MMSE, 39 had a baseline MMSE score of <= 27 (17 in the WBRT+SRS group and 22 in the SRS-alone group). Improvements of <= 3 points in the MMSEs of 9 WBRT+SRS patients and 11 SRS-alone patients (p = 0.85) were observed. Of the 82 patients with a baseline MMSE score of >= 27 or whose baseline MMSE score was >= 26 but had improved to = 27 after the initial brain treatment, the 12-,24-, and 36-month actuarial free rate of the 3-point drop in the MMSE was 76.1%, 68.5 %, and 14.7 % in the WBRT+SRS group and 59.3 %, 51.9 %, and 51.9 % in the SRS-alone group, respectively. The average duration until deterioration was 16.5 months in the WBRT+SRS group and 7.6 months in the SRS-alone group (p = 0.05). Conclusion: The results of the present study have revealed that, for most brain metastatic patients, control of the brain tumor is the most important factor for stabilizing neurocognitive function. However, the long-term adverse effects of WBRT on neurocognitive function might not be negligible. (C) 2007 Elsevier Inc.
• 脊椎脊髄病変に対する最新の放射線治療 脊椎脊髄病変に対する強度変調放射線治療(IMRT)

  溝口史樹, 安田耕一, 青山英史, 白土博樹  脊椎脊髄ジャーナル  20-  (7)  781  -785  2007/07/25  [Not refereed][Not invited]
  
• 当院におけるMU値検証システムについて

  鈴木恵士郎, 白土博樹, 青山英史, 鬼丸力也, 加藤徳雄, 田口大志, 藤野賢治, 吉田有里, 宮坂和男, 熊谷まなみ, 藤田勝久  Radiat Med  25-  (Suppl.I)  8  -8  2007/04/25  [Not refereed][Not invited]
  
• 3. The Role of Radiation Therapy for the Treatment of Brain Metastases : WBRT, SRS, or Both?(PS1-4 Modern Management of Metastatic Brain Tumors, The 27^ Annual Meeting of The Japanese Congress of Neurological Surgeons)

  Aoyama Hidefumi  Japanese journal of neurosurgery  16-  (4)  313  -313  2007/04/20
• 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]
  
• 脳動静脈奇形定位照射におけるMR‐perfusionを用いた治療前後の血流動態の検討

  芹澤慈子, THA Khin K, 青山英史, 工藤與亮, 加藤徳雄, 寺江聡, 白土博樹  日本医学放射線学会学術集会抄録集  66th-  S225  -S225  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]
  
• Low-dose craniospinal irradiation (CSI) with computed tomographic (CT) simulation and ifosfamide, cisplatin, and etopiside for non-metastatic embryonal tumors in the central nervous system

  H. Taguchi, K. Yasuda, H. Aoyama, Y. Sawamura, J. Ikeda, K. Fujieda, Y. Iwasaki, H. Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  69-  (3)  S241  -S241  2007  [Not refereed][Not invited]
  
• A novel approach to advanced carcinoma of the tongue: Cases successfully treated with combination of superselective intra-arterial chemotherapy and external/high-dose-rate interstitial radiotherapy

  Takeshi Nishioka, Akihiro Homma, Yasushi Furuta, Hidefumi Aoyama, Fumiyuki Suzuki, Keiichi Ohmori, Takeshi Asano, Daisuke Yoshida, Hiroki Shirato, Satoshi Fukuda  JAPANESE JOURNAL OF CLINICAL ONCOLOGY  36-  (12)  822  -826  2006/12  [Not refereed][Not invited]
   

  Objective: This study sought to evaluate the efficacy and safety of a novel treatment regimen, intra-arterial cisplatin infusion plus external/high-dose-rate radiotherapy. Methods: Superselective intra-arterial infusion of cisplatin (100-120 mg) was performed concomitantly with external radiotherapy in four patients with locally advanced carcinoma of the tongue. A high-dose-rate brachytherapy boost was performed after combination therapy in all patients. Brachytherapy was performed after external radiotherapy, and the treatment schedule was twice daily, with a fraction of 600 cGy up to a total of 30-48 Gy. Results: All patients completed the therapy as scheduled. There were no vascular or neurological complications. Grade III acute radiation mucositis developed in all patients but this did not necessitate a treatment break. With a mean follow-up period of 35 months, loco-regional control was obtained for all patients. Conclusions: The combination of weekly administration of intra-arterial cisplatin plus external/high-dose-rate radiotherapy seems effective for advanced carcinoma of the tongue.
• A novel approach to advanced carcinoma of the tongue: Cases successfully treated with combination of superselective intra-arterial chemotherapy and external/high-dose-rate interstitial radiotherapy

  Takeshi Nishioka, Akihiro Homma, Yasushi Furuta, Hidefumi Aoyama, Fumiyuki Suzuki, Keiichi Ohmori, Takeshi Asano, Daisuke Yoshida, Hiroki Shirato, Satoshi Fukuda  JAPANESE JOURNAL OF CLINICAL ONCOLOGY  36-  (12)  822  -826  2006/12  [Not refereed][Not invited]
   

  Objective: This study sought to evaluate the efficacy and safety of a novel treatment regimen, intra-arterial cisplatin infusion plus external/high-dose-rate radiotherapy. Methods: Superselective intra-arterial infusion of cisplatin (100-120 mg) was performed concomitantly with external radiotherapy in four patients with locally advanced carcinoma of the tongue. A high-dose-rate brachytherapy boost was performed after combination therapy in all patients. Brachytherapy was performed after external radiotherapy, and the treatment schedule was twice daily, with a fraction of 600 cGy up to a total of 30-48 Gy. Results: All patients completed the therapy as scheduled. There were no vascular or neurological complications. Grade III acute radiation mucositis developed in all patients but this did not necessitate a treatment break. With a mean follow-up period of 35 months, loco-regional control was obtained for all patients. Conclusions: The combination of weekly administration of intra-arterial cisplatin plus external/high-dose-rate radiotherapy seems effective for advanced carcinoma of the tongue.
• Radiosurgery plus whole-brain radiation therapy for brain metastases - Reply

  Hidefumi Aoyama, Hiroki Shirato, Masao Tago, Keiichi Nakagawa, Gen Kobashi  JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION  296-  (17)  2090  -2090  2006/11  [Not refereed][Not invited]
  
• In reply [6]

  Hidefumi Aoyama, Hiroki Shirato, Masao Tago, Keiichi Nakagawa, Gen Kobashi  Journal of the American Medical Association  296-  2090  2006/11/01  [Not refereed][Not invited]
  
• 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]
  
• What is the "standard treatment" for 1 to 4 brain metastases?

  Hidefumi Aoyama, Hidefumi Aoyama, Hiroki Shirato, Masao Tago, Keiichi Nakagawa, Gen Kobashi  American Journal of Oncology Review  5-  625  -628  2006/10/01  [Not refereed][Not invited]
  
• Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases - A randomized controlled trial

  H Aoyama, H Shirato, M Tago, K Nakagawa, T Toyoda, K Hatano, M Kenjyo, N Oya, S Hirota, H Shioura, E Kunieda, T Inomata, K Hayakawa, N Katoh, G Kobashi  JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION  295-  (21)  2483  -2491  2006/06  [Not refereed][Not invited]
   

  Context In patients with brain metastases, it is unclear whether adding up-front whole-brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) has beneficial effects on mortality or neurologic function compared with SRS alone. Objective To determine if WBRT combined with SRS results in improvements in survival, brain tumor control, functional preservation rate, and frequency of neurologic death. Design, Setting, and Patients Randomized controlled trial of 132 patients with 1 to 4 brain metastases, each less than 3 cm in diameter, enrolled at 11 hospitals in Japan between October 1999 and December 2003. Interventions Patients were randomly assigned to receive WBRT plus SRS ( 65 patients) or SRS alone ( 67 patients). Main Outcome Measures The primary end point was overall survival; secondary end points were brain tumor recurrence, salvage brain treatment, functional preservation, toxic effects of radiation, and cause of death. Results The median survival time and the 1-year actuarial survival rate were 7.5 months and 38.5% (95% confidence interval, 26.7%-50.3%) in the WBRT + SRS group and 8.0 months and 28.4% (95% confidence interval, 17.6%-39.2%) for SRS alone (P=. 42). The 12-month brain tumor recurrence rate was 46.8% in the WBRT + SRS group and 76.4% for SRS alone group ( P <. 001). Salvage brain treatment was less frequently required in the WBRT + SRS group (n = 10) than with SRS alone ( n = 29) ( P <. 001). Death was attributed to neurologic causes in 22.8% of patients in the WBRT + SRS group and in 19.3% of those treated with SRS alone ( P=. 64). There were no significant differences in systemic and neurologic functional preservation and toxic effects of radiation. Conclusions Compared with SRS alone, the use of WBRT plus SRS did not improve survival for patients with 1 to 4 brain metastases, but intracranial relapse occurred considerably more frequently in those who did not receive WBRT. Consequently, salvage treatment is frequently required when up-front WBRT is not used.
• Fluctuation in speed and amplitude of lung tumor motion detected by real-time tumor-tracking radiotherapy system

  S Onodeara, M Fujino, K Fujita, R Onimaru, H Aoyama, G Sharp, H Shirato  RADIOTHERAPY AND ONCOLOGY  78-  S86  -S87  2006/03  [Not refereed][Not invited]
  
• CT‐FDG‐PET fusion imageの肺癌放射線治療計画への利用

  藤野賢治, 加藤千恵次, 小野寺俊輔, 白土博樹, 長嶺嘉彦, 梅川徹, 青山英史, 西岡健, 宮坂和男, 玉木長良  日本医学放射線学会学術集会抄録集  65th-  S215  -S215  2006/02/25  [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]
  
• Predictive value of FDG-PET before radiation therapy for head and neck malignancy: Can SUV tell the truth?

  K. Suzuki, T. Nishioka, H. Aoyama, K. Tsuchiya, H. Shirato, K. Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  66-  (3)  S444  -S444  2006  [Not refereed][Not invited]
  
• Challenges in the use of breath-hold (18)F-fluorodeoxyglucose positron emission tomography in real-time tumor-tracking radiotherapy in patients with lung cancer without atelectasis

  M. Fujino, C. Katoh, T. Kaji, N. Kubo, N. Kato, S. Onodera, T. Shiga, H. Aoyama, H. Shirato, N. Tamaki  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  66-  (3)  S617  -S618  2006  [Not refereed][Not invited]
  
• 放射線治療計画用分子イメージングシステムの肺癌放射線治療計画への初期利用経験

  小野寺俊輔, 藤野賢治, 加藤徳雄, 青山英史, 西岡健, 白土博樹, 宮坂和男, 加藤千恵次, 志賀哲, 玉木長良  日本放射線腫よう学会誌  17-  (Supplement 1)  164  -164  2005/10/25  [Not refereed][Not invited]
  
• 頭頚部腫ようにおけるFDG‐PET—SUVは放射線治療の予後因子となりうるか?—

  鈴木恵士郎, 西岡健, 青山英史, 土屋和彦, 鬼丸力也, 白土博樹, 宮坂和男  日本放射線腫よう学会誌  17-  (Supplement 1)  103  -103  2005/10/25  [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]
  
• 放射線治療計画用分子イメージングシステムの開発

  藤野賢治, 加藤徳雄, 青山英史, 西岡健, 白土博樹, 加藤千恵次, 志賀哲, 玉木長良, 田口太志, 鬼丸力也  日本放射線腫よう学会誌  17-  (Supplement 1)  102  -102  2005/10/25  [Not refereed][Not invited]
  
• Pinnacleを用いた強度変調放射線治療のInverse PlanningとTomoTherapyへの一考察

  TAMURA MASAYA, SHIRATO HIROKI, AOYAMA EIJI, FUJINO KENJI, FUJITA KATSUHISA, ONIMARU RIKIYA, KATO TOKUSHI, ODA KYOTA, IDE WATARU, SHIBAMOTO YUTA  日本放射線腫よう学会誌  17-  (Supplement 1)  102  -102  2005/10/25  [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]
  
• Comparison of imaging modalities for the accurate delineation of arteriovenous malformation, with reference to stereotactic radiosurgery

  H Aoyama, H Shirato, N Katoh, K Kudo, T Asano, S Kuroda, T Ishikawa, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  62-  (4)  1232  -1238  2005/07  [Not refereed][Not invited]
   

  Purpose: To investigate the discrepancy between the arteriovenous malformations seen on magnetic resonance angiography (MRA) and on stereotactic digital subtracted angiography (DSA). Methods and Materials: The target volume on stereotactic DSA (V-DSA) and the target volume on MRA (V,(MRA) rA) were separately delineated in 28 intracranial arteriovenous malformations. The coordinates of the center and the outer edges of V-DSA and V-MRA,A were calculated and used for the analyses. Results: The standard deviations (mean value) of the displacement of centers of V-MRA from V-DSA were 2.67 mm (-1.82 mm) in the left-right direction, 3.23 mm (-0.08 mm) in the anterior-posterior direction, and 2.16 mm (0.91 mm) in the craniocaudal direction. V-MRA covered less than 80% of V-DSA, in any dimensions in 9 cases (32%), although no significant difference was seen in the target volume between each method, with a mean value of 11.9 cc for V-DSA and 12.3 cc for V-MRA (p = 0.948). Conclusion: The shift of centers between each modality is not negligible. Considering no significant difference between V-DSA and V-MRA, but inadequate coverage of the V-DSA by V (MRA), it is reasonable to consider that the target on MRA might include the feeding artery and draining vein and possibly miss a portion of the nidus. (c) 2005 Elsevier Inc.
• Integral radiation dose to normal structures with conformal external beam radiation

  H Aoyama, DC Westerly, TR Mackie, SM Bentzen, GH Olivera, RR Patel, H Jaradat, WA Tome, MA Ritter, MP Mehta  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  63-  (2)  S559  -S559  2005  [Not refereed][Not invited]
   

  BACKGROUND: This study was designed to evaluate the integral dose (ID) received by normal tissue from intensity-modulated radiotherapy (IMRT) for prostate cancer. METHODS AND MATERIALS: Twenty-five radiation treatment plans including IMRT using a conventional linac with both 6 MV (6MV-IMRT) and 20 MV (20MV-IMRT), as well as three-dimensional conformal radiotherapy (3DCRT) using 6 MV (6MV-3DCRT) and 20 MV (20MV-3DCRT) and IMRT using tomotherapy (6MV) (Tomo-IMRT), were created for 5 patients with localized prostate cancer. The ID (mean dose x tissue volume) received by normal tissue (NTID) was calculated from dose-volume histograms. RESULTS: The 6MV-IMRT resulted in 5.0% lower NTID than 6MV-3DCRT; 20 MV beam plans resulted in 7.7%-11.2% lower NTID than 6MV-3DCRT. Tomo-IMRT NTID was comparable to 6MV-IMRT. Compared with 6MV-3DCRT, 6MV-IMRT reduced IDs to the rectal wall and penile bulb by 6.1% and 2.7%, respectively. Tomo-IMRT further reduced these IDs by 11.9% and 16.5%, respectively. The 20 MV did not reduce IDs to those structures. CONCLUSIONS: The difference in NTID between 3DCRT and IMRT is small. The 20 MV plans somewhat reduced NTID compared with 6 MV plans. The advantage of tomotherapy over conventional IMRT and 3DCRT for localized prostate cancer was demonstrated in regard to dose sparing of rectal wall and penile bulb while slightly decreasing NTID as compared with 6MV-3DCRT.
• Long-term outcome of fractionated small-field irradiation (FSR) for vestibular schwannoma in patients followed for more than five years

  N Katoh, T Sakamoto, H Aoyama, W Sakai, H Taguchi, K Suzuki, K Tsuchiya, S Fukuda, H Shirato  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  63-  (2)  S264  -S265  2005  [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]
  
• 脊髄原発gliomaに対する放射線治療

  加藤徳雄, 白土博樹, 青山英史, 鬼丸力也, 飛騨一利, 岩崎喜信, 宮坂和男  日本放射線腫よう学会誌  16-  (Supplement 1)  106  2004/11  [Not refereed][Not invited]
  
• 治療計画装置を用いた動体追跡システムによるX線透視線量の評価

  渡辺良晴, 笈田将皇, 鬼丸力也, 青山英史, 藤野賢治, 大坂康博, 藤田勝久, 白土博樹, 宮坂和男  日本放射線腫よう学会誌  16-  (Supplement 1)  121  2004/11  [Not refereed][Not invited]
  
• Combination chemotherapy with gemcitabine and docetaxel for recurrent germ cell tumors in the central nervous system.

  J Ikeda, H Kobayashi, N Ishii, Y Sawamura, H Aoyama, H Shirato  JOURNAL OF CLINICAL ONCOLOGY  22-  (14)  117S  -117S  2004/07  [Not refereed][Not invited]
  
• Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography

  H Aoyama, K Kamada, H Shirato, F Takeuchi, S Kuriki, Y Iwasaki, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  58-  (4)  1177  -1183  2004/03  [Not refereed][Not invited]
   

  Purpose: To minimize the risk of neurologic deficit after stereotactic irradiation, functional brain information was integrated into treatment planning. Methods and Materials: Twenty-one magnetoencephalography and six magnetic resonance axonographic images were made in 20 patients to evaluate the sensorimotor cortex (n = 15 patients, including the corticospinal tract in 6), visual cortex (n = 4), and Wernicke's area (n = 2). One radiation oncologist was asked to formulate a treatment plan first without the functional images and then to modify the plan after seeing them. The pre- and postmodification values were compared for the volume of the functional area receiving greater than or equal to15 Gy and the volume of the planning target volume receiving greater than or equal to80% of the prescribed dose. Results: Of the 21 plans, 15 (71%) were modified after seeing the functional images. After modification, the volume receiving greater than or equal to15 Gy was significantly reduced compared with the values before modification in those 15 sets of plans (p = 0.03). No statistically significant difference was found in the volume of the planning target volume receiving greater than or equal to80% of the prescribed dose (p = 0.99). During follow-up, radiation-induced necrosis at the corticospinal tract caused a minor motor deficit in 1 patient for whom magnetic resonance axonography was not available in the treatment planning. No radiation-induced functional deficit was observed in the other patients. Conclusion: Integration of magnetoencephalography and magnetic resonance axonography in treatment planning has the potential to reduce the risk of radiation-induced functional dysfunction without deterioration of the dose distribution in the target volume. (C) 2004 Elsevier Inc.
• Methionine PET in differentiating recurrent brain tumor from radiation necrosis following cranial radiation

  Norio Katoh, Kunihiro Nakada, Toshiki Takei, Hidefumi Aoyama, Hiroki Shirato, Chietsugu Katoh, Yuji Kuge, Eriko Tsukamoto, Nagara Tamaki  International Congress Series  1264-  217  -221  2004/03/01  [Not refereed][Not invited]
   

  Objectives: The purpose of the present study was to determine whether PET with 11 C-methionine (MET) is valuable in distinguishing recurrent tumor from radiation necrosis. Methods: Twenty-one patients (27 lesions) with previously treated 10 primary or 11 metastatic brain tumor who presented focally enhanced mass lesion on postcontrast magnetic resonance imaging (MRI) images were studied with MET-PET. Uptake of MET was visually interpreted by three independent nuclear medicine physicians in a blind manner. In addition, semiquantitative evaluation was performed in forms of tumor-to-contralateral (TCR) tissue ratio of standardized uptake value (SUV). Final confirmation was established based on pathological diagnosis in 13 lesions and clinical follow-up for more than 6 months in the remaining 14. Results: Final diagnosis was radiation necrosis in nine lesions and recurrent tumor in 18. Every recurrent tumor showed intense MET uptake while none of the radiation necrosis showed significant MET uptake. Sensitivity as well as specificity of visual interpretation of MET-PET images were 100%. The difference in the mean value of TCR was statistically significant between radiation necrosis and recurrent tumor (1.05±0.11 vs. 1.79±0.32, p < 0.0001). Conclusions: MET-PET accurately distinguishes recurrent brain tumor from radiation necrosis. © 2004, Elsevier Inc. All rights reserved.
• Interim report of the JROSG99-1 multi-institutional randomized trial, comparing radiosurgery alone vs. radiosurgery plus whole brain irradiation for 1-4 brain metastases. Proceedings of 40^ annual meeting of American Society of Clinical Oncology

  AOYAMA H  J Clin Oncol  22-  1506  -1506  2004
• 患者のための放射線治療 動体追跡放射線治療

  白土博樹, 青山英史, 鬼丸力也, 土屋和彦, 宮坂和男  月刊新医療  30-  (12)  71-73  -63  2003/12/01  [Not refereed][Not invited]
  
• Visualization of the corticospinal tract pathway using magnetic resonance axonography and magnetoencephalography for stereotactic irradiation planning of arteriovenous malformations

  H Aoyama, K Kamada, H Shirato, F Takeuchi, S Kuriki, Y Iwasaki, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  68-  (1)  27  -32  2003/07  [Not refereed][Not invited]
   

  Corticospinal tract (CST) information using anisotropic diffusion-weighted imaging and magnetoencephalography were integrated into radiosurgical planning for two patients with deeply seated arteriovenous malformation. The volume of CST receiving > 10 Gy, > 15 Gy, and maximum dose of CST could be reduced when plans were created with the aid of CST information compared with plans without the information. The results indicate that the use of CST information might reduce the risk of post-radiosurgical motor disturbance resulting from radiation necrosis. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.
• Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis using noninvasive fixation of the skull

  HI Aoyama, H Shirato, R Onimaru, K Kagei, J Ikeda, N Ishii, Y Sawamura, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  56-  (3)  793  -800  2003/07  [Not refereed][Not invited]
   

  Purpose: To evaluate the efficacy and toxicity of hypofractionated stereotactic radiotherapy (HSRT) using nortinvasive fixation of the skull on solitary or oligo brain metastatic patients as an alternative to stereotactic radiosurgery (SRS) using invasive fixation. Patients and Methods: The subjects were 87 patients who had 4 or fewer brain metastases (50 solitary, 37 oligometastases). Treatment was conducted on 159 metastases by using a linac-based stereotactic system. The median isocentric dose was 35 Gy in 4 fractions. Whole-brain irradiation was not applied as an initial treatment. For the salvage treatment of metachronous brain metastases, repeat HSRT or whole-brain irradiation was applied. Results: The actuarial I-year local tumor control rate was 81%. Treatment-related complications were observed in 4 patients in the early period (<3 months) and in 2 patients in the late period. The median survival period was 8.7 months. Metachronous brain metastases occurred in 30 patients, and none of the 18 patients who were eligible for salvage HSRT refused to receive it again. Conclusions: Hypofractionated stereotactic radiotherapy achieved tumor control and survival equivalent to those of SRS reported in the literature. The results suggested that HSRT could be an alternative for solitary or oligo brain metastatic patients with less toxicity and less invasiveness compared to SRS. (C) 2003 Elsevier Inc.
• 脊髄・脊椎腫ようの治療戦略 脊髄・脊椎腫ようへの放射線治療戦略

  白と博樹, 鬼丸力也, 青山英史, 宮坂和男, 関俊隆, 飛騨一利, 岩崎喜信  脊椎脊髄ジャーナル  16-  (6)  681-687  -687  2003/06/25  [Not refereed][Not invited]
  
• 臨床画像診断におけるデータ信頼性:放射線治療計画用MRIの歪みについて

  寺江聡, 青山英史, 白土博樹, 宮坂和男  日本ME学会大会論文集  42nd-  63  2003/06/03  [Not refereed][Not invited]
  
• 転移性脳腫ようの定位照射:施設間差の検討

  青山英史, 白土博樹, 鬼丸力也, 多湖正夫, 中川恵一, 晴山雅人, 吉田弘, 権丈雅浩, 鈴木恵士郎, 今井敦, 明神美弥子, 幡野和男  定位的放射線治療  7-  67-72  -72  2003/05/31  [Not refereed][Not invited]
  
• Methionine PET in differentiating recurrent brain tumor from radiation necrosis following cranial radiation therapy.

  K Nakada, N Katoh, N Takei, H Aoyama, H Shirato, C Katoh, Y Kuge, F Yamamoto, E Tsukamoto, N Tamaki  JOURNAL OF NUCLEAR MEDICINE  44-  (5)  244P  -245P  2003/05  [Not refereed][Not invited]
  
• 肺非小細胞癌における肺腫瘍・脳転移に対する定位放射線照射(第46回肺癌学会北海道支部会 北海道支部 支部活動)

  加藤 徳雄, 青山 英史, 鬼丸 力也, 白土 博樹, 宮坂 和男, 原田 敏之, 木下 一郎, 山崎 浩一, 西村 正治, 秋田 弘俊  肺癌  43-  (1)  72  -73  2003/02/20  [Not refereed][Not invited]
  
• Erratum: Calculation of rotational setup error using the real-time tracking radiation therapy (RTRT) system and its application to the treatment of spinal schwannoma (International Journal of Radiation Oncology Biology Physics (2002) 54 (939-947))

  R. Onimaru, H. Shirato, H. Aoyama, K. Kitamura, T. Seki, K. Hida, K. Fujita, K. Kagel, T. Nishioka, T. Kunieda, Y. Iwasaki, K. Miyasaka  International Journal of Radiation Oncology Biology Physics  54-  (5)  1609  2002/12/01  [Refereed][Not invited]
  
• Calculation of rotational setup error using the real-time tracking radiation therapy (RTRT) system and its application to the treatment of spinal schwannoma. (vol 54, pg 939, 2002)

  R Onimaru, H Shirato, H Aoyama, K Kitamura, T Seki, K Hida, K Fujita, K Kagel, T Nishioka, T Kunieda, Y Iwasaki, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  54-  (5)  1609  -1609  2002/12  [Not refereed][Not invited]
  
• Effectiveness of cisplatin/vincristine combination chemotherapy for hypothalamic/chiasmatic pilocytic astrocytoma in very young children

  SAWAMURA Yutaka, KATOH Tsutomu, MAYUZUMI Hideyasu, IKEDA Jun, AOYAMA Hidehumi, SHIRATO Hiroki  小児がん  39-  (2)  187  -191  2002/10/25
• Stereotactic irradiation for intramedullary spinal arteriovenous malformations

  K Hida, H Shirato, T Isu, T Seki, R Onimaru, H Aoyama, S Ushikoshi, K Miyasaka, Y Iwasaki  NEUROSURGERY  51-  (2)  544  -544  2002/08  [Not refereed][Not invited]
  
• 乳幼児hypothalamic / optic-pathway pilocytic astrocytomaに対するシスプラチン・ピンクリスチン併用化学療法

  澤村 豊, 加藤 功, 池田 潤, 青山 英史, 白土 博樹  日本内分泌学会雑誌  78-  70  -72  2002/06/20
• Induction chemotherapy and involved-field radiotherapy for intracranial germinoma - In Reply

  H Aoyama, H Shirato, M Kashiwamura, J Ikeda, Y Sawamura  JOURNAL OF CLINICAL ONCOLOGY  20-  (12)  2911  -2912  2002/06  [Not refereed][Not invited]
  
• 海綿静脈洞硬膜動静脈奇形への定位放射線治療

  小前隆, 青山英史, 牛越聡, 鬼丸力也, 西岡健, 米坂祥郎, 土屋和彦, 白土博樹, 宮坂和男  日本医学放射線学会雑誌  62-  (6)  300  -300  2002/05/25  [Not refereed][Not invited]
  
• 婦人科領域悪性腫ように対する動体追跡照射の初期経験

  米坂祥朗, 西岡井子, 西岡健, 喜多村圭, 青山英史, 鬼丸力也, 土屋和彦, 白土博樹, 宮坂和男  日本医学放射線学会雑誌  62-  (3)  S184  -S184  2002/03/10  [Not refereed][Not invited]
  
• Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors

  H Aoyama, H Shirato, J Ikeda, K Fujieda, K Miyasaka, Y Sawamura  JOURNAL OF CLINICAL ONCOLOGY  20-  (3)  857  -865  2002/02  [Not refereed][Not invited]
   

  Purpose : To investigate the efficacy of chemotherapy followed by low-dose involved-field radiotherapy for the treatment of intracranial germ cell tumors (GCTs). Patients and Methods: Thirty-three patients with GCTs, including 16 pure germinomas, 11 human chorionic gonadotropin-beta (HCG-beta)-secreting germinomas, three mixed GCTs composed of immature teratomas plus germinomas (IMT/G), and three highly malignant mixed GCTs, were treated. Etoposide and cisplatin (EP) were used for the treatment of solitary pure germinomos, and ifosfamide, cisplatin, and etoposide (ICE) were used for the treatment of other GCTs. The dose schedule was 24 Gy for germinomas and 40 to 54 Gy for other GCTs. An involved-field set-up was used except for highly malignant GCTs, in which craniospinal irradiation was used. The median follow-up was 58 months (range, 18 to 102 months). Results: Disease-related, overall, and relapse-free survival rates at S years were 100%, 93%, and 69% for all patients, 100%, 100%, and 86% for patients with pure germinomas, and 100%, 75%, and 44% for patients with HCG-beta-secreting germinomas, respectively. All six patients with nongerminomatous GCTs were alive at the last follow-up. All eight relapses (one pure germinoma, five HCG-beta-secreting germinomas, and two IMT/G), except one in a course of salvage treatment, were salvaged and free of disease at the lost follow-up. No decline was observed in the full-scale, verbal, or performance intelligence quotient at 12 to 51 months after the treatment in 11 patients. Conclusion: Our results support an excellent prognosis after EP and ICE regimens followed by radiotherapy. Dose and volume can be reduced to 24 Gy in 12 fractions and involve a field set-up after EP chemotherapy for the treatment of pure germinomas. (C) 2002 by American Society of Clinical Oncology.
• 動体追跡照射装置を用いたConformal Set‐up

  上垣慎二, 白土博樹, 喜多村圭, 鬼丸力也, 青山英史, 西岡健, 西岡井子, 米坂祥朗, 宮坂和男  日本放射線腫よう学会誌  13-  (Supplement 1)  78  2001/11  [Not refereed][Not invited]
  
• 定位放射線照射への脳機能情報導入

  青山英史, 白土博樹, 鬼丸力也  日本放射線腫よう学会誌  13-  (Supplement 1)  79  2001/11  [Not refereed][Not invited]
  
• Medication for hearing loss after fractionated stereotactic radiotherapy (SRT) for vestibular schwannoma

  T Sakamoto, H Shirato, N Takeichi, H Aoyama, K Kagei, T Nishioka, S Fukuda  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  50-  (5)  1295  -1298  2001/08  [Not refereed][Not invited]
   

  Purpose: To investigate the effectiveness of corticosteroid treatments for patients showing decreases in hearing levels after stereotactic radiotherapy for vestibular schwannoma. Methods and Materials: Twenty-one patients experienced a hearing loss in pure-tone average at greater than 20 dB or less than within 1 year after irradiation administration of 44 Gy/22 fractions followed by a 4 Gy boost. Eight received oral prednisone at a daily dose of 30 mg, which was gradually decreased (medicated group), and 13 received none (nonmedicated group). The average observation period was 26.7 +/- 16.6 (range: 6-69) months. Results: Hearing recovery was seen after initial onset of the hearing loss in all 8 patients in the medicated group and in 2 of 13 patients in the nonmedicated group (p = 0.001). The hearing recovery, that is, the change in pure-tone average (dB) at the last follow-up from the onset of hearing loss, was 9.8 +/- 6.9 dB (recovery) in the medicated group and -9.4 +/- 12.8 dB (further loss) in the nonmedicated group (p = 0.0013). The hearing recovery rate, normalizing to the degree of the hearing loss before medication, was also significantly higher in the medicated group than in the nonmedicated group (p = 0.0014). Conclusions: Corticosteroidal intake is suggested to be effective in improving hearing loss after stereotactic radiotherapy, at least in young patients having a useful pretreatment hearing level, if the treatment for hearing loss is administered immediately after the hearing loss is first detected. (C) 2001 Elsevier Science Inc.
• Magnetic resonance imaging system for three-dimensional conformal radiotherapy and its impact on gross tumor volume delineation of central nervous system tumors

  H Aoyama, H Shirato, T Nishioka, S Hashimoto, K Tsuchiya, K Kagei, R Onimaru, Y Watanabe, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  50-  (3)  821  -827  2001/07  [Not refereed][Not invited]
   

  Purpose: We developed an MRI system for three-dimensional planning in radiotherapy. Its contribution on gross tumor volume (GTV) delineation of central nervous system (CNS) diseases was evaluated. Methods and Materials: The MRI system, with corrected distortion, was registered on computed tomography (CT) by means of fiducial/anatomic landmarks. In 41 consecutive patients with various CNS diseases, GTVs determined by MRI/CT registration (MR/CT-GTV) and CT alone (CT-GTV) were compared. Hard copies of diagnostic MRI were shown to doctors when CT-GTV was determined to simulate a conventional planning situation. Multi-observer volumetric analysis was conducted, assessing interobserver deviations among four radiation oncologists and intermethodological deviations between MR/CT-GTV and CT-GTV, Results: Overall, the mean of geometric distortion was significantly reduced from 1.08 mm to 0.3 mm by distortion correction (p < 0.0001), The contribution of the correction was apparent at > 12.0 cm radius from the center of the magnetic field. Interobserver deviation was significantly reduced by MR/CT registration (p 0.005), The improvement was significant for acoustic neurinoma (p = 0.038), astrocytomas (p = 0.043), and lesions at the cerebellum/brainstem (p = 0.008), The regression coefficient between MR/CT-GTV and CT-GTV was <0.9 for cerebellum/brainstem lesions, suggesting that MRI/CT-GTV was smaller than CT-GTV, Conclusions: This system is feasible for three-dimensional planning and was shown to reduce interobserver deviations in GTV delineation for CNS diseases. (C) 2001 Elsevier Science Inc.
• Annual rate of hearing loss falls after fractionated stereotactic irradiation for vestibular schwannoma

  T Sakamoto, H Shirato, N Takeichi, H Aoyama, S Fukuda, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  60-  (1)  45  -48  2001/07  [Not refereed][Not invited]
   

  Purpose: The rate of hearing loss in a population before and after irradiation was investigated to determine the effect of irradiation on hearing impairment. Methods and materials: In 72 patients with vestibular schwannoma who received fractionated stereotactic irradiation from 1992 to 1999, 21 had had their hearing levels examined 3 months or more before the treatment. The mean time between the initial examination and treatment was 18.6 months (range: 3-89 months), and the mean time between treatment and the last follow-up was 24.2 months (12-69 months). Thirty-six to 50 Gy in 20-25 fractions over 5 to 6 weeks was given using an X-ray beam from a linear accelerator. Pure tone average (PTA) was measured using the mean hearing level at five frequencies, and the annual rate of hearing loss was defined as [(hearing loss in PTA(dB))/(follow-up period (months) x 12)]. Results: The actual cumulative curve of decrease in tumor size of 2 mm or more was 38.3% at 2 years and 80.0% at 3 years. The mean of hearing loss in PTA was 11.6 +/- 10.3 dB (-1 to 35 dB) from the initial examination to the start of irradiation and 11.9 +/- 14.4 dB (-14 to 37 dB) from the start of irradiation to the last follow-up. The mean annual rates of hearing loss before irradiation and in the 1st,2nd,3rd and 4th years after irradiation were, respectively, 18.6, 11.2, 6.2, 5.1, and 5.0 dB/year. The annual rates of hearing loss in the 2nd year (P = 0.025) and 3rd year (P = 0.018) were significantly slower than the rate before irradiation. Conclusions: The mean annual rate of hearing loss was higher before irradiation than after irradiation, and hearing loss slowed rather than accelerated after irradiation. Although hearing loss after the treatment was usually permanent, fractionated stereotactic irradiation was suggested to be effective to lower the rate of hearing loss. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
• Treatment outcome of single or hypofractionated single-isocentric stereotactic irradiation (STI) using a linear accelerator for intracranial arteriovenous malformation

  H Aoyama, H Shirato, T Nishioka, K Kagei, R Onimaru, K Suzuki, S Ushikoshi, K Houkin, S Kuroda, H Abe, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  59-  (3)  323  -328  2001/06  [Not refereed][Not invited]
   

  Background and purpose: We investigated the use of hypofractionated stereotactic radiotherapy (HFSR) to reduce adverse radiation effects in comparison to single-fraction stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (AVMs). Materials and methods: This study includes 53 intracranial AVMs treated between 1991-1998. HFSR was selected for 26 AVMs with a maximum diameter greater than or equal to2.5 cm or at eloquent area. Twenty-seven patients were treated with SRS (18 AVMs <2.5 cm at non-eloquent area, nine patients who were unlit for prolonged ring-wearing). The most frequent minimum dose (Dmin) was 20 Gy for SRS and 28 Gy for HFSR in four fractions. The mean follow-up duration was 34.6 months for SRS and 35.4 months for HFSR. Results: As a whole, the 3 and 5-year actuarial obliteration rates were 64 and 92%. Age <20 years old (P = 0.02) and a maximum diameter <2 cm were favorable factors (P = 0.05). A difference in the distribution of patients was observed in size (<greater than or equal to>2.5 cm or not) (P < 0.001) and location (eloquent or not) (P < 0.001) between SRS and HFSR due to the treatment selection. However, no significant differences were observed in the actuarial rates or obliteration and transient increased signals with T2-weighted MR images between SRS and HFSR. Radiation necrosis occurred in two patients treated with SRS and in none with HFSR. Intracranial hemorrhage after treatment happened in two treated with SRS and three with HFSR. Conclusions: HFSR appears to be at least us effective as SRS in achieving complete obliteration of intracranial AVM, although its definitive role remains to be investigated. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
• Palliative Radiotherapy 脳病変 眼か内を除く

  青山英史, 白土博樹, 鬼丸力也  緩和医療学  3-  (2)  146-151  -151  2001/04/01  [Not refereed][Not invited]
   

  転移性脳腫瘍,悪性膠芽腫の患者は放射線治療を行っても,余命は各々4ヵ月,1年程度であり,治療の目的は延命及びQOLの維持となる.転移性脳腫瘍に関しては全脳照射が標準的治療法であり,種々の分割方法が試みられてきたが,治療期間が短い点から30Gy/10frが標準的方法となっている.近年普及してきた定位照射は高い抗腫瘍効果が期待できるが,まだ新しい治療法であり,適応症例は現時点では不明確である.我が国で開始された無作為割付試験の結果が待たれる.悪性膠芽腫では60Gy/30frの外照射が標準照射法である.更なる線量増加が余命を改善するというエビデンスはない
• Functional imagesを用いた三次元放射線治療計画

  青山英史, 白土博樹, 鬼丸力也, 西岡健, 影井兼司, 橋本井子, 宮坂和男, 鎌田恭輔  日本医学放射線学会雑誌  61-  (4)  188  -188  2001/03/25  [Not refereed][Not invited]
  
• 頭蓋内はい細胞腫(GCT)に対する小照射野低線量放射線治療 治療成績と知能への影響

  青山英史, 白土博樹, 鬼丸力也, 西岡健, 影井兼司, 宮坂和男  日本医学放射線学会雑誌  61-  (2)  S76  -S76  2001/02/20  [Not refereed][Not invited]
  
• 頭蓋咽頭腫に対する縮小手術と定位放射線照射の併用

  長谷川雅一, 白土博樹, 青山英史, 鬼丸力也, 田口大志, 加藤扶美, 宮坂和男  日本医学放射線学会雑誌  61-  (2)  S79  -S79  2001/02/20  [Not refereed][Not invited]
  
• Fractionated stereotactic radiotherapy for vestibular schwannoma (VS): Comparison between cystic-type and solid-type VS

  H Shirato, T Sakamoto, N Takeichi, H Aoyama, K Suzuki, K Kagei, T Nishioka, S Fukuda, Y Sawamura, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  48-  (5)  1395  -1401  2000/12  [Not refereed][Not invited]
   

  Purpose: To compare the effectiveness and complications of fractionated stereotactic radiotherapy (SRT) for cystic-type vestibular schwannoma (VS) with those of solid-type VS. Methods and Materials: In 65 patients treated,vith fractionated SRT between 1991 and 1999, 20 were diagnosed with cystic VS, in which at least one-third of the tumor volume was a cystic component on magnetic resonance imaging (MRI), and 45 were diagnosed with solid VS. Thirty-six Gy to 50 Gy in 20-25 fractions was administered to the isocenter and approximately 80% of the periphery of the tumor. All cystic and solid components were included in the gross tumor volume. The mean follow-up period was 37 months, ranging from 6 to 97 months. Results: The actuarial 3-year rate of no episode of enlargement greater than 2.0 mm was 55% for cystic-type and 75% for solid-type VS; the difference was statistically significant (p = 0.023). The actuarial 3-year tumor-reduction (reduction in tumor size greater than 2.0 mm) rates were 93% and 31%, respectively (p = 0.0006). The overall actuarial tumor control rate (no tumor growth greater than 2.0 mm after 2 years or no requirement of salvage surgery) was 92% at 5 years in 44 patients with a follow-up period of 2 or more years. There was no difference in the class hearing preservation rate between cystic VS and solid VS. No permanent trigeminal or facial nerve palsy was observed in either group. Conclusion: Transient tumor enlargement occurs in cystic VS more frequently than in solid-type VS, but the subsequent tumor-reduction rate in cystic VS is better. (C) 2000 Elsevier Science Inc.
• Four-dimensional treatment planning and fluoroscopic real-time tumor tracking radiotherapy for moving tumor

  H Shirato, S Shimizu, K Kitamura, T Nishioka, K Kagei, S Hashimoto, H Aoyama, T Kunieda, N Shinohara, H Dosaka-Akita, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  48-  (2)  435  -442  2000/09  [Not refereed][Not invited]
   

  Purpose: To achieve precise three-dimensional (3D) conformal radiotherapy for mobile tumors, a new radiotherapy system and its treatment planning system were developed and used for clinical practice. Methods and Materials: We developed a linear accelerator synchronized with a fluoroscopic real-time tumor tracking system by which 3D coordinates of a 2.0-mm gold marker in the tumor can be determined every 0.03 second, The 3D relationships between the marker and the tumor at different respiratory phases are evaluated using CT image at each respiratory phase, whereby the optimum phase can be selected to synchronize with irradiation (4D treatment planning). The linac is triggered to irradiate the tumor only when the marker is located within the region of the planned coordinates relative to the isocenter. Results: The coordinates of the marker were detected with an accuracy of +/- 1 mm during radiotherapy in the phantom experiment. The time delay between recognition of the marker position and the start or stop of megavoltage X-ray irradiation was 0.03 second. Fourteen patients with various tumors were treated by conformal radiotherapy with a "tight" planning target volume (PTV) margin, They were surviving without relapse or complications with a median follow-up of 6 months. Conclusion: Fluoroscopic real-time tumor tracking radiotherapy following 4D treatment planning was developed and shown to be feasible to improve the accuracy of the radiotherapy for mobile tumors. (C) 2000 Elsevier Science Inc.
• Impact of respiratory movement on the computed tomographic images of small lung tumors in three-dimensional (3D) radiotherapy

  S Shimizu, H Shirato, K Kagei, T Nishioka, Bo, X, H Dosaka-Akita, S Hashimoto, H Aoyama, K Tsuchiya, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  46-  (5)  1127  -1133  2000/03  [Not refereed][Not invited]
   

  Purpose: Three-dimensional (3D) treatment planning has often been performed while patients breathe freely, under the assumption that the computed tomography (CT) images represent the average position of the tumor. We investigated the impact of respiratory movement on the free-breathing CT images of small lung tumors using sequential CT scanning at the same table position. Methods: Using a preparatory free-breathing CT scan, the patient's couch was fixed at the position where each tumor showed its maximum diameter on image, For 16 tumors, over 20 sequential CT images were taken every 2 s, with a 1-s acquisition time occurring during free breathing. For each tumor, the distance between the surface of the CT table and the posterior border of the tumor was measured to determine whether the edge of the tumor was sufficiently included in the planning target volume (PTV) during normal breathing. Results: In the sequential CT scanning, the tumor itself was not visible in the examination slice in 21% (75/357) of cases. There were statistically significant differences between lower lobe tumors (39.4%, 71/180) and upper lobe tumors (0%, 0/89) (p < 0.01) and between lower lobe tumors and middle lobe tumor (8.9%, 4/45) (p < 0.01) in the incidence of the disappearance of the tumor from the image. The mean difference between the maximum and minimum distances between the surface of the CT table and the posterior border of the tumor was 6.4 mm (range 2.1-24.4), Conclusion: Three-dimensional treatment planning for lung carcinoma would significantly underdose many lesions, especially those in the lower lobe, The excess "safety margin" might call into question any additional benefit of 3D treatment. More work is required to determine how to control respiratory movement. (C) 2000 Elsevier Science Inc.
• MRI画像放射線治療計画への応用 (特集 放射線治療の新潮流)

  青山 英史, 渡辺 良晴, 古屋 輝夫  映像情報  31-  (16)  895  -898  1999/08/15
• 2軸X線透視装置を用いた3次元的患者セットアップシステムの開発 (特集 放射線治療の新潮流)

  清水 伸一, 白土 博樹, 青山 英史  映像情報  31-  (16)  879  -884  1999/08/15
• Pathologically-proven intracranial germinoma treated with radiation therapy (vol 47, pg 201, 1998)

  H Aoyama, H Shirato, Y Kakuto, H Inakoshi, M Nishio, H Yoshida, M Hareyama, T Yanagisawa, J Watarai, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  50-  (2)  241  -241  1999/02  [Not refereed][Not invited]
  
• Erratum: Pathologically-proven intracranial germinoma treated with radiation therapy (Radiolgoy and Oncology (1998) 47 (201-205) PII S0167814098000176)

  H. Aoyama, H. Shirato, Y. Kakuto, H. Inakoshi, M. Nishio, H. Yoshida, M. Hareyama, T. Yanagisawa, J. Watarai, K. Miyasaka  Radiotherapy and Oncology  50-  (2)  241  1999  [Not refereed][Not invited]
  
• Retrospective multi-institutional study of radiotherapy for intracranial non-germinomatous germ cell tumors

  H Aoyama, H Shirato, H Yoshida, M Hareyama, M Nishio, T Yanagisawa, Y Kakuto, J Watarai, H Inakoshi, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  49-  (1)  55  -59  1998/10  [Not refereed][Not invited]
   

  The treatment outcome of 24 patients with pathologically-proven non-germinomatous germ cell tumor was retrospectively investigated to determine the effectiveness of radiotherapy. The patients were divided into three groups as follows: group 1, five patients with mature teratoma with or without germinoma; group 2, six patients with immature teratoma with or without germinoma; group 3, 13 patients with other highly malignant tumors. The overall actuarial survival and relapse-free rates at 5 years were 82% and 59%, respectively, with a median follow-up period of 62 months. The actuarial relapse-free rate at 5 years was 100% for group 1, 63% for group 2 and 44% for group 3, There was no difference in the relapse-free rates between total resection and partial resection. Usage of chemotherapy was adversely related to survival probably due to selection bias. No local failure was observed with 10 Gy or more for group 1, 40 Gy or more for group 2 and 54 Gy or more for group 3. In groups 1 and 2, there was no spinal relapses without craniospinal irradiation. In group 3, three of eight patients who did not receive craniospinal irradiation and none of five patients who received craniospinal irradiation experienced spinal relapse. In conclusion, highly malignant GCTs show a high incidence of spinal metastasis and craniospinal irradiation may reduce the risk of spinal metastasis, Radiation dose and volume are to be determined according to the histopathological aggressiveness. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.
• Pathologically-proven intracranial germinoma treated with radiation therapy

  H Aoyama, H Shirato, Y Kakuto, H Inakoshi, M Nishio, H Yoshida, M Hareyama, T Yanagisawa, J Watarai, K Miyasaka  RADIOTHERAPY AND ONCOLOGY  47-  (2)  201  -205  1998/05  [Not refereed][Not invited]
   

  Background and purpose: A retrospective multi-institutional study was conducted to survey what percentage of intracranial germinomas were treated with pathological confirmation before radiotherapy and to investigate the influence of field selection on outcome. Materials and methods: Thirty-seven percent of patients (41 of 110 patients) were pathologically confirmed before radiotherapy during the past 16 years at eight institutions in Northern Japanese prefectures, Pathological confirmation was obtained in 26, 37 and 53% of cases during 1978-1983, 1984-1989 and 1990-1994, respectively. All 110 patients were examined using computed tomography (CT) scans. Among the 41 patients with pathologically confirmed germinoma, radiation fields were craniospinal in 23 patients, whole-brain in 10 patients and local without ventricle inclusion in eight patients. Results: For the 41 patients with pathologically confirmed germinoma, the actuarial and cause-specific survival rates were 91/94% at 5 years and 87/90% at 10 years, respectively. The relapse-free survival rate at 10 years was 90, 76 and 22% for the craniospinal field, whole-brain field and local field without ventricle inclusion, respectively. Conclusion: Pathological confirmation was obtained in only 37% of CT-scan era cases, although the confirmations were more commonly carried out later in the study period. Limited local irradiation alone without ventricle inclusion cannot be recommended for localized tumors even with the help of CT scanning. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.
• Hypofractionated stereotactic radiotherapy for arteriovenous malformations in eloquent area

  K Suzuki, H Aoyama, H Shirato, K Kitamura, K Kagel, T Kitahara  RADIOLOGY  205-  716  -716  1997/11  [Not refereed][Not invited]
  
• 定位的放射線照射の現況 (特集 放射線治療の最前線)

  青山 英史, 白土 博樹  映像情報  29-  (16)  946  -950  1997/08/15
• Tc-99m Labeled Leukocyte Scintigraphy and CT for the Evaluation of Patients with Inflammatory Bowel Disease

  MIYAZAKI Chihoko, KUBO Kohzoh, AOYAMA Hidefumi, ENDOH Hideho, ODASHIMA Yae, SAITOH Eri  日本醫學放射線學會雜誌  57-  (7)  395  -401  1997/06/25
• Attempt to minimize contralateral parotid gland dose using a computed tomography simulator in radiation therapy for oropharyngeal cancer

  K Kagei, H Shirato, T Nishioka, T Kitahara, K Omori, M Kaneko, S Hashimoto, H Aoyama, T Arimoto, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  39-  (2)  239  -239  1997  [Not refereed][Not invited]
  
• Should vestibular schwannoma in patients with useful hearing be treated with radiation? A comparison of patients treated with stereotactic radiotherapy (SRT) and those not treated with SRT.

  H Shirato, T Sakamoto, K Kagei, N Satoh, S Hashimotok, H Aoyama, H Kitahara, Y Inuyama, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  39-  (2)  225  -225  1997  [Not refereed][Not invited]
  
• Clinical trial of neoadjuvant chemotherapy combined with radiotherapy for primary intracranial germinomas

  K Kitamura, K Suzuki, H Shirato, K Kagei, H Aoyama, Y Sawamura, J Ikeda, K Miyasaka  INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS  39-  (2)  278  -278  1997  [Not refereed][Not invited]
  

Awards & Honors

• 2018/11 新潟日報社 新潟日報文化賞（学術部門）
  
• 2016/11 JASTRO (Japanese Society for Radiation Oncology) Abe Award
  
• 2013/12 日本医学放射線学会 優秀演題賞
  
• 2011/04 Best Paper Award 2010 Bronze Medal
  
• 2011/04 JRS (Japan Radiological Society) CyPos Award Gold Medal
  
• 2008/07 北海道大学医学部放射線科同門会 入江賞
  
• 2008/07 JASTRO (Japanese Society for Radiation Oncology) Umegaki Award
  
• 2007/04 JRS (Japan Radiological Society) Excellent Paper Award
  
• 2007/02 北海道大学医学部同窓会 フラテ研究奨励賞
  
• 2006/07 JROSG (Japan Radiation Oncology Study Group) Special prize
  
• 2001/07 北海道大学医学部放射線科同門会 若林記念奨
  

Research Grants & Projects

• 肺癌に対する陽子線治療の選択基準確立に向けた心肺相互作用勘案NTCPモデル構築

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)

  Date (from‐to) : 2022/04 -2025/03 

  Author : 青山 英史, 鈴木 隆介, 宮本 直樹, 高尾 聖心, 金平 孝博, 橋本 孝之, 小橋 啓司, 西岡 健太郎, 田口 大志
• 超低侵襲リアルタイムアダプティブ（RA）放射線治療の実現

  国立研究開発法人日本医療研究開発機構：

  -2024/03
• 頭頸部扁平上皮癌に対する強度変調陽子線治療の実用化に向けた技術開発と有効性検証

  国立研究開発法人日本医療研究開発機構：

  -2023/03
• 切除可能肝細胞癌に対する陽子線治療と外科的切除の非ランダム化同時対照試験

  国立研究開発法人日本医療研究開発機構：

  -2023/03
• Comprehensive research on individualized optimization of brain radiation therapy

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (B)

  Date (from‐to) : 2015/04 -2020/03 

  Author : Aoyama Hidefumi

   

  The purpose of this study was to investigate a method for individual optimization of radiation therapy for patients with brain metastases. Through this research, a possibility was shown as follows; 1) the combined use of whole-brain radiation therapy (WBRT) with stereotactic irradiation (STI) may reduce the recurrence rate of brain tumors and improve the prognosis in a group of patients with an estimated prognosis of12 months or longer, 2) the cut-off value reflecting the clinically significant changes in neurocognitive function should be 1.5SD or higher in the international standardized neuro-cognitive battery, 3) the WBRT dose when combined with STI could be reduced from 30Gy-in-10 to 25Gy-in-10 without compromising brain tumor control and the reduction of dosage may improve the rate of preservation of neurocognitive function.
• A study on backscatter radiation from dental alloys and a protective device during radiotherapy using a three-dimensional dose distribution analysis system

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)

  Date (from‐to) : 2012/04 -2017/03 

  Author : KATSURA Kouji, KIMURA Syuhei, UTSUNOMIYA Satoru

   

  A dental alloy (DA) in the radiation field can cause severe oral mucositis and uncertain dose distribution due to the scattering and absorption of radiation. A spacer is thought to increase the accuracy and safety of radiotherapy. But, the effects of them on dose distribution have not been clarified. This study was conducted to identify the change of dose distribution caused by backscatter radiation from DAs and the optimal material and thicknesses of a spacer. This study showed that the dose enhancement caused by back and lateral scatter radiation from DA disappears at distances >= 6 mm and >= 3 mm, respectively. These dose enhancements strongly depended on both an atomic number and a physical density of DA, and the estimated equation was 0.077√atomic number + 0.79. Additionally, the optimal material and thickness of spacer should have a lower atomic number and physical density and the thickness of >= 6 mm each to prevent severe mucositis caused by backscatter radiation from DAs.
• Investigation of decline of neurocognitive function after cranial radiation therapy for brain tumors and exploring early diagnostic method

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)

  Date (from‐to) : 2009/04 -2014/03 

  Author : AOYAMA Hidefumi, TERAE Satoshi, SHIGA Toru, ONODERA Shunsuke

   

  Adverse radiation effect after brain radiation may cause severe deterioration of neurocognitive function (NCF). The lack of standardized objective scale to determine the severity of the decline of NCF has been an obstacle to investigate the way to prevent and/or treat this condition. We assorted Japanese version of neurocognitive battery which is compatible to those used in Western countries. In a prospective study, this NCB demonstrated deterioration of NCF 4 months after whole-brain radiation therapy (WBRT), recovery at 8 months, and decline at 12 months. In the examination of diffusion tensor imaging, mean diffusivity (MD), which could be a potential index to determine the damage to white matter, continued to increase overtime. At 8 months after radiation, the magnitude of %difference of MD compared with baseline was greatest at corpus callosum followed by cingulate. The correlation of findings in DTI and NCB is a matter of further investigation.
• Basic Research for four-dimensional stereotactic radiotherapy

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research on Priority Areas

  Date (from‐to) : 2005 -2009 

  Author : SHIRATO Hiroki, KANEKO Junichi, NISHIYAMA Syusuke, KATOH Chietsugu, AOYAMA Hidefumi, SEKI Koh-ichi, ONIMARU Rikiya, NISHIOKA Takeshi, MORITA Koichi, DATE Hiroyuki, TAKADA Eiji, TOMIOKA Satoshi, KUDO Kohsude, ONODERA Yuya, KAMISHIMA Tamotsu, ONIMARU Rikiya, SHIMIZU Shinichi, SAKUHARA Yusuke, OYAMA Noriko, ABO Daisuke, TAGUCHI Hiroshi

   

  We developed a four-dimensional (4-D, space and time) focal positron emission localizer, FPEL, using two sets of BGO scintillators, photo-electric multiplier, and collimators. A narrow (5-mm in diameter) 45-MeV electron beam was controlled to irradiate a target with an accuracy of 0.1mm in 4D coordinates automatically if the amount of positron emitters at the target exceeds the threshold. A mouse model was established to irradiate the tumor in which FDG is accumulated. Using the FPEL, 45-MeV electron beam hit the tumor in mice which move in front of the beam exit with the amplitude resembling human respiration. Tumor without fiducial gold marker disappeared within a week after the irradiation. Basis for 4D stereotacic radiotherapy was established successfully.
• Interactive Radiotherapy

  Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (A)

  Date (from‐to) : 2006 -2008 

  Author : SHIRATO Hiroki, HONMA Sato, TAMAKI Nagara, KUGE Yuji, DATE Hiroyuki, KIYANAGI Yoshiaki, HATAKEYAMA Masanori, KANEKO Junichi, MIZUTA Masahiro, INUBUSHI Masayuki, TADANO Shigeru, TAMURA Mamoru, HAYAKAWA Kazushige, MATSUNAGA Naofumi, ISHIKAWA Masayori, AOYAMA Hidefumi, SAKUHARA Yusuke, ONIMARU Rikiya, ABO Daisuke, OITA Masataka, KAMISHIMA Tamotsu, TERAE Satoshi, KUDO Kohsuke, ONODERA Yuya, OMATSU Tokuhiko, SHIMIZU Shinichi, NISHIMURA Takashi, SUZUKI Ryusuke, GERARD Bengua

   

  いままでの先端放射線医療に欠けていた医療機器と患者のinteractionを取り入れた放射線治療を可能にする。臓器の動き・腫瘍の照射による縮小・免疫反応などは、線量と時間に関して非線形であり、システムとしての癌・臓器の反応という概念を加えることが必要であることが示唆された。生体の相互作用を追求していく過程で、動体追跡技術は先端医療のみならず、基礎生命科学でも重要な役割を果たすことがわかった。

Educational Activities

Teaching Experience

Committee Membership

• 2023/10 - Today   Japan Society of Clinical Oncology   delegate