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There are no clinical reports of long-term follow-up after carbon-ion radiotherapy (CIRT) using a dose of 51.6Gy (relative biological effectiveness [RBE]) in 12 fractions for localized prostate cancer, or of a comparison of clinical outcomes between passive and scanning beam irradiation. A total of 256 patients with localized prostate cancer who received CIRT at a dose of 51.6Gy (RBE) in 12 fractions using two different beam delivery techniques (passive [n=45] and scanning [n=211]), and who were followed for more than 1year, were analyzed. The biochemical relapse-free (bRF) rate was defined by the Phoenix definition, and the actuarial toxicity rates were evaluated using the Kaplan-Meier method. Of the 256 patients, 41 (16.0%), 111 (43.4%), and 104 (40.6%) were classified as low, intermediate, and high risk, respectively, after a median follow-up of 7.0 (range 1.1-10.4) years. Androgen deprivation therapy was performed in 212 patients (82.8%). The 5-year bRF rates of the low-, intermediate-, and high-risk patients were 95.1%, 90.9%, and 91.1%, respectively. The 5-year rates of grade 2 late gastrointestinal and genitourinary toxicities in all patients were 0.4% and 6.3%, respectively. No grade ≥3 toxicities were observed. There were no significant differences in the rates of bRF or grade 2 toxicities in patients who received passive irradiation versus scanning irradiation. Our long-term follow-up results showed that a CIRT regimen of 51.6Gy (RBE) in 12 fractions for localized prostate cancer yielded a good therapeutic outcome and low toxicity rates irrespective of the beam delivery technique.

Background: To evaluate the clinical relative biological effectiveness (RBE) of carbon-ion radiotherapy (C-ion RT) for prostate cancer. Methods: The records of 262 patients with low-risk prostate cancer (median age, 65 [47-80] years) treated with C-ion RT at QST Hospital, National Institutes for Quantum Science and Technology in Japan during 2000-2018 were reviewed retrospectively. Four different protocol outcomes and prostate-specific antigen (PSA) responses were evaluated. The median follow-up was 8.4 years. The Kaplan-Meier method was used to estimate the biochemical or clinical failure-free rate (BCFFR). Clinical RBE was calculated using the tumor control probability model. Results: The 5-, 7-, and 10-year BCFFRs were 91.7%, 83.8%, and 73.2%, respectively. The 10-year BCFFRs of patients who received C-ion RT at 66 Gy (RBE) in 20 fractions, 63 Gy (RBE) in 20 fractions, and 57.6 Gy (RBE) in 16 fractions were 81.4%, 70.9%, and 68.9%, respectively. The PSA level and density during follow-up were better in the patients treated with the lower fraction size. A higher PSA nadir and shorter time to PSA nadir were risk factors for biochemical or clinical failure by multivariate Cox regression. The tumor control probability analysis showed that the estimated clinical RBE values to achieve an 80% BCFFR at 10 years for 20, 16, and 12 fractions were 2.19 (2.18-2.24), 2.16 (2.14-2.23), and 2.12 (2.09-2.21), respectively. Conclusions: Using clinical data from low-risk prostate cancer patients, we showed the clinical RBE of C-ion RT decreased with increasing dose per fraction.

Carbon ion beams constitute the primary delivery method of heavy ion radiotherapy. It offers improved dose distribution, and enables concentration of dose within target volumes with minimal extraneous exposure of normal tissue, while delivering superior biological effect in comparison with photon and proton technologies. Here, we review the application of this technology to various gastrointestinal cancers.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures changes in the concentration of an administered contrast agent to quantitatively evaluate blood circulation in a tumor or normal tissues. This method uses a pharmacokinetic analysis based on the time course of a reference region, such as muscle, rather than arterial input function. However, it is difficult to manually define a homogeneous reference region. In the present study, we developed a method for automatic extraction of the reference region using a clustering algorithm based on a time course pattern for DCE-MRI studies of patients with prostate cancer.

Purpose: Carbon ion beams have several physical and biological advantages compared with conventional radiation for cancer therapy. The objective of this study is to evaluate the safety and effectiveness of 2-fraction carbon ion radiation therapy (CIRT) in patients with hepatocellular carcinoma (HCC). Methods and Materials: Between December 2008 and March 2013, 57 patients with localized HCC were treated with CIRT at a total dose of 45 Gy (relative biological effectiveness) in 2 fractions and retrospectively analyzed after long-term observation. The main endpoints of this study were treatment-related toxicity and local tumor control. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Changes in the Child-Pugh score from before to after CIRT were also examined to evaluate hepatic toxicity. Local control was defined as no progression of the irradiated lesion according to the modified Response Evaluation Criteria in Solid Tumors. Results: The median age of the patients was 75 years (range, 49-89 years). Of these patients, 41 had a newly diagnosed lesion, and 16 had residual or recurrent lesions after previous treatments.

To evaluate the safety and efficacy of carbon-ion radiotherapy (CIRT) for cholangiocarcinoma via a multicenter retrospective study. Clinical data were collected from patients with cholangiocarcinoma who had received CIRT at one of four treating institutions in Japan. Of 56 eligible patients, none received surgery for cholangiocarcinoma before or after CIRT. The primary endpoint was overall survival (OS). Based on the tumor site, the 56 cases were categorized as intrahepatic cholangiocarcinoma (IHC) (n=27) or perihilar cholangiocarcinoma (PHC) (n=29). In all patients, the median tumor size was 37 (range, 15‒110) mm, and the most commonly prescribed dose was 76 Gy (relative biological effectiveness) in 20 fractions. The median survival was 14.8 (range, 2.1-129.2) months, and the 1- and 2-year OS rates were 69.7% and 40.9%, respectively. The median survival times of the patients with IHC and those with PHC were 23.8 and 12.6 months, respectively. Both univariate and multivariate analyses revealed that cholangitis pre-CIRT and Child‒Pugh class B were significant prognostic factors for an unfavorable OS. Of four patients who died of liver failure, one with IHC was suspected to have radiation-induced liver disease because of newly developed ascites, and died at 4.3 months post-CIRT. Grade 3 CIRT-related bile duct stenosis was observed in one IHC case. No other CIRT-related severe adverse events, including gastrointestinal events, were observed. These results suggest that CIRT yields relatively favorable treatment outcomes, especially for patients with IHC, and acceptable toxicities were observed in patients with cholangiocarcinoma who did not receive surgery.

[Objective] 99mTc-GSA SPECT is performed for patients before and after carbon-ion radiotherapy (CIRT) for liver tumors in our hospital. It is essential to assess reduced liver reserve capacity and prediction of post-CIRT value before treatment. In this study, we evaluated the usefulness of the liver reserve capacity estimation using GSA SPECT and CT/MRI fusion images in patients before and after CIRT for liver tumors. [Materials and Methods] Eight patients who received 99mTc-GSA SPECT imaging before and 3 months after CIRT were enrolled in this investigation. After intravenous injection of 99mTc-GSA, dynamic and SPECT imaging was performed using a gamma camera. All acquired SPECT images were fused with CT or MRI images using fusion viewer software, followed by evaluation of liver reserve capacity by the maximal GSA removal rate (GSA-Rmax) and GSA-Rmax of the predicted residual liver after CIRT (GSA-RL) using multicompartment analysis. Then we assessed correlation between GSA-RL before CIRT and GSA-Rmax after CIRT to evaluate the usefulness of residual liver function estimation with 99mTc-GSA SPECT. [Results] GSA-Rmax before and after CIRT were 0.302±0.189 and 0.264±0.172, respectively. GSA-RL before CIRT was 0.266±0.174, which was estimated using GSA SPECT-CT/MRI fusion images before CIRT. There was a high correlation between GSA-RL before CIRT and GSA-Rmax after CIRT (r=0.93, p, 第79回日本医学放射線学会総会

【演題名】123I-IMP SPECT 6時間後撮像による脈絡膜悪性黒色腫の半定量的評価 【目的】当院では、脈絡膜悪性黒色腫に対する重粒子線治療前評価としてIMP SPECTを行っている。本研究の目的は、SUVをSPECTに応用した半定量的評価法と、従来の放射線カウントによる診断能を比較し、特に静注6時間後の早期相での評価を試みることである。 【方法】重粒子線治療前の12名の患者にIMP静注6時間後、24時間後のSPECT撮像を行った。SPECT像とCTを融合し、融合画像上で患側・健側眼球のSUVを求めた。従来法として病変集積部位、健側眼球にROIを作成し、バックグラウンドとのカウント比からuptake index(UI)を求め、SUVと比較した。 【結果】6時間後と24時間後の患側眼球のSUV maxは各々2.37±0.88, 3.25±1.57、同様にUIは各々2.24±0.67, 4.03±1.30であった。UIとSUVmaxの相関は6時間後でρ=0.47(P=0.124)、24時間後でρ=0.87(P, 第92回日本核医学会関東甲信越地方会

Prognosis is usually grim for those who cannot receive resection with liver metastasis from colorectal cancer (CRC). Radiation therapy can be an option for those unsuitable for resection, and carbon-ion radiotherapy (CIRT) would be expected higher effective and less toxic than X-ray due to its physio-biological characteristics. The objective of this study is to identify the optimal dose of single fraction CIRT for colorectal cancer liver metastasis. Thirty-one patients with liver metastasis from CRC were enrolled. Twenty-nine patients received a single-fraction CIRT, escalating dose from 36 Gy (RBE) in 5 to 10% increments until unacceptable incidence of dose-limiting toxicity is observed. Dose-limiting toxicity was defined as grade ≥ 3 acute toxicity attributed to radiotherapy. The prescribed doses were: 36 Gy (RBE) (3 cases), 40 (2), 44 (4), 46 (6), 48 (3), 53 (8), and 58 (3). Dose-limiting toxicity was not observed but late grade 3 liver toxicity due to biliary obstruction was observed in 2 patients at 53 Gy (RBE). Both cases had lesions close to the hepatic portal region, and therefore dose was escalated to 58 Gy (RBE) limited to peripheral lesions. Three-year actuarial overall survival rate of all 29 patients was 78%, and median survival time was 65 months. Local control improved significantly at ≥53 Gy (RBE), with 3-year actuarial local control rate of 82%, compared to 28% in lower doses. Treatment for CRC liver metastasis with single-fraction CIRT appeared to be safe up to 58Gy (RBE) as long as the central hepatic portal region is avoided. This article is protected by copyright. All rights reserved.

The long-term oncologic outcomes for primary renal cell carcinoma (RCC) treated with carbon-ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12/16-fraction CIRT at our institution outside of clinical trials. The outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease-free, cancer-specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7-16.5) years; 9 of these patients were inoperable because of comorbidities or advanced-stage disease. The diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In four of five patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney, or solitary kidney pre-CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although one case of grade 4 dermatitis was observed, there were no other grade 3 or higher non-renal adverse events. The local control rate, and disease-free, cancer-specific, and overall survival rates at 5- years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long-term follow-up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre-CIRT, and yielding favorable treatment outcomes, even in inoperable cases. This article is protected by copyright. All rights reserved.

TEACHING POINTS 1) 99mTc-MAG3 renogram is a useful non-invasive diagnostic tool to evaluate renal function after CIRT in patients with renal cell carcinoma, especially for the assessment of split renal function. 2) With 99mTc-MAG3 renogram, it is possible to detect renal function deterioration of non-irradiated renal parenchyma. 3) Serial assessment of renal function by measuring tubular extraction with 99mTc-MAG3 might permit earlier and more sensitive detection of renal damage after CIRT. TABLE OF CONTENTS/OUTLINE # Background # Contents - Renogram before and after CIRT for RCC. - Renogram; Pre-, 3-6 months and 12-18 months after CIRT with comparison National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 as adverse event evaluation. - Relationship between total cERPF and eGFR # Case presentation, - Case: T1aN0M0, 66Gy/12Fr., Comorbidity: none - Case: T1bN0M0, 66Gy/12Fr., Comorbidity: none - Case: T1bN0M0, 66Gy/12Fr., Cerebrovascular disease - Case: T1aN0M0, 72Gy/12Fr., Cerebrovascular disease - Case: T1aN0M0, 72Gy/12Fr., Diabetic nephropathy - Case: T3aN0M0, 72Gy/12Fr., Diabetic nephropathy # Summary, RSNA2019

【目的】脈絡膜悪性黒色腫に対する重粒子線治療前評価として123I-IMP SPECTによる病変評価を行った。123I-IMP静注24時間後のSPECT像を用いた病変評価の有用性について以前より検討しているが、1泊の入院が必要となり長期的に評価を継続していくことが困難である。本研究では静注6時間後の撮像も行い、評価法としての有用性を検討した。 【方法】重粒子線治療予定の5名の患者に123I-IMP SPECTを行い、静注6時間後、24時間後の2相撮像を行った。ソフトウェアを用いてSPECT像とCTを融合させ、患側・健側眼球の2相のSUV値を計測した。 【結果】患側と健側眼球の6時間後SUV maxは各々2.78+/-1.29, 1.82+/-0.55、24時間後SUV maxは各々4.06+/-2.21, 2.02+/-0.20であった。また患側眼球では6時間後(X)と24時間後(Y)のSUV max=1.64X-0.52 (p＜0.01, r=0.96)と有意な相関がみられたが、健側眼球ではSUV max=0.14X+1.77(p=0.53, r=0.38)と有意な相関がなかった。 【結論】より患者負担の少ない6時間後の撮像でも脈絡膜悪性黒色腫の評価指標としては有用である可能性が示唆された。, 第59回日本核医学会学術総会

1. 研究の目的とバックグラウンド 眼球脈絡膜悪性黒色腫の標準治療は手術、強膜縫着照射、粒子線治療の大きく3 つである。欧米ではすでに陽子線やヘリウム線照射で4000 例以の眼球脈絡膜悪性黒色腫に対する粒子線治療報告があり、その局所制御率は96%以上で5 年生存率は約60～85％という優れた成績が得られている。当施設においては、2001 年より眼球脈絡膜悪性黒色腫に対する重粒子線治療を5 回分割で施行しており、局所制御率93%、5 年生存率80%と良好な成績が得られている。一方で、緑内障の発生など、晩期の有害事象は改善の余地があると考えられる。 これを実現するためにエネルギースキャンと回転ガントリーを組み合わせることで、従来では叶わなかった、いかなる角度からも照射が可能となる。このことにより従来の治療では避けることのできなかった、角膜や毛様体への照射線量を下げ、有害事象を減らすことができると想定される。 平成29 年度の基礎的検討を踏まえ、本研究においてはG 室を使用した脈絡膜悪性黒色腫に対する重粒子線治療の安全性試験を行う。 2. 今年度の研究内容 臨床試験概要 試験デザイン 無対照非盲検症例集積研究（侵襲あり・介入研究） 評価指標 主要評価指標 正常組織の急性期反応 副次的評価指標 正常組織の遅発正反応 局所制御率 生存率 眼球温存率 対象者 選択基準 ・臨床的に診断された眼球の脈絡膜悪性黒色腫の患者。 ・腫瘍の計測が可能である。 ・Performance Status (ECOG)は0-2 である。 ・同意能力を有する患者。ただし、20 歳未満に関しては、十分な理解力、判断 力を有したうえで、文書での賛意を表することが可能であり、かつ代諾者の 同意が得られること。 除外基準 ・眼窩外病変の存在。 ・生存期間が6 か月に満たないと推定される。 ・照射部位に難治性感染症がある。 ・活動性の重複癌がある。 ・重篤な合併症を有する。 ・医学的、心理学的理由等により本研究の遂行が困難と判断される。 プロトコール治療方法 重粒子線治療1 回17Gy(RBE)で4 回、総線量68Gy(RBE)の照射を行う。最初の15例はSingle Field Uniform Dose で治療計画を行い、続く15例を Multi-Field Sequential Optimization 若しくはIntensity Modulated Particle Therapy と Single Field Uniform Dose で比較検討し、治療計画を行う。 研究対象者の研究参加予定期間 文書同意取得時から照射終了後36 か月までの期間。 3. 今年度の研究成果と解析結果 臨床試験実施準備 平成29 年度の検討を踏まえ、安全性試験が実施可能であると判断された。本試験の倫理審査は2018 年3 月5 日付で当機構研究倫理審査委員会において承認された。 臨床試験実施状況 2018 年4 月より登録を開始し、2019 年2 月20日現在で9 例の登録を行った。全例において、患者QA での誤差は許容範囲内であった。9 例中、5例は3 か月までの正常組織の急性期反応を評価済みであり、grade 2 以上の急性期反応は見られなかった。全例において局所再発、遠隔転移は認めていない。 患者QA 昨年度の成果を踏まえ、深部線量測定をBragg Peak chamber で、側方線量測定をPinpoint 電離箱および位置モニターで行った。結果、いずれの症例においても臨床上問題となる誤差は認められず、治療可能であることが確認された。, 平成30年度HIMAC共同利用研究成果発表会

1.研究目的と背景 放射線暴露は明確な発がん因子であり、放射線治療後に二次がんが増加することは広く知られている。一方で、重粒子線治療後の二次がんの解析は現在のところ存在しない。本研究は前立腺癌に対して重粒子線治療を受けた症例を研究し、その二次がんの発生頻度を確認することで、重粒子線治療による影響を確認することを目的としています。 2.昨年までに得られている結果 無し 3.今年度の研究内容 Subsequent Primary Cancers After Carbon Ion Radiotherapy, Photon Radiotherapy or Surgery for Prostate Cancer: A Propensity Score-Weighted Analysis 4.今年度の研究結果と解析結果 CIRT has a lower risk of SPCs compared to XRT in patients with prostate cancer., 平成30年度HIMAC共同利用研究成果発表会

1. 研究の目的とバックグラウンド 腎細胞癌への炭素イオン線治療は2017 年までに27 例が施行され、良好な成績が示されてきた（1-3）。しかし治療後の腫瘍および正常臓器への影響は不明である。本研究の目的は、炭素イオン線治療後の腫瘍および正常臓器へ線量や体積の関係を定量的に評価し、それらの臨床的意義を見いだすことである。 2．昨年までに得られている結果 本研究は今年度開始された研究である。 3．今年度の研究内容 1) 腎腫瘍の経時的変化 1 年以内の他因死による早期死亡例2 例を除く、25 例を解析対象とした。 局所再発との関連を調査するため、治療後の年間の腫瘍体積変化（pre-1y、1y-2y、2y-3y）、ならびに線量処方、T stage との関係を調査した。 2) 正常腎への影響とその経時的変化 1)と同じ25 例を解析対象とした。治療後chronic kidney disease[CKD] grade 悪化をevent として、照射された腎の正常腎臓体積（照射腎臓体積－planning target volume [PTV]）の線量と体積の関係を調査した。 3) 健側腎の経時的変化 1 年以内の他因死による早期死亡例2 例と片腎2 症例を除く、23 例を解析対象とした。健側腎の10％以上の体積増加を示した症例について、腫瘍の位置(腎門部、非腎門部)、照射された側の正常腎臓体積（照射腎体積－PTV）、およびT stage との関係を調査した。 4) 周囲腸管耐容線量 1)と同じ25 例を解析対象とした。明らかな腸管障害は認められなかったが、3名に見られた治療中の食欲低下と結腸、小腸、胃、十二指腸への線量との関係を調査した。 4. 今年度の研究成果と解析結果 1) 腎腫瘍の経時的変化 局所再発に対して、治療後1 年間の腫瘍体積増加、処方線量ならびにT stage に有意な関連はなかった。一方、照射後1～2 年、2～3 年の間の腫瘍体積の増大が、局所再発に有意に関連した(それぞれp=0.033、p=0.039)。照射後1 年間の腫瘍体積変化よりも、照射後1～2 年、2～3 年の腫瘍体積増加が局所再発に影響する可能性が示唆された。 2) 正常腎への影響とその経時的変化 治療後のCKD grade 悪化に対し、V0 に有意ではないが、強い相関が認められた。Receiver Operating Characteristic 解析により正常腎体積 = 144ml で治療後CKD grade 悪化に対する感度・特異度が最も高かった。治療後のCKD grade 悪化に対し、正常腎体積 >144ml vs, 平成30年度HIMAC共同利用研究成果発表会

[Objective] Choroidal melanoma is the most common primary ocular malignant tumor. I-123 IMP SPECT imaging was reported to be useful diagnostic imaging tool, however the diagnostic values in terms of assessment of fused image with CT/MRI and the semi-quantitative evaluation of the IMP-SPECT are still left to be discussed. [Materials and Methods] Among patients who visited our institution for carbon-ion radiotherapy, ten patients who received I-123 IMP SPECT imaging were enrolled in this investigation. Fifteen min and 24 hours after intravenous injection of the radiotracer, SPECT imaging was performed using a gamma camera (E.CAM, Canon Medical, Tokyo, Japan). All acquired SPECT images were fused with CT or MRI images using a fusion viewer software (AZE-Hayabusa, AZE, Japan). ROIs of the tumor, contralateral normal choroidal tissue and normal soft tissue referring to CT or MRI image were analyzed, followed by semi-quantitative evaluation was assessed using non-parametric Wilcoxon rank sum test. [Results] All tumors were visualized clearly in the 24h-SPECT image than those in 15min-SPECT image. The uptake index (UI) of the tumor: (tumor count) / (normal soft tissue count) and the contralateral normal choroidal tissue: (normal choroidal tissue count) / (normal soft tissue count) were 3.16+/-0.97 and 1.35+/-0.17, respectively (p < 0.001). The tumor-to-normal tissue ratios was 7.78+/-5.10. [Conclusion] I-123 IMP SPECT imaging performed 24h after injection of the radiotracer and fusion-image-analysis with CT or MRI were useful for detection of the choroidal melanoma. Also semi-quantitative evaluation using the fused images using tumor-UI and T/N ratio were considered to be valuable imaging techniques for diagnosis of the choroidal melanoma., 第78回日本医学放射線学会総会

【目的】腎細胞癌に対する重粒子線治療(carbon ion radiotherapy；CIRT)を施行し、治療前および治療後に99mTc-MAG3レノグラム検査にて腎機能評価を行った6症例を対象として99mTc-MAG3レノグラム検査の有用性を検討した。 【方法】治療前、治療後3-6ヶ月後、治療後12-18ヶ月後に施行した99mTc-MAG3レノグラム検査と臨床経過、血液検査推移、およびCKD gradeとの比較を行った。 【結果】治療後にCKD gradeの増悪を認めなかった4症例の99mTc-MAG3レノグラム検査では両腎機能に有意な増悪はなかった。治療後eGFRが増悪した2症例（eGFR:66.1→46.9、eGFR:42.3→34.5）は、99mTc-MAG3レノグラム解析の結果、健側腎を含めた総腎機能低下傾向が認められた。 【結論】腎細胞癌重粒子線治療前後の分腎機能評価方法として、99mTc-MAG3レノグラムは有用であった。, 第90回日本核医学会関東甲信越地方会

【目的】腎細胞癌に対する重粒子線治療（carbon ion radiotherapy；CIRT)を施行し、治療前および治療後に99mTc-MAG3レノグラム検査にて腎機能評価を行った6症例を対象として99mTc-MAG3検査の有用性を検討した。 【方法】治療前、治療後3-6ヶ月後、12-18ヶ月後に施行した99mTc-MAG3レノグラム検査と臨床経過および血液検査推移との比較を行った。 【結果】治療前後に血中Cre、eGFRの増悪を認めなかった4症例の99mTc-MAG3レノグラム検査では両腎機能に有意な変化はなかった。治療後血中Cre、eGFRが増悪した2症例（Cre: 0.91→ 1.17、eGFR: 66.1 → 50およびCre: 1.27 →1.52、eGFR: 42.3 → 34.5）は、99mTc-MAG3レノグラム解析結果、健側腎を含めた総腎機能低下傾向が認められた。 【結論】腎細胞癌CIRT後99mTc-MAG3レノグラム分腎機能評価は有用であった。, 第90回日本核医学会関東甲信越地方会

BACKGROUND: Whether biochemical recurrence (BR) is a significant predictive factor of mortality after definitive radiation therapy for prostate cancer remains unknown. The aim of the current study was to investigate the relation between BR and overall mortality (OAM) in high-risk prostate cancer patients who were treated with carbon-ion radiotherapy (CIRT) and had long-term follow-up in 2 prospective trials. METHODS: In the 2 phase 2 clinical trials, which involved 466 prostate cancer patients who received 63.0 to 66.0 Gy of CIRT (relative biological effect) in 20 fractions between 2000 and 2007, 324 patients who were deemed to be at high risk on the basis of the modified D'Amico classification criteria and received CIRT along with androgen-deprivation therapy (ADT) were examined. The OAM rate was adjusted for the ADT duration, and multivariate analyses using a Cox proportional hazards model were performed for OAM with BR as a time-dependent covariate. RESULTS: The median follow-up period was 107.4 months, and the 5- and 10-year OAM rates after adjustments for the ADT duration were 7.0% (95% confidence interval [CI], 4.0%-9.4%) and 23.9% (95% CI, 16.4%-26.2%), respectively. A multivariate analysis revealed that the presence of BR (hazard ratio, 2.82; 95% Cl, 1.57-5.08; P = .001) was one of the predictive factors for OAM. On the other hand, the duration of ADT had no impact on OAM. CONCLUSIONS: BR after CIRT combined with ADT is an independent predictive factor for OAM in high-risk prostate cancer patients. The results of this study could be applied to other high-dose radiation therapies. Cancer 2016. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Purpose: To determine the prognostic factors for biochemical recurrence (BR) and mortality in patients with high-risk localized prostate cancer after carbon-ion radiotherapy (CIRT) combined with long-term androgen deprivation therapy (LTADT). Methods and Materials: A total of 1247 patients were enrolled in three phase II clinical trials of fixed-dose CIRT between 2000 and 2013. Excluding T4 disease, 614 patients received CIRT combined with LTADT for high- or very-high-risk disease, according to the National Comprehensive Cancer Network (NCCN) classification system. Results: Median follow-up time was 78.7 months, and 5-year rates of BR-free, prostate cancer-specific survival, and overall survival were 90.4% (95% confidence interval [CI]: 87.6 - 92.7), 98.5% (95% CI: 97.2 - 99.2), and 94.7% (95% CI: 92.8 - 96.5), respectively. T3a/b disease, Gleason score (GS) 9-10, percentage of positive biopsy cores (PPCs) > 75%, and age > 75 years had a significant impact on BR. Moreover, patients with T3b disease, GS 9-10, and PPCs > 75% had significantly higher prostate cancer-specific mortality (p = 0.007, p = 0.009, and p = 0.015, respectively) and overall mortality (p = 0.035, p = 0.025, and p < 0.001, respectively), on multivariate analyses. Conclusions: Prognostic factors for BR and mortality were identified. Patients with T3b disease, GS 9-10, and PPCs > 75% should be considered to have very-high-risk disease requiring a new treatment strategy., the 56th Annual Conference of the Particle Therapy Co-operative Group (PTCOG56)

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