詳細

松尾　幸憲 （マツオ　ユキノリ）

  • 医学科　教授/主任
Last Updated :2024/04/25

コミュニケーション情報 byコメンテータガイド

  • コメント

    放射線を用いたがん治療全般。特に高齢者のがん、オリゴ転移などの体幹部定位放射線治療（SBRT）に詳しい。

研究者情報

学位

  • 博士（医学）（2007年03月 京都大学）

ホームページURL

科研費研究者番号

  • 80456897

ORCID ID

Researcher ID

  • O-6200-2014

J-Global ID

研究キーワード

  • 高精度放射線治療   癌   体幹部定位放射線治療   肝臓癌   放射線   肺癌   定位放射線治療   ４次元線量分布   放射線治療   高精度放射線照射   トランスレーショナルリサーチ   難治癌   

現在の研究分野（キーワード）

    放射線を用いたがん治療全般。特に高齢者のがん、オリゴ転移などの体幹部定位放射線治療（SBRT）に詳しい。

研究分野

  • ライフサイエンス / 放射線科学

経歴

  • 2023年04月 - 現在  近畿大学医学部 医学科主任教授
  • 2017年04月 - 2023年03月  京都大学大学院医学研究科准教授
  • 2012年02月 - 2017年03月  京都大学大学院医学研究科講師
  • 2007年06月  京都大学医学部附属病院助教
  • 2007年04月  京都大学医学部附属病院医員
  • 2000年05月  日本赤十字社和歌山医療センター医師
  • 1999年05月  京都大学医学部附属病院研修医

学歴

  • 2003年04月 - 2007年03月   京都大学   大学院医学研究科   放射線腫瘍学・画像応用治療学
  • 1993年04月 - 1999年03月   京都大学   医学部   医学科

所属学協会

  • 日本頭頸部癌学会   日本癌治療学会   日本肺癌学会   日本医学放射線学会   日本放射線腫瘍学会   

研究活動情報

論文

  • Noriko Kishi; Masahiro Yoneyama; Hiroyuki Inoo; Minoru Inoue; Hiraku Iramina; Akiyoshi Nakakura; Tomohiro Ono; Hideaki Hirashima; Takanori Adachi; Norimasa Matsushita; Makoto Sasaki; Takahiro Fujimoto; Mitsuhiro Nakamura; Yukinori Matsuo; Takashi Mizowaki
    Radiation oncology (London, England) 19 1 32 - 32 2024年03月 
    BACKGROUND: Centrally located lung tumours present a challenge because of their tendency to exhibit symptoms such as airway obstruction, atelectasis, and bleeding. Surgical resection of these tumours often requires sacrificing the lungs, making definitive radiotherapy the preferred alternative to avoid pneumonectomy. However, the proximity of these tumours to mediastinal organs at risk increases the potential for severe adverse events. To mitigate this risk, we propose a dual-method approach: deep inspiration breath-hold (DIBH) radiotherapy combined with adaptive radiotherapy. The aim of this single-centre, single-arm phase II study is to investigate the efficacy and safety of DIBH daily online adaptive radiotherapy. METHODS: Patients diagnosed with centrally located lung tumours according to the International Association for the Study of Lung Cancer recommendations, are enrolled and subjected to DIBH daily online adaptive radiotherapy. The primary endpoint is the one-year cumulative incidence of grade 3 or more severe adverse events, as classified by the Common Terminology Criteria for Adverse Events (CTCAE v5.0). DISCUSSION: Delivering definitive radiotherapy for centrally located lung tumours presents a dilemma between ensuring optimal dose coverage for the planning target volume and the associated increased risk of adverse events. DIBH provides measurable dosimetric benefits by increasing the normal lung volume and distancing the tumour from critical mediastinal organs at risk, leading to reduced toxicity. DIBH adaptive radiotherapy has been proposed as an adjunct treatment option for abdominal and pelvic cancers. If the application of DIBH adaptive radiotherapy to centrally located lung tumours proves successful, this approach could shape future phase III trials and offer novel perspectives in lung tumour radiotherapy. TRIAL REGISTRATION: Registered at the Japan Registry of Clinical Trials (jRCT; https://jrct.niph.go.jp/ ); registration number: jRCT1052230085 ( https://jrct.niph.go.jp/en-latest-detail/jRCT1052230085 ).
  • Takuya Uehara; Yasumasa Nishimura; Kazuki Ishikawa; Masahiro Inada; Kenji Matsumoto; Hiroshi Doi; Hajime Monzen; Yukinori Matsuo
    Journal of radiation research 2024年01月 
    The present study aimed to evaluate whether an adapted plan with Ethos™ could be used for pharyngeal cancer. Ten patients with pharyngeal cancer who underwent chemoradiotherapy with available daily cone-beam computed tomography (CBCT) data were included. Simulated treatments were generated on the Ethos™ treatment emulator using CBCTs every four to five fractions for two plans: adapted and scheduled. The simulated treatments were divided into three groups: early (first-second week), middle (third-fourth week), and late (fifth-seventh week) periods. Dose-volume histogram parameters were compared for each period between the adapted and scheduled plans in terms of the planning target volume (PTV) (D98%, D95%, D50% and D2%), spinal cord (Dmax and D1cc), brainstem (Dmax) and ipsilateral and contralateral parotid glands (Dmedian and Dmean). The PTV D98%, D95% and D2% of the adapted plan were significantly higher than those of the scheduled plans in all periods, except for D98% in the late period. The adapted plan significantly reduced the spinal cord Dmax and D1cc compared with the scheduled plan in all periods. Ipsilateral and contralateral parotid glands Dmean of the adapted plan were lower than those of scheduled plan in the late period. In conclusion, the present study revealed that the adapted plans could maintain PTV coverage while reducing the doses to organs at risk in each period compared with scheduled plans.
  • Iwai T; Imagumbai T; Hiraoka S; Kishi T; Okabayashi S; Ashida R; Mitsuyoshi T; Matsuo Y; Ishigaki T; Mizowaki T; Kokubo M
    Journal of radiation research 2023年11月
  • Hirashima H; Nakamura M; Nakamura K; Matsuo Y; Mizowaki T
    Journal of radiation research 2023年11月
  • Nakayama S; Hirose M; Kaneshige S; Nakamura K; Matsuo Y; Monzen H
    Radiological physics and technology 2023年10月
  • Hiroshi Onishi; Yoshiyuki Shioyama; Yasuo Matsumoto; Yukinori Matsuo; Akifumi Miyakawa; Hideomi Yamashita; Haruo Matsushita; Masahiko Aoki; Keiji Nihei; Tomoki Kimura; Hiromichi Ishiyama; Naoya Murakami; Kensei Nakata; Atsuya Takeda; Takashi Uno; Takuma Nomiya; Hiroshi Taguchi; Yuji Seo; Takafumi Komiyama; Kan Marino; Shinichi Aoki; Masaki Matsuda; Tomoko Akita; Masahide Saito
    Cancers 15 17 2023年09月 [査読有り]
     
    Surgery is the standard treatment for stage I non-small cell lung cancer (NSCLC); however, no clear randomized trial demonstrates its superiority to stereotactic body radiotherapy (SBRT) regarding survival. We aimed to retrospectively evaluate the treatment outcomes of SBRT in operable patients with stage I NSCLC using a large Japanese multi-institutional database to show real-world outcome. Exactly 399 patients (median age 75 years; 262 males and 137 females) with stage I (IA 292, IB 107) histologically proven NSCLC (adenocarcinoma 267, squamous cell carcinoma 96, others 36) treated at 20 institutions were reviewed. SBRT was prescribed at a total dose of 48-70 Gy in 4-10 fractions. The median follow-up period was 38 months. Local progression-free survival rates were 84.2% in all patients and 86.1% in the T1, 78.6% in T2, 89.2% in adenocarcinoma, and 70.5% in squamous cell subgroups. Overall 3-year survival rates were 77.0% in all patients: 90.7% in females, 69.6% in males, and 41.2% in patients with pulmonary interstitial changes. Fatal radiation pneumonitis was observed in two patients, all of whom had pulmonary interstitial changes. This real-world evidence will be useful in shared decision-making for optimal treatment, including SBRT for operable stage I NSCLC, particularly in older patients.
  • Yuta Sakurai; Shintaro Ambo; Mitsuhiro Nakamura; Hiraku Iramina; Yusuke Iizuka; Takamasa Mitsuyoshi; Yukinori Matsuo; Takashi Mizowaki
    Journal of applied clinical medical physics e14112  2023年08月 [査読有り]
     
    PURPOSE: To develop a prediction model (PM) for target positioning using diaphragm waveforms extracted from CBCT projection images. METHODS: Nineteen patients with lung cancer underwent orthogonal rotational kV x-ray imaging lasting 70 s. IR markers placed on their abdominal surfaces and an implanted gold marker located nearest to the tumor were considered as external surrogates and the target, respectively. Four different types of regression-based PM were trained using surrogate motions and target positions for the first 60 s, as follows: Scenario A: Based on the clinical scenario, 3D target positions extracted from projection images were used as they were (PMCL ). Scenario B: The short-arc 4D-CBCT waveform exhibiting eight target positions was obtained by averaging the target positions in Scenario A. The waveform was repeated for 60 s (W4D-CBCT ) by adapting to the respiratory phase of the external surrogate. W4D-CBCT was used as the target positions (PM4D-CBCT ). Scenario C: The Amsterdam Shroud (AS) signal, which depicted the diaphragm motion in the superior-inferior direction was extracted from the orthogonal projection images. The amplitude and phase of W4D-CBCT were corrected based on the AS signal. The AS-corrected W4D-CBCT was used as the target positions (PMAS-4D-CBCT ). Scenario D: The AS signal was extracted from single projection images. Other processes were the same as in Scenario C. The prediction errors were calculated for the remaining 10 s. RESULTS: The 3D prediction error within 3 mm was 77.3% for PM4D-CBCT , which was 12.8% lower than that for PMCL . Using the diaphragm waveforms, the percentage of errors within 3 mm improved by approximately 7% to 84.0%-85.3% for PMAS-4D-CBCT in Scenarios C and D, respectively. Statistically significant differences were observed between the prediction errors of PM4D-CBCT and PMAS-4D-CBCT . CONCLUSION: PMAS-4D-CBCT outperformed PM4D-CBCT , proving the efficacy of the AS signal-based correction. PMAS-4D-CBCT would make it possible to predict target positions from 4D-CBCT images without gold markers.
  • Satoshi Kito; Nobutaka Mukumoto; Mitsuhiro Nakamura; Hiroaki Tanabe; Katsuyuki Karasawa; Masaki Kokubo; Takashi Sakamoto; Yusuke Iizuka; Michio Yoshimura; Yukinori Matsuo; Masahiro Hiraoka; Takashi Mizowaki
    Medical physics 2023年07月 [査読有り]
     
    BACKGROUND: Both geometric and dosimetric components are commonly considered when determining the margin for planning target volume (PTV). As dose distribution is shaped by controlling beam aperture in peripheral dose prescription and dose-escalated simultaneously integrated boost techniques, adjusting the margin by incorporating the variable dosimetric component into the PTV margin is inappropriate; therefore, geometric components should be accurately estimated for margin calculations. PURPOSE: We introduced an asymmetric margin-calculation theory using the guide to the expression of uncertainty in measurement (GUM) and intra-fractional motion. The margins in fiducial marker-based real-time tumor tracking (RTTT) for lung, liver, and pancreatic cancers were calculated and were then evaluated using Monte Carlo (MC) simulations. METHODS: A total of 74 705, 73 235, and 164 968 sets of intra- and inter-fractional positional data were analyzed for 48 lung, 48 liver, and 25 pancreatic cancer patients, respectively, in RTTT clinical trials. The 2.5th and 97.5th percentiles of the positional error were considered representative values of each fraction of the disease site. The population-based statistics of the probability distributions of these representative positional errors (PD-RPEs) were calculated in six directions. A margin covering 95% of the population was calculated using the proposed formula. The content rate in which the clinical target volume (CTV) was included in the PTV was calculated through MC simulations using the PD-RPEs. RESULTS: The margins required for RTTT were at most 6.2, 4.6, and 3.9 mm for lung, liver, and pancreatic cancer, respectively. MC simulations revealed that the median content rates using the proposed margins satisfied 95% for lung and liver cancers and 93% for pancreatic cancer, closer to the expected rates than the margins according to van Herk's formula. CONCLUSIONS: Our proposed formula based on the GUM and motion probability distributions (MPD) accurately calculated the practical margin size for fiducial marker-based RTTT. This was verified through MC simulations.
  • Shuri Aoki; Hiroshi Onishi; Masataka Karube; Naoyoshi Yamamoto; Hideomi Yamashita; Yoshiyuki Shioyama; Yasuo Matsumoto; Yukinori Matsuo; Akifumi Miyakawa; Haruo Matsushita; Hitoshi Ishikawa
    Cancers 15 14 2023年07月 [査読有り]
     
    The emergence of an aging society and technological advances have made radiotherapy, especially stereotactic body radiotherapy (SBRT), a common alternative to surgery for elderly patients with early stage non-small-cell lung cancer (NSCLC). Carbon-ion radiotherapy (CIRT) is also an attractive treatment option with potentially lower toxicity for elderly patients with comorbidities. We compared the clinical outcomes of the two modalities using Japanese multicenter data. SBRT (n = 420) and single-fraction CIRT (n = 70) data for patients with stage I NSCLC from 20 centers were retrospectively analyzed. Contiguous patients ≥ 80 years of age were enrolled, and overall survival (OS), disease-specific survival (DSS), local control (LC), and adverse event rates were compared. The median age was 83 years in both groups and the median follow-up periods were 28.5 and 42.7 months for SBRT and CIRT, respectively. The 3-year OS, DSS, and LC rates were 76.0% vs. 72.3% (p = 0.21), 87.5% vs. 81.6% (p = 0.46), and 79.2% vs. 78.2% (p = 0.87), respectively, for the SBRT vs. CIRT groups. Regarding toxicity, 2.9% of the SBRT group developed grade ≥ 3 radiation pneumonitis, whereas none of the CIRT group developed grade ≥ 2 radiation pneumonitis. SBRT and CIRT in elderly patients showed similar survival and LC rates, although CIRT was associated with less severe radiation pneumonitis.
  • 【肝胆膵癌に対する放射線治療:2023 Update】膵癌 膵NENに対するペプチド受容体放射性核種療法(PRRT)
    細野 眞; 李 在俊; 立野 沙織; 福田 隼己; 石田 奈緒子; 植原 拓也; 稲田 正浩; 松浦 知弘; 土井 啓至; 中松 清志; 門前 一; 松尾 幸憲
    肝胆膵 87 1 79 - 84 (株)アークメディア 2023年07月
  • Yusuke Iizuka; Masahiro Hiraoka; Masaki Kokubo; Takashi Sakamoto; Katsuyuki Karasawa; Keiko Murofushi; Mitsuhiro Nakamura; Yukinori Matsuo; Satoshi Morita; Haruo Inokuchi; Takashi Mizowaki
    Clinical and translational radiation oncology 39 100591 - 100591 2023年03月 [査読有り]
     
    BACKGROUND AND PURPOSE: This prospective multicenter phase II study aimed to evaluate the safety and efficacy of dynamic tumor tracking (DTT) stereotactic body radiotherapy (SBRT) with real-time monitoring of liver tumors using a gimbal-mounted system. MATERIALS AND METHODS: Patients with < 4 primary or metastatic liver tumors with diameters ≤ 50 mm and expected to have a respiratory motion of ≥ 10 mm were eligible. The prescribed dose was 40 Gy in five fractions. The primary endpoint was local control (LC) at 2 years. The secondary endpoints were overall survival (OS), progression-free survival (PFS), treatment-related toxicity, and tracking accuracy. RESULTS: Between September 2015 and March 2019, 48 patients (48 lesions) with a median age of 74 years were enrolled from four institutions. Of these, 39 were diagnosed with hepatocellular carcinoma and nine with metastatic liver cancer. The median tumor diameter was 17.5 mm. DTT-SBRT was successfully performed in all patients; the median treatment time was 28 min/fraction. The median follow-up period was 36.5 months. The 2-year LC, OS, and PFS rates were 98.0 %, 88.8 %, and 55.1 %, respectively. Disease progression was observed in 33 (68.8 %) patients. One patient (0.2 %) had local recurrence, 31 (64.6 %) developed new hepatic lesions outside the irradiation field, and nine (18.8 %) had distant metastases (including overlap). Grade 3 late adverse events were observed in seven patients (14.5 %). No grade 4 or 5 treatment-related toxicity was observed. The median tracking accuracy was 2.9 mm. CONCLUSION: Employing DTT-SBRT to treat liver tumors results in excellent LC with acceptable adverse-event incidence.
  • Yukinori Matsuo
    Current oncology (Toronto, Ont.) 30 2 2493 - 2500 2023年02月 [査読有り][招待有り]
     
    Stereotactic body radiotherapy (SBRT), a type of external beam radiotherapy, yields local control of hepatocellular carcinoma (HCC) at rates as high as 90%. SBRT has been recognized as an alternative therapy for patients for whom standard modalities such as surgery (resection or transplantation) or ablation are deemed unsuitable. SBRT has the potential to improve the prognosis of HCC, as it can be used as an adjunct to other treatment modalities. The assessment of post-SBRT images of the treated tumor and surrounding normal liver tissue requires special attention. Future research is warranted to determine how best to use SBRT versus other therapies and how to combine them.
  • Dejun Zhou; Mitsuhiro Nakamura; Nobutaka Mukumoto; Yukinori Matsuo; Takashi Mizowaki
    Journal of applied clinical medical physics 24 4 e13894  2022年12月 [査読有り]
     
    PURPOSE: The feasibility of a deep learning-based markerless real-time tumor tracking (RTTT) method was retrospectively studied with orthogonal kV X-ray images and clinical tracking records acquired during lung cancer treatment. METHODS: Ten patients with lung cancer treated with marker-implanted RTTT were included. The prescription dose was 50 Gy in four fractions, using seven- to nine-port non-coplanar static beams. This corresponds to 14-18 X-ray tube angles for an orthogonal X-ray imaging system rotating with the gantry. All patients underwent 10 respiratory phases four-dimensional computed tomography. After a data augmentation approach, for each X-ray tube angle of a patient, 2250 digitally reconstructed radiograph (DRR) images with gross tumor volume (GTV) contour labeled were obtained. These images were adopted to train the patient and X-ray tube angle-specific GTV contour prediction model. During the testing, the model trained with DRR images predicted GTV contour on X-ray projection images acquired during treatment. The predicted three-dimensional (3D) positions of the GTV were calculated based on the centroids of the contours in the orthogonal images. The 3D positions of GTV determined by the marker-implanted RTTT during the treatment were considered as the ground truth. The 3D deviations between the prediction and the ground truth were calculated to evaluate the performance of the model. RESULTS: The median GTV volume and motion range were 7.42 (range, 1.18-25.74) cm3 and 22 (range, 11-28) mm, respectively. In total, 8993 3D position comparisons were included. The mean calculation time was 85 ms per image. The overall median value of the 3D deviation was 2.27 (interquartile range: 1.66-2.95) mm. The probability of the 3D deviation smaller than 5 mm was 93.6%. CONCLUSIONS: The evaluation results and calculation efficiency show the proposed deep learning-based markerless RTTT method may be feasible for patients with lung cancer.
  • 岸 徳子; 松尾 幸憲
    日本臨床 80 増刊8 最新臨床肺癌学 466 - 471 (株)日本臨床社 2022年12月
  • Yukinori Matsuo; Hideki Hanazawa; Noriko Kishi; Kazuhito Ueki; Takashi Mizowaki
    Medical Radiology 717 - 737 2022年09月
  • Noriko Kishi; Yukinori Matsuo; Takashi Shintani; Masakazu Ogura; Takamasa Mitsuyoshi; Norio Araki; Kota Fujii; Setsuko Okumura; Kiyoshi Nakamatsu; Takahiro Kishi; Tomoko Atsuta; Takashi Sakamoto; Shuji Ohtsu; Tomohiro Katagiri; Masaru Narabayashi; Satsuki Fujishiro; Yusuke Iizuka; Hiroaki Ozasa; Toyohiro Hirai; Takashi Mizowaki
    Journal of radiation research 64 1 142 - 153 2022年09月 [査読有り]
     
    Chemoradiotherapy followed by consolidation durvalumab (CCRT+D) improves survival in patients with stage III non-small-cell lung cancer (NSCLC). We compared recurrence patterns and survival in the CCRT+D and CCRT cohorts. We conducted a multicenter, retrospective study in Japan. Patients who received CCRT for stage III NSCLC were included in this study. Of 178 eligible patients, 136 were in the CCRT+D and 42 were in the CCRT cohorts. Locoregional recurrence (LR), LR plus distant metastases (DM), and DM were observed in 20.6%, 8.8%, 27.9% of the CCRT+D, and 26.2%, 16.7% and 33.3% of the CCRT cohorts, respectively. In-field recurrence was the most common LR pattern in both cohorts. Squamous cell carcinoma and PD-L1 expression < 1%, and female sex and EGFR mutations were significantly associated with an increased risk of LR and DM. In patients with any risk factors for LR, the incidence of LR was similar in the CCRT+D and CCRT (39.5% vs 45.5%). The 24 month progression-free survival (PFS) and overall survival (OS) were 40.3% and 69.4% in the CCRT+D and 24.7% and 61.0% in the CCRT cohorts, respectively. Poor performance status and no consolidation durvalumab were significantly associated with shorter PFS. There was a significant difference in PFS between the CCRT+D and CCRT in the propensity score-matched cohort (HR = 0.51, P = 0.005). In conclusion, consolidation durvalumab decreased both LR and DM, and significantly improved PFS. However, in-field recurrence was still a major problem, as well as DM.
  • Noriko Kishi; Yukinori Matsuo; Toshi Menju; Masatsugu Hamaji; Akiyoshi Nakakura; Hideki Hanazawa; Keiichi Takehana; Hiroshi Date; Takashi Mizowaki
    Journal of radiation research 63 5 758 - 771 2022年07月 [査読有り]
     
    We applied two propensity score-based analyses to simultaneously compare three treatment modalities-stereotactic body radiotherapy (SBRT), lobectomy, or sublobar resection (SLR)-for stage I non-small cell lung cancer (NSCLC), with the aim of clarifying the average treatment effect (ATE) and formulating a risk-adapted approach to treatment selection. A retrospective review of 823 patients aged ≥65 years who underwent SBRT, lobectomy, or SLR for stage I NSCLC was conducted. The following two analyses using machine learning-based propensity scores were performed: (i) propensity score weighting (PSW) to assess the ATE in the entire cohort, and (ii) propensity score subclassification (PSS) to evaluate treatment effects of subgroups. PSW showed no significant difference in the 5-year overall survival (OS) between SBRT and SLR (60.0% vs 61.2%; P = 0.70) and significant difference between SBRT and lobectomy (60.0% vs 77.6%; P = 0.026). Local (LR) and distant recurrence (DR) rates were significantly lower in lobectomy than in SBRT, whereas there was no significant difference between SBRT and SLR. PSS identified four subgroups with different patient characteristics: lobectomy-oriented (5-year cumulative incidences of non-lung cancer death, 7.5%), SLR-oriented (14.2%), SBRT-oriented (23.8%) and treatment-neutral subgroups (16.1%). Each subgroup showed different survival trends regarding the three treatments. The ATE of SBRT was not significantly different from that of SLR, but it was inferior to lobectomy. Four subgroups with different risks of non-lung cancer death and different survival trends for each treatment were identified. These would help decision-making for patients with stage I NSCLC.
  • Kazuihto Ueki; Yukinori Matsuo; Noriko Kishi; Masahiro Yoneyama; Hironori Yoshida; Yuichi Sakamori; Hiroaki Ozasa; Toyohiro Hirai; Takashi Mizowaki
    Journal of radiation research 63 4 636 - 645 2022年07月 [査読有り]
     
    Prophylactic cranial irradiation (PCI) is recommended for patients with limited-stage small-cell lung cancer (LS-SCLC) who respond well to initial treatment. However, PCI is often omitted because of its potential neurotoxicity in the era of modern diagnostic imaging devices. In the present study, we aimed to investigate the risk factors for brain metastasis (BM) in patients eligible for PCI and who may benefit more from it. Patients with LS-SCLC who responded well to definitive thoracic chemoradiotherapy were included in the present study. Competing risk regression was used to identify factors associated with BM, and the Kaplan-Meier method was used to assess overall survival (OS). Between 2004 and 2017, 62 patients were eligible for PCI and were analyzed. Of these, 38 (61.3%) underwent PCI. Overall, 17 patients (27.4%) developed BM, with a 2-year cumulative incidence of 22.8%. Multivariate analysis (MVA) revealed that pretreatment elevated pro-gastrin-releasing peptide (ProGRP) levels were associated with an increased risk for BM (HR, 7.96, P = 0.0091). PCI tended to reduce the risk of BM (HR, 0.33; P = 0.051). The use of PCI was associated with improved OS in patients with ProGRP levels > 410 pg/mL (P = 0.008), but not in those with ProGRP ≤ 410 pg/mL (P = 0.9). Pretreatment ProGRP levels may be useful in predicting the development of BM in patients with LS-SCLC who achieved a good response to initial therapy and to determine which patients should undergo PCI.
  • Keiichi Takehana; Ryo Sakamoto; Koji Fujimoto; Yukinori Matsuo; Naoki Nakajima; Akihiko Yoshizawa; Toshi Menju; Mitsuhiro Nakamura; Ryo Yamada; Takashi Mizowaki; Yuji Nakamoto
    Scientific reports 12 1 10323 - 10323 2022年06月 
    The spread through air spaces (STAS) is recognized as a negative prognostic factor in patients with early-stage lung adenocarcinoma. The present study aimed to develop a machine learning model for the prediction of STAS using peritumoral radiomics features extracted from preoperative CT imaging. A total of 339 patients who underwent lobectomy or limited resection for lung adenocarcinoma were included. The patients were randomly divided (3:2) into training and test cohorts. Two prediction models were created using the training cohort: a conventional model based on the tumor consolidation/tumor (C/T) ratio and a machine learning model based on peritumoral radiomics features. The areas under the curve for the two models in the testing cohort were 0.70 and 0.76, respectively (P = 0.045). The cumulative incidence of recurrence (CIR) was significantly higher in the STAS high-risk group when using the radiomics model than that in the low-risk group (44% vs. 4% at 5 years; P = 0.002) in patients who underwent limited resection in the testing cohort. In contrast, the 5-year CIR was not significantly different among patients who underwent lobectomy (17% vs. 11%; P = 0.469). In conclusion, the machine learning model for STAS prediction based on peritumoral radiomics features performed better than the C/T ratio model.
  • Takafumi Nemoto; Atsuya Takeda; Yukinori Matsuo; Noriko Kishi; Takahisa Eriguchi; Etsuo Kunieda; Ryusei Kimura; Naoko Sanuki; Yuichiro Tsurugai; Masamichi Yagi; Yousuke Aoki; Yohei Oku; Yuto Kimura; Changhee Han; Naoyuki Shigematsu
    JCO Clinical Cancer Informatics 6 6 e2100176  2022年06月 
    PURPOSE Clear evidence indicating whether surgery or stereotactic body radiation therapy (SBRT) is best for non–small-cell lung cancer (NSCLC) is lacking. SBRT has many advantages. We used artificial neural networks (NNs) to predict treatment outcomes for patients with NSCLC receiving SBRT, aiming to aid in decision making. PATIENTS AND METHODS Among consecutive patients receiving SBRT between 2005 and 2019 in our institution, we retrospectively identified those with Tis–T4N0M0 NSCLC. We constructed two NNs for prediction of overall survival (OS) and cancer progression in the first 5 years after SBRT, which were tested using an internal and an external test data set. We performed risk group stratification, wherein 5-year OS and cancer progression were stratified into three groups. RESULTS In total, 692 patients in our institution and 100 patients randomly chosen in the external institution were enrolled. The NNs resulted in concordance indexes for OS of 0.76 (95% CI, 0.73 to 0.79), 0.68 (95% CI, 0.60 to 0.75), and 0.69 (95% CI, 0.61 to 0.76) and area under the curve for cancer progression of 0.80 (95% CI, 0.75 to 0.84), 0.72 (95% CI, 0.60 to 0.83), and 0.70 (95% CI, 0.57 to 0.81) in the training, internal test, and external test data sets, respectively. The survival and cumulative incidence curves were significantly stratified. NNs selected low-risk cancer progression groups of 5.6%, 6.9%, and 7.0% in the training, internal test, and external test data sets, respectively, suggesting that 48% of patients with peripheral Tis–4N0M0 NSCLC can be at low-risk for cancer progression. CONCLUSION Predictions of SBRT outcomes using NNs were useful for Tis–4N0M0 NSCLC. Our results are anticipated to open new avenues for NN predictions and provide decision-making guidance for patients and physicians.
  • Yukinori Matsuo; Masahiro Hiraoka; Katsuyuki Karasawa; Masaki Kokubo; Takashi Sakamoto; Nobutaka Mukumoto; Mitsuhiro Nakamura; Satoshi Morita; Takashi Mizowaki
    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 172 18 - 22 2022年05月 [査読有り]
     
    BACKGROUND AND PURPOSE: This study aimed to evaluate the safety and efficacy of dynamic tumor tracking-stereotactic body radiotherapy (DTT-SBRT) for lung tumors. MATERIALS AND METHODS: Patients with cStage I primary lung cancer or metastatic lung cancer with an expected range of respiratory motion of ≥10 mm were eligible for the study. The prescribed dose was 50 Gy in four fractions. A gimbal-mounted linac was used for DTT-SBRT delivery. The primary endpoint was local control at 2 years. RESULTS: Forty-eight patients from four institutions were enrolled in this study. Forty-two patients had primary non-small-cell lung cancer, and six had metastatic lung tumors. DTT-SBRT was delivered for 47 lesions in 47 patients with a median treatment time of 28 min per fraction. The median respiratory motion during the treatment was 13.7 mm (range: 4.5-28.1 mm). The motion-encompassing method was applied for the one remaining patient due to the poor correlation between the abdominal wall and tumor movement. The median follow-up period was 32.3 months, and the local control at 2 years was 95.2% (lower limit of the one-sided 85% confidence interval [CI]: 90.3%). The overall survival and progression-free survival at 2 years were 79.2% (95% CI: 64.7%-88.2%) and 75.0% (95% CI: 60.2%-85.0%), respectively. Grade 3 toxicity was observed in one patient (2.1%) with radiation pneumonitis. Grade 4 or 5 toxicity was not observed. CONCLUSION: DTT-SBRT achieved excellent local control with low incidences of severe toxicities in lung tumors with respiratory motion.
  • Takanori Adachi; Mitsuhiro Nakamura; Ryo Kakino; Hideaki Hirashima; Hiraku Iramina; Yusuke Tsuruta; Tomohiro Ono; Nobutaka Mukumoto; Yuki Miyabe; Yukinori Matsuo; Takashi Mizowaki
    Radiological physics and technology 15 1 63 - 71 2022年03月 [査読有り]
     
    To evaluate the reproducibility of dose-based radiomic (dosiomic) features between dose-calculation algorithms for lung stereotactic body radiation therapy (SBRT). We analyzed 105 patients with early-stage non-small cell lung cancer who underwent lung SBRT between March 2011 and December 2017. Radiation doses of 48, 60, and 70 Gy were prescribed to the isocenter in 4-8 fractions. Dose calculations were performed using X-ray voxel Monte Carlo (XVMC) on the iPlan radiation treatment planning system (RTPS). Thereafter, the radiation doses were recalculated using the Acuros XB (AXB) and analytical anisotropic algorithm (AAA) on the Eclipse RTPS while maintaining the XVMC-calculated monitor units and beam arrangements. A total of 6808 dosiomic features were extracted without preprocessing (112 shape, 144 first-order, and 600 texture features) or with wavelet filters to eight decompositions (1152 first-order and 4800 texture features). Features with absolute pairwise concordance correlation coefficients-|CCcon|-values exceeding or equaling 0.85 were considered highly reproducible. Subgroup analyses were performed considering the wavelet filters and prescribed doses. The numbers of highly reproducible first-order and texture features were 34.8%, 26.9%, and 31.0% for the XVMC-AXB, XVMC-AAA, and AXB-AAA pairs, respectively. The maximum difference between the mean |CCcon| values was 0.70 and 0.11 for the subgroup analyses of wavelet filters and prescribed dose, respectively. The application of wavelet filter-based dosiomic analyses may be limited when using different types of dose-calculation algorithms for lung SBRT.
  • Dejun Zhou; Mitsuhiro Nakamura; Nobutaka Mukumoto; Hiroaki Tanabe; Yusuke Iizuka; Michio Yoshimura; Masaki Kokubo; Yukinori Matsuo; Takashi Mizowaki
    Radiation oncology (London, England) 17 1 42 - 42 2022年02月 [査読有り]
     
    BACKGROUND: In infrared reflective (IR) marker-based hybrid real-time tumor tracking (RTTT), the internal target position is predicted with the positions of IR markers attached on the patient's body surface using a prediction model. In this work, we developed two artificial intelligence (AI)-driven prediction models to improve RTTT radiotherapy, namely, a convolutional neural network (CNN) and an adaptive neuro-fuzzy inference system (ANFIS) model. The models aim to improve the accuracy in predicting three-dimensional tumor motion. METHODS: From patients whose respiration-induced motion of the tumor, indicated by the fiducial markers, exceeded 8 mm, 1079 logfiles of IR marker-based hybrid RTTT (IR Tracking) with the gimbal-head radiotherapy system were acquired and randomly divided into two datasets. All the included patients were breathing freely with more than four external IR markers. The historical dataset for the CNN model contained 1003 logfiles, while the remaining 76 logfiles complemented the evaluation dataset. The logfiles recorded the external IR marker positions at a frequency of 60 Hz and fiducial markers as surrogates for the detected target positions every 80-640 ms for 20-40 s. For each logfile in the evaluation dataset, the prediction models were trained based on the data in the first three quarters of the recording period. In the last quarter, the performance of the patient-specific prediction models was tested and evaluated. The overall performance of the AI-driven prediction models was ranked by the percentage of predicted target position within 2 mm of the detected target position. Moreover, the performance of the AI-driven models was compared to a regression prediction model currently implemented in gimbal-head radiotherapy systems. RESULTS: The percentage of the predicted target position within 2 mm of the detected target position was 95.1%, 92.6% and 85.6% for the CNN, ANFIS, and regression model, respectively. In the evaluation dataset, the CNN, ANFIS, and regression model performed best in 43, 28 and 5 logfiles, respectively. CONCLUSIONS: The proposed AI-driven prediction models outperformed the regression prediction model, and the overall performance of the CNN model was slightly better than that of the ANFIS model on the evaluation dataset.
  • Noriko Kishi; Yukinori Matsuo; Masahiro Yoneyama; Kazuhito Ueki; Takashi Mizowaki
    Advances in Radiation Oncology 7 3 100911 - 100911 2022年02月 [査読有り]
     
    PURPOSE: Stereotactic body radiation therapy (SBRT) can be easily used for patients with tumors in various organs and is a promising local therapy for eradicating tumors in cancer patients. There is a rising clinical need for increasing knowledge of oligometastases in the treatment of multiple pulmonary tumors. This study aimed to explore the predictive factors for symptomatic radiation pneumonitis (RP) after SBRT for multiple pulmonary oligometastases or synchronous primary lung cancer (SPLC). METHODS AND MATERIALS: A total of 38 consecutive patients who had 2 or more pulmonary oligometastases (n = 21) or SPLC (n = 17) and who were treated with SBRT were investigated. Patient characteristics, tumor characteristics, and details of radiation therapy were retrospectively collected from a clinical database. The association between RP of grade 2 or worse (grade 2+ RP) and clinical or dosimetric factors was assessed using logistic regression analyses. RESULTS: The tumors presented ipsilaterally in 24 patients and bilaterally in 14 patients. During the median follow-up period of 4.9 years, grade 2+ RP, grade 2 RP, and grade 3 RP were observed in 9 patients (23.7%), 7 patients (18.4%), and 2 patients (5.3%), respectively. The mean lung dose (MLD) and the volume of the normal lung receiving ≥5 Gy (lung V5Gy) were significantly associated with grade 2+ RP (P = .023 and P = .012, respectively). The logistic model showed that 20% and 50% of the predicted probability of grade 2+ RP were 6.1 Gy and 9.1 Gy for MLD and 31.6 % and 42.8% for lung V5Gy, respectively. CONCLUSION: Although further investigation is required to validate the metrics and establish reliable dose constraints, the dose-volume metrics for the normal lung could be predictive of the development of grade 2+ RP after SBRT for multiple pulmonary oligometastases or SPLCs.
  • Takashi Murakami; Rihito Aizawa; Yukinori Matsuo; Hideki Hanazawa; Kojiro Taura; Akihisa Fukuda; Norimitsu Uza; Masahiro Shiokawa; Masashi Kanai; Etsuro Hatano; Hiroshi Seno; Manabu Muto; Takashi Mizowaki
    Cancer diagnosis & prognosis 2 6 634 - 640 2022年 [査読有り]
     
    BACKGROUND/AIM: Treatment options for unresectable cholangiocarcinoma are limited. The aim of the study was to evaluate the clinical outcomes of definitive external-beam radiation therapy (EBRT) for patients with unresectable cholangiocarcinoma. PATIENTS AND METHODS: Patients with unresectable primary cholangiocarcinoma, or local recurrent cholangiocarcinoma after primary surgery, without distant metastasis who received definitive EBRT (≥45 Gy) between January 2006 and December 2020 at our Institution were analyzed retrospectively. EBRT was basically performed using conventional fractionation (1.8-2 Gy per fraction). Prophylactic nodal irradiation was not performed. RESULTS: A total of 21 consecutive patients were analyzed: 7 primary and 14 recurrent cases. The median age was 70 (range=38-85) years at initiation of EBRT. A median dose of 54 (range=45-60) Gy comprising 1.8 (range=1.8-3) Gy per fraction was administered to the primary/recurrent local tumor site. The median follow-up period was 21.6 months. The 2-year overall survival, cause-specific survival, progression-free survival, and local recurrence-free rates were 35.7, 35.7, 16.1, and 32.7%, respectively. Long-term local control (>2 years after EBRT) was achieved in 19.0%. Grade 3 toxicities related to EBRT were observed in 4.8% (duodenum hemorrhage). No grade 4 or higher toxicities were observed. CONCLUSION: Definitive EBRT for unresectable cholangiocarcinoma was feasible and achieved long-term local control in a subset of patients. As the avoidance of local recurrence may lead to the benefits of prolonging biliary patency and subsequently alleviating the need for an invasive procedure for biliary drainage, EBRT could be one sustainable therapeutic option for patients with unresectable cholangiocarcinoma.
  • Abdelghaffar, A.; Kishi, N.; Ashida, R.; Matsuo, Y.; Hirashima, H.; Mukumoto, N.; Yoshimura, M.; Nakamura, M.; El Sayed Mohamed, A.; Ali, E.M.; Gaber, M.S.; Mizowaki, T.
    Iranian Journal of Medical Physics 19 1 1 - 8 2022年 [査読有り]
  • Noriko Kishi; Yukinori Matsuo; Hideki Hanazawa; Yusuke Iizuka; Takashi Mizowaki
    PloS one 17 6 e0269463  2022年 [査読有り]
     
    Marital status has been proposed as a promising prognostic factor in many malignancies, including non-small-cell lung cancer (NSCLC). However, its prognostic value is still unclear for individual non-surgical treatments for stage I NSCLC. This study investigated the prognostic value of marital status in patients with early-stage NSCLC treated with stereotactic body radiotherapy (SBRT). Patients with early-stage NSCLC treated with SBRT between January 2003 and March 2014 at our institute were enrolled, and marital status at the time of SBRT was investigated. Propensity score matching (PSM) was applied to reduce potential selection bias between the married and unmarried groups. Two hundred and forty patients (median age 77 years; 152 married, 87 unmarried) were analyzed. The unmarried included higher proportions of the elderly, women, never smokers, and those with decreased pulmonary function compared to the married. PSM identified 53 matched pairs of married and unmarried patients, with no significant difference in patient background parameters. The 5-year overall survival (OS) was 52.8% and 46.9% in the married and unmarried groups, respectively (P = 0.26). There was no significant difference in NSCLC death or non-NSCLC death between the two groups (P = 0.88 and 0.30, respectively). There was no significant difference in OS between married and unmarried male patients (n = 85, 5-year OS, 52.6% vs. 46.0%; P = 0.42) and between married and unmarried female patients (n = 21, 54.5% vs. 50.0%; P = 0.44). In conclusion, marital status was not associated with OS in patients receiving SBRT for early-stage NSCLC.
  • Hiromi Asada; Yoshimitsu Takahashi; Yuka Ono; Noriko Kishi; Yukinori Matsuo; Takashi Mizowaki; Takeo Nakayama
    Patient preference and adherence 16 1359 - 1369 2022年 [査読有り]
     
    Purpose: Patients undergoing radiotherapy often have their skin marked. Previous studies on skin markings examined the durability and physical effects of the markings, but no study has focused on patients' emotional experiences toward the markings. This study aimed to clarify how patients undergoing radiotherapy feel about skin markings, as well as factors that affect patients' emotional experiences. Patients and Methods: We conducted a cross-sectional study using a self-administered questionnaire and medical records. Participants were patients aged ≥20 years undergoing cancer radiotherapy at a designated cancer care hospital. The primary outcome was the level of uncomfortable emotions toward skin markings, and the secondary outcome was the level of favorable ratings on skin markings. To examine factors related to uncomfortable emotions, ordinal logistic regression analysis was performed. Results: Questionnaire forms were distributed to 153 patients, and responses were collected from 132 (86%). Among 108 patients included in the analysis, 56% (59/105, excluding 3 who did not answer this question) responded that they were uncomfortable with skin markings. The proportion of patients who favorably rated skin markings was 63% (59/93, excluding 15 who did not answer this question). No factors were significantly associated with the primary outcome. Conclusion: Many patients accepted skin markings with resignation, as they understood the necessity of the markings in their treatment. Medical staff should understand the emotional experiences of patients toward skin markings and take sufficient care to ensure that they are provided with explanations, including the impact of skin markings on their daily lives, as well as a sense of security that treatment is being performed in a precise manner.
  • Kazuhito Ueki; Yukinori Matsuo; Atsuya Takeda; Satoshi Morita; Masataka Taguri; Noriko Kishi; Hideki Hanazawa; Yuichiro Tsurugai; Takashi Mizowaki
    International Journal of Radiation Oncology*Biology*Physics 112 5 1135 - 1143 2021年11月 [査読有り]
     
    PURPOSE: The purpose of this study was to assess the impact of local recurrence (LR) on cause-specific death (CSD) in patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). A dynamic prediction model that incorporated LR as a time-dependent covariate was used. METHODS AND MATERIALS: This study included 535 stage I (cT1-T2aN0M0) NSCLC patients treated with SBRT from two institutions. We developed a landmark dynamic prediction model to estimate the probability of a CSD. This model determined the probability of surviving for an additional 3 years at different prediction time points during follow-up, given the history of recurrence status. The baseline covariates included in the model were age, sex, T stage, and histology, while the time-dependent covariates were LR and regional and/or distant recurrence (RDR) status. RESULTS: Overall, 137 patients (25.6%) died of lung cancer within a median follow-up of 4.1 years. Of the 195 patients who developed recurrence, 28, 125, and 42 patients had LR only, RDR only, and both, respectively. The landmark model showed that older age, advanced T stage, LR, and RDR were significantly associated with an increased risk of subsequent CSD. Among these covariates, LR (odds ratio [OR], 8.5; 95% confidence interval [CI], 6.0-12.0; P < .001) and RDR (OR, 11.6; 95% CI, 9.1-14.9; P < .001) demonstrated strong effects on CSD within 3 years after the prediction time points. The dynamic prediction provided information on the probability of future CSD according to individual recurrence status during follow-up. CONCLUSIONS: Dynamic prediction using the landmark model showed that LR had a substantial impact on subsequent CSD, which was comparable to that of RDR. This result supports the notion that strategies to improve local control are reasonable.
  • Hideki Hanazawa; Yukinori Matsuo; Atsuya Takeda; Yuichiro Tsurugai; Yusuke Iizuka; Noriko Kishi; Keiichi Takehana; Takashi Mizowaki
    Journal of radiation research 2021年10月 [査読有り]
     
    This study sought to develop and validate a prognostic model for non-lung cancer death (NLCD) in elderly patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). Patients aged ≥65 diagnosed with NSCLC (Tis-4N0M0), tumor diameter ≤5 cm and SBRT between 1998 and 2015 were retrospectively registered from two independent institutions. One institution was used for model development (arm D, 353 patients) and the other for validation (arm V, 401 patients). To identify risk factors for NLCD, multiple regression analysis on age, sex, performance status (PS), body mass index (BMI), Charlson comorbidity index (CCI), tumor diameter, histology and T-stage was performed on arm D. A score calculated using the regression coefficient was assigned to each factor and three risk groups were defined based on total score. Scores of 1.0 (BMI ≤18.4), 1.5 (age ≥ 5), 1.5 (PS ≥2), 2.5 (CCI 1 or 2) and 3 (CCI ≥3) were assigned, and risk groups were designated as low (total ≤ 3), intermediate (3.5 or 4) and high (≥4.5). The cumulative incidences of NLCD at 5 years in the low, intermediate and high-risk groups were 6.8, 23 and 40% in arm D, and 23, 19 and 44% in arm V, respectively. The AUC index at 5 years was 0.705 (arm D) and 0.632 (arm V). The proposed scoring system showed usefulness in predicting a high risk of NLCD in elderly patients treated with SBRT for NSCLC.
  • 濱路 政嗣; 岸 徳子; 松尾 幸憲; 毛受 暁史; 中倉 章祥; 花澤 豪樹; 竹花 恵一; 田中 里奈; 山田 義人; 豊 洋次郎; 大角 明宏; 中島 大輔; 溝脇 尚志; 伊達 洋至
    日本胸部外科学会定期学術集会 74回 LDB1 - 3 (一社)日本胸部外科学会 2021年10月
  • 小型肺癌に対する治療 手術vs定位放射線治療(SBRT) Propensity score-weighted analysisを用いたI期NSCLC高齢患者における治療成績の検討
    濱路 政嗣; 岸 徳子; 松尾 幸憲; 毛受 暁史; 中倉 章祥; 花澤 豪樹; 竹花 恵一; 田中 里奈; 山田 義人; 豊 洋次郎; 大角 明宏; 中島 大輔; 溝脇 尚志; 伊達 洋至
    日本胸部外科学会定期学術集会 74回 LDB1 - 3 (一社)日本胸部外科学会 2021年10月
  • 80歳以上の頭頸部扁平上皮癌患者に対する放射線治療の検討
    中嶋 綾; 吉村 通央; 松尾 幸憲
    頭頸部癌 47 2 212 - 212 (一社)日本頭頸部癌学会 2021年05月
  • Yamazaki, H.; Suzuki, G.; Aibe, N.; Nakamura, S.; Yoshida, K.; Oh, R.; Inoue, T.; Nozue, M.; Katano, A.; Inagaki, T.; Noda, Y.; Ishibashi, N.; Kodai, K.; Yoshimitsu, K.; Mori, Y.; Naoi, Y.; Ogawa, S.; Ishihara, S.; Tanaka, H.; Kanaoka, N.; Matsuo, Y.; Yoshimoto, Y.; Toma, Y.; Itasaka, S.; Yamada, M.; Negoro, Y.; Akagi, Y.; Maemoto, H.; Nishida, T.; Ogura, K.; Hidaka, K.; Izumi, S.; Tomoda, T.; Okubo, Y.; Ushijima, Y.; Okamoto, Y.; Kato, E.; Miyagawa, A.; Toyoda, T.; Adachi, K.; Nagano, F.; Tatsumi, T.; Marudai, M.; Tsujino, K.; Ogita, M.; Komiyama, T.; Takebe, H.; Oguri, T.; Matsuyama, T.; Konishi, K.; Michimoto, K.; MacHida, K.; Okumura, T.; Kodani, N.; Tsubokura, T.; Furuya, S.; Yoshioka, Y.; Doho, Y.; Chatani, M.; Yamamoto, M.; Soejima, T.; Okamoto, M.; Yanagi, T.; Yamamoto, N.; Nomoto, A.; Kato, N.; Inoue, K.; Murakami, M.; Araya, M.; Kato, H.; Takagi, M.; Okumura, T.; Demizu, Y.; Nishizaki, O.; Moriyama, M.; Saya, K.; Ariga, T.; Manabe, Y.; Okubo, Y.; Kosaki, K.; Shibamoto, Y.; Murai, T.; Ishiyama, H.; Tanooka, M.; Dokiya, T.; Ichiki, M.; Matsui, T.; Miyamoto, A.; Fukuyama, Y.; Suzuki, K.; Mayahara, H.; Shibata, Y.
    Journal of Radiation Research 62 2 2021年
  • Matsuo, Y.; Nagata, Y.; Wakabayashi, M.; Ishikura, S.; Onishi, H.; Kokubo, M.; Karasawa, K.; Shioyama, Y.; Onimaru, R.; Hiraoka, M.
    Journal of Radiation Research 62 5 901 - 909 2021年 [査読有り]
     
    This study aimed to evaluate the impact of pretreatment C-reactive protein (CRP) and skeletal muscle mass (SMM) on outcomes after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of JCOG0403. Patients were divided into high and low CRP groups with a threshold value of 0.3 mg/dL. The paraspinous musculature area at the level of the 12th thoracic vertebra was measured on simulation computed tomography (CT). When the area was lower than the sex-specific median, the patient was classified into the low SMM group. Toxicities, overall survival (OS) and cumulative incidence of cause-specific death were compared between the groups. Sixty operable and 92 inoperable patients were included. In the operable cohort, OS significantly differed between the CRP groups (log-rank test p = 0.009; 58.8% and 83.6% at three years for high and low CRP, respectively). This difference in OS was mainly attributed to the difference in lung cancer deaths (Gray's test p = 0.070; 29.4% and 7.1% at three years, respectively). No impact of SMM on OS was observed. The incidence of Grade 3-4 toxicities tended to be higher in the low SMM group (16.7% vs 0%, Fisher's exact test p = 0.052). In the inoperable cohort, no significant impact on OS was observed for either CRP or SMM. The toxicity incidence was also not different between the CRP and SMM groups. The present study suggests that pretreatment CRP level may provide prognostic information in operable patients receiving SBRT for early-stage NSCLC.
  • Hiraoka, S.; Nakajima, A.; Kishi, N.; Takehana, K.; Hanazawa, H.; Matsuo, Y.; Mizowaki, T.
    International Journal of Clinical Oncology 26 10 1968 - 1976 2021年 [査読有り]
     
    BACKGROUND: The prognosis of patients with recurrence of uterine cervical cancer after definitive radiotherapy and the efficacy of local salvage therapy for recurrence were evaluated. METHODS: We retrospectively reviewed 110 patients who were treated with definitive radiotherapy/chemoradiotherapy for uterine cervical cancer between 2008 and 2017 at our institution. Local salvage therapy was defined as any surgery or radiotherapy described in the medical record as intended for local control or cure. RESULTS: We identified 25 patients who developed recurrence after definitive radiotherapy/chemoradiotherapy. The median follow-up time post-recurrence was 18.9 months. Thirteen patients (52%) reported recurrence in the isolated extra-pelvic lymph node (EPLN). The 2-year overall survival after first recurrence (OSr) for patients with isolated EPLN recurrence was 83.1%, compared to that of 31.2% for patients with other patterns of recurrence (p < 0.001). The 2-year OSr for patients who underwent local salvage therapy was 75.2%, whereas that for patients who did not undergo therapy was 41.6% (p = 0.04). Among patients who had recurrence in the isolated EPLN and received local salvage therapy, 20% of the patients reported recurrence in visceral and/or bone metastases after local salvage therapy, and 50% of the patients experienced another EPLN recurrence, which was salvaged with repeating local therapy. CONCLUSIONS: Patients with uterine cervical cancer with isolated EPLN recurrence had favorable prognoses. The indications of local salvage therapy should be considered, especially for patients with isolated EPLN recurrence.
  • Adachi, T.; Nakamura, M.; Shintani, T.; Mitsuyoshi, T.; Kakino, R.; Ogata, T.; Ono, T.; Tanabe, H.; Kokubo, M.; Sakamoto, T.; Matsuo, Y.; Mizowaki, T.
    Medical Physics 48 4 1781 - 1791 2021年 [査読有り]
     
    PURPOSE: To predict radiation pneumonitis (RP) grade 2 or worse after lung stereotactic body radiation therapy (SBRT) using dose-based radiomic (dosiomic) features. METHODS: This multi-institutional study included 247 early-stage nonsmall cell lung cancer patients who underwent SBRT with a prescribed dose of 48-70 Gy at an isocenter between June 2009 and March 2016. Ten dose-volume indices (DVIs) were used, including the mean lung dose, internal target volume size, and percentage of entire lung excluding the internal target volume receiving greater than x Gy (x = 5, 10, 15, 20, 25, 30, 35, and 40). A total of 6,808 dose-segmented dosiomic features, such as shape, first order, and texture features, were extracted from the dose distribution. Patients were randomly partitioned into two groups: model training (70%) and test datasets (30%) over 100 times. Dosiomic features were converted to z-scores (standardized values) with a mean of zero and a standard deviation (SD) of one to put different variables on the same scale. The feature dimension was reduced using the following methods: interfeature correlation based on Spearman's correlation coefficients and feature importance based on a light gradient boosting machine (LightGBM) feature selection function. Three different models were developed using LightGBM as follows: (a) a model with ten DVIs (DVI model), (b) a model with the selected dosiomic features (dosiomic model), and (c) a model with ten DVIs and selected dosiomic features (hybrid model). Suitable hyperparameters were determined by searching the largest average area under the curve (AUC) value in the receiver operating characteristic curve (ROC-AUC) via stratified fivefold cross-validation. Each of the final three models with the closest the ROC-AUC value to the average ROC-AUC value was applied to the test datasets. The classification performance was evaluated by calculating the ROC-AUC, AUC in the precision-recall curve (PR-AUC), accuracy, precision, recall, and f1-score. The entire process was repeated 100 times with randomization, and 100 individual models were developed for each of the three models. Then the mean value and SD for the 100 random iterations were calculated for each performance metric. RESULTS: Thirty-seven (15.0%) patients developed RP after SBRT. The ROC-AUC and PR-AUC values in the DVI, dosiomic, and hybrid models were 0.660 ± 0.054 and 0.272 ± 0.052, 0.837 ± 0.054 and 0.510 ± 0.115, and 0.846 ± 0.049 and 0.531 ± 0.116, respectively. For each performance metric, the dosiomic and hybrid models outperformed the DVI models (P < 0.05). Texture-based dosiomic feature was confirmed as an effective indicator for predicting RP. CONCLUSIONS: Our dose-segmented dosiomic approach improved the prediction of the incidence of RP after SBRT.
  • Ono, Y.; Yoshimura, M.; Ono, T.; Fujimoto, T.; Miyabe, Y.; Matsuo, Y.; Mizowaki, T.
    Radiation Oncology 16 1 49 - 49 2021年 [査読有り]
     
    BACKGROUND: This study aimed to quantify errors by using a cine electronic portal imaging device (cine EPID) during deep inspiration breath-hold (DIBH) for left-sided breast cancer and to estimate the planning target volume (PTV) by variance component analysis. METHODS: This study included 25 consecutive left-sided breast cancer patients treated with whole-breast irradiation (WBI) using DIBH. Breath-holding was performed while monitoring abdominal anterior-posterior (AP) motion using the Real-time Position Management (RPM) system. Cine EPID was used to evaluate the chest wall displacements in patients. Cine EPID images of the patients (309,609 frames) were analyzed to detect the edges of the chest wall using a Canny filter. The errors that occurred during DIBH included differences between the chest wall position detected by digitally reconstructed radiographs and that of all cine EPID images. The inter-patient, inter-fraction, and intra-fractional standard deviations (SDs) in the DIBH were calculated, and the PTV margin was estimated by variance component analysis. RESULTS: The median patient age was 55 (35-79) years, and the mean irradiation time was 20.4 ± 1.7 s. The abdominal AP motion was 1.36 ± 0.94 (0.14-5.28) mm. The overall mean of the errors was 0.30 mm (95% confidence interval: - 0.05-0.65). The inter-patient, inter-fraction, and intra-fractional SDs in the DIBH were 0.82 mm, 1.19 mm, and 1.63 mm, respectively, and the PTV margin was calculated as 3.59 mm. CONCLUSIONS: Errors during DIBH for breast radiotherapy were monitored using EPID images and appropriate PTV margins were estimated by variance component analysis.
  • Shintani, T.; Kishi, N.; Matsuo, Y.; Ogura, M.; Mitsuyoshi, T.; Araki, N.; Fujii, K.; Okumura, S.; Nakamatsu, K.; Kishi, T.; Atsuta, T.; Sakamoto, T.; Narabayashi, M.; Ishida, Y.; Sakamoto, M.; Fujishiro, S.; Katagiri, T.; Kim, Y.H.; Mizowaki, T.
    Clinical Lung Cancer 22 5 401 - 410 2021年 [査読有り]
     
    INTRODUCTION: Data on the risk factors for symptomatic radiation pneumonitis (RP) in non-small-cell lung cancer (NSCLC) patients treated with concurrent chemoradiotherapy (CCRT) and consolidation durvalumab are limited; we aimed to investigate these risk factors. MATERIALS AND METHODS: This multicenter retrospective study, conducted at 15 institutions in Japan, included patients who were ≥20 years of age; who started definitive CCRT for NSCLC between July 1, 2018, and July 31, 2019; and who then received durvalumab. The primary endpoint was grade 2 or worse (grade 2+) RP. RESULTS: In the 146 patients analyzed, the median follow-up period was 16 months. A majority of the patients had stage III disease (86%), received radiation doses of 60 to 66 Gy equivalent in 2-Gy fractions (93%) and carboplatin and paclitaxel/nab-paclitaxel (77%), and underwent elective nodal irradiation (71%) and 3-dimensional conformal radiotherapy (75%). RP grade 2 was observed in 44 patients (30%); grade 3, in four patients (3%); grade 4, in one patient (1%); and grade 5, in one patient (1%). In the multivariable analysis, lung V20 was a significant risk factor, whereas age, sex, smoking history, irradiation technique, and chemotherapy regimen were not. The 12-month grade 2+ RP incidence was 34.4% (95% confidence interval [CI], 26.7%-42.1%); the values were 50.0% (95% CI, 34.7%-63.5%) and 27.1% (95% CI, 18.8%-36.2%) in those with lung V20 ≥ 26% and < 26%, respectively (P = .007). CONCLUSION: The incidence of grade 2+ RP was relatively high in this multicenter real-world study, and its risk increased remarkably at elevated lung V20. Our findings can aid in RP risk prediction and the safe radiotherapy treatment planning.
  • Genki Edward Sato; Yukinori Matsuo; Hideo Kanemitsu; Kenji Minatoya; Daisuke Nakajima; Hiroshi Date; Yasuaki Nakagawa; Takashi Mizowaki
    JTO Clinical and Research Reports 2 1 100101 - 100101 2021年01月 [査読有り]
  • Yamanashi, K.; Hamaji, M.; Matsuo, Y.; Kishi, N.; Chen-Yoshikawa, T.F.; Mizowaki, T.; Date, H.
    Interactive Cardiovascular and Thoracic Surgery 31 6 892 - 894 2021年 [査読有り]
     
    There is dearth of data regarding the long-term survival outcomes of salvage surgery after stereotactic body radiotherapy for early-stage non-small-cell lung cancer, as previous studies have included a short follow-up period. There is also scarce information on the management of re-relapse in previous studies. This study examined the long-term survival outcomes of patients who underwent salvage surgery for isolated local relapse (LR). We reviewed consecutive patients who underwent salvage surgery for isolated LR after stereotactic body radiotherapy for early-stage non-small-cell lung cancer between 1999 and 2015. All patients were followed up until death or at least 5 years from salvage surgery. Twelve patients were included for analysis. The median follow-up from isolated LR was 62.4 (range: 14.3-152.1) months. The 5-year overall survival rate was 58.3%, updated from 79.5% in our previous report. During the interim, new re-relapses did not occur, whereas there were 5 additional deaths. The median survival after re-relapse was 32.6 months. Our follow-up report confirmed that our patient selection for salvage surgery appeared to be appropriate and that long-term follow-up is required to assess the outcomes of patients undergoing salvage surgery. Long-term follow-up would provide detailed information on late re-relapses, treatment and outcomes of re-relapses and mortality from any causes.
  • Masahiro Hiraoka; Takashi Mizowaki; Yukinori Matsuo; Mitsuhiro Nakamura; Dirk Verellen
    Radiotherapy and Oncology 153 311 - 318 2020年12月 [査読有り]
     
    A gimbaled-head radiotherapy device was developed by industry-academic collaborations, with a concept of robust structures whilst maintaining high flexibilities, and its clinical application started in 2008. The unique structures with multi-image guidance functions initiated 2 new treatment modalities. One is dynamic tumor tracking radiotherapy with real time monitoring (DTTRM), which enables 4-D radiotherapy without prolongation of radiotherapy treatment time. This treatment has become clinically feasible for stereotactic body radiotherapy (SBRT) of lung cancers and liver tumors, and intensity-modulated radiotherapy (IMRT) for pancreatic cancers. The second one is Dynamic WaveArc therapy (DWA), the non-coplanar versatility of the SBRT system by combining the gantry-ring synchronized rotation with dynamic multileaf collimator optimization. DWA opens the possibility to create patient-individualized treatment plans, allowing additional flexibility in organ at risk sparing while preserving dosimetric robust delivery. The clinical usefulness of the DWA has been preliminary shown for those tumors in the prostate, breast and skull base. Prospective clinical trials are under way with a support of the national funding of Japan for DTTRM and DWA, respectively. Marketing of the system was terminated in 2016 due to a commercial decision. However, lessons can be learned from the development process of this device that might be useful for those who have interests in new technologies and clinical applications in radiation oncology. This review article aims to summarize the developments and achievements of a gimbaled-head radiotherapy device with a focus on DTTRM and DWA.
  • Shun Okabayashi; Yukinori Matsuo; Noriko Kishi; Hideki Hanazawa; Takashi Mizowaki
    International Cancer Conference Journal 9 4 221 - 226 2020年10月 [査読有り]
     
    Solid-organ transplant recipients require long-term immunosuppressants to prevent graft rejection. However, immunosuppressant use increases the risk of malignancy. Radiotherapy can be a treatment option for patients who are medically inoperable or refuse surgery; however, whether the irradiation of transplanted organs is safe remains unclear. We present two patients with malignancies that developed in transplanted organs and were treated with dynamic tumor-tracking (DTT) stereotactic body radiation therapy (SBRT). The first patient underwent transplantation owing to liver cirrhosis caused by hepatitis C virus and subsequently developed hepatocellular carcinoma in the donated liver. There was no evidence of recurrence 12 months post-treatment, and liver function enzyme levels did not deviate from their pre-SBRT baselines. The second patient had a solitary tongue cancer metastasis in a transplanted lung; she also had a history of interstitial pneumonia caused by scleroderma. Six weeks after DTT-SBRT, she developed grade 3 radiation pneumonitis but recovered with oral steroids; she experienced no tumor recurrence after 14 months, although her respiratory function was worse than it was pre-SBRT owing to post-transplant rejection. DTT-SBRT is thus feasible for treating tumors that arise in transplanted lungs and livers.
  • 飯間 麻美; 飯塚 裕介; 松尾 幸憲; 高山 賢二; 中本 裕士; 山本 憲; 片岡 正子; 石守 崇好; 溝脇 尚志; 富樫 かおり
    医学物理 40 1 3 - 7 (公社)日本医学物理学会 2020年03月 [査読有り]
     

    Advances in medical devices have allowed the use of CT, MRI, and PET-CT for the diagnosis of tumors and the detailed evaluation of the extent of lesions. For several decades, CT has been established as the gold standard modality for the treatment planning of radiotherapy, while MRI has emerged as a tool to evaluate the functional characteristics of tumors without radiation exposure. To further optimize precision radiation therapy, we should consider how functional images can be used in the workflow for radiation therapy. In this regard, MRI, as a modality without the need for a contrast agent, may allow more frequent scans and more detailed dose painting, such as increasing the dose to viable lesion parts while reducing the dose to less aggressive parts. Thus, a more personalized treatment based on precision radiation medicine might be realized. In recent years, MR-Linac systems (MRI integrated linear accelerator radiation therapy systems) have been applied in clinical settings by fusing MRI with Linac planning, and further development of radiation therapy utilizing MRI-derived functional images is expected. The use of MR-Linac techniques allows the characteristics of the tumor to be evaluated in more detail before treatment, and the treatment planning can be modified according to the position and characteristics of the tumor (which may change daily during irradiation) to avoid harming normal tissue. Compared with conventional cone beam CT, MR-Linac can offer MR images with much better contrast of soft tissue for image-guided radiation therapy, even when acquired at 0.35 T. A multicenter study of liver tumors using MR-Linac was recently reported. In current tumor imaging, various MRI sequences can be used to evaluate tumor functional information such as tumor heterogeneity, cell density, microenvironment, angiogenesis, necrosis, hypoxic status, and microstructure. In this article, we introduce state-of-the-art acquisition methods for MRI imaging, and discuss how the functional information obtained from these imaging methods can be useful for radiation therapy.

  • Kishi, N.; Nakamura, M.; Hirashima, H.; Mukumoto, N.; Takehana, K.; Uto, M.; Matsuo, Y.; Mizowaki, T.
    Journal of Applied Clinical Medical Physics 21 10 141 - 150 2020年 [査読有り]
     
    PURPOSE:To validate the clinical applicability of knowledge-based (KB) planning in single-isocenter volumetric-modulated arc therapy (VMAT) for multiple brain metastases using the k-fold cross-validation (CV) method. METHODS:This study comprised 60 consecutive patients with multiple brain metastases treated with single-isocenter VMAT (28 Gy in five fractions). The patients were divided randomly into five groups (Groups 1-5). The data of Groups 1-4 were used as the training and validation dataset and those of Group 5 were used as the testing dataset. Four KB models were created from three of the training and validation datasets and then applied to the remaining Groups as the fourfold CV phase. As the testing phase, the final KB model was applied to Group 5 and the dose distributions were calculated with a single optimization process. The dose-volume indices (DVIs), modified Ian Paddick Conformity Index (mIPCI), modulation complexity scores for VMAT plans (MCSv), and the total number of monitor units (MUs) of the final KB plan were compared to those of the clinical plan (CL) using a paired Wilcoxon signed-rank test. RESULTS:In the fourfold CV phase, no significant differences were observed in the DVIs among the four KB plans (KBPs). In the testing phase, the final KB plan was statistically equivalent to the CL, except for planning target volumes (PTVs) D2% and D50% . The differences between the CL and KBP in terms of the PTV D99.5% , normal brain, and Dmax to all organs at risk (OARs) were not significant. The KBP achieved a lower total number of MUs and higher MCSv than the CL with no significant difference. CONCLUSIONS:We demonstrated that a KB model in a single-isocenter VMAT for multiple brain metastases was equivalent in dose distribution, MCSv, and total number of MUs to a CL with a single optimization.
  • Kakino, R.; Nakamura, M.; Mitsuyoshi, T.; Shintani, T.; Kokubo, M.; Negoro, Y.; Fushiki, M.; Ogura, M.; Itasaka, S.; Yamauchi, C.; Otsu, S.; Sakamoto, T.; Sakamoto, M.; Araki, N.; Hirashima, H.; Adachi, T.; Matsuo, Y.; Mizowaki, T.
    Medical Physics 47 9 4634 - 4643 2020年 [査読有り]
     
    PURPOSE: To predict local recurrence (LR) and distant metastasis (DM) in early stage non-small cell lung cancer (NSCLC) patients after stereotactic body radiotherapy (SBRT) in multiple institutions using breath-hold computed tomography (CT)-based radiomic features with random survival forest. METHODS: A total of 573 primary early stage NSCLC patients who underwent SBRT between January 2006 and March 2016 and met the eligibility criteria were included in this study. Patients were divided into two datasets: training (464 patients in 10 institutions) and test (109 patients in one institution) datasets. A total of 944 radiomic features were extracted from manually segmented gross tumor volumes (GTVs). Feature selection was performed by analyzing inter-segmentation reproducibility, GTV correlation, and inter-feature redundancy. Nine clinical factors, including histology and GTV size, were also used. Three prognostic models (clinical, radiomic, and combined) for LR and DM were constructed using random survival forest (RSF) to deal with total death as a competing risk in the training dataset. Robust models with optimal hyper-parameters were determined using fivefold cross-validation. The patients were dichotomized into two groups based on the median value of the patient-specific risk scores (high- and low-risk score groups). Gray's test was used to evaluate the statistical significance between the two risk score groups. The prognostic power was evaluated by the concordance index with the 95% confidence intervals (CI) via bootstrapping (2000 iterations). RESULTS: The concordance indices at 3 yr of clinical, radiomic, and combined models for LR were 0.57 [CI: 0.39-0.75], 0.55 [CI: 0.38-0.73], and 0.61 [CI: 0.43-0.78], respectively, whereas those for DM were 0.59 [CI: 0.54-0.79], 0.67 [CI: 0.54-0.79], and 0.68 [CI: 0.55-0.81], respectively, in the test dataset. The combined DM model significantly discriminated its cumulative incidence between high- and low-risk score groups (P < 0.05). The variable importance of RSF in the combined model for DM indicated that two radiomic features were more important than other clinical factors. The feature maps generated on the basis of the most important radiomic feature had visual difference between high- and low-risk score groups. CONCLUSIONS: The radiomics approach with RSF for competing risks using breath-hold CT-based radiomic features might predict DM in early stage NSCLC patients who underwent SBRT although that may not have potential to predict LR.
  • Yoshida, Hironori; Nagai, Hiroki; Sakamori, Yuichi; Ozasa, Hiroaki; Nishimura, Takashi; Tomii, Keisuke; Hirai, Toyohiro; Matsuo, Yukinori; Iizuka, Yusuke; Mizowaki, Takashi; Yoshimura, Kenichi; Kim, Young Hak
    In Vivo 34 2 897 - 902 2020年 [査読有り]
     
    Background: Concurrent chemoradiotherapy (CCRT) is the gold standard for limited-stage small-cell lung cancer (LS-SCLC); however, most patients inevitably experience relapse. We hypothesized consolidation amrubicin following CCRT to be a potential treatment for LS-SCLC. Patients and Methods: All enrolled patients were treated using induction CCRT consisting of four cycles of etoposide and cisplatin plus concurrent thoracic radiotherapy. Eligible patients then received three cycles of amrubicin as consolidation therapy ( consolidation population). The primary endpoint was the 2-year progression-free survival rate in the consolidation population. Results: Of the 36 intention-to-treat patients, 28 (78%) received amrubicin and 24 ( 67%) completed all planned treatments. The 2-year progression-free survival rate and overall response rate were 35.7% and 86%, respectively. The median progression-free and overall survival were 14.3 and 60.9 months, respectively. There were no treatment-related deaths in the intention-to-treat population. Conclusion: This study was terminated due to slow patient accrual; however, this treatment strategy was feasible and demonstrated promising efficacy.
  • Ono, Tomohiro; Mitsuyoshi, Takamasa; Shintani, Takashi; Tsuruta, Yusuke; Iramina, Hiraku; Hirashima, Hideaki; Miyabe, Yuki; Nakamura, Mitsuhiro; Matsuo, Yukinori; Mizowaki, Takashi
    Journal of Applied Clinical Medical Physics 21 7 135 - 143 2020年 [査読有り]
     
    This study aimed to investigate the feasibility of independent calculation-based verification of volumetric-modulated arc therapy (VMAT)-stereotactic body radiotherapy (SBRT) for patients with lung cancer using a secondary treatment planning system (sTPS). In all, 50 patients with lung cancer who underwent VMAT-SBRT between April 2018 and May 2019 were included in this study. VMAT-SBRT plans were devised using the Collapsed-Cone Convolution in RayStation (primary TPS: pTPS). DICOM files were transferred to Eclipse software (sTPS), which utilized the Eclipse software, and the dose distribution was then recalculated using Acuros XB. For the verification of dose distribution in homogeneous phantoms, the differences among pTPS, sTPS, and measurements were evaluated using passing rates of a dose difference of 5% (DD5%) and gamma index of 3%/2 mm (γ3%/2 mm). The ArcCHECK cylindrical diode array was used for measurements. For independent verification of dose-volume parameters per the patient's geometry, dose-volume indices for the planning target volume (PTV) including D95% and the isocenter dose were evaluated. The mean differences (± standard deviations) between the pTPS and sTPS were then calculated. The gamma passing rates of DD5% and γ3%/2 mm criteria were 99.2 ± 2.4% and 98.6 ± 3.2% for pTPS vs. sTPS, 92.9 ± 4.0% and 94.1 ± 3.3% for pTPS vs. measurement, and 93.0 ± 4.4% and 94.3 ± 4.1% for sTPS vs. measurement, respectively. The differences between pTPS and sTPS for the PTVs of D95% and the isocenter dose were -3.1 ± 2.0% and -2.3 ± 1.8%, respectively. Our investigation of VMAT-SBRT plans for lung cancer revealed that independent calculation-based verification is a time-efficient method for patient-specific quality assurance.
  • Ito, H.; Matsuo, Y.; Ohtsu, S.; Nishimura, T.; Terada, Y.; Sakamoto, T.; Mizowaki, T.
    International Journal of Clinical Oncology 25 2 274 - 281 2020年 [査読有り]
     
    BACKGROUND: Chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer. Unlike metastatic disease, histological differences are usually not considered while planning chemoradiotherapy. This study aimed to compare clinical outcomes and relapse patterns between squamous cell carcinomas and adenocarcinomas, and investigated possible histology-specific approaches for chemoradiotherapy in locally advanced non-small cell lung cancer. METHODS: We retrospectively analyzed the outcomes and relapse patterns in patients who received definitive chemoradiotherapy for locally advanced non-small cell lung cancer in Katsura hospital between 2003 and 2012. RESULTS: A total of 68 and 33 patients with squamous cell carcinomas and adenocarcinomas, respectively, were enrolled. Patients with adenocarcinoma had less advanced T stages, and a larger proportion of female patients. Other factors were not different between the two groups. The median follow-up duration in all patients and survivors was 21.3 months and 91.4 months, respectively. Median survival and relapse-free survival were not significantly different between the two groups. In contrast, the failure patterns and incidences of distant failure were significantly different. Patients with squamous cell carcinomas had predominantly locoregional disease features and a shorter duration from relapse to death compared to patients with adenocarcinoma. CONCLUSION: Failure pattern was significantly different between the two histologies. Among relapsed patients, the prognosis was poorer in those with squamous cell carcinomas than those with adenocarcinomas. Further studies, to evaluate histology-specific approaches in chemoradiotherapy, are warranted.
  • Ryo Kakino; Mitsuhiro Nakamura; Takamasa Mitsuyoshi; Takashi Shintani; Hideaki Hirashima; Yukinori Matsuo; Takashi Mizowaki
    Physica Medica 69 176 - 182 2020年01月 [査読有り]
     
    PURPOSE: To compare radiomic features extracted from diagnostic computed tomography (CT) images with and without contrast enhancement in delayed phase for non-small cell lung cancer (NSCLC) patients. METHODS: Diagnostic CT images from 269 tumors [non-contrast CT, 188 (dataset NE); contrast-enhanced CT, 81 (dataset CE)] were enrolled in this study. Eighteen first-order and seventy-five texture features were extracted by setting five bin width levels for CT values. Reproducible features were selected by the intraclass correlation coefficient (ICC). Radiomic features were compared between datasets NE and CE. Subgroup analyses were performed based on the CT acquisition period, exposure value, and patient characteristics. RESULTS: Eighty features were considered reproducible (0.5 ≤ ICC). Twelve of the sixteen first-order features, independent of the bin width levels, were statistically different between datasets NE and CE (p < 0.05), and the p-values of two first-order features depending on the bin width levels were reduced with narrower bin widths. Sixteen out of sixty-two features showed a significant difference, regardless of the bin width (p < 0.05). There were significant differences between datasets NE and CE with older age, lighter body weight, better performance status, being a smoker, larger gross tumor volume, and tumor location at central region. CONCLUSIONS: Contrast enhancement in the delayed phase of CT images for NSCLC patients affected some of the radiomic features and the variability of radiomic features due to contrast uptake may depend largely on the patient characteristics.
  • Shintani, Takashi; Nakamura, Mitsuhiro; Matsuo, Yukinori; Miyabe, Yuki; Mukumoto, Nobutaka; Mitsuyoshi, Takamasa; Iizuka, Yusuke; Mizowaki, Takashi
    Journal of Radiation Research 61 2 325 - 334 2020年 [査読有り]
     
    The aim of this study was to assess the impact of fractional dose and the number of arcs on interplay effects when volumetric modulated arc therapy (VMAT) is used to treat lung tumors with large respiratory motions. A three (fractional dose of 4, 7.5 or 12.5 Gy) by two (number of arcs, one or two) VMAT plan was created for 10 lung cancer cases. The median 3D tumor motion was 17.9 mm (range: 8.2-27.2 mm). Ten phase-specific subplans were generated by calculating the dose on each respiratory phase computed tomography (CT) scan using temporally assigned VMAT arcs. We performed temporal assignment of VMAT arcs using respiratory information obtained from infrared markers placed on the abdomens of the patients during CT simulations. Each phase-specific dose distribution was deformed onto exhale phase CT scans using contour-based deformable image registration, and a 4D plan was created by dose accumulation. The gross tumor volume dose of each 4D plan (4D GTV dose) was compared with the internal target volume dose of the original plan (3D ITV dose). The near-minimum 4D GTV dose (D99%) was higher than the near-minimum 3D internal target volume (ITV) dose, whereas the near-maximum 4D GTV dose (D1%) was lower than the near-maximum 3D ITV dose. However, the difference was negligible, and thus the 4D GTV dose corresponded well with the 3D ITV dose, regardless of the fractional dose and number of arcs. Therefore, interplay effects were negligible in VMAT-based stereotactic body radiation therapy for lung tumors with large respiratory motions.
  • 松尾 幸憲
    肺癌 59 Suppl. 1104 - 1106 (NPO)日本肺癌学会 2019年11月
  • Yukinori Matsuo
    International Journal of Radiation Oncology Biology Physics 105 1 E525 - E526 2019年09月 [査読有り]
  • Masatsugu Hamaji; Yukinori Matsuo; Toyofumi Fengshi Chen-Yoshikawa; Takashi Mizowaki; Hiroshi Date
    Journal of thoracic disease 11 Suppl 13 S1646-S1652  2019年08月 [査読有り]
     
    Observational or randomized studies on survival outcome following surgery versus stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) demonstrated various results, and several meta-analyses on this topic have been published. The PubMed database was queried for meta-analyses comparing surgery and SBRT for early stage NSCLC. Six meta-analyses on this comparison were identified and 4 (66.7%) suggested that surgery be associated with significantly more favorable overall survival than SBRT, using odds ratio or hazard ratio (HR) as measures of effect. Most of the included studies in the meta-analyses were observational studies and those meta-analyses should be interpreted with caution.
  • Yukinori Matsuo
    Journal of thoracic disease 11 Suppl 9 S1420-S1422  2019年05月 [査読有り]
  • Yukinori Matsuo
    Medical Physics 2019年 [査読有り]
  • Yukinori Matsuo
    Radiotherapy and Oncology 2019年 [査読有り]
  • Iizuka, Y.; Nakamura, M.; Kozawa, S.; Mitsuyoshi, T.; Matsuo, Y.; Mizowaki, T.
    European Journal of Radiology 117 120 - 125 2019年 [査読有り]
     
    PURPOSE: We compared image quality and volume of a moving simulated tumour and of lung tumours in patients who were treated with stereotactic body radiotherapy (SBRT) in a 16-row multi-detector CT (MDCT) versus a 320-row area-detector CT (ADCT). Tumour volumes in each respiratory phase were also evaluated. MATERIALS AND METHODS: We acquired static and four-dimensional CT (4DCT) images of a moving phantom with 10- and 30-mm amplitudes with three periods of patterns (2, 4, and 6 s). Breath-hold and 4DCT images were acquired for 12 lung tumour patients who underwent SBRT. Image data were acquired via MDCT and ADCT. The tumours were delineated in each respiratory phase and their volumes in end-expiratory/end-inspiratory phase and mid-respiratory phase were compared. RESULTS: In the phantom study, tumour volumes were smaller and closer to the static image when evaluated by ADCT than by MDCT. In the clinical study, average tumour volumes ± standard deviations were 9.58 ± 1.07 cm3 with MDCT (2.5-mm slice), and 7.12 ± 0.23 cm3 with ADCT (p < 0.01). Tumour volumes were closer to that of the breath hold CT in all patients evaluated by ADCT than by MDCT. Unlike MDCT, tumour volumes acquired by ADCT were smaller in end-expiratory or end-inspiratory phase than in the mid-respiratory phase. CONCLUSIONS: Tumour volumes in each of the respiratory phases in ADCT were significantly smaller and closer to the static image than the corresponding volumes in MDCT. This suggests that treated volume can be reduced if ADCT is used in treatment planning.
  • Kawamura, M.; Yoshimura, M.; Asada, H.; Nakamura, M.; Matsuo, Y.; Mizowaki, T.
    Radiation Oncology 14 1 14 - 14 2019年 [査読有り]
     
    BACKGROUND AND PURPOSE: We created a scoring system incorporating dosimetric and clinical factors to assess the risk of severe, acute skin reactions in patients undergoing intensity-modulated radiation therapy (IMRT) to treat head and neck cancer (HNC). MATERIALS AND METHODS: A total of 101 consecutive patients who received definitive IMRT or volumetric modulated arc therapy (VMAT) with a prescription dose of 70 Gy to treat HNC between 2013 and 2017 in our hospital were enrolled. Skin V5Gy, V10Gy, V20Gy, V30Gy, V40Gy, V50Gy, and V60Gy values delivered 5 mm within the body contour were compared between patients with Grades 1-2 and Grade 3 dermatitis. A scoring system was created based on logistic regression analysis (LRA) that identified the most significant dosimetric and clinical factors. RESULTS: The V60Gy was significantly associated with radiation dermatitis grade in both LRA and recursive partitioning analysis (RPA). A scoring system incorporating the V60Gy, concurrent chemotherapy status, age, and body mass index was used to divide all patients into three subgroups (0-1, 2-3, and 4-6 points) in the RPA. The incidence of Grade 3 dermatitis significantly differed among the subgroups (0, 20.5, and 58.6%, respectively, P < 0.01). CONCLUSIONS: A risk analysis model incorporating dose-volume parameters successfully predicted acute skin reactions and will aid in the appropriate management of radiation dermatitis.
  • Matsuo, Y.
    Journal of Thoracic Disease 11 Suppl 3 S443-S445 - S445 2019年 [査読有り]
  • Rikiya Onimaru; Hiroshi Onishi; Gakuto Ogawa; Masahiro Hiraoka; Satoshi Ishikura; Katsuyuki Karasawa; Yukinori Matsuo; Masaki Kokubo; Yoshiyuki Shioyama; Haruo Matsushita; Yoshinori Ito; Hiroki Shirato
    Japanese journal of clinical oncology 48 12 1076 - 1082 2018年12月 [査読有り]
     
    Purpose: A dose escalation study to determine the recommended dose with stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinomas (JCOG0702) was conducted. The purpose of this paper is to report the survival and the late toxicities of JCOG0702. Materials and methods: The continual reassessment method was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose. The starting dose was 40 Gy in four fractions at D95 of PTV. Results: Twenty-eight patients were enrolled. Ten patients were treated with 40 Gy at D95 of PTV, four patients with 45 Gy, eight patients with 50 Gy, one patient with 55 Gy and five patients with 60 Gy. Ten patients were alive at the last follow-up. Overall survival (OS) for all patients was 67.9% (95% CI 47.3-81.8%) at 3 years and 40.8% (95% CI 22.4-58.5%) at 5 years. No Grade 3 or higher toxicity was observed after 181 days from the beginning of the SBRT. Compared to the toxicities up to 180 days, chest wall related toxicities were more frequent after 181 days. Conclusions: The 5-year OS of 40.8% indicates the possibility that SBRT for peripheral T2N0M0 non-small cell lung cancer is superior to conventional radiotherapy. The effect of the SBRT dose escalation on OS is unclear and further studies are warranted.
  • Akira Nakamura; Masahiro Hiraoka; Satoshi Itasaka; Mitsuhiro Nakamura; Mami Akimoto; Yoshitomo Ishihara; Nobutaka Mukumoto; Yoko Goto; Takahiro Kishi; Michio Yoshimura; Yukinori Matsuo; Shinsuke Yano; Takashi Mizowaki
    Scientific reports 8 1 17096 - 17096 2018年11月 [査読有り]
     
    Intensity-modulated radiotherapy (IMRT) is now regarded as an important treatment option for patients with locally advanced pancreatic cancer (LAPC). To reduce the underlying tumor motions and dosimetric errors during IMRT as well as the burden of respiratory management for patients, we started to apply a new treatment platform of the dynamic tumor dynamic tumor-tracking intensity-modulated radiotherapy (DTT-IMRT) using the gimbaled linac, which can swing IMRT toward the real-time tumor position under patients' voluntary breathing. Between June 2013 and March 2015, ten patients were treated, and the tumor-tracking accuracy and the practical benefits were evaluated. The mean PTV size in DTT-IMRT was 18% smaller than a conventional ITV-based PTV. The root-mean-squared errors between the predicted and the detected tumor positions were 1.3, 1.2, and 1.5 mm in left-right, anterior-posterior, and cranio-caudal directions, respectively. The mean in-room time was 24.5 min. This high-accuracy of tumor-tracking with reasonable treatment time are promising and beneficial to patients with LAPC.
  • Takamasa Mitsuyoshi; Yukinori Matsuo; Takashi Shintani; Yusuke Iizuka; Nami Ueki; Mitsuhiro Nakamura; Takashi Mizowaki
    Clinical Lung Cancer 19 3 e287 - e296 2018年05月 [査読有り]
     
    This pilot study evaluated the safety and efficacy of a dose escalation method with steep dose gradients using stereotactic body radiotherapy for peripheral lung tumors. The rate of grade 2 or higher radiation pneumonitis within 1 year was almost 10%. This dose escalation method was safe and effective for peripheral lung tumors and may obtain excellent local control rates. Background: This pilot study aimed to evaluate the safety and efficacy of a dose escalation method for the treatment of peripheral lung tumors by administrating steep dose gradients in the target volumes via stereotactic body radiotherapy (SBRT). Patients and Methods: Patients with peripheral lung tumors were enrolled onto this study and treated with SBRT using a total dose of 70 Gy in 4 fractions at target isocenter, covering the planning target volume surface with 70% of the isodose. The primary end point was the rate of grade 2 or higher radiation pneumonitis (RP) within 1 year. Results: A total of 35 patients were enrolled onto this study between September 2014 and January 2016. Thirty-two patients with primary lung cancers and 3 patients with lung metastases were treated with SBRT. Grade 2 RP was observed in 4 patients within 1 year. No severe RP (grade 3 or higher) was observed within the follow-up period. The median follow-up period was 21.2 months (range, 4.2-31.7 months). Local recurrence was observed in a single patient with lung metastasis. No local recurrence was observed within the follow-up period in the 32 patients with primary lung cancer. The local control and overall survival rates at 2 years were 95.7% (95% confidence interval, 72.9-99.4) and 85.2% (95% confidence interval, 67.8-93.6), respectively. Conclusion: This dose escalation method with steep dose gradients using SBRT for peripheral lung tumors was safe in the subacute phases. These results also suggest that this method can obtain excellent local control rates.
  • Hiraku Iramina; Mitsuhiro Nakamura; Yusuke Iizuka; Takamasa Mitsuyoshi; Yukinori Matsuo; Takashi Mizowaki; Ikuo Kanno
    Radiation Oncology 13 1 73  2018年04月 [査読有り]
     
    Background: During therapeutic beam irradiation, an unvisualized three-dimensional (3D) target position should be estimated using an external surrogate with an estimation model. Training periods for the developed model with no additional imaging during beam irradiation were optimized using clinical data. Methods: Dual-source 4D-CBCT projection data for 20 lung cancer patients were used for validation. Each patient underwent one to three scans. The actual target positions of each scan were equally divided into two equal parts: one for the modeling and the other for the validating session. A quadratic target position estimation equation was constructed during the modeling session. Various training periods for the session-i.e., modeling periods (T M)-were employed: T M ε(5,10,15,25,35) [s]. First, the equation was used to estimate target positions in the validating session of the same scan (intra-scan estimations). Second, the equation was then used to estimate target positions in the validating session of another temporally different scan (inter-scan estimations). The baseline drift of the surrogate and target between scans was corrected. Various training periods for the baseline drift correction-i.e., correction periods (T Cs)-were employed: T C ε (5,10,15 T C ≤ T M) [s]. Evaluations were conducted with and without the correction. The difference between the actual and estimated target positions was evaluated by the root-mean-square error (RMSE). Results: The range of mean respiratory period and 3D motion amplitude of the target was 2.4-13.0 s and 2.8-34.2 mm, respectively. On intra-scan estimation, the median 3D RMSE was within 1.5-2.1 mm, supported by previous studies. On inter-scan estimation, median elapsed time between scans was 10.1 min. All T Ms exhibited 75th percentile 3D RMSEs of 5.0-6.4 mm due to baseline drift of the surrogate and the target. After the correction, those for each T Ms fell by 1.4-2.3 mm. The median 3D RMSE for both the 10-s T M and the T C period was 2.4 mm, which plateaued when the two training periods exceeded 10 s. Conclusions: A widely-applicable estimation model for the 3D target positions during beam irradiation was developed. The optimal T M and T C for the model were both 10 s, to allow for more than one respiratory cycle.
  • Masatsugu Hamaji; Takamasa Mitsuyoshi; Akihiko Yoshizawa; Toshihiko Sato; Yukinori Matsuo; Toyofumi-Fengshi Chen-Yoshikawa; Makoto Sonobe; Takashi Mizowaki; Hiroshi Date
    Annals of Thoracic Surgery 105 4 e165 - e168 2018年04月 [査読有り]
     
    Although several studies have evaluated the local control and survival outcomes in patients undergoing stereotactic body radiotherapy (SBRT) for pulmonary oligometastases, little data are available on the management of local relapse. Here, we present 3 patients who underwent lobectomy and mediastinal lymph node dissection as salvage pulmonary metastasectomy for local relapse after SBRT. The postoperative course has been uneventful for all 3 patients, with no evidence of disease at 40, 51, and 6 months from the salvage metastasectomy. Our experience suggests that salvage pulmonary metastasectomy may be associated with local control and long-term survival in carefully selected patients.
  • Yukinori Matsuo
    Translational Lung Cancer Research 7 Suppl 2 S111 - S113 2018年04月 [査読有り]
  • Takashi Shintani; Yukinori Matsuo; Yusuke Iizuka; Takamasa Mitsuyoshi; Takashi Mizowaki
    International Journal of Radiation Oncology Biology Physics 100 5 1228 - 1236 2018年04月 [査読有り]
     
    Purpose: To assess the local recurrence (LR) rate and timing after stereotactic body radiation therapy (SBRT) for non-small cell lung cancer using long-term follow-up data from a single institution. Methods and Materials: Patients with primary or recurrent non-small cell lung cancer with or without pathologic verification, with tumors < 3 cm, treated with SBRT (isocenter prescription of 48 Gy in 4 fractions) between April 1998 and August 2014, and with > 6 months’ follow-up were eligible. The LR rate was calculated by the cumulative incidence function, accounting for death as a competing risk. Univariate and multivariate analyses were performed to identify prognostic factors for LR. Results: A total of 216 patients and 230 tumors were analyzed. The median follow-up time of tumors without LR was 3.9 years, and the crude number of LR cases was 49 (21%). The actuarial rate of LR was 19% (95% confidence interval, 14%-25%) at 5 years. The number of LR cases in each period was 10 in year 1, 17 in year 2, 9 in year 3, 3 in year 4, 3 in year 5, and 7 after 5 years. Among 73 tumors with > 5 years’ follow-up, we observed 7 late LRs. The tumor histology of these late LRs was adenocarcinoma in 3, squamous cell carcinoma in 2, and unknown in 2 (1 of the unknown cases was confirmed as adenocarcinoma following salvage surgery). The median time to LR was 2.1 years (interquartile range, 1.5-4.2 years) for adenocarcinoma compared with 1.3 years (interquartile range, 1.0-2.3 years) for squamous cell carcinoma. Multivariate analysis revealed that larger tumor size, squamous cell histology compared with adenocarcinoma, and use of abdominal compression for respiratory motion management were independent negative prognostic factors for LR. Conclusions: Long-term follow-up data demonstrated that late LR was not uncommon and that careful follow-up after SBRT is needed, especially in patients with adenocarcinoma.
  • Mitsuhiro Nakamura; Yoshitomo Ishihara; Yukinori Matsuo; Yusuke Iizuka; Nami Ueki; Hiraku Iramina; Hideaki Hirashima; Takashi Mizowaki
    Journal of radiation research 59 2 173 - 181 2018年03月 [査読有り]
     
    Knowledge of the imaging doses delivered to patients and accurate dosimetry of the radiation to organs from various imaging procedures is becoming increasingly important for clinicians. The purposes of this study were to calculate imaging doses delivered to the organs of lung cancer patients during real-time tumor tracking (RTTT) with three-dimensional (3D), and four-dimensional (4D) cone-beam computed tomography (CBCT), using Monte Carlo techniques to simulate kV X-ray dose distributions delivered using the Vero4DRT. Imaging doses from RTTT, 3D-CBCT and 4D-CBCT were calculated with the planning CT images for nine lung cancer patients who underwent stereotactic body radiotherapy (SBRT) with RTTT. With RTTT, imaging doses from correlation modeling and from monitoring of imaging during beam delivery were calculated. With CBCT, doses from 3D-CBCT and 4D-CBCT were also simulated. The doses covering 2-cc volumes (D2cc) in correlation modeling were up to 9.3 cGy for soft tissues and 48.4 cGy for bone. The values from correlation modeling and monitoring were up to 11.0 cGy for soft tissues and 59.8 cGy for bone. Imaging doses in correlation modeling were larger with RTTT. On a single 4D-CBCT, the skin and bone D2cc values were in the ranges of 7.4-10.5 cGy and 33.5-58.1 cGy, respectively. The D2cc from 4D-CBCT was approximately double that from 3D-CBCT. Clinicians should Figure that the imaging dose increases the cumulative doses to organs.
  • Yukinori Matsuo
    International Journal of Radiation Oncology Biology Physics 2018年
  • Yukinori Matsuo
    Journal of Thoracic Oncology 2018年
  • Takamasa Mitsuyoshi; Yukinori Matsuo; Hitoshi Itou; Takashi Shintani; Yusuke Iizuka; Young Hak Kim; Takashi Mizowaki
    Journal of Radiation Research 59 1 50 - 57 2018年01月 [査読有り]
     
    Systemic inflammation and poor nutritional status have a negative effect on the outcomes of cancer. Here, we analyzed the effects of the pretreatment inflammatory and nutritional status on clinical outcomes of locally advanced non-small-cell lung cancer (NSCLC) patients treated with chemoradiotherapy. We retrospectively reviewed 89 patients with locally advanced NSCLC treated with chemoradiotherapy between July 2006 and June 2013. Serum C-reactive protein (CRP) was assessed as an inflammatory marker, and serum albumin, body mass index (BMI) and skeletal mass index were assessed as nutritional status markers. The relationships between these markers and overall survival (OS) were assessed. The median OS was 24.6 months [95% confidence interval (CI): 19.4-39.3 months]. During follow-up, 58 patients (65%) had disease recurrence and 52 patients (58%) died. In multivariate Cox hazard analysis, CRP levels and BMI approached but did not achieve a significant association with OS (P = 0.062 and 0.094, respectively). Recursive partitioning analysis identified three prognostic groups based on hazard similarity (CRP-BMI scores): 0 = CRP < 0.3 mg/dl, 1 = CRP = 0.3 mg/dl and BMI = 18.5 kg/m2, and 2 = CRP = 0.3 mg/dl and BMI < 18.5 kg/m2. The CRP-BMI score was significantly associated with OS (P = 0.023). Patients with scores of 0, 1 and 2 had median OS of 39.3, 24.5 and 14.5 months, respectively, and the scores also predicted the probability of receiving salvage treatment after recurrence. The CRP-BMI score is thus a simple and useful prognostic marker of clinical outcome for patients with locally advanced NSCLC treated with chemoradiotherapy.
  • Yukinori Matsuo; Takamasa Mitsuyoshi; Takashi Shintani; Yusuke Iizuka; Takashi Mizowaki
    Journal of Geriatric Oncology 9 6 589 - 593 2018年 [査読有り]
     
    Purpose: The purpose of the present study was to retrospectively evaluate impact of pre-treatment skeletal muscle mass (SMM) on overall survival and non-lung cancer mortality after stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC). Methods and Materials: One-hundred and eighty-six patients whose abdominal CT before the treatment was available were enrolled into this study. The patients were divided into two groups of SMM according to gender-specific thresholds for unilateral psoas area. Operability was judged by the treating physician or thoracic surgeon after discussion in a multi-disciplinary tumor board. Results: Patients with low SMM tended to be elderly and underweight in body mass index compared with the high SMM. Overall survival in patients with the low SMM tended to be worse than that in the high SMM (41.1% and 55.9% at 5 years, P = 0.115). Cumulative incidence of non-lung cancer death was significantly worse in the low SMM (31.3% at 5 years compared with 9.7% in the high SMM, P = 0.006). Multivariate analysis identified SMM and operability as significant factors for non-lung cancer mortality. Impact of SMM on lung cancer death was not significant. No difference in rate of severe treatment-related toxicity was observed between the SMM groups. Conclusion: Low SMM is a significant risk factor for non-lung cancer death, which might lead to worse overall survival, after SBRT for stage I NSCLC. However, the low SMM does not increase lung cancer death or severe treatment-related toxicity.
  • Shioyama Y; Onishi H; Takayama K; Matsuo Y; Takeda A; Yamashita H; Miyakawa A; Murakami N; Aoki M; Matsushita H; Matsumoto Y; Shibamoto Y; Japanese Radiological; Society Multi-Institutional SBRT Study Group; JRS-SBRTSG
    Technology in cancer research & treatment 17 1533033818783904  2018年01月 [査読有り]
     
    Stereotactic body radiotherapy (SBRT) is widely used as a curative treatment option for stage I non-small-cell lung cancer, but for patients with stage I small-cell lung cancer, the role of stereotactic body radiotherapy is unclear. In this study, we retrospectively analyzed the outcomes of a subset of patients with stage I small-cell lung cancer treated with stereotactic body radiotherapy in the database of the Japanese Radiological Society-Multi-Institutional stereotactic body radiotherapy Study Group. The 43 patients treated with stereotactic body radiotherapy for stage I small-cell lung cancer between 2004 and 2012 at 11 Japanese institutions were studied: median age = 77 years; 32 (74%) males and 11 females; and 80% were medically inoperable. The clinical stage was IA in 31 and IB in 12. In all patients, the lung tumors were pathologically proven as small-cell lung cancer. A total dose of 48 to 60 Gy was administered in 4 to 8 fractions. The median biologically effective dose (alpha/beta = 10 Gy) was 105.6 Gy. Chemotherapy and prophylactic cranial irradiation were administered in only 8 patients, respectively. The median follow-up time was 23.2 months. The 2-year overall survival, progression-free survival, and distant metastasis-free survival rates were 72.3%, 44.6%, and 47.2%, respectively. The 2-year local control was 80.2%. Regarding the patterns of failure, distant metastasis, lymph node metastasis, and local recurrence were observed in 47%, 28%, and 16% of patients, respectively. No >= grade 3 stereotactic body radiotherapy-related toxicities were observed. Although stereotactic body radiotherapy was thus revealed to be effective for the local control of stage I small-cell lung cancer, the incidence of distant metastases was high. Further investigations of larger cohorts are needed, including analyses of the effects of combined chemotherapy.
  • Onishi, H.; Yamashita, H.; Shioyama, Y.; Matsumoto, Y.; Takayama, K.; Matsuo, Y.; Miyakawa, A.; Matsushita, H.; Aoki, M.; Nihei, K.; Kimura, T.; Ishiyama, H.; Murakami, N.; Nakata, K.; Takeda, A.; Uno, T.; Nomiya, T.; Takanaka, T.; Seo, Y.; Komiyama, T.; Marino, K.; Aoki, S.; Saito, R.; Araya, M.; Maehata, Y.; Tominaga, L.; Kuriyama, K.
    Cancers 10 8 2018年 [査読有り]
     
    Pretreatment pulmonary interstitial change (PIC) has been indicated as a risk factor of severe radiation pneumonitis (RP) following stereotactic body radiation therapy (SBRT) for early-stage lung cancer, but details of its true effect remain unclear. This study aims to evaluate treatment outcomes of SBRT for stage I non-small cell lung cancer in patients with PIC. A total of 242 patients are included in this study (88% male). The median age is 77 years (range, 55⁻92 years). A total dose of 40⁻70 Gy is administered in 4 to 10 fractions during a 4-to-25 day period. One, two, and three-year overall survival (OS) rates are 82.1%, 57.1%, and 42.6%, respectively. Fatal RP is identified in 6.9% of all patients. The percent vital capacity <70%, mean percentage normal lung volume receiving more than 20 Gy (>10%), performance status of 2⁻4, presence of squamous cell carcinoma, clinical T2 stage, regular use of steroid before SBRT, and percentage predicting forced expiratory volume in one second (<70%) are associated with worse prognoses for OS. Our results indicate that fatal RP frequently occurs after SBRT for stage I lung cancer in patients with PIC.
  • Yukinori Matsuo
    Technology in cancer research & treatment 17 1533033818798633 - 1533033818798633 2018年01月 [査読有り]
     
    PURPOSE: The purpose of this review article was to summarize available data on the efficacy and safety of salvage radiotherapy for isolated local or regional recurrence after prior stereotactic body radiotherapy for lung cancer. METHODS: Studies were systematically searched on PubMed, following which suitable papers were selected. Reported outcomes and toxicities were qualitatively reviewed. RESULTS: Nineteen papers, which were retrospective studies based on single institution experiences, were selected. Sixteen papers were on salvage radiotherapy for local tumor recurrence, and the remaining 3 papers evaluated radiotherapy for regional failures after stereotactic body radiotherapy for lung cancer. Patient cohorts in the selected papers seemed very frail with 2-year survival of 30% to 40% after the salvage. Local control was reported to be approximately 60% to 70%, which is worse than that after primary stereotactic body radiotherapy. Reported rates of toxicity grade 3 or worse were considered acceptable. Larger target volume and central tumor localization were suggested as risk factors for severe toxicities. Dosimetric data on patients having toxicities were found to help with considering dose constraints for organs at risk. CONCLUSION: Based on data from a limited number of articles, salvage radiotherapy is a reasonable treatment option for select patients with local or regional tumor recurrence after prior stereotactic body radiotherapy for lung cancer. Optimal patient selection and dose prescription can be clarified with a larger study that include more data on experiences with salvage radiotherapy.
  • Hiroshi Onishi; Kan Marino; Hideomi Yamashita; Atsuro Terahara; Rikiya Onimaru; Masaki Kokubo; Yoshiyuki Shioyama; Takuyo Kozuka; Yukinori Matsuo; Takashi Aruga; Masahiro Hiraoka
    Technology in cancer research & treatment 17 1533033818801323 - 1533033818801323 2018年01月 [査読有り]
     
    The purpose of this study was to examine the characteristics and treatment plans of patients who experienced fatal radiation pneumonitis after stereotactic body radiation therapy for primary or oligometastatic lung cancer. Records of 1789 patients treated with stereotactic body radiation therapy for primary or oligometastatic lung cancer were retrospectively reviewed to identify those who developed fatal radiation pneumonitis. Twenty-three (1.3%; 18 men and 5 women) patients developed fatal radiation pneumonitis after stereotactic body radiation therapy for lung cancer; their median age was 74 years. The mean Krebs von den Lungen-6 level and percent vital capacity were 1320 U/mL and 82%, respectively. Prestereotactic body radiation therapy computed tomography revealed pulmonary interstitial change in 14 (73.7%) of 19 patients in whom computed tomography data could be reviewed. Seven (30.4%) of 23 patients had regularly used steroids. The median time duration between stereotactic body radiation therapy commencement and pneumonia symptom appearance was 75 (range: 14-204) days. Median survival time following pneumonia symptom appearance was 53 (range: 4-802) days. The 6- and 12-month overall survival rates were 34.8% and 13.0%, respectively. The 6-month overall survival rates in patients with and without heart disease were 50.0%, 16.7%, and 46.7% for heart disease existence, respectively. There were 4 patients in whom fatal radiation pneumonitis occurred within 2 months after stereotactic body radiation therapy and who died within 1 month. Three of them had no pulmonary interstitial change before stereotactic body radiation therapy, but had heart disease. In summary, the survival time in this case series was generally short but varied widely. More than half of the patients had pulmonary interstitial change before stereotactic body radiation therapy, although immediately progressive fatal radiation pneumonitis was also observed in patients without pulmonary interstitial change. True risk factors for fatal radiation pneumonitis should be examined in a prospective study with a larger cohort.
  • Yusuke Tsuruta; Mitsuhiro Nakamura; Yuki Miyabe; Manabu Nakata; Yoshitomo Ishihara; Nobutaka Mukumoto; Mami Akimoto; Tomohiro Ono; Shinsuke Yano; Kyoji Higashimura; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka
    PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS 44 86 - 95 2017年12月 [査読有り]
     
    Purpose: To verify lung stereotactic body radiotherapy (SBRT) plans using a secondary treatment planning system (TPS) as an independent method of verification and to define tolerance levels (TLs) in lung SBRT between the primary and secondary TPSs. Methods: A total of 147 lung SBRT plans calculated using X-ray voxel Monte Carlo (XVMC) were exported from iPlan to Eclipse in DICOM format. Dose distributions were recalculated using the Acuros XB (AXB) and the anisotropic analytical algorithm (AAA), while maintaining monitor units (MUs) and the beam arrangement. Dose to isocenter and dose-volumetric parameters, such as D-2, D-50, D-95 and D-98, were evaluated for each patient. The TLs of all parameters between XVMC and AXB (TLAXB) and between XVMC and AAA (TLAAA) were calculated as the mean +/- 1.96 standard deviations. Results: AXB values agreed with XVMC values within 3.5% for all dosimetric parameters in all patients. By contrast, AAA sometimes calculated a 10% higher dose in PTV D-95 and D-98 than XVMC. The TLAXB and TLAAA of the dose to isocenter were -0.3 +/- 1.4% and 0.6 +/- 2.9%, respectively. Those of D-95 were 1.3 +/- 1.8% and 1.7 +/- 3.6%, respectively. Conclusions: This study quantitatively demonstrated that the dosimetric performance of AXB is almost equal to that of XVMC, compared with that of AAA. Therefore, AXB is a more appropriate algorithm for an independent verification method for XVMC. (C) 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
  • 松尾 幸憲
    診断と治療 105 11 1405 - 1409 (株)診断と治療社 2017年11月 
    ＜Headline＞ 1 放射線治療のおもな適応は、早期肺がんに対する体幹部定位放射線治療、局所進行がんに対する化学放射線療法および転移がんに対する緩和照射である。転移性脳腫瘍の治療にあたっては、予後に応じた治療法選択が必要である。2 体幹部定位放射線治療は、標準手術不能のI期症例においては標準治療に位置づけられる。高齢などの理由で手術を希望されない場合や、医学的な理由で縮小手術しか耐容できない症例においても検討される 3 局所進行がんに対する化学放射線療法では、プラチナ製剤を含む2剤以上の化学療法とともに放射線治療60Gy以上の投与が標準治療とされる 4 体幹部定位放射線治療および強度変調放射線治療は、近年肺がんへの適用が広がっている。前者は優れた局所制御、後者は有害事象の低減を得るのに有用である。陽子線治療の肺がんにおける有用性は今後の検討課題である。(著者抄録)
  • Tomoki Kimura; Yasushi Nagata; Hideyuki Harada; Shinya Hayashi; Yukinori Matsuo; Tsuyoshi Takanaka; Masaki Kokubo; Kenji Takayama; Hiroshi Onishi; Koichi Hirakawa; Yoshiyuki Shioyama; Takeshi Ehara
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 22 5 849 - 856 2017年10月 [査読有り]
     
    To investigate the maximum tolerated dose (MTD) and recommended dose (RD) of stereotactic body radiation therapy (SBRT) for centrally located stage IA non-small cell lung cancer (NSCLC). Five dose levels, ranging from of 52 to 68 Gy in eight fractions, were determined; the treatment protocol began at 60 Gy (level 3). Each dose level included 10 patients. Levels 1-2 were indicated if more than four patients exhibited dose-limiting toxicity (DLT), which was defined as an occurrence of a grade 3 (or worse) adverse effect within 12 months after SBRT initiation. MTD was defined as the lowest dose level at which more than four patients exhibited DLT. Ten patients were enrolled in the level 3 study. One patient was considered unsuitable because of severe emphysema. Therefore, nine patients were evaluated and no patient exhibited DLT. The level 3 results indicated that we should proceed to level 4 (64 Gy). However, due to the difficulty involved in meeting the dose constraints, further dose escalation was not feasible and the MTD was found to be 60 Gy. The RD of SBRT for centrally located stage IA NSCLC was 60 Gy in eight fractions.
  • Takashi Shintani; Yukinori Matsuo; Yusuke Iizuka; Takamasa Mitsuyoshi; Takashi Mizowaki; Masahiro Hiraoka
    ANTICANCER RESEARCH 37 9 5161 - 5167 2017年09月 [査読有り]
     
    Background/Aim: To examine the prognostic significance of serum carcinoembryonic antigen (CEA) for stage I non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). Patients and Methods: In total, 129 stage I NSCLC patients were analyzed and divided into two groups: CEA-High (CEA> 5 ng/ml) and CEA-Low (CEA <= 5 ng/ml). Results: Median follow-up time was 38 months. Overall survival was not significantly different between CEA-High (n= 47) and CEA-Low (n= 82) patients (57% vs. 63% at 3 years; p= 0.39), although progression-free survival (PFS) was significantly worse in CEA-High patients (31% vs. 51% at 3 years; p= 0.01). Larger tumor size and high CEA level were independent prognostic factors for worse PFS. Failure pattern analysis showed that regional node or distant recurrence was more common in CEA-High patients (47%) than in CEA-Low patients (29%). Conclusion: Patients with CEA-High stage I NSCLC have a higher risk of regional or systemic relapse and should be followed-up carefully.
  • 松尾 幸憲
    日本臨床 75 8 1172 - 1176 (株)日本臨床社 2017年08月
  • Nobutaka Mukumoto; Mitsuhiro Nakamura; Mami Akimoto; Yuki Miyabe; Kenji Yokota; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka
    MEDICAL PHYSICS 44 8 3899 - 3908 2017年08月 [査読有り]
     
    Purpose: To explore the effect of sampling interval of training data acquisition on the intrafractional prediction error of surrogate signal-based dynamic tumor-tracking using a gimbal-mounted linac. Materials and methods: Twenty pairs of respiratory motions were acquired from 20 patients (ten lung, five liver, and five pancreatic cancer patients) who underwent dynamic tumor-tracking with the Vero4DRT. First, respiratory motions were acquired as training data for an initial construction of the prediction model before the irradiation. Next, additional respiratory motions were acquired for an update of the prediction model due to the change of the respiratory pattern during the irradiation. The time elapsed prior to the second acquisition of the respiratory motion was 12.6 +/- 3.1 min. A four-axis moving phantom reproduced patients' three dimensional (3D) target motions and one dimensional surrogate motions. To predict the future internal target motion from the external surrogate motion, prediction models were constructed by minimizing residual prediction errors for training data acquired at 80 and 320 ms sampling intervals for 20 s, and at 500, 1,000, and 2,000 ms sampling intervals for 60 s using orthogonal kV x-ray imaging systems. The accuracies of prediction models trained with various sampling intervals were estimated based on training data with each sampling interval during the training process. The intrafractional prediction errors for various prediction models were then calculated on intrafractional monitoring images taken for 30 s at the constant sampling interval of a 500 ms fairly to evaluate the prediction accuracy for the same motion pattern. In addition, the first respiratory motion was used for the training and the second respiratory motion was used for the evaluation of the intrafractional prediction errors for the changed respiratory motion to evaluate the robustness of the prediction models. Results: The training error of the prediction model was 1.7 +/- 0.7 mm in 3D for all sampling intervals. The intrafractional prediction error for the same motion pattern was 1.9 +/- 0.7 mm in 3D for an 80 ms sampling interval, which increased larger than 1 mm in 10.0% of prediction models trained at a 2,000 ms sampling interval with a significant difference (P < 0.01) and up to 2.5% for the other sampling intervals without a significant difference (P > 0.05). The intrafractional prediction error for the changed respiratory motion pattern increased to 5.1 +/- 2.4 mm in 3D for an 80 ms sampling interval; however, there was not a significant difference in the robustness of the prediction model between the 80 ms sampling interval and other sampling intervals (P > 0.05). Conclusions: Although the training error of the prediction model was consistent for the all sampling intervals, the prediction model using the larger sampling interval of the 2,000 ms increased the intrafractional prediction error for the same motion pattern. The realistic accuracy of the prediction model was difficult to estimate using the larger sampling interval during the training process. It is recommended to construct the prediction model at sampling interval >= 1,000 ms and to reconstruct the model during treatment.
  • Takashi Shintani; Yukinori Matsuo; Yusuke Iizuka; Takamasa Mitsuyoshi; Shigeaki Umeoka; Yuji Nakamoto; Takashi Mizowaki; Kaori Togashi; Masahiro Hiraoka
    EUROPEAN JOURNAL OF RADIOLOGY 92 58 - 63 2017年07月 [査読有り]
     
    Background and purpose: There is no early predictor of treatment response after lung stereotactic body radiotherapy (SBRT). We conducted this pilot study to evaluate whether serial diffusion weighted magnetic resonance imaging (DW-MRI) or positron emission tomography (PET) could predict response after SBRT. Material and methods: Early stage non-small cell lung cancer patients who received SBRT were eligible. DW-MRI and PET were undertaken pretreatment and every 3 months after SBRT in the first year. Patients with <1 year of follow-up were excluded from the analysis. The apparent diffusion coefficient (ADC) value and maximum standardized uptake value (SUVmax) of tumors were measured and compared between groups with or without local recurrence (LR). Results: Fifteen patients were enrolled and the data of 14 patients were analyzed. The median ADC value was significantly lower in patients with LR (n = 3) than in those without LR (n = 11) at 3 and 6 months (1.11 vs. 1.54 and 0.98 vs. 1.69 [x10(-3) mm(2)/s]; p = 0.039 and 0.012, respectively) while there was no significant difference pretreatment and at 9 and 12 months after treatment. No significant difference was observed in the SUVmax at any time point. Conclusions: DW-MRI could be an early predictor of treatment response after lung SBRT.
  • Keiichi Jingu; Yukinori Matsuo; Hiroshi Onishi; Takaya Yamamoto; Masahiko Aoki; Yuji Murakami; Hideomi Yamashita; Hisao Kakuhara; Kenji Nemoto; Toru Sakayauchi; Masahiko Okamoto; Yuzuru Niibe; Yasushi Nagata; Kazuhiko Ogawa
    ANTICANCER RESEARCH 37 5 2709 - 2713 2017年05月 [査読有り]
     
    Aim: To evaluate the efficacy of stereotactic body radiotherapy (SBRT) for pulmonary metastasis from colorectal cancer. Patients and Methods: Data for 104 lesions from 93 patients who underwent SBRT for pulmonary oligometastases from colorectal cancer at ten Institutions were retrospectively analyzed. Toxicity was graded according to the Common Terminology Criteria for Adverse Events v4.0. Results: The median calculated biological effective dose using the linear-quadratic model with alpha/beta of 10 Gy (BED10) was 105.6 Gy. Adjuvant chemotherapy after SBRT was performed in 47 patients. The median observation period was 28 months. The 3- and 5-year local control rates were 65.2% and 56.2%, respectively. The 3- and 5-year overall survival rates were 55.9% and 42.7%, respectively. Only two patients had grade 3 radiation pneumonitis. In multivariate analysis for local control, primary site, age, adjuvant chemotherapy after SBRT and BED10 were selected as prognostic factors. Conclusion: Dose escalation and adjuvant chemotherapy might improve local control in SBRT for pulmonary oligometastases from colorectal cancer.
  • Yoshitomo Ishihara; Mitsuhiro Nakamura; Yuki Miyabe; Nobutaka Mukumoto; Yukinori Matsuo; Akira Sawada; Masaki Kokubo; Takashi Mizowaki; Masahiro Hiraoka
    PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS 35 59 - 65 2017年03月 [査読有り]
     
    Purpose: To develop a four-dimensional (4D) dose calculation system for real-time tumor tracking (RTTT) irradiation by the Vero4DRT. Methods: First, a 6-MV photon beam delivered by the Vero4DRT was simulated using EGSnrc. A moving phantom position was directly measured by a laser displacement gauge. The pan and tilt angles, monitor units, and the indexing time indicating the phantom position were also extracted from a log file. Next, phase space data at any angle were created from both the log file and particle data under the dynamic multileaf collimator. Irradiation both with and without RTTT, with the phantom moving, were simulated using several treatment field sizes. Each was compared with the corresponding measurement using films. Finally, dose calculation for each computed tomography dataset of 10 respiratory phases with the X-ray head rotated was performed to simulate the RTTT irradiation (4D plan) for lung, liver, and pancreatic cancer patients. Dose-volume histograms of the 4D plan were compared with those calculated on the single reference respiratory phase without the gimbal rotation [three-dimensional (3D) plan]. Results: Differences between the simulated and measured doses were less than 3% for RTTT irradiation in most areas, except the high-dose gradient. For clinical cases, the target coverage in 4D plans was almost identical to that of the 3D plans. However, the doses to organs at risk in the 4D plans varied at intermediate-and low-dose levels. Conclusions: Our proposed system has acceptable accuracy for RTTT irradiation in the Vero4DRT and is capable of simulating clinical RTTT plans. (C) 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
  • Wambaka Ange Mampuya; Yukinori Matsuo; Akira Nakamura; Masahiro Hiraoka
    JOURNAL OF RADIATION RESEARCH 58 2 217 - 224 2017年03月 [査読有り]
     
    This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and < 0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.
  • Onimaru R; Onishi H; Shibata T; Hiraoka M; Ishikura S; Karasawa K; Matsuo Y; Kokubo M; Shioyama Y; Matsushita H; Ito Y; Shirato H
    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 122 2 281 - 285 2017年02月 [査読有り]
     
    Purpose: A dose escalation study to determine the recommended dose (RD) with stereotactic body radiation therapy (SBRT) for peripheral T2NOMO non-small cell carcinomas (NSCLC) was conducted. The results of the group with PTV 100 cc are reported in this paper. Materials and methods: The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose (MTD). Dose limiting toxicity (DLT) was Grade 3 or higher radiation pneumonitis (RP), and Grade 2 or higher RP was used as a surrogate DLT. The RD was equal to the MID. The dose was prescribed at D-95 of the PTV. Results: Thirteen patients were accrued. More patients should have been enrolled but we decided not to prolong the study period. No patients experienced Grade 3 RP. Two patients experienced Grade 2 RP at 50 Gy in 4 fractions. The predicted MTD was 50.2 Gy. The posterior probability of the Grade 2 RP frequency over 40% was 5.3% for the dose level of 50 Gy. The RD was determined to be 50 Gy. Conclusions: The RD was determined to be 50 Gy in 4 fractions in this population. (c) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Yukinori Matsuo
    2017年
  • Yukinori Matsuo
    Journal of Thoracic Oncology 2017年
  • Yukinori Matsuo
    Radiotherapy and Oncology 2017年
  • Yukinori Matsuo
    Journal of Thoracic Oncology 2017年
  • Iizuka, Y.; Matsuo, Y.; Nakamura, M.; Kozawa, S.; Ueki, N.; Mitsuyoshi, T.; Mizowaki, T.; Hiraoka, M.
    Physics and Imaging in Radiation Oncology 4 2017年 [査読有り]
  • Hamaji M; Chen-Yoshikawa TF; Matsuo Y; Motoyama H; Hijiya K; Menju T; Aoyama A; Sato T; Sonobe M; Date H
    Journal of visualized surgery 3 86  2017年 [査読有り]
  • Yukinori Matsuo; Keiko Shibuya; Kenichi Okubo; Nami Ueki; Akihiro Aoyama; Makoto Sonobe; Mitsuhiro Nakamura; Takashi Mizowaki; Hiroshi Date; Masahiro Hiraoka
    ACTA ONCOLOGICA 56 7 957 - 962 2017年 [査読有り]
     
    Background: The purpose was to evaluate safety and efficacy of intensity-modulated radiotherapy (IMRT) following extra-pleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM).Material and methods: Patients with MPM of clinical stage I-III, which were macroscopic completely resected with EPP were eligible for this prospective study. The ipsilateral hemithorax was irradiated with a prescribed dose of 50.4Gy. When the high-risk surgical margins or FDG-avid regions were identified, simultaneous integrated boost (SIB) with 56.0Gy or 61.6Gy was applied.Results: Twenty-one patients were enrolled. SIB was applied to five patients. The planned IMRT fractions were completed in all, but four patients who suffered from severe fatigue or radiation pneumonitis. With a potential median follow-up of 6.3 years, overall survival was 37.5% at 3 years since the IMRT. The median survival time was 17.5 and 27.0 months since the IMRT and the initial treatment, respectively. Three patients have survived for more than 5 years. Distant metastasis was observed in 15 patients. Local recurrence was also observed in 2 of the 15 patients. Acute toxicities of Grade 3 or worse were observed in 15 patients, including 9 with hematological, 3 with pneumonitis and 6 with fatigue, nausea or vomiting. Five patients developed Grade 3 or worse late toxicities associated with IMRT, consisting of one with persistent Grade 4 thrombocytopenia, one with brain infarction and congestive liver dysfunction, and three with elevation of serum transaminase or biliary enzyme. No Grade 5 toxicity was observed. Patients with N2 showed significantly worse survival than those with N0-1 (18.2% vs. 60.0% at 3 years, p=.014).Conclusion: IMRT following EPP achieved excellent local control for MPM, that might lead to the long-term survival in selected patients. However, treatment burden including acute and late toxicities should be considered in this treatment approach.
  • 松尾 幸憲
    肺癌 56 Suppl. 988 - 990 (NPO)日本肺癌学会 2016年12月
  • Nobutaka Mukumoto; Mitsuhiro Nakamura; Masahiro Yamada; Kunio Takahashi; Mami Akimoto; Yuki Miyabe; Kenji Yokota; Shuji Kaneko; Akira Nakamura; Satoshi Itasaka; Yukinori Matsuo; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    MEDICAL PHYSICS 43 12 6364 - 6374 2016年12月 [査読有り]
     
    Purpose: The purposes of this study were two-fold: first, to develop a four-axis moving phantom for patient-specific quality assurance (QA) in surrogate signal-based dynamic tumor-tracking intensity-modulated radiotherapy (DTT-IMRT), and second, to evaluate the accuracy of the moving phantom and perform patient-specific dosimetric QA of the surrogate signal-based DTT-IMRT. Methods: The four-axis moving phantom comprised three orthogonal linear actuators for target motion and a fourth one for surrogate motion. The positional accuracy was verified using four laser displacement gauges under static conditions (+/- 40 mm displacements along each axis) and moving conditions [eight regular sinusoidal and fourth-power-of-sinusoidal patterns with peak-to-peak motion ranges (H) of 10-80 mm and a breathing period (T) of 4 s, and three irregular respiratory patterns with H of 1.4-2.5 mm in the left-right, 7.7-11.6 mm in the superior-inferior, and 3.1-4.2 mm in the anterior-posterior directions for the target motion, and 4.8-14.5 mm in the anterior-posterior direction for the surrogate motion, and T of 3.9-4.9 s]. Furthermore, perpendicularity, defined as the vector angle between any two axes, was measured using an optical measurement system. The reproducibility of the uncertainties in DTT-IMRT was then evaluated. Respiratory motions from 20 patients acquired in advance were reproduced and compared three-dimensionally with the originals. Furthermore, patient-specific dosimetric QAs of DTT-IMRT were performed for ten pancreatic cancer patients. The doses delivered to Gafchromic films under tracking and moving conditions were compared with those delivered under static conditions without dose normalization. Results: Positional errors of the moving phantom under static and moving conditions were within 0.05 mm. The perpendicularity of the moving phantom was within 0.2 degrees of 90 degrees. The differences in prediction errors between the original and reproduced respiratory motions were -0.1 +/- 0.1 mm for the lateral direction, -0.1 +/- 0.2 mm for the superior-inferior direction, and -0.1 +/- 0.1 mm for the anterior-posterior direction. The dosimetric accuracy showed significant improvements, of 92.9% +/- 4.0% with tracking versus 69.8% +/- 7.4% without tracking, in the passing rates of. with the criterion of 3%/1 mm (p < 0.001). Although the dosimetric accuracy of IMRT without tracking showed a significant negative correlation with the 3D motion range of the target (r = -0.59, p < 0.05), there was no significant correlation for DTT-IMRT (r = 0.03, p = 0.464). Conclusions: The developed four-axis moving phantom had sufficient accuracy to reproduce patient respiratory motions, allowing patient-specific QA of the surrogate signal-based DTT-IMRT under realistic conditions. Although IMRT without tracking decreased the dosimetric accuracy as the target motion increased, the DTT-IMRT achieved high dosimetric accuracy. (C) 2016 American Association of Physicists in Medicine.
  • Hiraku Iramina; Mitsuhiro Nakamura; Yusuke Iizuka; Takamasa Mitsuyoshi; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka; Ikuo Kanno
    RADIOTHERAPY AND ONCOLOGY 121 1 46 - 51 2016年10月 [査読有り]
     
    Purpose: To quantify the accuracy of extracted target motion trajectories in dual-source four-dimensional cone-beam computed tomography (4D-CBCT) by comparison with the actual three-dimensional (3D) target motion acquired simultaneously during 4D-CBCT scan. Materials and methods: 4D-CBCT scans were performed for 19 different sinusoidal-like patterns and 13 lung cancer patients with implanted markers. Internal (In) or external (Ex) surrogates with amplitude (Amp)- or phase (Ph)-based sorting were used for the reconstructions. The targets were a pseudo-tumor and implanted marker for the phantom and clinical studies, respectively. The accuracy was evaluated by determining the maximum error (MaxE(i)) between the 3D target position extracted from 4D-CBCT and the actual 3D target position detected by fluoroscopy in each ith phase (0 <= i <= 7). Results: Median peak-to-peak target displacements in the superior-inferior (SI) direction were 20.6 and 20.6 mm in the phantom and clinical studies, respectively. In the phantom and clinical studies, the maximum of median MaxE(i)s in the SI direction was 4.6 and 9.2 mm in the In_Ph reconstruction. In the clinical study, the maximum of median MaxEis was observed during the end-inhalation phase among all reconstruction approaches. Conclusions: This study showed the magnitude of underestimation toward the inferior direction of target motion in clinical 4D-CBCT. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Yukinori Matsuo; Mitsuhiro Nakamura; Takashi Mizowaki; Masahiro Hiraoka
    MEDICAL PHYSICS 43 9 5195 - 5198 2016年09月 [査読有り]
     
    Purpose: The purpose of this technical note is to introduce variance component analysis to the estimation of systematic and random components in setup error of radiotherapy. Methods: Balanced data according to the one-factor random effect model were assumed. Results: Analysis-of-variance (ANOVA.)-based computation was applied to estimate the values and their confidence intervals (CIs) for systematic and random errors and the population mean of setup errors. The conventional method overestimates systematic error, especially in hypofractionated settings. The CI for systematic error becomes much wider than that for random error. The ANOVA-based estimation can be extended to a multifactor model considering multiple causes of setup errors (e.g., interpatient, interfraction, and intrafraction). Conclusions: Variance component analysis may lead to novel applications to setup error analysis in radiotherapy. (C) 2016 American Association of Physicists in Medicine.
  • Takahiro Kishi; Yukinori Matsuo; Akira Nakamura; Yuji Nakamoto; Satoshi Itasaka; Takashi Mizowaki; Kaori Togashi; Masahiro Hiraoka
    RADIOTHERAPY AND ONCOLOGY 120 2 217 - 221 2016年08月 [査読有り]
     
    Objective: The purpose of this study was to evaluate the usefulness of respiratory-gated positron emission tomography (4D-PET) in pancreatic cancer radiotherapy treatment planning (RTTP). Materials and methods: Fourteen patients with 18F-fluorodeoxyglucose (FDG)-avid pancreatic tumours were evaluated between December 2013 and March 2015. Two sets of volumes were contoured for the pancreatic tumour of each patient. The biological target volume in three-dimensional RTTP (BTV3D) was contoured using conventional respiratory un-gated PET. The BTV3D was then expanded using population-based margins to generate a series of internal target volume 3D (ITV3D) values. The ITV 4D (ITV4D) was contoured using 4D-PET. Each of the five phases of 4D-PET was used for 4D contouring, and the ITV4D was constructed by summing the volumes defined on the five individual 4D-PET images. The relative volumes and normalized volumetric overlap were computed between ITV3D and ITV4D. Results: On average, the FDG-avid tumour volumes were 1.6 (range: 0.8-2.3) fold greater in the ITV4D than in the BTV3D. On average, the ITV3D values were 2.0 (range: 1.1-3.4) fold larger than the corresponding ITV4D values. Conclusion: The ITV generated from 4D-PET can be used to improve the accuracy or reduce normal tissue irradiation compared with conventional un-gated PET-based ITV. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Masanori Takamiya; Mitsuhiro Nakamura; Mami Akimoto; Nami Ueki; Masahiro Yamada; Hiroaki Tanabe; Yukinori Matsuo; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka; Akio Itoh
    MEDICAL PHYSICS 43 4 1907 - 1912 2016年04月 [査読有り]
     
    Purpose: To assess the target localization error (TLE) in terms of the distance between the target and the localization point estimated from the surrogates (vertical bar TMD vertical bar), the average of respiratory motion for the surrogates and the target (vertical bar aRM vertical bar), and the number of fiducial markers used for estimating the target (n). Methods: This study enrolled 17 lung cancer patients who subsequently underwent four fractions of real-time tumor tracking irradiation. Four or five fiducial markers were implanted around the lung tumor. The three-dimensional (3D) distance between the tumor and markers was at maximum 58.7 mm. One of the markers was used as the target (P-t), and those markers with a 3D vertical bar TMDn vertical bar <= 58.7 mm at end-exhalation were then selected. The estimated target position (P-e) was calculated from a localization point consisting of one to three markers except P-t. Respiratory motion for P-t and P-e was defined as the root mean square of each displacement, and vertical bar aRM vertical bar was calculated from the mean value. TLE was defined as the root mean square of each difference between P-t and P-e during the monitoring of each fraction. These procedures were performed repeatedly using the remaining markers. To provide the best guidance on the answer with n and vertical bar TMD vertical bar, fiducial markers with a 3D vertical bar aRM >= 10 mm were selected. Finally, a total of 205, 282, and 76 TLEs that fulfilled the 3D vertical bar TMD vertical bar and 3D vertical bar aRM vertical bar criteria were obtained for n = 1, 2, and 3, respectively. Multiple regression analysis (MRA) was used to evaluate TLE as a function of vertical bar TMD vertical bar and vertical bar aRM vertical bar in each n. Results: vertical bar TMD vertical bar for n = 1 was larger than that for n = 3. Moreover, vertical bar aRM vertical bar was almost constant for all n, indicating a similar scale for the marker's motion near the lung tumor. MRA showed that vertical bar aRM vertical bar in the left-right direction was the major cause of TLE; however, the contribution made little difference to the 3D TLE because of the small amount of motion in the left-right direction. The TLE calculated from the MRA ((TLE)-T-MRA) increased as vertical bar TMD vertical bar and vertical bar aRM vertical bar increased and adversely decreased with each increment of n. The median 3D (TLE)-T-MRA was 2.0 mm (range, 0.6-4.3 mm) for n = 1, 1.8 mm (range, 0.4-4.0 mm) for n = 2, and 1.6 mm (range, 0.3-3.7 mm) for n = 3. Although statistical significance between n = 1 and n = 3 was observed in all directions, the absolute average difference and the standard deviation of the (TLE)-T-MRA between n = 1 and n = 3 were 0.5 and 0.2 mm, respectively. Conclusions: A large vertical bar TMD vertical bar and vertical bar aRM vertical bar increased the differences in TLE between each n; however, the difference in 3D (TLEs)-T-MRA was, at most, 0.6 mm. Thus, the authors conclude that it is acceptable to continue fiducial marker-based radiotherapy as long as vertical bar TMD vertical bar is maintained at <= 58.7 mm for a 3D vertical bar aRM vertical bar >= 10 mm. (C) 2016 American Association of Physicists in Medicine.
  • Manuela Burghelea; Dirk Verellen; Kenneth Poels; Cecilia Hung; Mitsuhiro Nakamura; Jennifer Dhont; Thierry Gevaert; Robbe Van den Begin; Christine Collen; Yukinori Matsuo; Takahiro Kishi; Viorica Simon; Masahiro Hiraoka; Mark de Ridder
    RADIATION ONCOLOGY 11 1 63  2016年04月 [査読有り]
     
    Background: Dynamic Wave Arc (DWA) is a clinical approach designed to maximize the versatility of Vero SBRT system by synchronizing the gantry-ring noncoplanar movement with D-MLC optimization. The purpose of this study was to verify the delivery accuracy of DWA approach and to evaluate the potential dosimetric benefits. Methods: DWA is an extended form of VMAT with a continuous varying ring position. The main difference in the optimization modules of VMAT and DWA is during the angular spacing, where the DWA algorithm does not consider the gantry spacing, but only the Euclidian norm of the ring and gantry angle. A preclinical version of RayStation v4.6 (RaySearch Laboratories, Sweden) was used to create patient specific wave arc trajectories for 31 patients with various anatomical tumor regions (prostate, oligometatstatic cases, centrally-located non-small cell lung cancer (NSCLC) and locally advanced pancreatic cancer-LAPC). DWA was benchmarked against the current clinical approaches and coplanar VMAT. Each plan was evaluated with regards to dose distribution, modulation complexity (MCS), monitor units and treatment time efficiency. The delivery accuracy was evaluated using a 2D diode array that takes in consideration the multi-dimensionality of DWA during dose reconstruction. Results: In centrally-located NSCLC cases, DWA improved the low dose spillage with 20 %, while the target coverage was increased with 17 % compared to 3D CRT. The structures that significantly benefited from using DWA were proximal bronchus and esophagus, with the maximal dose being reduced by 17 % and 24 %, respectively. For prostate and LAPC, neither technique seemed clearly superior to the other; however, DWA reduced with more than 65 % of the delivery time over IMRT. A steeper dose gradient outside the target was observed for all treatment sites (p < 0.01) with DWA. Except the oligometastatic cases, where the DWA-MCSs indicate a higher modulation, both DWA and VMAT modalities provide plans of similar complexity. The average gamma (3 % /3 mm) passing rate for DWA plans was 99.2 +/- 1 % (range from 96.8 to 100 %). Conclusions: DWA proven to be a fully functional treatment technique, allowing additional flexibility in dose shaping, while preserving dosimetrically robust delivery and treatment times comparable with coplanar VMAT.
  • 松尾 幸憲
    大津市民病院雑誌 17 11 - 14 市立大津市民病院 2016年03月
  • Takamasa Mitsuyoshi; Mitsuhiro Nakamura; Yukinori Matsuo; Nami Ueki; Akira Nakamura; Yusuke Iizuka; Wambaka Ange Mampuya; Takashi Mizowaki; Masahiro Hiraoka
    Medical Dosimetry 41 4 305 - 309 2016年02月 [査読有り]
     
    The purpose of this article is to quantitatively evaluate differences in dose distributions calculated using various computed tomography (CT) datasets, dose-calculation algorithms, and prescription methods in stereotactic body radiotherapy (SBRT) for patients with early-stage lung cancer. Data on 29 patients with early-stage lung cancer treated with SBRT were retrospectively analyzed. Averaged CT (Ave-CT) and expiratory CT (Ex-CT) images were reconstructed for each patient using 4-dimensional CT data. Dose distributions were initially calculated using the Ave-CT images and recalculated (in the same monitor units [MUs]) by employing Ex-CT images with the same beam arrangements. The dose-volume parameters, including D95, D90, D50, and D2 of the planning target volume (PTV), were compared between the 2 image sets. To explore the influence of dose-calculation algorithms and prescription methods on the differences in dose distributions evident between Ave-CT and Ex-CT images, we calculated dose distributions using the following 3 different algorithms: x-ray Voxel Monte Carlo (XVMC), Acuros XB (AXB), and the anisotropic analytical algorithm (AAA). We also used 2 different dose-prescription methods the isocenter prescription and the PTV periphery prescription methods. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data were within 3 percentage points (%pts) employing the isocenter prescription method, and within 1.5%pts using the PTV periphery prescription method, irrespective of which of the 3 algorithms (XVMC, AXB, and AAA) was employed. The frequencies of dose-volume parameters differing by > 1%pt when the XVMC and AXB were used were greater than those associated with the use of the AAA, regardless of the dose-prescription method employed. All differences in PTV dose-volume parameters calculated using Ave-CT and Ex-CT data on patients who underwent lung SBRT were within 3%pts, regardless of the dose-calculation algorithm or the dose-prescription method employed.
  • 中村 光宏; 植木 奈美; 中村 晶; 飯塚 裕介; 椋本 宜学; 石原 佳知; 秋元 麻未; 宮部 結城; 松尾 幸憲; 溝脇 尚志; 平岡 真寛
    臨床放射線 61 2 285 - 292 金原出版(株) 2016年02月
  • Yukinori Matsuo
    Radiotherapy and Oncology 2016年
  • Yukinori Matsuo
    Radiotherapy and Oncology 2016年
  • Yukinori Matsuo
    Radiotherapy and Oncology 2016年
  • Yukinori Matsuo
    Radiotherapy and Oncology 2016年
  • Mitsuyoshi T; Nakamura M; Matsuo Y; Ueki N; Nakamura A; Iizuka Y; Mampuya WA; Mizowaki T; Hiraoka M
    Med. Dosim. 41 4 305 - 309 2016年 [査読有り]
  • Mitsuhiro Nakamura; Masanori Takamiya; Mami Akimoto; Nami Ueki; Masahiro Yamada; Hiroaki Tanabe; Nobutaka Mukumoto; Kenji Yokota; Yukinori Matsuo; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS 31 8 934 - 941 2015年12月 [査読有り]
     
    Purpose: To assess target localization errors (TLEs) from implanted fiducial markers by three different centers of gravity (CG) and three different multiple regression analysis (MRA) approaches. Methods: The three-dimensional (3D) positions of the markers were detected on the fluoroscopic images of 15 lung cancer patients, and the marker closest to the tumor was then assumed to be the target (P-t). The estimated target position (P-e) was calculated from three markers adjacent to the target (P-i, 1 <= i <= 3) using the equation P-e = aP(1) + bP(2) + cP(3) + d.P-e was then calculated using three different CGs and three different MRAs. The TLE was calculated as the root-mean-square error of the difference between Pt and Pe calculated for each fraction. First, we compared the TLE of the first fraction to assess the intrafraction TLE of the six approaches tested. Second, interfraction TLEs were calculated to evaluate the robustness of the coefficients obtained in the first fraction. The interfraction TLE was defined as the difference between the TLE of a later and the first fraction. Results: The mean plus two times the standard deviation of the intrafraction TLE was up to 4.3 mm in the CG approaches, while the MRA approaches provided TLEs within 1.5 mm. The mean plus two times the standard deviation of the interfraction TLE did not exceed 1.7 mm in any direction using either approach. Conclusions: The MRA approach was superior to the CG approach in terms of estimating the target position based on the implanted fiducial markers. (C) 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
  • Yusuke Iizuka; Yukinori Matsuo; Yoshitomo Ishihara; Mami Akimoto; Hiroaki Tanabe; Kenji Takayama; Nami Ueki; Kenji Yokota; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    Radiotherapy and Oncology 117 3 496 - 500 2015年12月 [査読有り]
     
    Purpose Dynamic tumor-tracking stereotactic body radiotherapy (DTT-SBRT) for liver tumors with real-time monitoring was carried out using a gimbal-mounted linear accelerator and the efficacy of the system was determined. In addition, four-dimensional (4D) dose distribution, tumor-tracking accuracy, and tumor-marker positional variations were evaluated. Materials and methods A fiducial marker was implanted near the tumor prior to treatment planning. The prescription dose at the isocenter was 48–60 Gy, delivered in four or eight fractions. The 4D dose distributions were calculated with a Monte Carlo method and compared to the static SBRT plan. The intrafractional errors between the predicted target positions and the actual target positions were calculated. Results Eleven lesions from ten patients were treated successfully. DTT-SBRT allowed an average 16% reduction in the mean liver dose compared to static SBRT, without altering the target dose. The average 95th percentiles of the intrafractional prediction errors were 1.1, 2.3, and 1.7 mm in the left–right, cranio-caudal, and anterior–posterior directions, respectively. After a median follow-up of 11 months, the local control rate was 90%. Conclusions Our early experience demonstrated the dose reductions in normal tissues and high accuracy in tumor tracking, with good local control using DTT-SBRT with real-time monitoring in the treatment of liver tumors.
  • Mitsuhiro Nakamura; Masanori Takamiya; Mami Akimoto; Nami Ueki; Masahiro Yamada; Hiroaki Tanabe; Nobutaka Mukumoto; Kenji Yokota; Yukinori Matsuo; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    Physica Medica 31 8 934 - 941 2015年12月 [査読有り]
     
    Purpose: To assess target localization errors (TLEs) from implanted fiducial markers by three different centers of gravity (CG) and three different multiple regression analysis (MRA) approaches. Methods: The three-dimensional (3D) positions of the markers were detected on the fluoroscopic images of 15 lung cancer patients, and the marker closest to the tumor was then assumed to be the target (Pt). The estimated target position (Pe) was calculated from three markers adjacent to the target (Pi, 1 ≤ i ≤ 3) using the equation Pe = aP1 + bP2 + cP3 + d. Pe was then calculated using three different CGs and three different MRAs. The TLE was calculated as the root-mean-square error of the difference between Pt and Pe calculated for each fraction. First, we compared the TLE of the first fraction to assess the intrafraction TLE of the six approaches tested. Second, interfraction TLEs were calculated to evaluate the robustness of the coefficients obtained in the first fraction. The interfraction TLE was defined as the difference between the TLE of a later and the first fraction. Results: The mean plus two times the standard deviation of the intrafraction TLE was up to 4.3 mm in the CG approaches, while the MRA approaches provided TLEs within 1.5 mm. The mean plus two times the standard deviation of the interfraction TLE did not exceed 1.7 mm in any direction using either approach. Conclusions: The MRA approach was superior to the CG approach in terms of estimating the target position based on the implanted fiducial markers.
  • Masatsugu Hamaji; Fengshi Chen; Yukinori Matsuo; Nami Ueki; Masahiro Hiraoka; Hiroshi Date
    Journal of Thoracic Oncology 10 11 1616 - 1624 2015年11月 [査読有り]
     
    Introduction: Many efforts have been made to detect local relapse (LR) in the follow-up after stereotactic body radiotherapy (SBRT) for non-small-cell lung cancer (NSCLC) although limited data are available on its treatment and prognosis. We aimed to characterize treatment options and clarify long-term outcomes of isolated LR after SBRT for patients with clinical stage I NSCLC. Methods: We reviewed our institutional database in search of patients with isolated LR after SBRT for clinical stage I NSCLC at our institution between 1999 and 2013. Patient characteristics were compared with Mann-Whitney U test, χ2 test, or Fisher's exact test as appropriate. Survival outcomes were estimated with Kaplan-Meier method. Potential prognostic factors were investigated using Cox proportional hazard model. Results: Of 308 patients undergoing SBRT for clinical stage I NSCLC, 49 patients were identified to have isolated LR. Twelve patients underwent salvage surgery, none underwent radiotherapy, and eight patients received chemotherapy, whereas 29 patients received best supportive care. No patient characteristic except operability was significantly related with patient selection for LR treatments. Five-year overall survival (OS) rate of the whole cohort was 47.9% from SBRT and 25.7% from LR. Salvage surgery was associated with improved OS after LR (p = 0.014), and 5-year OS for patients undergoing salvage surgery was 79.5% from LR. Conclusions: It was confirmed that our patient selection for salvage surgery for isolated LR was associated with favorable survival outcomes. Operability based on multidisciplinary conferences, rather than measurable patient characteristics, is essential for appropriate patient selection for salvage surgery.
  • Onimaru Rikiya; Shirato Hiroki; Shibata Taro; Hiraoka Masahiro; Ishikura Satoshi; Karasawa Katsuyuki; Matsuo Yukinori; Kokubo Masaki; Shioyama Yoshiyuki; Matsushita Haruo; Ito Yoshinori; Onishi Hiroshi
    Radiotherapy and oncology 116 2 276 - 280 Elsevier 2015年08月 
    Purpose: To estimate the maximum tolerated dose (MTD) and to determine the recommended dose (RD) of stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinoma (NSCLC) with target volume (PTV) < 100 cc. Materials and methods: The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the MTD. Dose limiting toxicity (DLT) was grade 3 radiation pneumonitis (RP) within 180 days after the start of SBRT, grade 2 RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D95 of the PTV. Results: Fifteen patients were accrued. Only 1 experienced grade 2 RP at 60 Gy in 4 fractions. It was difficult to fulfill the dose constraints at 60 Gy in 4 fractions, and the maximum dose level assigned by CRM was changed to 55 Gy in 4 fractions. The lower limit of 95% of the credible interval exceeded the adjacent level, and the RD was determined as 55 Gy in 4 fractions. Conclusions: The RD of SBRT for peripheral T2N0M0 NSCLC with PTV < 100 cc was determined to be 55 Gy in 4 fractions.
  • Yukinori Matsuo
    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 116 2 276 - 280 2015年07月 [査読有り]
     
    PURPOSE: To estimate the maximum tolerated dose (MTD) and to determine the recommended dose (RD) of stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinoma (NSCLC) with target volume (PTV) &lt; 100cc. MATERIALS AND METHODS: The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the MTD. Dose limiting toxicity (DLT) was grade 3 radiation pneumonitis (RP) within 180days after the start of SBRT, grade 2 RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D95 of the PTV. RESULTS: Fifteen patients were accrued. Only 1 experienced grade 2 RP at 60Gy in 4 fractions. It was difficult to fulfill the dose constraints at 60Gy in 4 fractions, and the maximum dose level assigned by CRM was changed to 55Gy in 4 fractions. The lower limit of 95% of the credible interval exceeded the adjacent level, and the RD was determined as 55Gy in 4 fractions. CONCLUSIONS: The RD of SBRT for peripheral T2N0M0 NSCLC with PTV&lt;100cc was determined to be 55Gy in 4 fractions.
  • Takahiro Kishi; Yukinori Matsuo; Nami Ueki; Yusuke Iizuka; Akira Nakamura; Katsuyuki Sakanaka; Takashi Mizowaki; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 92 3 619 - 626 2015年07月 [査読有り]
     
    Purpose: This study aimed to evaluate the prognostic significance of the modified Glasgow Prognostic Score (mGPS) in patients with non-small cell lung cancer (NSCLC) who received stereotactic body radiation therapy (SBRT). Methods and Materials: Data from 165 patients who underwent SBRT for stage I NSCLC with histologic confirmation from January 1999 to September 2010 were collected retrospectively. Factors, including age, performance status, histology, Charlson comorbidity index, mGPS, and recursive partitioning analysis (RPA) class based on sex and T stage, were evaluated with regard to overall survival (OS) using the Cox proportional hazards model. The impact of the mGPS on cause of death and failure patterns was also analyzed. Results: The 3-year OS was 57.9%, with a median follow-up time of 3.5 years. A higher mGPS correlated significantly with poor OS (P<.001). The 3-year OS of lower mGPS patients was 66.4%, whereas that of higher mGPS patients was 44.5%. On multivariate analysis, mGPS and RPA class were significant factors for OS. A higher mGPS correlated significantly with lung cancer death (P=.019) and distant metastasis (P=.013). Conclusions: The mGPS was a significant predictor of clinical outcomes for SBRT in NSCLC patients. (C) 2015 Elsevier Inc. All rights reserved.
  • Yukinori Matsuo; Dirk Verellen; Kenneth Poels; Nobutaka Mukumoto; Tom Depuydt; Mami Akimoto; Mitsuhiro Nakamura; Nami Ueki; Benedikt Engels; Christine Collen; Masaki Kokubo; Masahiro Hiraoka; Mark de Ridder
    RADIOTHERAPY AND ONCOLOGY 115 3 412 - 418 2015年06月 [査読有り]
     
    Purpose: This study aimed to compare procedures for dynamic tumour tracking (DTT) using a gimbal-mounted linac between centres in Japan (KU-IBRI) and Belgium (UZB), to quantify tracking error (TE), and to estimate tumour-fiducial uncertainties and PTV margins. Methods: Twenty-two patients were evaluated. TE was divided into components originating from the patient, fraction, segment, and residuals. Results: KU-IBRI applied DTT to king cancer, while UZB treated both the lung and liver. Patients from UZB were younger and had a higher body mass index. DTT procedures differed in the use of body fixation, correction for set-up error, type of fiducial markers, and goodness of fit of correlation model. TE was larger at UZB in the intra-fraction components, whereas the tumour-fiducial uncertainties were estimated to be larger at KU-IBRI. These results ultimately led to similar PTV margins at both centres (2.1, 4.2, and 2.6 mm for KU-IBRI; 2.4, 3.6, and 2.0 mm for UZB in LR, AP, and SI, respectively, for 99% coverage of patients). Conclusion: Several differences in procedures and patient characteristics were observed that affected TE and tumour-fiducial uncertainties. This analysis confirmed similar accuracy in DTT delivery and adequate PTV margins in the different centres based on their local specific workflows. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
  • Mitsuhiro Nakamura; Mami Akimoto; Nobutaka Mukumoto; Masahiro Yamada; Hiroaki Tanabe; Nami Ueki; Yukinori Matsuo; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS 31 3 204 - 209 2015年05月 [査読有り]
     
    Purpose: To assess the utility of 10 s and 20 s modeling periods, rather than the 40 s currently used, in the clinical construction of practical correlation models (CMs) in dynamic tumor tracking irradiation using the Vero4DRT. Methods: The CMs with five independent parameters (CM parameters) were analyzed retrospectively for 10 consecutive lung cancer patients. CM remodeling was performed two or three times per treatment session. Three different CMs trained over modeling periods of 10, 20, and 40 s were built from a single, original CM log file. The predicted target positions were calculated from the CM parameters and the vertical displacement of infrared markers on the abdomen (P-IR) during the modeling. We assessed how the CM parameters obtained over modeling periods of T s (T = 10, 20, and 40 s) were robust to changes in respiratory patterns after several minutes. The mimic-predicted target positions after several minutes were computed based on the previous CM parameters and P-IR during the next modeling. The 95th percentiles of the differences between mimic-predicted and detected target positions over 40 s (E95(robust, T): T = 10, 20, and 40 s) were then calculated. Results: Strong correlations greater than 0.92 were observed between the E95(robust, 20) and E95(robust, 40) values. Meanwhile, irregular respiratory patterns with inconsistent amplitudes of motion created differences between the E95(robust, 10) and E95(robust, 40) values of >= 10 mm. Conclusions: The accuracies of CMs derived using 20 s were almost identical to those obtained over 40 s, and superior to those obtained over 10 s. (C) 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
  • Hideomi Yamashita; Hiroshi Onishi; Naoya Murakami; Yasuo Matsumoto; Yukinori Matsuo; Takuma Nomiya; Keiichi Nakagawa
    JOURNAL OF RADIATION RESEARCH 56 3 561 - 567 2015年05月 [査読有り]
     
    Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. Outcomes of SBRT for liver tumors unsuitable for ablation or surgical resection were evaluated. A total of 79 patients treated with SBRT for primary hepatocellular carcinoma (HCC) between 2004 and 2012 in six Japanese institutions were studied retrospectively. Patients treated with SBRT preceded by trans-arterial chemoembolization were eligible. Their median age was 73 years, 76% were males, and their Child-Pugh scores were Grades A (85%) and B (11%) before SBRT. The median biologically effective dose (alpha/beta = 10 Gy) was 96.3 Gy. The median follow-up time was 21.0 months for surviving patients. The 2-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival were 53%, 40% and 76%, respectively. Sex and serum PIVKA-II values were significant predictive factors for OS. Hypovascular or hypervascular types of HCC, sex and clinical stage were significant predictive factors for PFS. The 2-year PFS was 66% in Stage I vs 18% in Stages II-III. Multivariate analysis indicated that clinical stage was the only significant predictive factor for PFS. No Grade 3 laboratory toxicities in the acute, sub-acute, and chronic phases were observed. PFS after SBRT for liver tumor was satisfactory, especially for Stage I HCC, even though these patients were unsuitable for resection and ablation. SBRT is safe and might be an alternative to resection and ablation.
  • Masatsugu Hamaji; Fengshi Chen; Yukinori Matsuo; Atsushi Kawaguchi; Satoshi Morita; Nami Ueki; Makoto Sonobe; Yasushi Nagata; Masahiro Hiraoka; Hiroshi Date
    ANNALS OF THORACIC SURGERY 99 4 1122 - 1129 2015年03月 [査読有り]
     
    Background. Previous comparative reports of stereotactic body radiotherapy (SBRT) and surgery for non-small cell lung cancer (NSCLC) suffered from short follow-up, mixed extents of resection and inclusion of benign lesion. We aimed to make comparisons of long-term outcomes between a pure series of video-assisted thoracoscopic surgery (VATS) lobectomy and SBRT for biopsy-proven clinical stage I NSCLC. Methods. We retrospectively compared overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control, regional lymph node (LN) control, and distant control between VATS lobectomy (n = 413) and SBRT (n = 104) for biopsy-proven clinical stage I NSCLC at our institution between 2003 and 2009. Propensity score matching was used to adjust the confounding effects in estimating treatment hazard ratios. Forty-one VATS lobectomy patients and 41 SBRT patients were matched blinded to outcome (1:1 ratio, caliper distance; 0.5). Results. After propensity score matching, the follow-up period of the whole cohort ranged from 5 to 120 months with a median of 48. After propensity score matching there were significant differences in OS (p = 0.0016), CSS (p = 0.0015), RFS (p < 0.0001), local control (p = 0.0019), and distant control (p < 0.0001) and no significant difference in regional LN control (p = 0.11). The VATS lobectomy patients and SBRT patients had 68.5% and 37.3% of 5-year OS, 83.5% and 56.7% of 5-year CSS, and 60.4% and 19.5% of 5-year RFS, respectively. Conclusions. Our results suggest VATS lobectomy may offer significantly more favorable long-term outcomes than SBRT in potentially operable patients with biopsyproven clinical stage I NSCLC. (C) 2015 by The Society of Thoracic Surgeons
  • 【高精度放射線治療の最新トピックス】 Vero4DRTを用いた動体追尾強度変調放射線治療の臨床適用
    中村 光宏; 中村 晶; 飯塚 裕介; 松尾 幸憲; 溝脇 尚志; 平岡 真寛
    Rad Fan 13 3 57 - 60 (株)メディカルアイ 2015年02月 
    当院では2011年9月に肺癌に対してVero4DRTによるリアルタイムモニタリング下の動体追尾定位照射を開始し、2013年3月には肝癌に対して本照射法を適応拡大した。さらに、2013年6月からは膵癌に対して、2014年9月からは肝癌に対してリアルタイムモニタリング下の動体追尾強度変調放射線治療を開始している。本稿では、動体追尾強度変調放射線治療の使用経験について報告する。(著者抄録)
  • Kimiko Hirata; Mitsuhiro Nakamura; Michio Yoshimura; Nobutaka Mukumoto; Manabu Nakata; Hitoshi Ito; Haruo Inokuchi; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka
    JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS 16 4 52 - 64 2015年 [査読有り]
     
    In this study, we assessed the differences in the dose distribution of a 4 MV photon beam among different calculation algorithms: the Acuros XB (AXB) algorithm, the analytic anisotropic algorithm (AAA), and the pencil beam convolution (PBC) algorithm (ver. 11.0.31), in phantoms and in clinical intensity-modulated radiation therapy (IMRT) plans. Homogeneous and heterogeneous, including middle-, low-, and high-density, phantoms were combined to assess the percentage depth dose and lateral dose profiles among AXB, AAA, and PBC. For the phantom containing the low-density area, AXB was in agreement with measurement within 0.5%, while the greatest differences between the AAA and PBC calculations and measurement were 2.7% and 3.6%, respectively. AXB showed agreement with measurement within 2.5% at the high-density area, while AAA and PBC overestimated the dose by more than 4.5% and 4.0%, respectively. Furthermore, 15 IMRT plans, calculated using AXB, for oropharyngeal, hypopharyngeal, and laryngeal carcinomas were analyzed. The dose prescription was 70 Gy to 50% of the planning target volume (PTV70). Subsequently, each plan was recalculated using AAA and PBC while maintaining the AXB-calculated monitor units, leaf motion, and beam arrangement. Additionally, nine hypopharyngeal and laryngeal cancer patients were analyzed in terms of PTV70 for cartilaginous structures (PTV70 cartilage)(.) The doses covering 50% to PTV70 calculated by AAA and PBC were 2.1% +/- 1.0% and 3.7% +/- 0.8% significantly higher than those using AXB, respectively (p < 0.01). The increases in doses to PTV70_cartilage calculated by AAA and PBC relative to AXB were 3.9% and 5.3% on average, respectively, and were relatively greater than those in the entire PTV70. AXB was found to be in better agreement with measurement in phantoms in heterogeneous areas for the 4 MV photon beam. Considering AXB as the standard, AAA and PBC overestimated the IMRT dose for head and neck cancer. The dosimetric differences should not be ignored, particularly with cartilaginous structures in PTV.
  • Matsuo, Y.; Kokubo, M.; Hiraoka, M.
    Stereotactic Body Radiation Therapy: Principles and Practices 2015年 [査読有り]
  • Kimiko Hirata; Mitsuhiro Nakamura; Michio Yoshimura; Nobutaka Mukumoto; Manabu Nakata; Hitoshi Ito; Haruo Inokuchi; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka
    Journal of Applied Clinical Medical Physics 16 4 52 - 64 2015年 [査読有り]
     
    In this study, we assessed the differences in the dose distribution of a 4 MV photon beam among different calculation algorithms: the Acuros XB (AXB) algorithm, the analytic anisotropic algorithm (AAA), and the pencil beam convolution (PBC) algorithm (ver. 11.0.31), in phantoms and in clinical intensity-modulated radiation therapy (IMRT) plans. Homogeneous and heterogeneous, including middle-, low-, and high-density, phantoms were combined to assess the percentage depth dose and lateral dose profiles among AXB, AAA, and PBC. For the phantom containing the low-density area, AXB was in agreement with measurement within 0.5%, while the greatest differences between the AAA and PBC calculations and measurement were 2.7% and 3.6%, respectively. AXB showed agreement with measurement within 2.5% at the high-density area, while AAA and PBC overestimated the dose by more than 4.5% and 4.0%, respectively. Furthermore, 15 IMRT plans, calculated using AXB, for oropharyngeal, hypopharyngeal, and laryngeal carcinomas were analyzed. The dose prescription was 70 Gy to 50% of the planning target volume (PTV70). Subsequently, each plan was recalculated using AAA and PBC while maintaining the AXB-calculated monitor units, leaf motion, and beam arrangement. Additionally, nine hypopharyngeal and laryngeal cancer patients were analyzed in terms of PTV70 for cartilaginous structures (PTV70_cartilage). The doses covering 50% to PTV70 calculated by AAA and PBC were 2.1% ± 1.0% and 3.7% ± 0.8% significantly higher than those using AXB, respectively (p < 0.01). The increases in doses to PTV70_cartilage calculated by AAA and PBC relative to AXB were 3.9% and 5.3% on average, respectively, and were relatively greater than those in the entire PTV70. AXB was found to be in better agreement with measurement in phantoms in heterogeneous areas for the 4 MV photon beam. Considering AXB as the standard, AAA and PBC overestimated the IMRT dose for head and neck cancer. The dosimetric differences should not be ignored, particularly with cartilaginous structures in PTV.
  • Mami Akimoto; Mitsuhiro Nakamura; Nobutaka Mukumoto; Masahiro Yamada; Hiroaki Tanabe; Nami Ueki; Shuji Kaneko; Yukinori Matsuo; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS 16 2 14 - 22 2015年 [査読有り]
     
    We previously found that the baseline drift of external and internal respiratory motion reduced the prediction accuracy of infrared (IR) marker-based dynamic tumor tracking irradiation (IR Tracking) using the Vero4DRT system. Here, we proposed a baseline correction method, applied immediately before beam delivery, to improve the prediction accuracy of IR Tracking. To perform IR Tracking, a four-dimensional (4D) model was constructed at the beginning of treatment to correlate the internal and external respiratory signals, and the model was expressed using a quadratic function involving the IR marker position (x) and its velocity (v), namely function F(x,v). First, the first 4D model, F-1st(x,v), was adjusted by the baseline drift of IR markers (BDIR) along the x-axis, as function F'(x,v). Next, BDdetect, that defined as the difference between the target positions indicated by the implanted fiducial markers (P-detect) and the predicted target positions with F'(x,v) (P-predict) was determined using orthogonal kV X-ray images at the peaks of the P-detect of the end-inhale and end-exhale phases for 10 s just before irradiation. F'(x,v) was corrected with BDdetect to compensate for the residual error. The final corrected 4D model was expressed as F-cor(x,v) = F-1st{(x-BDIR), v}-BDdetect. We retrospectively applied this function to 53 paired log files of the 4D model for 12 lung cancer patients who underwent IR Tracking. The 95th percentile of the absolute differences between P-detect and P-predict (vertical bar E-p vertical bar) was compared between F-1st(x,v) and F-cor(x,v). The median 95th percentile of vertical bar E-p vertical bar (units: mm) was 1.0, 1.7, and 3.5 for F-1st(x,v), and 0.6, 1.1, and 2.1 for F-cor(x,v) in the left-right, anterior-posterior, and superior-inferior directions, respectively. Over all treatment sessions, the 95th percentile of vertical bar E-p vertical bar peaked at 3.2 mm using F-cor(x,v) compared with 8.4 mm using F-1st(x,v). Our proposed method improved the prediction accuracy of IR Tracking by correcting the baseline drift immediately before irradiation.
  • Yusuke Iizuka; Michio Yoshimura; Haruo Inokuchi; Yukinori Matsuo; Akira Nakamura; Takashi Mizowaki; Shigeru Hirano; Morimasa Kitamura; Ichiro Tateya; Masahiro Hiraoka
    ACTA OTO-LARYNGOLOGICA 135 1 96 - 102 2015年01月 [査読有り]
     
    Conclusions: Distant metastasis was a major pattern of recurrence after postoperative radiotherapy (PORT) for squamous cell carcinoma (SCC) of the oropharynx, hypopharynx, and larynx. PORT provided good loco-regional control, with tolerable toxicities. Advanced pT and pN were unfavorable prognostic factors. Objective: To determine the clinical outcomes, and the patterns and risk factors for recurrence of SCCs of the oropharynx, hypopharynx, and larynx treated with surgery and PORT. Methods: We retrospectively reviewed 84 patients who received PORT after definitive surgery for SCC of the oropharynx, hypopharynx, or larynx between 2000 and 2010. The primary sites were the oropharynx in 25 patients, hypopharynx in 47 patients, and larynx in 12 patients. Results: The 3-year overall survival (OS), progression-free survival (PFS), and loco-regional control (LRC) rates were 64.9%, 56.7%, and 92.1%, respectively. Recurrences were observed in 27 patients: 6 patients had loco-regional recurrence and 23 patients developed distant metastasis. On multivariate analysis, pT4 and pN2c-N3 displayed significantly worse effects on OS (p = 0.02 and p < 0.01, respectively) and PFS (p = 0.02 and p < 0.001, respectively). In the acute phase, 12 patients experienced grade 3 or 4 toxicities. There were no grade 5 toxicities. Late grade 3 toxicity developed in six patients and no grade 4 or 5 toxicities were observed.
  • Nami Ueki; Yukinori Matsuo; Yosuke Togashi; Takeshi Kubo; Keiko Shibuya; Yusuke Iizuka; Takashi Mizowaki; Kaori Togashi; Michiaki Mishima; Masahiro Hiraoka
    JOURNAL OF THORACIC ONCOLOGY 10 1 116 - 125 2015年01月 [査読有り]
     
    Introduction: To investigate the impact of pre-existing radiological interstitial lung disease (ILD) findings on the incidence of radiation pneumonitis (RP) and clinical outcomes after stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer. Methods: We included 157 consecutive patients who underwent SBRT alone for stage I non-small-cell lung cancer and whose pretreatment lung computed tomography images were available for retrospective review. The pretreatment computed tomography images were evaluated retrospectively for the presence of ILD. The incidence of RP, overall survival (OS) rate, and the incidence of disease progression and local progression were evaluated between patients with ILD (ILD[+]) and without ILD (ILD[-]). Results: Pre-existing ILD was identified in 20 patients. The median follow-up period was 39.5 months. The incidences of RP worse than grade 2 (>= Gr2 RP) and worse than grade 3 (>= Gr3 RP) were significantly higher in ILD(+) than ILD(-) (1 year >= Gr2 RP rate, 55.0% versus 13.3%; p < 0.001 and 1year >= Gr3 RP rate 10.0% versus 1.5%; p = 0.020). Multivariate analysis also indicated that ILD(+) was a risk factor for >= Gr2 and >= Gr3 RP, and the volume of the irradiated lung. The OS rate tended to be worse in ILD(+) than ILD(-) (3-year OS, 53.8% versus 70.8%; p = 0.28). No difference was observed in the disease progression or local progression rates. Conclusions: Pre-existing ILD was a significant risk factor for symptomatic and severe RP. Prescreening for ILD findings is important for determining the radiation pneumonitis risk when planning SBRT.
  • Yukinori Matsuo; Fengshi Chen; Masatsugu Hamaji; Atsushi Kawaguchi; Nami Ueki; Yasushi Nagata; Makoto Sonobe; Satoshi Morita; Hiroshi Date; Masahiro Hiraoka
    EUROPEAN JOURNAL OF CANCER 50 17 2932 - 2938 2014年11月 [査読有り]
     
    Background: The aim of this study was to perform a survival comparison between stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small-cell lung cancer (NSCLC) at high risk for lobectomy. Methods: All patients who underwent SBRT or SLR because of medical comorbidities for clinical stage I NSCLC were reviewed retrospectively. Propensity score matching (PSM) was performed to reduce selection bias between SLR and SBRT patients based on age, gender, performance status, tumour diameter, forced expiratory volume in 1 second (FEV1) and Charlson comorbidity index (CCI). Results: One hundred and fifteen patients who underwent SBRT and 65 SLR were enrolled. The median potential follow-up periods for SBRT and SLR were 6.7 and 5.3 years, respectively. No treatment-related deaths were observed. Before PSM, the 5-year overall survival (OS) was 40.3% and 60.5% for SBRT and SLR, respectively (P = 0.008). PSM identified 53 patients from each treatment group with similar characteristics: a median age of 76 years, a performance status of 0-1, a median tumour diameter of similar to 20 mm, a median FEV1 of similar to 1.8 L and a median CCI of 1. The difference in OS became insignificant between the matched pairs (40.4% and 55.6% at 5 years with SBRT and SLR; P = 0.124). The cumulative incidence of cause-specific death was comparable between groups (35.3% and 30.3% at 5 years, P = 0.427). Conclusion: SBRT can be an alternative treatment option to SLR for patients who cannot tolerate lobectomy because of medical comorbidities. (C) 2014 Elsevier Ltd. All rights reserved.
  • Yusuke Iizuka; Yukinori Matsuo; Shigeaki Umeoka; Yuji Nakamoto; Nami Ueki; Takashi Mizowaki; Kaori Togashi; Masahiro Hiraoka
    EUROPEAN JOURNAL OF RADIOLOGY 83 11 2087 - 2092 2014年11月 [査読有り]
     
    Purpose/objectives: To evaluate the use of diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for predicting disease progression (DP) among patients with non-small cell lung carcinoma (NSCLC) treated with stereotactic body radiotherapy (SBRT). Materials/methods: Fifteen patients with histologically confirmed stage I NSCLC who underwent pretreatment DW-MRI and PET and were treated with SBRT were enrolled. The mean apparent diffusion coefficient (ADC) value and maximum standardised uptake value (SUVmax) were measured at the target lesion and evaluated for correlations with DP. Results: The median pre-treatment ADC value was 1.04 x 10(-3) (range 0.83-1.29 x 10(-3)) mm(2)/s, and the median pre-treatment SUVmax was 9.9 (range 1.6-30). There was no correlation between the ADC value and SUV,T,a. The group with the lower ADC value (<= 1.05 x 10(-3) mm(2)/s) and that with a higher SUVmax (>= 7.9) tended to have poor DP, but neither trend was statistically significant (p = 0.09 and 0.32, respectively). The combination of the ADC value and SUVmax was a statistically significant predictor of DP (p = 0.036). Conclusion: A low ADC value on pre-treatment DW-MRI and a high SUV,Tiax may be associated with poor DP in NSCLC patients treated with SBRT. Using both values in combination was a better predictor. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
  • Katsuyuki Sakanaka; Yukinori Matsuo; Yasushi Nagata; Sayo Maki; Keiko Shibuya; Yoshiki Norihisa; Masaru Narabayashi; Nami Ueki; Takashi Mizowaki; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 19 5 814 - 821 2014年10月 [査読有り]
     
    Pathological diagnosis fails in some pulmonary tumors, although they may be highly suspected to be primary lung cancer. We studied the outcome of stereotactic body radiotherapy for a clinically diagnosed primary stage I lung cancer without pathological confirmation.The current study included 37 patients (39 lesions) treated with stereotactic body radiotherapy who were clinically diagnosed with primary stage I lung cancer between August 1998 and April 2009 at our hospital. Pulmonary tumors were highly suspected to be malignant from physical and imaging examinations. Biopsies were performed for 62 % of patients, although malignancy was not pathologically confirmed. In the other 38 % of patients, a biopsy was not feasible. Median age of the patients was 77 years. Median tumor diameter was 20 mm. A total median dose of 48 Gy was prescribed to the isocenter in four fractions. Median follow-up period was 39 months.The 3-year overall survival, local control, and regional-distant control were 74.2, 94.0, and 68.6 %, respectively. In patients with tumors a parts per thousand currency sign20 mm, overall survival and regional-distant control were significantly higher than in patients with tumors > 20 mm (p a parts per thousand currency sign 0.001), whereas no significant difference was observed regarding local control. No grade 3-5 adverse events possibly, probably, or definitely related to the treatment were observed.Stereotactic body radiotherapy is safe and effective for a clinically diagnosed primary stage I lung cancer when pathological diagnosis is difficult even with repeat biopsies, or a biopsy is not feasible for reasons of the patient's health condition or wishes.
  • 松尾 幸憲
    肺癌 54 6 821 - 824 (NPO)日本肺癌学会 2014年10月 
    体幹部定位放射線治療は、手術不能もしくは手術困難なI期非小細胞肺癌に対する治療オプションとして認められつつあり、特に近年増加している高齢癌患者のニーズにマッチしている。肺機能に関して治療後の一秒量変化は軽微であり、それ自体は治療適応に影響しないとの報告が多いが、間質性肺炎が併存する場合には治療後の重篤な放射線肺臓炎の頻度が高いとされる。また、中枢側存在型肺癌においては致死的な有害事象が報告されており、適応には慎重を要する。国内外で実施された多施設共同前向き臨床試験の結果を見ると、局所制御率は約90%、手術不能症例における3年全生存は約60%と見込まれる。今後も治療成績の向上ならびに有害事象の低減、治療適応の拡大を目指したエビデンスの蓄積を進めるとともに、新規の技術開発を継続して行っていくことが求められる。(著者抄録)
  • 池田 政樹; 青山 晃博; 松尾 幸憲; 園部 誠; 伊達 洋至
    日本呼吸器外科学会雑誌 28 6 777 - 782 (NPO)日本呼吸器外科学会 2014年09月 
    悪性胸膜中皮腫治療後に血小板減少を呈した症例を報告する。68歳男性。右悪性胸膜中皮腫にて右胸膜肺全摘・シスプラチン・ペメトレキセド併用化学療法後、強度変調放射線治療中に放射線肺臓炎を来したため照射中止し、ステロイドを開始した。1ヵ月後血小板2×10^3/μLに著減し頻回に血小板輸血を行った。サイトメガロウイルス(CMV)抗原血症の診断でガンシクロビル治療後も血小板は増加しなかった。骨髄検査で細胞密度はやや低形成であったが巨核球数は保たれており、免疫性血小板減少性紫斑病に準じ治療を行なった。免疫グロブリン治療後も数万/μLに留まり、トロンボポエチン受容体作動薬も効果不良であった。ステロイド投与中に発症し、薬物治療への反応が不良かつ一時的という点から、化学療法による骨髄機能低下に、放射線・薬剤・CMV感染など複合的要素が関与し血小板減少が発症・遷延したと考える。(著者抄録)
  • Yukinori Matsuo; Nami Ueki; Kenji Takayama; Mitsuhiro Nakamura; Yuki Miyabe; Yoshitomo Ishihara; Nobutaka Mukumoto; Shinsuke Yano; Hiroaki Tanabe; Shuji Kaneko; Takashi Mizowaki; Hajime Monzen; Akira Sawada; Masaki Kokubo; Masahiro Hiraoka
    RADIOTHERAPY AND ONCOLOGY 112 3 360 - 364 2014年09月 [査読有り]
     
    Purpose: To evaluate feasibility and acute toxicities after dynamic tumour tracking (DTT) irradiation with real-time monitoring for lung tumours using a gimbal mounted linac. Materials and methods: Spherical gold markers were placed around the tumour using a bronchoscope prior to treatment planning. Prescription dose at the isocentre was 56 Gy in 4 fractions for T2a lung cancer and metastatic tumour, and 48 Gy in 4 fractions for the others. Dose-volume metrics were compared between DTT and conventional static irradiation using in-house developed software. Results: Of twenty-two patients enrolled, DTT radiotherapy was successfully performed for 16 patients, except 4 patients who coughed out the gold markers, one who showed spontaneous tumour regression, and one where the abdominal wall motion did not correlate with the tumour motion. Dose covering 95% volume of GTV was not different between the two techniques, while normal lung volume receiving 20 Gy or more was reduced by 20%. A mean treatment time per fraction was 36 min using DTT. With a median follow-up period of 13.2 months, no severe toxicity grade 3 or worse was observed. Conclusions: DTT radiotherapy using a gimbal mounted linac was clinically feasible for lung treatment without any severe acute toxicity. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
  • Wambaka Ange Mampuya; Yukinori Matsuo; Nami Ueki; Mitsuhiro Nakamura; Nobutaka Mukumoto; Akira Nakamura; Yusuke Iizuka; Takahiro Kishi; Takashi Mizowaki; Masahiro Hiraoka
    JOURNAL OF RADIATION RESEARCH 55 5 934 - 939 2014年09月 [査読有り]
     
    The aim of this study was to evaluate the impact of abdominal compression (AC) on outcome in patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer. We retrospectively reviewed data for 47 patients with histologically proven non-small cell lung cancer and lung tumour motion >= 8 mm treated with SBRT. Setup error was corrected based on bony structure. The differences in overall survival (OS), local control (LC) and disease-free survival (DFS) were evaluated to compare patients treated with AC (n = 22) and without AC (n = 25). The median follow-up was 42.6 months (range, 1.4-94.6 months). The differences in the 3-year OS, LC and DFS rate between the two groups were not statistically significant (P = 0.909, 0.209 and 0.639, respectively). However, the largest difference was observed in the LC rate, which was 82.5% (95% CI, 54.9-94.0%) for patients treated without AC and 65.4% (95% CI, 40.2-82.0%) for those treated with AC. After stratifying the patients into prognostic groups based on sex and T-stage, the LC difference increased in the group with an unfavourable prognosis. The present study suggests that AC might be associated with a worse LC rate after SBRT using a bony-structure-based set-up.
  • Yusuke Tsuruta; Manabu Nakata; Mitsuhiro Nakamura; Yukinori Matsuo; Kyoji Higashimura; Hajime Monzen; Takashi Mizowaki; Masahiro Hiraoka
    MEDICAL PHYSICS 41 8 189 - 197 2014年08月 [査読有り]
     
    Purpose: To compare the dosimetric performance of Acuros XB (AXB), anisotropic analytical algorithm (AAA), and x-ray voxel Monte Carlo (XVMC) in heterogeneous phantoms and lung stereotactic body radiotherapy (SBRT) plans. Methods: Water- and lung-equivalent phantoms were combined to evaluate the percentage depth dose and dose profile. The radiation treatment machine Novalis (BrainLab AG, Feldlcirchen, Germany) with an x-ray beam energy of 6 MV was used to calculate the doses in the composite phantom at a source-to-surface distance of 100 cm with a gantry angle of 0 degrees. Subsequently, the clinical lung SBRT plans for the 26 consecutive patients were transferred from the iPlan (ver. 4.1; BrainLab AG) to the Eclipse treatment planning systems (ver. 11.0.3; Varian Medical Systems, Palo Alto, CA). The doses were then recalculated with AXB and AAA while maintaining the XVMC-calculated monitor units and beam arrangement. Then the dose-volumetric data obtained using the three different radiation dose calculation algorithms were compared. Results: The results from AXB and XVMC agreed with measurements within 3.0% for the lungequivalent phantom with a 6 x 6 cm(2) field size, whereas AAA values were higher than measurements in the heterogeneous zone and near the boundary, with the greatest difference being 4.1%. AXB and XVMC agreed well with measurements in terms of the profile shape at the boundary of the heterogeneous zone. For the lung SBRT plans, AXB yielded lower values than XVMC in terms of the maximum doses of ITV and PTV; however, the differences were within 3.0%. In addition to the dose-volumetric data, the dose distribution analysis showed that AXB yielded dose distribution calculations that were closer to those with XVMC than did AAA. Means +/- standard deviation of the computation time was 221.6 +/- 53.1 s (range, 124-358s), 66.1 +/- 16.0 s (range, 42-94 s), and 6.7 +/- 1.1 s (range, 5-9 s) for XVMC, AXB, and AAA, respectively. Conclusions: In the phantom evaluations, AXB and XVMC agreed better with measurements than did AAA. Calculations differed in the density-changing zones (substance boundaries) between AXB/XVMC and AAA. In the lung SBRT cases, a comparative analysis of dose-volumetric data and dose distributions with XVMC demonstrated that the AXB provided better agreement with XVMC than AAA. The computation time of AXB was faster than that of XVMC; therefore, AXB has better balance in terms of the dosimetric performance and computation speed for clinical use than XVMC. 2014 American Association of Physicists in Medicine.
  • Hideomi Yamashita; Hiroshi Onishi; Yasuo Matsumoto; Naoya Murakami; Yukinori Matsuo; Takuma Nomiya; Keiichi Nakagawa
    RADIATION ONCOLOGY 9 2014年05月 
    Background and aims: Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. The outcomes of SBRT for liver tumor unfit for ablation and surgical resection were evaluated. Methods: Liver tumor patients treated with SBRT in seven Japanese institutions were studied retrospectively. Patients given SBRT for liver tumor between 2004 and 2012 were collected. Patients treated with SBRT preceded by trans-arterial chemoembolization (TACE) were eligible. Seventy-nine patients with hepatocellular carcinoma (HCC) and 51 patients with metastatic liver tumor were collected. The median biologically effective dose (BED) (alpha/beta= 10 Gy) was 96.3 Gy for patients with HCC and 105.6 Gy with metastatic liver tumor. Results: The median follow-up time was 475.5 days in patients with HCC and 212.5 days with metastatic liver tumor. The 2-year local control rate (LCR) for HCC and metastatic liver tumor was 74.8% +/- 6.3% and 64.2 +/- 9.5% (p = 0.44). The LCR was not different between BED10 >= 100 Gy and < 100 Gy (p = 0.61). The LCR was significantly different between maximum tumor diameter > 30 mm vs. <= 30 mm (64% vs. 85%, p = 0.040) in all 130 patients. No grade 3 laboratory toxicities in the acute, sub-acute and chronic phases were observed. Conclusions: There was no difference in local control after SBRT in the range of median BED10 around 100 Gy for between HCC and metastatic liver tumor. SBRT is safe and might be an alternative method to resection and ablation. Summary: There was no difference in local control after SBRT in the range of median BED10 around 100 Gy for between HCC and metastatic liver tumor and SBRT is safe and might be an alternative method to resection and ablation.
  • Nobutaka Mukumoto; Mitsuhiro Nakamura; Masahiro Yamada; Kunio Takahashi; Hiroaki Tanabe; Shinsuke Yano; Yuki Miyabe; Nami Ueki; Shuji Kaneko; Yukinori Matsuo; Takashi Mizowaki; Akira Sawada; Masaki Kokubo; Masahiro Hiraoka
    RADIOTHERAPY AND ONCOLOGY 111 2 301 - 305 2014年05月 [査読有り]
     
    Purpose: To verify the intrafractional tracking accuracy in infrared (IR) marker-based hybrid dynamic tumour tracking irradiation ("IR Tracking") with the Vero4DRT. Materials and methods: The gimballed X-ray head tracks a moving target by predicting its future position from displacements of IR markers in real-time. Ten lung cancer patients who underwent IR Tracking were enrolled. The 95th percentiles of intrafractional mechanical (iE(M)(95)), prediction (iE(p)(95)), and overall targeting errors (iE(T)(95))were calculated from orthogonal fluoroscopy images acquired during tracking irradiation and from the synchronously acquired log files. Results: Averaged intrafractional errors were (left-right, cranio-caudal [CC], anterior-posterior [AP]) = (0.1 mm, 0.4 mm, 0.1 mm) for iE(M)(95), (1.2 mm, 2.7 mm, 2.1 mm) for iE(p)(95), and (1.3 mm, 2.4 mm, 1.4 mm) for iE(T)(95). By correcting systematic prediction errors in the previous field, the iE(p)(95) was reduced significantly, by an average of 0.4 mm in the CC (p < 0.05) and by 0.3 mm in the AP (p < 0.01) directions. Conclusions: Prediction errors were the primary cause of overall targeting errors, whereas mechanical errors were negligible. Furthermore, improvement of the prediction accuracy could be achieved by correcting systematic prediction errors in the previous field. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
  • Akira Nakamura; Satoshi Itasaka; Kyoichi Takaori; Yoshiya Kawaguchi; Keiko Shibuya; Michio Yoshimura; Yukinori Matsuo; Takashi Mizowaki; Shinji Uemoto; Masahiro Hiraoka
    STRAHLENTHERAPIE UND ONKOLOGIE 190 5 485 - 490 2014年04月 [査読有り]
     
    Background and purpose. To evaluate the treatment outcomes of radiotherapy and prognostic factors for recurrent pancreatic cancer. Patients and methods. The study comprised 30 patients who developed a locoregional recurrence of primarily resected pancreatic cancer and received radiotherapy between 2000 and 2013 with a median dose of 54 Gy (range, 39-60 Gy). Concurrent chemotherapy included gemcitabine for 18 patients and S-1 for seven patients. The treatment outcomes and prognostic factors were retrospectively analyzed. Results. The median follow-up after radiotherapy was 14.6 months. The 1-year overall survival, local control, and progression-free survival rates were 69 %, 67 %, and 32 %, respectively. The median overall survival and progression-free survival rates were 15.9 and 6.9 months, respectively. Tumor marker reduction and >= 50 % reduction were observed in 18 and two patients, respectively. Of the seven patients who exhibited pain symptoms, four and two patients were partly and completely relieved, respectively. Late grade 3 ileus and gastroduodenal bleeding were observed in one patient each. Among the clinicopathological factors evaluated, only a disease-free interval of greater than 18.9 months exhibited a significant association with improved overall survival (p = 0.017). Radiotherapy for isolated locally recurrent pancreatic cancer resulted in encouraging local control, overall survival, and palliative effects with mild toxicity, particularly in patients with a prolonged disease-free interval. This treatment strategy should be prospectively evaluated.
  • Nami Ueki; Yukinori Matsuo; Mitsuhiro Nakamura; Nobutaka Mukumoto; Yusuke Iizuka; Yuki Miyabe; Akira Sawada; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    RADIOTHERAPY AND ONCOLOGY 110 3 523 - 528 2014年03月 [査読有り]
     
    Purpose: To quantify the intra- and interfractional variations between lung tumours and implanted markers. Materials and methods: Gold markers were implanted transbronchially around a lung tumour in fifteen patients. They underwent four-dimensional computed tomography scans twice, and the centroids of the tumour and markers were determined. Intrafractional variations were defined as the residual tumour motions relative to the markers due to respiration from the end-exhale phase. Interfractional variations were defined as the residual setup errors after correction for the position of the implanted markers in end-exhale phase images. Results: The intrafractional variations differed between patients. The root mean squares of standard deviations for each phase were 0.6, 0.9, and 1.5 mm in the right-left, anterior-posterior, and superior-inferior directions, respectively. The maximum difference in intrafractional variation among 10 phases was correlated with the amplitude of tumour motion in all directions and the tumour-marker distance in the anterior-posterior and superior-inferior directions. The interfractional variations were within 2.5 mm. Conclusions: The intrafractional variations differed according to the amount of tumour motion and the tumour-marker distance. Additionally, interfractional variations of up to 2.5 mm were observed. Thus, a corresponding margin should be considered during implanted marker-based beam delivery to account for these variations. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
  • 植木 奈美; 松尾 幸憲; 平岡 眞寛
    Rad Fan 12 3 79 - 82 (株)メディカルアイ 2014年02月 
    Vero4DRTを用いた動体追尾定位放射線治療は、周囲臓器への線量を低減し、リアルタイムに腫瘍位置をモニタリングしながら高精度の治療を行うことが可能である。また自由呼吸下で照射を行うため治療時間の延長もない。今後マーカーレス追尾照射の実現によりさらに患者にやさしい治療法の実現が期待される。(著者抄録)
  • Yukinori Matsuo
    Journal of applied clinical medical physics / American College of Medical Physics 2014年01月 
    We are developing an innovative dynamic tumor tracking irradiation technique using gold markers implanted around a tumor as a surrogate signal, a real-time marker detection system, and a gimbaled X-ray head in the Vero4DRT. The gold markers implanted in a normal organ will produce uncertainty in the dose calculation during treatment planning because the photon mass attenuation coefficient of a gold marker is much larger than that of normal tissue. The purpose of this study was to simulate the dose variation near the gold markers in a lung irradiated by a photon beam using the Monte Carlo method. First, the single-beam and the opposing-beam geometries were simulated using both water and lung phantoms. Subsequently, the relative dose profiles were calculated using a stereotactic body radiotherapy (SBRT) treatment plan for a lung cancer patient having gold markers along the anterior-posterior (AP) and right-left (RL) directions. For the single beam, the dose at the gold marker-phantom interface laterally along the perpendicular to the beam axis increased by a factor of 1.35 in the water phantom and 1.58 in the lung phantom, respectively. Furthermore, the entrance dose at the interface along the beam axis increased by a factor of 1.63 in the water phantom and 1.91 in the lung phantom, while the exit dose increased by a factor of 1.00 in the water phantom and 1.12 in the lung phantom, respectively. On the other hand, both dose escalations and dose de-escalations were canceled by each beam for opposing portal beams with the same beam weight. For SBRT patient data, the dose at the gold marker edge located in the tumor increased by a factor of 1.30 in both AP and RL directions. In clinical cases, dose escalations were observed at the small area where the distance between a gold marker and the lung tumor was ≤ 5 mm, and it would be clinically negligible in multibeam treatments, although further investigation may be required.
  • 診断から10年後に肺転移を来した顆粒膜細胞腫の1例
    Yukinori Matsuo
    和歌山医学 2014年
  • Shiinoki, T.; Sawada, A.; Ishihara, Y.; Miyabe, Y.; Matsuo, Y.; Mizowaki, T.; Kokubo, M.; Hiraoka, M.
    Journal of applied clinical medical physics / American College of Medical Physics 15 3 2014年
  • Shiinoki T; Sawada A; Ishihara Y; Miyabe Y; Matsuo Y; Mizowaki T; Kokubo M; Hiraoka M
    2014年
  • Shiinoki, T.; Sawada, A.; Ishihara, Y.; Miyabe, Y.; Matsuo, Y.; Mizowaki, T.; Kokubo, M.; Hiraoka, M.
    Journal of Applied Clinical Medical Physics 15 3 2014年
  • Yukinori Matsuo
    Medical Physics 2014年
  • Shiinoki, T.; Sawada, A.; Ishihara, Y.; Miyabe, Y.; Matsuo, Y.; Mizowaki, T.; Kokubo, M.; Hiraoka, M.
    Journal of Applied Clinical Medical Physics 15 3 2014年
  • Ikeda, T.; Yoshimatsu, T.; Tamura, T.; Nasu, H.; Nakano, Y.; Ozaki, T.; Miyamoto, K.; Matsuo, Y.
    Journal of the Wakayama Medical Society 65 2 2014年
  • 飯塚 裕介; 松尾 幸憲; 中村 光宏; 宮部 結城; 矢野 慎輔; 山田 昌弘; 溝脇 尚志; 門前 一; 小久保 雅樹; 平岡 眞寛
    定位的放射線治療 18 9 - 16 日本定位放射線治療学会 2014年01月 
    72歳男。肺腺癌の単発肝転移で径36mmであった。腫瘍位置の参照として腫瘍近傍に金マーカー(Visicoil)を経皮的に留置し、毎回の治療前に腹壁の赤外線反射マーカーとVisicoil間の相関モデルを作成した。治療中は腹壁のマーカー位置に基づいて照射ビームのヘッドを制御して動体追尾照射を施行し、同時にX線透視でVisicoilの位置をモニタリングした。処方線量は56Gy/4frであり、特に問題なく終了した。治療時間は平均38.5分であり従来の照射法(15-30分)より延長していたが、計画標的体積は従来法と比較して133.3mlから85.6mlへ低減し、正常肝の平均線量も14.3Gyから11.5Gyへ低減した。治療終了後5ヵ月現在、腫瘍は縮小傾向にあり、良好に制御できている。
  • 松尾 幸憲
    日本臨床 71 増刊6 最新肺癌学 507 - 510 (株)日本臨床社 2013年11月 
    当科でI期非小細胞肺癌に対し体幹部定位放射線治療(SBRT)を施行した66例の治療成績について検討した。その結果、治療後5年の時点で19例が無病生存中であったが、その後の経過観察により4例(21.1%)に晩期再発、2例(10.5%)に二次肺癌が認められた。再発4例の再発時期は6年4ヵ月〜9年1ヵ月で、再発形式は局所単独再発が2例、遠隔転移(脳)1例、局所再発+遠隔転移(肺)1例であった。局所再発の1例はゲフィチニブ投与を試みたが肝障害にて数ヵ月で中止し、他の3例は無治療であった。1例は心不全と腎不全で死亡し、他の3例は原病死した。二次肺癌はそれぞれ9年2ヵ月、10年2ヵ月で認め、前者は追加治療を現在検討中、後者は無治療にて経過観察中で、いずれも生存中である。
  • Wambaka Ange Mampuya; Mitsuhiro Nakamura; Yukinori Matsuo; Nami Ueki; Yusuke Iizuka; Takahiro Fujimoto; Shinsuke Yano; Hajime Monzen; Takashi Mizowaki; Masahiro Hiraoka
    MEDICAL PHYSICS 40 9 2013年09月 [査読有り]
     
    Purpose: To assess the effect of abdominal compression on the interfraction variation in tumor position in lung stereotactic body radiotherapy (SBRT) using cone-beam computed tomography (CBCT) in a larger series of patients with large tumor motion amplitude. Methods: Thirty patients with lung tumor motion exceeding 8 mm who underwent SBRT were included in this study. After translational and rotational initial setup error was corrected based on bone anatomy, CBCT images were acquired for each fraction. The residual interfraction variation was defined as the difference between the centroid position of the visualized target in three dimensions derived from CBCT scans and those derived from averaged intensity projection images. The authors compared the magnitude of the interfraction variation in tumor position between patients treated with [n = 16 (76 fractions)] and without [ n = 14 (76 fractions)] abdominal compression. Results: The mean +/- standard deviation (SD) of the motion amplitude in the longitudinal direction before abdominal compression was 19.9 +/- 7.3 (range, 10-40) mm and was significantly (p < 0.01) reduced to 12.4 +/- 5.8 (range, 5-30) mm with compression. The greatest variance of the interfraction variation with abdominal compression was observed in the longitudinal direction, with a mean +/- SD of 0.79 +/- 3.05 mm, compared to -0.60 +/- 2.10 mm without abdominal compression. The absolute values of the 95th percentile of the interfraction variation for one side in each direction were 3.97/6.21 mm (posterior/anterior), 4.16/3.76 mm (caudal/cranial), and 2.90/2.32 mm (right/left) without abdominal compression, and 2.14/5.03 mm (posterior/anterior), 3.93/9.23 mm (caudal/cranial), and 2.37/5.45 mm (right/left) with abdominal compression. An absolute interfraction variation greater than 5 mm was observed in six (9.2%) fractions without and 13 (17.1%) fractions with abdominal compression. Conclusions: Abdominal compression was effective for reducing the amplitude of tumor motion. However, in most of the authors' patients, the use of abdominal compression seemed to increase the interfraction variation in tumor position, despite reducing lung tumor motion. The daily tumor position deviated more systematically from the tumor position in the planning CT scan in the lateral and longitudinal directions in patients treated with abdominal compression compared to those treated without compression. Therefore, target matching is required to correct or minimize the interfraction variation. (C) 2013 American Association of Physicists in Medicine.
  • Takahisa Eriguchi; Atsuya Takeda; Yohei Oku; Satoshi Ishikura; Tomoki Kimura; Shuichi Ozawa; Takeo Nakashima; Yukinori Matsuo; Mitsuhiro Nakamura; Yasuo Matsumoto; Sadanori Yamazaki; Naoko Sanuki; Yoshinori Ito
    RADIATION ONCOLOGY 8 2013年05月 [査読有り]
     
    Introduction: Several single institution phase I and phase II trials of stereotactic ablative body radiotherapy (SABR) for liver tumors have reported promising results and high local control rates of over 90%. However, there are wide variations in dose and fractionation due to different prescription policies and treatment methods across SABR series that have been published to date. This study aims to assess and minimize inter-institutional variations in treatment planning using SABR for hepatocellular carcinoma (HCC) in preparation for a prospective multi-institutional study. Methods: Four institutions (A-D) participated in this study. Each institution was provided with data from four cases, including planning and diagnostic CT images and clinical information, and asked to implement three plans (a practice plan and protocol plans 1 and 2). Practice plans were established based on the current treatment protocols at each institution. In protocol plan 1, each institution was instructed to prescribe 40 Gy in five fractions within 95% of the planning target volume (PTV). After protocol plan 1 was evaluated, we made protocol plan 2, The additional regulation to protocol plan 1 was that 40 Gy in five fractions was prescribed to a 70% isodose line of the global maximum dose within the PTV. Planning methods and dose volume histograms (DVHs) including the median PTV D50 (D(m)50) and the median normal liver volume that received 20 Gy or higher (V(m)20) were compared. Results: In the practice plan, D(m)50 was 48.4 Gy (range, 43.6-51.2 Gy). V(m)20 was 15.9% (range, 12.2-18.9%). In protocol plan 1, the D(m)50 at institution A was higher (51.2 Gy) than the other institutions (42.0-42.2 Gy) due to differences in dose specifications. In protocol plan 2, variations in DVHs were reduced. The D(m)50 was 51.9 Gy (range, 51.0-53.1 Gy), and the V(m)20 was 12.3% (range, 10.4-13.2%). The homogeneity index was nearly equivalent at all institutions. Conclusions: There were notable inter-institutional differences in practice planning using SABR to treat HCC. The range of PTV and normal liver DVH values was reduced when the dose was prescribed to an isodose line within the PTV. In multi-institutional studies, detailed dose specifications based on collaboration are necessary.
  • Yukinori Matsuo; Hiroshi Onishi; Keiichi Nakagawa; Mitsuhiro Nakamura; Takaki Ariji; Yu Kumazaki; Munefumi Shimbo; Naoki Tohyama; Teiji Nishio; Masahiko Okumura; Hiroki Shirato; Masahiro Hiraoka
    Journal of Radiation Research 54 3 561 - 568 2013年05月 [査読有り]
     
    Respiratory motion management (RMM) systems in external and stereotactic radiotherapies have been developed in the past two decades. Japanese medical service fee regulations introduced reimbursement for RMM from April 2012. Based on thorough discussions among the four academic societies concerned, these Guidelines have been developed to enable staff (radiation oncologists, radiological technologists, medical physicists, radiotherapy quality managers, radiation oncology nurses, and others) to apply RMM to radiation therapy for tumors subject to respiratory motion, safely and appropriately. © 2012 The Author 2012.
  • Nami Ueki; Yukinori Matsuo; Keiko Shibuya; Mitsuhiro Nakamura; Masaru Narabayashi; Katsuyuki Sakanaka; Yoshiki Norihisa; Takashi Mizowaki; Masahiro Hiraoka
    JOURNAL OF RADIATION RESEARCH 54 2 337 - 343 2013年03月 [査読有り]
     
    The purpose of this study is to evaluate the dose-volume metrics under different heterogeneity corrections and the factors associated with local recurrence (LR) after stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). Eighty-three patients who underwent SBRT for pathologically proven stage I NSCLC were reviewed retrospectively. The prescribed dose was 48 Gy in four fractions at the isocenter (IC) under heterogeneity correction with the Batho power law (BPL). The clinical plans were recalculated with Eclipse (Varian) for the same monitor units under the BPL and anisotropic analytical algorithm (AAA) and with no heterogeneity correction (NC). The dose at the IC, dose that covers 95% of the volume (D95), minimum dose (Min), and mean dose (Mean) of the planning target volume (PTV) were compared under each algorithm and between patients with local lesion control (LC) and LR. The IC doses under NC were significantly lower than those under the BPL and AAA. Under the BPL, the mean PTV D95, Min and Mean were 8.0, 9.4 and 7.4% higher than those under the AAA, and 9.6, 9.2 and 4.6% higher than those under NC, respectively. Under the AAA, all dose-volumetric parameters were significantly lower in T1a patients than in those with T1b and T2a. With a median follow-up of 35.9 months, LR occurred in 18 patients. Between the LC and LR groups, no significant differences were observed for any of the metrics. Even after stratification according to T-stage, no significant difference was observed between LC and LR.
  • Takashi Mizowaki; Kenji Takayama; Kazuo Nagano; Yuki Miyabe; Yukinori Matsuo; Shuji Kaneko; Masaki Kokubo; Masahiro Hiraoka
    Journal of Radiation Research 54 2 330 - 336 2013年03月 [査読有り]
     
    The Vero4DRT (MHI-TM2000) is a newly designed unique image-guided radiotherapy system consisting of an O-ring gantry. This system can realize a new irradiation technique in which both the gantry head and O-ring continuously and simultaneously rotate around the inner circumference of the O-ring and the vertical axis of the O-ring, respectively, during irradiation. This technique creates three-dimensional (3D) rotational dynamic conformal arc irradiation, which we term '3D unicursal irradiation'. The aim of this study was to present the concept and to estimate feasibility and potential advantages of the new irradiation technique. Collision maps were developed for the technique and a 3D unicursal plan was experimentally created in reference to the collision map for a pancreatic cancer case. Thereafter, dosimetric comparisons among the 3D unicursal, a two-dimensionally rotational dynamic conformal arc irradiation (2D-DCART), and an intensity-modulated radiation therapy (IMRT) plan were conducted. Dose volume data of the 3D unicursal plan were comparable or improved compared to those of the 2D-DCART and IMRT plans with respect to both the target and the organs at risk. The expected monitor unit (MU) number for the 3D unicursal plan was only 7% higher and 22.1% lower than the MUs for the 2D-DCART plan and IMRT plan, respectively. It is expected that the 3D unicursal irradiation technique has potential advantages in both treatment time and dose distribution, which should be validated under various conditions with a future version of the Vero4DRT fully implemented the function. © 2012 The Author 2012. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Therapeutic Radiology and Oncology.
  • Mami Akimoto; Mitsuhiro Nakamura; Nobutaka Mukumoto; Hiroaki Tanabe; Masahiro Yamada; Yukinori Matsuo; Hajime Monzen; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    Medical Physics 40 9 2013年 [査読有り]
     
    Purpose: To quantify the predictive uncertainty in infrared (IR)-marker-based dynamic tumor tracking irradiation (IR Tracking) with Vero4DRT (MHI-TM2000) for lung cancer using logfiles. Methods: A total of 110 logfiles for 10 patients with lung cancer who underwent IR Tracking were analyzed. Before beam delivery, external IR markers and implanted gold markers were monitored for 40 s with the IR camera every 16.7 ms and with an orthogonal kV x-ray imaging subsystem every 80 or 160 ms. A predictive model [four-dimensional (4D) model] was then created to correlate the positions of the IR markers (P IR) with the three-dimensional (3D) positions of the tumor indicated by the implanted gold markers (Pdetect). The sequence of these processes was defined as 4D modeling. During beam delivery, the 4D model predicted the future 3D target positions (Ppredict) from the P IR in real-time, and the gimbaled x-ray head then tracked the target continuously. In clinical practice, the authors updated the 4D model at least once during each treatment session to improve its predictive accuracy. This study evaluated the predictive errors in 4D modeling (E4DM) and those resulting from the baseline drift of PIR and Pdetect during a treatment session (EBD). E4DM was defined as the difference between Ppredict and Pdetect in 4D modeling, and EBD was defined as the mean difference between P predict calculated from PIR in updated 4D modeling using (a) a 4D model created from training data before the model update and (b) an updated 4D model created from new training data. Results: The mean E 4DM was 0.0 mm with the exception of one logfile. Standard deviations of E4DM ranged from 0.1 to 1.0, 0.1 to 1.6, and 0.2 to 1.3 mm in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. The median elapsed time before updating the 4D model was 13 (range, 2-33) min, and the median frequency of 4D modeling was twice (range, 2-3 times) per treatment session. EBD ranged from -1.0 to 1.0, -2.1 to 3.3, and -2.0 to 3.5 mm in the LR, AP, and SI directions, respectively. EBD was highly correlated with BDdetect in the LR (R = -0.83) and AP directions (R = -0.88), but not in the SI direction (R = -0.40). Meanwhile, EBD was highly correlated with BDIR in the SI direction (R = -0.67), but not in the LR (R = 0.15) or AP (R = -0.11) direction. If the 4D model was not updated in the presence of intrafractional baseline drift, the predicted target position deviated from the detected target position systematically. Conclusions: Application of IR Tracking substantially reduced the geometric error caused by respiratory motion however, an intrafractional error due to baseline drift of > 3 mm was occasionally observed. To compensate for EBD, the authors recommend checking the target and IR marker positions constantly and updating the 4D model several times during a treatment session. © 2013 American Association of Physicists in Medicine.
  • Akira Nakamura; Keiko Shibuya; Mitsuhiro Nakamura; Yukinori Matsuo; Takehiro Shiinoki; Manabu Nakata; Takashi Mizowaki; Masahiro Hiraoka
    Medical Physics 40 2 021701.1-021701.9  2013年 [査読有り]
     
    Purpose: This study aims to evaluate the interfractional dose variations in the organs-at-risk (OARs) during pancreatic breathhold intensity-modulated radiotherapy (IMRT) and to assess the impacts of "planning organs-at-risk volume" (POV) structures generated by isotropically expanding the dose-limiting OARs, based on the comparison of the interfractional doses to the OARs between IMRT plans and conventional three-dimensional-conformal radiotherapy (3D-CRT) plans. Methods: Thirty repeat CT scans were acquired from ten consecutive patients who were receiving chemoradiotherapy for pancreatic cancer. Six IMRT plans for each patient with two levels of prescription (45 and 51 Gy in 15 fractions) and 3 POV margin sizes (5, 7, and 10 mm) were generated based on the initial CT scan under predetermined constraints. Two 3D-CRT plans (39 and 42 Gy in 15 fractions) were simultaneously generated. The dose distribution of all of the treatment plans was recalculated with the repeat CT scans. The interfractional dose variations in the three OARs (stomach, duodenum, and small intestine) were evaluated, and the absolute volumes ≥39 Gy (V39Gy) of the OARs in the IMRT plans were compared to those in the 3D-CRT plans. Regression analyses were performed to assess the relative impact of the factors of interest on the interfractional dose variations of the OARs. Results: Substantial dose excesses to the three OARs were observed at all of the prescription dose levels and the POV margin sizes on the repeat CT scans. The safety threshold based on the mean stomach V39Gy on the recalculated 39 Gy-3D-CRT plans was 1.9 ml. Statistically significant and marginally insignificant mean V39Gy values above the safety thresholds were observed in the stomach in the 51 Gy-IMRT plans (2.6 and 2.1 ml with the 5- and 7-mm PRV margins, respectively (P = 0.015 and 0.085)). Only in the case of the 10-mm POV margin did the metric fall below the safety threshold to 1.5 ml (P = 0.634). The duodenum and the small intestine did not violate the safety thresholds (1.4 and 3.8 ml, respectively). From the multiple regression analyses, only the margin size (P < 0.001) and the POV V39Gy (P < 0.001) were significantly associated with the distribution of recalculated V39Gy for the stomach. Multiple factors, including the margin size (P = 0.020) and the POV V39Gy (P < 0.001) were associated with the recalculated V39Gy for the duodenum. However, none of the POV parameters for the small intestine were associated with the recalculated V39Gy. Conclusions: Considerable interfractional dose variation was observed in three critical OARs. At the escalated prescription dose of breathhold IMRT, the dose variations could exceed the dose variations using 3D-CRT at the safe prescription dose level, indicating that a dose-escalation strategy based solely on the initial advantageous dose distribution in a breathhold IMRT can be problematic. Given the current limitations for predicting or coping with variation throughout the treatment course, the use of POV should be considered for safely delivering escalated doses to patients with pancreatic cancer. © 2013 American Association of Physicists in Medicine.
  • Toru Takakura; Mitsuhiro Nakamura; Keiko Shibuy; Manabu Nakata; Akira Nakamura; Matsuo Yukinori; Takeshi Shiinoki; Kyoji Higashimura; Teruki Teshima; Masahiro Hiraoka
    JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS 14 5 43 - 51 2013年 [査読有り]
     
    In patients with pancreatic cancer, intensity-modulated radiotherapy (IMRT) under breath holding facilitates concentration of the radiation dose in the tumor, while sparing the neighboring organs at risk and minimizing interplay effects between movement of the multileaf collimator and motion of the internal structures. Although the breath-holding technique provides high interportal reproducibility of target position, dosimetric errors caused by interportal breath-holding positional error have not been reported. Here, we investigated the effects of interportal breath-holding positional errors on IMRT dose distribution by incorporating interportal positional error into the original treatment plan, using random numbers in ten patients treated for pancreatic cancer. We also developed a treatment planning technique that shortens breath-holding time without increasing dosimetric quality assurance workload. The key feature of our proposed method is performance of dose calculation using the same optimized fluence map as the original plan, after dose per fraction in the original plan was cut in half and the number of fractions was doubled. Results confirmed that interportal error had a negligible effect on dose distribution over multiple fractions. Variations in the homogeneity index and the dose delivered to 98%, 2%, and 50% of the volume for the planning target volume, and the dose delivered to 1 cc of the volume for the duodenum and stomach were +/- 1%, on average, in comparison with the original plan. The new treatment planning method decreased breath-holding time by 33%, and differences in dose-volume metrics between the original and the new treatment plans were within +/- 1%. An additional advantage of our proposed method is that interportal errors can be better averaged out; thus, dose distribution in the proposed method may be closer to the planned dose distribution than with the original plans.
  • Akira Nakamura; Keiko Shibuya; Mitsuhiro Nakamura; Yukinori Matsuo; Takehiro Shiinoki; Manabu Nakata; Takashi Mizowaki; Masahiro Hiraoka
    Medical Physics 40 2 2013年 [査読有り]
     
    Purpose: This study aims to evaluate the interfractional dose variations in the organs-at-risk (OARs) during pancreatic breathhold intensity-modulated radiotherapy (IMRT) and to assess the impacts of "planning organs-at-risk volume" (POV) structures generated by isotropically expanding the dose-limiting OARs, based on the comparison of the interfractional doses to the OARs between IMRT plans and conventional three-dimensional-conformal radiotherapy (3D-CRT) plans. Methods: Thirty repeat CT scans were acquired from ten consecutive patients who were receiving chemoradiotherapy for pancreatic cancer. Six IMRT plans for each patient with two levels of prescription (45 and 51 Gy in 15 fractions) and 3 POV margin sizes (5, 7, and 10 mm) were generated based on the initial CT scan under predetermined constraints. Two 3D-CRT plans (39 and 42 Gy in 15 fractions) were simultaneously generated. The dose distribution of all of the treatment plans was recalculated with the repeat CT scans. The interfractional dose variations in the three OARs (stomach, duodenum, and small intestine) were evaluated, and the absolute volumes ≥39 Gy (V39Gy) of the OARs in the IMRT plans were compared to those in the 3D-CRT plans. Regression analyses were performed to assess the relative impact of the factors of interest on the interfractional dose variations of the OARs. Results: Substantial dose excesses to the three OARs were observed at all of the prescription dose levels and the POV margin sizes on the repeat CT scans. The safety threshold based on the mean stomach V39Gy on the recalculated 39 Gy-3D-CRT plans was 1.9 ml. Statistically significant and marginally insignificant mean V39Gy values above the safety thresholds were observed in the stomach in the 51 Gy-IMRT plans (2.6 and 2.1 ml with the 5- and 7-mm PRV margins, respectively (P = 0.015 and 0.085)). Only in the case of the 10-mm POV margin did the metric fall below the safety threshold to 1.5 ml (P = 0.634). The duodenum and the small intestine did not violate the safety thresholds (1.4 and 3.8 ml, respectively). From the multiple regression analyses, only the margin size (P < 0.001) and the POV V39Gy (P < 0.001) were significantly associated with the distribution of recalculated V39Gy for the stomach. Multiple factors, including the margin size (P = 0.020) and the POV V39Gy (P < 0.001) were associated with the recalculated V39Gy for the duodenum. However, none of the POV parameters for the small intestine were associated with the recalculated V39Gy. Conclusions: Considerable interfractional dose variation was observed in three critical OARs. At the escalated prescription dose of breathhold IMRT, the dose variations could exceed the dose variations using 3D-CRT at the safe prescription dose level, indicating that a dose-escalation strategy based solely on the initial advantageous dose distribution in a breathhold IMRT can be problematic. Given the current limitations for predicting or coping with variation throughout the treatment course, the use of POV should be considered for safely delivering escalated doses to patients with pancreatic cancer. © 2013 American Association of Physicists in Medicine.
  • Kiyotomo Matsugi; Mitsuhiro Nakamura; Yuki Miyabe; Chikako Yamauchi; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka
    Radiological Physics and Technology 6 1 233 - 240 2013年01月 [査読有り]
     
    We evaluated the four-dimensional (4D) dose to a moving target by a Monte Carlo dose calculation algorithm in stereotactic body radiation therapy (SBRT) planning based on the isocenter dose prescription. 4D computed tomography scans were performed for 12 consecutive patients who had 14 tumors. The gross tumor volume (GTV) and internal target volume (ITV) were contoured manually, and the planning target volume (PTV) was defined as the ITV with a 5-mm margin. The beam apertures were shaped into the PTV plus a 5-mm leaf margin. The prescription dose was 48 Gy in 4 fractions at the isocenter. The GTV dose was calculated by accumulation of respiratory-phase dose distributions that were mapped to a reference images, whereas the ITV and PTV doses were calculated with the respiration-averaged images. The doses to 99 % (D99) of the GTV, ITV, and PTV were 90.2, 89.3, and 82.0 %, respectively. The mean difference between the PTV D99 and GTV D99 was -9.1 % (range -13.4 to -4.0 %), and that between the ITV and GTV was -1.1 % (range -5.5 to 1.9 %). The mean homogeneity index (HI) for the GTV, ITV, and PTV was 1.14, 1.15, and 1.26, respectively. Significant differences were observed in the D99 and HI between the PTV and GTV, whereas no significant difference was seen between the ITV and GTV. When SBRT planning is performed based on the isocenter dose prescription with a 5-mm PTV margin and a 5-mm leaf margin, the ITV dose provides a good approximation of the GTV dose. © 2012 Japanese Society of Radiological Technology and Japan Society of Medical Physics.
  • Wambaka Ange Mampuya; Yukinori Matsuo; Akira Nakamura; Mitsuhiro Nakamura; Nobutaka Mukumoto; Yuki Miyabe; Masaru Narabayashi; Katsuyuki Sakanaka; Takashi Mizowaki; Masahiro Hiraoka
    Medical Dosimetry 38 1 95 - 99 2013年 [査読有り]
     
    The objective of this study was to evaluate the differences in dose-volumetric data obtained using the analytical anisotropic algorithm (AAA) vs the x-ray voxel Monte Carlo (XVMC) algorithm for stereotactic body radiation therapy (SBRT) for lung cancer. Dose-volumetric data from 20 patients treated with SBRT for solitary lung cancer generated using the iPlan XVMC for the Novalis system consisting of a 6-MV linear accelerator and micro-multileaf collimators were recalculated with the AAA in Eclipse using the same monitor units and identical beam setup. The mean isocenter dose was 100.2% and 98.7% of the prescribed dose according to XVMC and AAA, respectively. Mean values of the maximal dose (Dmax), the minimal dose (Dmin), and dose received by 95% volume (D95) for the planning target volume (PTV) with XVMC were 104.3%, 75.1%, and 86.2%, respectively. When recalculated with the AAA, those values were 100.8%, 77.1%, and 85.4%, respectively. Mean dose parameter values considered for the normal lung, namely the mean lung dose, V5, and V20, were 3.7Gy, 19.4%, and 5.0% for XVMC and 3.6Gy, 18.35, and 4.7% for the AAA, respectively. All of these dose-volumetric differences between the 2 algorithms were within 5% of the prescribed dose. The effect of PTV size and tumor location, respectively, on the differences in dose parameters for the PTV between the AAA and XVMC was evaluated. A significant effect of the PTV on the difference in D95 between the AAA and XVMC was observed (p = 0.03). Differences in the marginal doses, namely Dmin and D95, were statistically significant between peripherally and centrally located tumors (p = 0.04 and p = 0.02, respectively). Tumor location and volume might have an effect on the differences in dose-volumetric parameters. The differences between AAA and XVMC were considered to be within an acceptable range (< 5 percentage points). © 2012 American Association of Medical Dosimetrists.
  • Iizuka Y; Matsuo Y; Umeoka S; Nakamoto Y; Ueki N; Mizowaki T; Togashi K; Hiraoka M
    2013年
  • Fengshi Chen; Kenichi Okubo; Makoto Sonobe; Keiko Shibuya; Yukinori Matsuo; Young Hak Kim; Kazuhiro Yanagihara; Toru Bando; Hiroshi Date
    WORLD JOURNAL OF SURGERY 36 12 2858 - 2864 2012年12月 [査読有り]
     
    The purpose of the present study was to improve the prognosis of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). To achieve that goal, we performed induction chemoradiotherapy followed by surgery. The criteria for this phase II study were a parts per thousand currency sign75-year-old patients with pathologically diagnosed stage IIIA-N2 NSCLC who had performance statuses of 0 or 1 with good organ function. Three cycles of chemotherapy with paclitaxel and carboplatin were carried out, with concurrent hyperfractionated irradiation (42 Gy). After re-evaluation, pulmonary resections were considered unless patients showed progressive disease. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS) and absence of toxicity. All 22 patients enrolled in this study completed the induction chemoradiotherapy without any severe complications. In these 22 patients, the 2- and 5-year OS were 81 and 47 %, respectively. There were no therapy-related deaths. Surgery was subsequently performed in 19 patients (86 %). Pathological complete responses were seen in 6 patients (27 %), while node downstaging was obtained in 10 patients (45 %). In the 19 patients who underwent surgery, the 2- and 5-year OS rates were 83 and 62 %, respectively, and the 2-year DFS rate was 63 %. All 6 patients with pathological complete responses survived without disease. Patients with residual multiple-station N2 showed worse OS and DFS rates than did those with downstaged and single-station N2 (P = 0.026 and P < 0.0001, respectively). This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.
  • 平野 滋; 北村 守正; 楯谷 一郎; 石川 征司; 嘉田 真平; 伊藤 壽一; 吉村 通央; 松尾 幸憲
    頭頸部癌 38 4 447 - 453 (一社)日本頭頸部癌学会 2012年12月 
    [緒言]局所進行喉頭癌(特にT4)に対する喉頭温存治療は確立しているとはいえない。京都大学がん診療部では頭頸部外科医と放射線治療医が一緒に患者診察を行い、局所進行喉頭癌に対しても喉頭温存治療の可能性を検討している。今回、主に導入化学療法を用いた喉頭温存治療の試みについて報告する。[対象]京大がん診療部が発足した2008年から2011年6月までに当診療部を受診した喉頭癌患者52例のうち、T3、T4症例7例について検討を行った。[結果]1例では基礎疾患の関係から喉頭全摘が行われたが、T3の1例では放射線療法(多分割照射)を、残りの5例にはTPFを用いた導入化学療法を施行した。5例中1例でCR、3例でPRがえられ、2例では化学放射線療法、2例では喉頭温存手術を行った。喉頭温存治療を完遂できた5例において、1〜3年(平均2年)の観察期間において再発を認めず、喉頭機能も温存できている。[考察]T3、4喉頭癌においても導入化学療法と化学放射線療法(IMRT)、喉頭温存手術を用いることで喉頭温存が可能となる可能性を示した。(著者抄録)
  • Akira Nakamura; Keiko Shibuya; Yukinori Matsuo; Mitsuhiro Nakamura; Takehiro Shiinoki; Takashi Mizowaki; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 84 2 369 - 375 2012年10月 [査読有り]
     
    Purpose: To identify the dosimetric parameters associated with gastrointestinal (GI) toxicity in patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine-based chemoradiotherapy. Methods and Materials: The data from 40 patients were analyzed retrospectively. Chemoradiotherapy consisted of conventional fractionated three-dimensional radiotherapy and weekly gemcitabine. Treatment-related acute GI toxicity and upper GI bleeding (UGB) were graded according to the Common Toxicity Criteria Adverse Events, version 4.0. The dosimetric parameters (mean dose, maximal absolute dose which covers 2 cm(3) of the organ, and absolute volume receiving 10-50 Gy [V10-50]) of the stomach, duodenum, small intestine, and a composite structure of the stomach and duodenum (StoDuo) were obtained. The planning target volume was also obtained. Univariate analyses were performed to identify the predictive factors for the risk of grade 2 or greater acute GI toxicity and grade 3 or greater UGB, respectively. Results: The median follow-up period was 15.7 months (range, 4-37). The actual incidence of acute GI toxicity was 33%. The estimated incidence of UGB at 1 year was 20%. Regarding acute GI toxicity, a V-50 of >= 16 cm(3) of the stomach was the best predictor, and the actual incidence in patients with V-50 <16 cm(3) of the stomach vs. those with V-50 of >= 16 cm(3) was 9% vs. 61%, respectively (p = 0.001). Regarding UGB, V-50 of >= 33 cm(3) of the StoDuo was the best predictor, and the estimated incidence at 1 year in patients with V-50 <33 cm(3) of the StoDuo vs. those with V-50 >= 33 cm(3) was 0% vs. 44%, respectively (p = 0.002). The dosimetric parameters correlated highly with one another. Conclusion: The irradiated absolute volume of the stomach and duodenum are important for the risk of acute GI toxicity and UGB. These results could be helpful in escalating the radiation doses using novel techniques, such as intensity-modulated radiotherapy, for the treatment of pancreatic cancer. (C) 2012 Elsevier Inc.
  • Mami Akimoto; Mitsuhiro Nakamura; Nobutaka Mukumoto; Masahiro Yamada; Nami Ueki; Yukinori Matsuo; Akira Sawada; Takashi Mizowaki; Masaki Kokubo; Masahiro Hiraoka
    MEDICAL PHYSICS 39 10 6309 - 6315 2012年10月 [査読有り]
     
    Purpose: To perform dynamic tumor tracking irradiation with the Vero4DRT (MHI-TM2000), a correlation model [four dimensional (4D) model] between the displacement of infrared markers on the abdominal wall and the three-dimensional position of a tumor indicated by a minimum of three implanted gold markers is required. However, the gold markers cannot be detected successfully on fluoroscopic images under the following situations: (1) overlapping of the gold markers; and (2) a low intensity ratio of the gold marker to its surroundings. In the present study, the authors proposed a method to readily determine the optimal x-ray monitoring angle for creating a 4D model utilizing computed tomography (CT) images. Methods: The Vero4DRT mounting two orthogonal kV x-ray imaging subsystems can separately rotate the gantry along an O-shaped guide-lane and the O-ring along its vertical axis. The optimal x-ray monitoring angle was determined on CT images by minimizing the root-sum-square of water equivalent path lengths (WEPLs) on the orthogonal lines passing all of the gold markers while rotating the O-ring and the gantry. The x-ray monitoring angles at which the distances between the gold markers were within 5 mm at the isocenter level were excluded to prevent false detection of the gold markers in consideration of respiratory motions. First, the relationship between the WEPLs (unit: mm) and the intensity ratios of the gold markers was examined to assess the validity of our proposed method. Second, our proposed method was applied to the 4D-CT images at the end-expiration phase for 11 lung cancer patients who had four to five gold markers. To prove the necessity of the x-ray monitoring angle optimization, the intensity ratios of the least visible markers (minimum intensity ratios) that were estimated from the WEPLs were compared under the following conditions: the optimal x-ray monitoring angle and the angles used for setup verification. Additionally, the intra- and interfractional variations in the intensity ratio were examined from the optimal x-ray monitoring angle. Results: A negative strong correlation was observed between the WEPL (x) and the intensity ratio (y) (y = 6.57 exp[-0.0125x] + 1, R = -0.88 [95% confidence interval: -0.85 to -0.90], p < 0.01). Our proposed method effectively avoided having the x-ray beam pass through high-density structures, although there were large interpatient variations in the optimal x-ray monitoring angle because of the geometric arrangement between the gold markers and the anatomical structures. The minimum intensity ratios that were estimated from the WEPLs at the optimal x-ray monitoring angle ranged from 1.43 to 2.48, which was an average of 1.27 times (range, 1.02-1.66) higher than the angles used for setup verification. The maximum intra- and interfractional decreases in the intensity ratio were 0.23 and 0.17, respectively. Conclusions: The authors demonstrated that the optimal x-ray monitoring angle for creating a 4D model can improve the visibility of gold markers. (C) 2012 American Association of Physicists in Medicine. [http://dx.doi.org/10.1118/1.4754648]
  • Yoshiki Norihisa; Takashi Mizowaki; Kenji Takayama; Yuki Miyabe; Kiyotomo Matsugi; Yukinori Matsuo; Masaru Narabayashi; Katsuyuki Sakanaka; Akira Nakamura; Yasushi Nagata; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 17 5 505 - 511 2012年10月 [査読有り]
     
    Intensity-modulated radiation therapy (IMRT) has been employed as a precision radiation therapy with higher conformity to the target. Although clinical outcomes have been reported for many investigations, detailed treatment planning results have not been mentioned to date. The aim of this study was to evaluate the dose specifications of our IMRT treatment plans for locally advanced prostate cancer.Seventy-seven clinically applied IMRT plans treated between September 2003 and December 2005, in which patients were irradiated with 78 Gy in the prone position, were retrospectively analyzed. Dosimetric data output from dose volume histograms were evaluated in detail.The mean dose +/- A standard deviation, homogeneity index, and conformity index to the planning target volume (PTV) were 78.3 +/- A 0.7 Gy (100.4 +/- A 0.9%), 13.7 +/- A 3.0, and 0.83 +/- A 0.04, respectively. For the clinical target volume, the mean dose was 80.3 +/- A 0.7 Gy (102.9 +/- A 0.9%).The V40, V60, and V70 Gy of the rectal wall were 58.3 +/- A 2.8, 29.6 +/- A 2.7, and 15.2 +/- A 3.0%, respectively. Planning difficulties were encountered in patients whose bowels were displaced downward, as constraints imposed by the bowel position altered the dose index of the PTV. In many cases, additional bowel optimization parameters were required to satisfy constraints for organs at risk. However, major deviation could be avoided by inverse planning with computer optimization.IMRT allowed the creation of acceptable and practical treatment plans for locally advanced prostate cancer. Reports regarding detailed dosimetric evaluations are mandatory for interpreting clinical outcomes in the future.
  • Masaru Narabayashi; Takashi Mizowaki; Yukinori Matsuo; Mitsuhiro Nakamura; Kenji Takayama; Yoshiki Norihisa; Katsuyuki Sakanaka; Masahiro Hiraoka
    JOURNAL OF RADIATION RESEARCH 53 5 777 - 784 2012年09月 [査読有り]
     
    Heterogeneity correction algorithms can have a large impact on the dose distributions of stereotactic body radiation therapy (SBRT) for lung tumors. Treatment plans of 20 patients who underwent SBRT for lung tumors with the prescribed dose of 48 Gy in four fractions at the isocenter were reviewed retrospectively and recalculated with different heterogeneity correction algorithms: the pencil beam convolution algorithm with a Batho power-law correction (BPL) in Eclipse, the radiological path length algorithm (RPL), and the X-ray Voxel Monte Carlo algorithm (XVMC) in iPlan. The doses at the periphery (minimum dose and D95) of the planning target volume (PTV) were compared using the same monitor units among the three heterogeneity correction algorithms, and the monitor units were compared between two methods of dose prescription, that is, an isocenter dose prescription (IC prescription) and dose volume based prescription (D95 prescription). Mean values of the dose at the periphery of the PTV were significantly lower with XVMC than with BPL using the same monitor units (P < 0.001). In addition, under IC prescription using BPL, RPL and XVMC, the ratios of mean values of monitor units were 1, 0.959 and 0.986, respectively. Under D95 prescription, they were 1, 0.937 and 1.088, respectively. These observations indicated that the application of XVMC under D95 prescription results in an increase in the actually delivered dose by 8.8% on average compared with the application of BPL. The appropriateness of switching heterogeneity correction algorithms and dose prescription methods should be carefully validated from a clinical viewpoint.
  • Yukinori Matsuo; Keiko Shibuya; Mitsuhiro Nakamura; Masaru Narabayashi; Katsuyuki Sakanaka; Nami Ueki; Ken Miyagi; Yoshiki Norihisa; Takashi Mizowaki; Yasushi Nagata; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 83 4 E545 - E549 2012年07月 [査読有り]
     
    Purpose: To identify dose-volume factors associated with radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT) for lung cancer.Methods and Materials: This study analyzed 74 patients who underwent SBRT for primary lung cancer. The prescribed dose for SBRT was uniformly 48 Gy in four fractions at the isocenter. RP was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v.3. Symptomatic RP was defined as grade 2 or worse. Optimal cut-offs dividing the patient population into two subgroups based on the incidence of symptomatic RP were sought using the following dose-volume metrics: PTV volume (ml), mean lung dose (Gy), and V5, V10, V15, V20, V25, V30, V35, and V40 (%) of both lungs excluding the PTV.Results: With a median follow-up duration of 31.4 months, symptomatic RP was observed in 15 patients (20.3%), including 1 patient with grade 3. Optimal cut-offs for pulmonary dose-volume metrics were V25 and V20. These two factors were highly correlated with each other, and V25 was more significant. Symptomatic RP was observed in 14.8% of the patients with V 25 < 4.2%, and the rate was 46.2% in the remainder (p = 0.019). PTV volume was another significant factor. The symptomatic RP rate was significantly lower in the group with PTV < 37.7 ml compared with the larger PTV group (11.1% vs. 34.5%, p = 0.020). The patients were divided into three subgroups (patients with PTV < 37.7 ml; patients with, PTV >= 37.7 ml and V25 < 4.2%; and patients with PTV >= 37.7 ml and V25 >= 4.2%); the incidence of RP grade 2 or worse was 11.1%, 23.5%, and 50.0%, respectively (p = 0.013).Conclusions: Lung V25 and PTV volume were significant factors associated with RP after SBRT. (C) 2012 Elsevier Inc.
  • Mitsuhiro Nakamura; Keiko Shibuya; Akira Nakamura; Takehiro Shiinoki; Yukinori Matsuo; Manabu Nakata; Akira Sawada; Takashi Mizowaki; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 82 5 1619 - 1626 2012年04月 [査読有り]
     
    Purpose: To investigate the interfractional dose variations for intensity-modulated radiotherapy (RT) combined with breath-hold (BH) at end-exhalation (EE) for pancreatic cancer. Methods and Materials: A total of 10 consecutive patients with pancreatic cancer were enrolled. Each patient was fixed in the supine position on an individualized vacuum pillow with both arms raised. Computed tomography (CT) scans were performed before RT, and three additional scans were performed during the course of chemoradiotherapy using a conventional RT technique. The CT data were acquired under EE-BH conditions (BH-CT) using a visual feedback technique. The intensity-modulated RT plan, which used five 15-MV coplanar ports, was designed on the initial BH-CT set with a prescription dose of 39 Gy at 2.6 Gy/fraction. After rigid image registration between the initial and subsequent BH-CT scans, the dose distributions were recalculated on the subsequent BH-CT images under the same conditions as in planning. Changes in the dose-volume metrics of the gross tumor volume (GTV), clinical target volume (CTV = GTV + 5 mm), stomach, and duodenum were evaluated. Results: For the GTV and clinical target volume (CTV), the 95th percentile of the interfractional variations in the maximal dose, mean dose, dose covering 95% volume of the region of structure, and percentage of the volume covered by the 90% isodose line were within +/- 3%. Although the volume covered by the 39 Gy isodose line for the stomach and duodenum did not exceed 0.1 mL at planning, the volume covered by the 39 Gy isodose line for these structures was up to 11.4 cm(3) and 1.8 cm(3), respectively. Conclusions: Despite variations in the gastrointestinal state and abdominal wall position at EE, the GTV and CTV were mostly ensured at the planned dose, with the exception of 1 patient. Compared with the duodenum, large variations in the stomach volume receiving high-dose radiation were observed, which might be beyond the negligible range in achieving dose escalation with intensity-modulated RT combined with BH at EE. (C) 2012 Elsevier Inc.
  • Yukinori Matsuo; Keiko Shibuya; Yasushi Nagata; Yoshiki Norihisa; Masaru Narabayashi; Katsuyuki Sakanaka; Nami Ueki; Takashi Mizowaki; Masahiro Hiraoka
    JOURNAL OF THORACIC ONCOLOGY 7 2 453 - 456 2012年02月 [査読有り]
     
    Introduction: Long-term outcomes remain unknown after stereotactic body radiation therapy (SBRT). We observed a few patients who developed disease progression late, at 5 years or more, after SBRT. In this report, we describe the characteristics of those patients with late recurrence after SBRT.Methods: We retrospectively reviewed patients who underwent SBRT for non-small cell lung cancer with histological confirmation between January 1999 and December 2005 at our institution. During this period, 48 Gy of SBRT in four fractions at the isocenter was prescribed for all patients.Results: In total, 66 patients were eligible. With a median follow-up period of 35.9 months, the 5-year overall survival and disease-free survival rates were 44.6% (95% confidence interval, 33.5-59.5%) and 33.8% (95% confidence interval, 23.6-48.4%), respectively. Of the patients, 16 survived without disease progression for 5 years or more after SBRT. Of these, four patients developed late recurrence at 76, 101, 108, and 109 months after SBRT. Three of the patients were females with adenocarcinomas; the other was a male with squamous cell carcinoma. The initial sites of recurrence were local in two patients, distant in one, and simultaneously local and distant in one. A total of two patients with local recurrence alone were still alive at 138 months after SBRT.Conclusions: The rate of late recurrence was not negligible in long-term survivors after SBRT. Our experiences indicate that long-term follow-up is needed after SBRT for non-small cell lung cancer.
  • Akira Nakamura; Keiko Shibuya; Kyoichi Takaori; Yoshiya Kawaguchi; Michio Yoshimura; Yukinori Matsuo; Satoshi Itasaka; Masahiro Hiraoka
    JOURNAL OF CLINICAL ONCOLOGY 30 4 2012年02月 [査読有り]
  • Mitsuhiro Nakamura; Yuki Miyabe; Yukinori Matsuo; Takeshi Kamomae; Manabu Nakata; Shinsuke Yano; Akira Sawada; Takashi Mizowaki; Masahiro Hiraoka
    Medical Dosimetry 37 1 20 - 25 2012年 [査読有り]
     
    The purpose of this study was to experimentally assess the validity of heterogeneity-corrected dose-volume prescription on respiratory-averaged computed tomography (RACT) images in stereotactic body radiotherapy (SBRT) for moving tumors. Four-dimensional computed tomography (CT) data were acquired while a dynamic anthropomorphic thorax phantom with a solitary target moved. Motion pattern was based on cos 6 (t) with a constant respiration period of 4.0 sec along the longitudinal axis of the CT couch. The extent of motion (A 1) was set in the range of 0.0-12.0 mm at 3.0-mm intervals. Treatment planning with the heterogeneity-corrected dose-volume prescription was designed on RACT images. A new commercially available Monte Carlo algorithm of well-commissioned 6-MV photon beam was used for dose calculation. Dosimetric effects of intrafractional tumor motion were then investigated experimentally under the same conditions as 4D CT simulation using the dynamic anthropomorphic thorax phantom, films, and an ionization chamber. The passing rate of γ index was 98.18%, with the criteria of 3 mm/3%. The dose error between the planned and the measured isocenter dose in moving condition was within ± 0.7%. From the dose area histograms on the film, the mean ± standard deviation of the dose covering 100% of the cross section of the target was 102.32 ± 1.20% (range, 100.59-103.49%). By contrast, the irradiated areas receiving more than 95% dose for A 1 = 12 mm were 1.46 and 1.33 times larger than those for A 1 = 0 mm in the coronal and sagittal planes, respectively. This phantom study demonstrated that the cross section of the target received 100% dose under moving conditions in both the coronal and sagittal planes, suggesting that the heterogeneity-corrected dose-volume prescription on RACT images is acceptable in SBRT for moving tumors. © 2012 American Association of Medical Dosimetrists.
  • Mitsuhiro Nakamura; Shun Kishimoto; Kohei Iwamura; Takehiro Shiinoki; Akira Nakamura; Yukinori Matsuo; Keiko Shibuya; Masahiro Hiraoka
    MEDICAL PHYSICS 39 1 48 - 54 2012年01月 [査読有り]
     
    Purpose: To experimentally investigate the effects of variations in respiratory motion during breath-holding (BH) at end-exhalation (EE) on intensity-modulated radiotherapy (BH-IMRT) dose distribution using a motor-driven base, films, and an ionization chamber. Methods: Measurements were performed on a linear accelerator, which has a 120-leaf independently moving multileaf collimator with 5-mm leaf width at the isocenter for the 20-cm central field. Polystyrene phantoms with dimensions of 40 x 40 x 10 cm were set on a motor-driven base. All gantry angles of seven IMRT plans (a total of 35 fields) were changed to zero, and doses were then delivered to a film placed at a depth of 4 cm and an ionization chamber at a depth of 5 cm in the phantom with a dose rate of 600 MU/min under the following conditions: pulsation from the abdominal aorta and baseline drift with speeds of 0.2 mm/s (BD0.2mm/s) and 0.4 mm/s (BD0.4mm/s). As a reference for comparison, doses were also delivered to the chamber and film under stationary conditions. Results: In chamber measurements, means +/- standard deviations of the dose deviations between stationary and moving conditions were -0.52% +/- 1.03% (range: -3.41-1.05%), -0.07% +/- 1.21% (range: -1.88-4.31%), and 0.03% +/- 1.70% (range: -2.70-6.41%) for pulsation, BD0.2mm/s, and BD0.4mm/s, respectively. The c passing rate ranged from 99.5% to 100.0%, even with the criterion of 2%/1 mm for pulsation pattern. In the case of BD0.4mm/s, the c passing rate for four of 35 fields (11.4%) did not reach 90% with a criterion of 3%/3 mm. The differences in c passing rate between BD0.2mm/s and BD0.4mm/s were statistically significant for each criterion. Taking c passing rates of> 90% as acceptable with a criterion of 3%/3 mm, large differences were observed in the c passing rate between the baseline drift of <= 5 mm and that of > 5 mm (minimum c passing rate: 92.0% vs 82.7%; p< 0.01). Conclusions: This study suggested that the baseline drift of > 5 mm should be avoided in the BH-IMRT. (C) 2012 American Association of Physicists in Medicine. [DOI: 10.1118/1.3668314]
  • 小山幸法; 波多野悦朗; 田浦康二朗; 中村公治郎; 長田博光; 成田匡大; 石井隆道; 松尾幸憲; 上本伸二
    肝臓. 53 8 486 - 493 一般社団法人 日本肝臓学会 2012年 [査読有り]
     
    切除不能肝細胞癌で，下大静脈腫瘍栓（5例）および門脈腫瘍栓（6例）の病勢コントロール目的に放射線治療（総線量39-60 Gy）を行った計11例を対象とし腫瘍栓に対する放射線治療の効果，腫瘍栓の無増悪期間，有害事象を検討した．腫瘍栓に対する前治療は11例中10例に肝動脈注入化学療法が行われていた．下大静脈腫瘍栓に対する有効性はCR 1例 PR 2例 SD 2例（奏効率60％）であったのに対し，門脈腫瘍栓ではPR 1例 SD 4例 PD 1例（奏効率16.7％）であった．放射線治療開始日からの生存期間中央値は下大静脈腫瘍栓症例で401日（141-612日），門脈腫瘍栓症例で374日（136-469日）であった．有害事象としては1例に放射線性肺臓炎を認めたが軽快した．放射線治療に伴う治療関連死は認めなかった．切除不能，肝動注不応腫瘍栓に対する放射線照射は，特に下大静脈腫瘍栓の病勢コントロールに有用である可能性が示唆された．
  • 肺がんの治療－早期肺がんに対する体幹部定位放射線治療.
    松尾幸憲
    Mebio. 2012年
  • M. Nakamura; Y. Miyabe; Y. Matsuo; T. Kamomae; M. Nakata; S. Yano; A. Sawada; T. Mizowaki; M. Hiraoka
    Medical Dosimetry 37 1 20 - 25 2012年 [査読有り]
  • 平野滋; 北村守正; 楯谷一郎; 石川征司; 嘉田真平; 伊藤壽一; 吉村通央; 松尾幸憲
    頭けい部癌 38 4 447-453 (J-STAGE)  2012年 [査読有り]
  • Akimoto, M.; Nakamura, M.; Mukumoto, N.; Yamada, M.; Ueki, N.; Matsuo, Y.; Mizowaki, T.; Sawada, A.; Kokubo, M.; Hiraoka, M.
    Medical Physics 39 6 3603 - 3603 2012年
  • Shiinoki, T.; Sawada, A.; Ishihara, Y.; Miyabe, Y.; Fujimoto, T.; Nakai, T.; Matsuo, Y.; Mizowaki, T.; Kokubo, M.; Hiraoka, M.
    Medical Physics 39 6 3685 - 3685 2012年
  • Takehiro Shihnoki; Keiko Shibuya; Mitsuhiro Nakamura; Akira Nakamura; Yukinori Matsuo; Manabu Nakata; Akira Sawada; Takashi Mizowaki; Akio Itoh; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 80 5 1567 - 1572 2011年08月 [査読有り]
     
    Purpose: To assess the interfractional positional variation of the pancreas using four-dimensional computed tomography (4D-CT) and to determine the suitable phase of respiration for dose delivery methods to account for pancreatic tumor motion. Methods and Materials: Fifteen patients with pancreatic cancer were enrolled in this study. For each patient, 4D-CT scans were performed at CT simulation and three times during the course of treatment. Regions of interest were set to the intrapancreatic bile ducts as a surrogate for pancreatic position. The centroids of the regions of interest were calculated at end-inhalation and end-exhalation of the respiration phase. The ranges of respiratory motion and interfractional positional variation were evaluated in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions. Results: The medians of respiratory motion were 1.1 mm (range, 0.0-9.8 mm), 1.5 mm (range, 0.0-7.0 mm), and 5.0 mm (range, 0.0-12.5 mm) in the LR, AP, and SI directions, respectively. The means +/- SDs of the interfractional positional variation at end-inhalation were 0.9 +/- 5.1 mm (range, -9.2 to 15.6 mm), -1.9 +/- 3.9 mm (range, -12.8 to 6.4 mm), and -1.3 +/- 6.9 mm (range, -15.0 to 13.7 mm) and those at end-exhalation were 0.0 +/- 3.1 mm (range, -7.0 to 5.3 mm), -1.2 +/- 3.9 mm (range, -11.2 to 6.7 mm), and 0.1 +/- 3.2 mm (range, -9.9 to 5.1 mm) in the LR, AP, and SI directions, respectively. The SDs of the interfractional positional variation in the LR and SI directions were significantly larger at end-inhalation than at end-exhalation (LR, p < 0.001; SI, p < 0.001). Conclusions: The ranges of respiratory motion during the course of treatment and the interfractional positional variation were not negligible. The interfractional positional reproducibility was higher at end-exhalation than at end-inhalation under free breathing. (C) 2011 Elsevier Inc.
  • 甲原貴子; 松原央; 渡邉健一郎; 森嶋達也; 才田聡; 新里亜紀; 藤野寿典; 梅田雄嗣; 中畑龍俊; 足立壮一; 平家俊男; 平野滋; 松尾幸憲; 駒田一郎; 永原國彦
    小児がん 48 2 135 - 139 2011年06月 [査読有り]
     
    患者は12歳男児。頸部リンパ節腫脹、難聴にて上咽頭癌と診断された。化学放射線併用療法に反応するも3ヵ月後に原発巣の再増大を認めた。Cisplatin、5-FU、docetaxelによる追加化学療法を行い完全寛解に至り、2年以上が経過した現在も完全寛解を維持している。治療中に再増大した症例に対し、追加化学療法が奏功し長期に寛解を維持している事は今後の治療戦略を考える上で参考になると考えられた。
  • Mitsuhiro Nakamura; Keiko Shibuya; Takehiro Shiinoki; Yukinori Matsuo; Akira Nakamura; Manabu Nakata; Akira Sawada; Takashi Mizowaki; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 79 5 1565 - 1571 2011年04月 [査読有り]
     
    Purpose: To assess positional reproducibility of pancreatic tumors under end-exhalation (EE) breath-hold (BH) conditions with a visual feedback technique based on computed tomography (CT) images. Methods and Materials: Ten patients with pancreatic cancer were enrolled in an institutional review board-approved trial. All patients were placed in a supine position on an individualized vacuum pillow with both arms raised. At the time of CT scan, they held their breath at EE with the aid of video goggles displaying their abdominal displacement. Each three-consecutive helical CT data set was acquired four times (sessions 1-4; session 1 corresponded to the time of CT simulation). The point of interest within or in proximity to a gross tumor volume was defined based on certain structural features. The positional variations in point of interest and margin size required to cover positional variations were assessed. Results: The means standard deviations (SDs) of intrafraction positional variations were 0.0 +/- 1.1, 0.1 +/- 1.2, and 0.1 +/- 1.0 mm in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively (p = 0.726). The means SDs of interfraction positional variations were 0.3 +/- 2.0, 0.8 +/- 1.8, and 0.3 1.8 mm in the LR, AP, and SI directions, respectively (p = 0.533). Population-based margin sizes required to cover 95th percentiles of the overall positional variations were 4.7, 5.3, and 4.9 mm in the LR, AP, and SI directions, respectively. Conclusions: A margin size of 5 mm was needed to cover the 95th percentiles of the overall positional variations under EE BH conditions, using this noninvasive approach to motion management for pancreatic tumors. (c) 2011 Elsevier Inc.
  • Keiko Shibuya; Natsuo Oya; Takashi Fujii; Ryuichiro Doi; Akira Nakamura; Yukinori Matsuo; Michihide Mitsumori; Masahiro Hiraoka
    AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS 34 2 115 - 119 2011年04月 [査読有り]
     
    Background: Through a phase I study with a fixed radiation dose of 54 Gy and escalating doses of weekly gemcitabine, we established a recommended dose of gemcitabine at 250 /m(2) in combination with radiation therapy for patients with unresectable pancreatic cancer. Objective: The purpose of this phase-II study was to evaluate the safety and efficacy of the regimen which was established in the phase I study. Methods: In all patients with unresectable stage III and limited stage IV pancreatic cancer with no distant metastasis except for para-aortic lymph node involvement at a level as low as the left renal vein, a total dose of 54 Gy was delivered in 30 fractions of 1.8 Gy/d. Gemcitabine was given weekly at a dose of 250 mg/m(2). Results: Between December 2002 and March 2006, 22 patients were enrolled in this study and one withdrew after enrollment. Twenty of 21 patients (95%) completed the protocol therapy. Radiologic partial response was observed in 6 and stable disease was noted in 15. Normalization of the tumor marker (CA19-9) occurred in 61% of patients. The 1-year survival rate was 74% and the median survival time was 16.6 months. The major toxicity was leucopenia; grade 3 in 14 (67%), anorexia grade 3 in 2 (9.5%), and grade 3 gastric ulcer in 2 (10%) in National Cancer Institute's Common Terminology Criteria for Adverse Events version 3.0 (NCI-CTCAE v3.0). Neither grade 4 nor 5 was recognized. Conclusion: Treatment with gemcitabine combined with radiation therapy according to the present schedule is well tolerated and can provide prolonged survival in patients with localized, unresectable pancreatic cancer.
  • Yukinori Matsuo; Keiko Shibuya; Yasushi Nagata; Kenji Takayama; Yoshiki Norihisa; Takashi Mizowaki; Masaru Narabayashi; Katsuyuki Sakanaka; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 79 4 1104 - 1111 2011年03月 [査読有り]
     
    Purpose: To investigate the factors that influence clinical outcomes after stereotactic body radiotherapy (SBRT) for non small-cell lung cancer (NSCLC). Methods and Materials: A total of 101 consecutive patients who underwent SBRT with 48 Gy in 4 fractions for histologically confirmed Stage I NSCLC were enrolled in this study. Factors including age, maximal tumor diameter, sex, performance status, operability, histology, and overall treatment time were evaluated with regard to local progression (LP), disease progression (DP), and overall survival (OS) using the Cox proportional hazards model. Prognostic models were built with recursive partitioning analysis. Results: Three-year OS was 58.6% with a median follow-up of 31.4 months. Cumulative incidence rates of LP and DP were 13.2% and 40.8% at 3 years, respectively. Multivariate analysis demonstrated that tumor diameter was a significant factor in all endpoints of LP, DP, and OS. Other significant factors were age in DP and sex in OS. Recursive partitioning analysis indicated a condition for good prognosis (Class I) as follows: female or T1a (tumor diameter <= 20 mm). When the remaining male patients with T1b-2a (> 20 mm) were defined as Class II, 3-year LP, DP, and OS were 6.8%, 23.6%, and 69.9% in recursive partitioning analysis Class I, respectively, whereas these values were 19.9%, 58.3%, and 47.1% in Class II. The differences between the classes were statistically significant. Conclusions: Tumor diameter and sex were the most significant factors in SBRT for NSCLC. T1a or female patients had good prognosis. (C) 2011 Elsevier Inc.
  • Nakamura, M.; Sawada, A.; Mukumoto, N.; Takahashi, K.; Miyabe, Y.; Takayama, K.; Matsuo, Y.; Mizowaki, T.; Kokubo, M.; Hiraoka, M.
    Medical Physics 38 6 2011年
  • Fengshi Chen; Yukinori Matsuo; Akihiko Yoshizawa; Toshihiko Sato; Hiroaki Sakai; Toru Bando; Kenichi Okubo; Keiko Shibuya; Hiroshi Date
    JOURNAL OF THORACIC ONCOLOGY 5 12 1999 - 2002 2010年12月 [査読有り]
     
    Background: Stereotactic body radiotherapy (SBRT) has emerged as a curative treatment for medically inoperable patients with early-stage non-small cell lung cancer (NSCLC). Since NSCLC recurs locally in 10% of the patients treated with SBRT, salvage lung resection after SBRT may be considered in these cases. To further understand the indications for salvage surgery and the pathogenesis of tumor recurrence in these patients, we retrospectively reviewed cases treated at our institution. Methods: SBRT has been performed in patients with early-stage NSCLC at Kyoto University Hospital. We encountered 5 patients who underwent salvage lung resection for NSCLC after SBRT. Results: All the patients were initially operable, but they chose SBRT. After SBRT, the tumors shrank initially in all patients, but increased in size within 18 months of SBRT in the case of 4 patients. During surgical extirpation, we did not find any significant SBRT-related adhesions in any of the patients. Conclusions: We have successfully treated 5 patients who underwent salvage lung resection for early-stage NSCLC after SBRT. We found that surgical resection was feasible after SBRT.
  • Yukinori Matsuo
    Journal of Thoracic Oncology 5 12 1999 - 2002 2010年12月 [査読有り]
  • Yukinori Matsuo; Yuji Nakamoto; Yasushi Nagata; Keiko Shibuya; Kenji Takayama; Yoshiki Norihisa; Masaru Narabayashi; Takashi Mizowaki; Tsuneo Saga; Tatsuya Higashi; Kaori Togashi; Masahiro Hiraoka
    RADIOTHERAPY AND ONCOLOGY 97 2 200 - 204 2010年11月 [査読有り]
     
    Background and purpose: The purpose was to characterize (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) findings after stereotactic body radiation therapy (SBRT) for lung cancer. Materials and methods: This was retrospective review of 32 FDG-PET scans from 23 patients who under-went SBRT for lung cancer and who showed no evidence of local recurrence. The FDG uptake by lesions was assessed visually using a 3-point scale (0, none of faint; 1, mild; or 2, moderate to intense), and the demarcation (ill- or well-defined) was calculated. Results: Grade 2 intensity was observed in 70%, 33%, 30%, and 0% of PET scans performed <6, 6-12, 12-24, and >24 months, respectively, after SBRT; well-defined demarcation was observed in 80%, 33%, 40%, and 17%, respectively, and the respective means of the SUVmax were 4.9, 2.6, 3.0, and 2.3. The SUVmax was significantly higher for scans performed at <6 months than at 6-12 or >24 months. Conclusion: FDG uptake tended to be intense and well-defined at early times after SBRT, especially within 6 months, and was faint and ill-defined at later periods. Moderate to intense FDG uptake observed soon after SBRT dose not always indicate a residual tumour. (C) Elsevier Ireland Ltd. rights reserved. Radiotherapy and Oncology 97 (2010) 200-204
  • Masahiro Hiraoka; Yukinori Matsuo; Kenji Takayama
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 40 9 846 - 854 2010年09月 [査読有り]
     
    Stereotactic body radiation therapy is a new treatment modality where narrow beams from several directions focus on the target while sparing the adjacent normal tissues with high accuracy. This technique basically derived from that of radiosurgery for intracranial lesions allows us to deliver high dose to the target leading to high control of the tumor without causing significant cytotoxicities associated with the treatment. Early-stage non-small cell lung cancers are regarded as most appropriate malignancies for this modality and accordingly have most intensively been investigated. With many encouraging outcomes in retrospective studies, several prospective clinical trials have been started world-wide. Japan Clinical Oncology Group protocol 0403 is a phase II trial of stereotactic body radiation therapy for T1N0M0 non-small cell lung cancer including both inoperable and operable patients. The results for operable patients are to be disclosed this year after 3 years of follow-up. It is highly probable that stereotactic body radiation therapy can be a standard treatment modality for inoperable patients for early-stage non-small cell lung cancer. The role of stereotactic body radiation therapy for operable patients is expected to be clarified by the outcomes of coming clinical trials. Tremendous advance in stereotactic body radiation therapy is expected when four-dimensional radiation therapy coping with tumor movement is realized. Among several approaches, tumor tracking appears most ideal. The new image-guided radiotherapy system which has the capability of tumor tracking has been developed in Japan.
  • Eisuke Abe; Takashi Mizowaki; Yoshiki Norihisa; Yuuichirou Narita; Yukinori Matsuo; Masaru Narabayashi; Yasushi Nagata; Masahiro Hiraoka
    JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS 11 4 144 - 154 2010年 [査読有り]
     
    The aim of this study was to investigate the impact of multileaf collimator width (MLC-W) on intraprostatic dose painting plans for prostate cancer. Prostate cancer maps based on the histopathological findings were superimposed onto simulation CT images. Clinical target volume (CTV) 1 was defined as the prostate and the base of the seminal vesicles, and CTV2 was defined as the dominant intraprostatic lesions. Planning target volume (PTV) 1 and PTV2 were delineated by adding 5 mm margins to CTV1 and CTV2, respectively. For each case, two dose painting plans were created to deliver 74 Gy to PTV1 and 84 Gy to PTV2 with dynamic multileaf collimator technique using two different MLCs: m3 (MLC-W: 3 mm) and Millennium (5 mm). Plans were evaluated by comparing the conformation number (CN), a quantity that defines the degree of conformality. The CNs for plans using the m3 and Millennium were 0.68 and 0.67 for PTV1 and 0.59 and 0.58 for PTV2, respectively. The CNs tended to be higher for a thinner leaf width (p < 0.05). Dosimetric advantages associated with smaller leaves were observed. However, differences between 3 mm and 5 mm leaf width were relatively small, which suggested that 5 mm leaf width would be acceptable in dose painting plans for prostate cancer.
  • T. Shiinoki; A. Sawada; M. Nakamura; Y. Miyabe; Y. Matsuo; K. Takayama; T. Mizowaki; M. Kokubo; A. Itoh; M. Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 78 3 S834 - S834 2010年 [査読有り]
  • Mitsuhiro Nakamura; Yuichiro Narita; Yukinori Matsuo; Masaru Narabayashi; Manabu Nakata; Akira Sawada; Takashi Mizowaki; Yasushi Nagata; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 75 2 558 - 563 2009年10月 [査読有り]
     
    Purpose: To assess the effect of audio coaching on the time-dependent behavior of the correlation between abdominal motion and lung tumor motion and the corresponding lung tumor position mismatches. Methods and Materials: Six patients who had a lung tumor with a motion range >8 mm were enrolled in the present study. Breathing-synchronized fluoroscopy was performed initially without audio coaching, followed by fluoroscopy with recorded audio coaching for multiple days. Two different measurements, anteroposterior abdominal displacement using the real-time positioning management system and superoinferior (SI) lung tumor motion by X-ray fluoroscopy, were performed simultaneously. Their sequential images were recorded using one display system. The lung tumor position was automatically detected with a template matching technique. The relationship between the abdominal and lung tumor motion was analyzed with and without audio coaching. Results: The mean SI tumor displacement was 10.4 mm without audio coaching and increased to 23.0 mm with audio coaching (p < .01). The correlation coefficients ranged from 0.89 to 0.97 with free breathing. Applying audio coaching, the correlation coefficients improved significantly (range, 0.93-0.99; p < .01), and the SI lung tumor position mismatches became larger in 75% of all sessions. Conclusion: Audio coaching served to increase the degree of correlation and make it more reproducible. In addition, the phase shifts between tumor motion and abdominal displacement were improved; however, all patients breathed more deeply, and the SI lung tumor position mismatches became slightly larger with audio coaching than without audio coaching. (C) 2009 Elsevier Inc.
  • Kiyotomo Matsugi; Yuichiro Narita; Akira Sawada; Mitsuhiro Nakamura; Yuki Miyabe; Yukinori Matsuo; Masaru Narabayashi; Yoshiki Norihisa; Takashi Mizowaki; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 75 2 543 - 548 2009年10月 [査読有り]
     
    Purpose: To investigate the interfraction variations in volume, motion range, and position of the gross tumor volume (GTV) in hypofractionated stereotactic body radiotherapy (SBRT) for lung cancer using four-dimensional computed tomography. Methods and Materials: Four-dimensional computed tomography scans were acquired for 8 patients once at treatment planning and twice during the SBRT period using a stereotactic body frame. The image registration was performed to correct setup errors for clinical four-dimensional computed tomography. The interfraction variations in volume, motion range, and position of GTV were computed at end-inhalation (EI) and end-exhalation (EE). Results: The random variations in the GTV were 0.59 cm(3) at EI and 0.53 cm(3) at EE, and the systematic variations were 3.04 cm(3) at EI and 3.21 cm(3) at EE. No significant variations in GTV were found during the SBRT sessions (p = .301 at EI and p = .081 at EE). The random variations in GTV motion range for the upper lobe in the craniocaudal direction were within 1.0 mm and for the lower lobe was 3.4 mm. The interfraction variations in the GTV centroid position in the anteroposterior and craniocaudal directions were mostly larger than in the right-left direction; however, no significant displacement was observed among the sessions in any direction. Conclusion: For patients undergoing hypofractionated SBRT, interfraction variations in GTV, motion range, and position mainly remained small. An additional approach is needed to assess the margin size. (C) 2009 Elsevier Inc.
  • Yasushi Nagata; Masahiro Hiraoka; Takashi Mizowaki; Yuichiro Narita; Yukinori Matsuo; Yoshiki Norihisa; Hiroshi Onishi; Hiroki Shirato
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 75 2 343 - 347 2009年10月 [査読有り]
     
    Purpose: To recognize the current status of stereotactic body radiotherapy (SBRT) in Japan, using a nationwide survey conducted by the Japan 3-D Conformal External Beam Radiotherapy Group. Methods and Materials: The questionnaire was sent by mail to 117 institutions. Ninety-four institutions (80%) responded by the end of November 2005. Fifty-three institutions indicated that they have already started SBRT, and 38 institutions had been reimbursed by insurance. Results: A total of 1111 patients with histologically confirmed lung cancer were treated. Among these patients, 637 had TIN0M0 and 272 had T2N0M0 lung cancer. Metastatic lung cancer was found in 702 and histologically unconfirmed lung tumor in 291 patients. Primary liver cancer was found in 207 and metastatic liver cancer in 76 patients. The most frequent schedule used for primary lung cancer was 48Gy in 4 fractions at 22 institutions (52%), followed by 50Gy in 5 fractions at I I institutions (26%) and 60Gy in 8 fractions at 4 institutions (10%). The tendency was the same for metastatic lung cancer. The average number of personnel involved in SBRT was 1.8 radiation oncologists, including 1.1 certified radiation oncologists, 2.8 technologists, 0.7 nurses, and 0.6 certified quality assurance personnel and 0.3 physicists. The most frequent amount of time for treatment planning was 61-120min, for quality assurance was 50-60min, and for treatment was 30min. There were 14 (0.6% of all cases) reported Grade 5 complications: 11 cases of radiation pneumonitis, 2 cases of hemoptysis, and 1 case of radiation esophagitis. Conclusion: The current status of SBRT in Japan was surveyed. (C) 2009 Elsevier Inc.
  • Yuki Miyabe; Yuichiro Narita; Takashi Mizowaki; Yukinori Matsuo; Kenji Takayama; Kunio Takahashi; Shuji Kaneko; Noriyuki Kawada; Akira Maruhashi; Masahiro Hiraoka
    MEDICAL PHYSICS 36 10 4328 - 4339 2009年10月 [査読有り]
     
    Purpose: The aim of this study was to develop a 4D-modeling algorithm, designated "3D+," to simulate organ movement and deformation for 4D dose calculation without the need for 4D-CT or deformable image registration and to assess the validity of this algorithm. Methods: This 3D+ algorithm virtually creates 4D-CT images by deforming static 3D-CT data according to a typical motion model and motion data at multiple observation points collected via fluoroscopy. A typical motion model intended for patients with lung tumors immobilized with a vacuum pillow inside a stereotactic body frame was constructed. The geometric accuracy of virtual 4D-CT images created using this 3D+ algorithm was evaluated in eight patients by comparing the simulated results with actual 4D-CT images in terms of visual assessment, landmark analysis, and comparison of the radial distance from the tumor centroid to the body or lung surface. Results: The average accuracy for all patients, as determined via landmark analysis, was 2.8 +/- 1.8 mm, very similar to results obtained through 4D-CT and deformable image registrations. Error in the radial distance from the tumor centroid to the body or lung surface was generally within 1.0 or 2.0 mm, respectively, in virtual versus actual 4D-CT images. Therefore, it is assumed that these geometric errors would have only negligible effects on dose calculation. Conclusions: 4D modeling of the thorax utilizing the 3D+ algorithm shows acceptable accuracy and is more suited for routine clinical use in terms of processing time than conventional 4D-CT and deformable image registration. The 3D+ algorithm may be useful for simulating dose distribution for advanced beam delivery techniques, such as real-time tumor tracking irradiation and adaptive radiation therapy. (C) 2009 American Association of Physicists in Medicine. [DOI: 10.1118/1.3213083]
  • Mitsuhiro Nakamura; Yuichiro Narita; Akira Sawada; Kiyotomo Matsugi; Manabu Nakata; Yukinori Matsuo; Takashi Mizowaki; Masahiro Hiraoka
    MEDICAL PHYSICS 36 5 1610 - 1617 2009年05月 [査読有り]
     
    This study aims to assess the impact of motion velocity that may cause motion artifacts on target volumes (TVs) using a one-dimensional moving phantom. A 20 mm diameter spherical object embedded in a QUASAR (TM) phantom sinusoidally moved with approximately 5.0 or 10.0 mm amplitude (A) along the longitudinal axis of the computed tomography (CT) couch. The motion period was manually set in the range of 2.0-10.0 s at approximately 2.0 s interval. Four-dimensional (4D) CT images were acquired by a four-slice CT scanner (LightSpeed RT; General Electric Medical Systems, Waukesha, WI) with a slice thickness of 1.25 mm in axial cine mode. The minimum gantry rotation of 1.0 s was employed to achieve the maximum in-slice temporal resolution. Projection data over a full gantry rotation (1.0 s) were used for image reconstruction. Reflective marker position was recorded by the real-time positioning management system (Varian Medical Systems, Palo Alto, CA). ADVANTAGE 4D software exported ten respiratory phase volumes and the maximum intensity volume generated from all reconstructed data (MIV). The threshold to obtain static object volume (V(0), 4.19 ml) was used to automatically segment TVs on CT images, and then the union of TVs on 4D CT images (TV(4D)) was constructed. TVs on MIV (TV(MIV)) were also segmented by the threshold that can determine the area occupied within the central slice of TV(MIV). The maximum motion velocity for each phase bin was calculated using the actual averaged motion period displayed on ADVANTAGE 4D software (T), the range of phases used to construct the target phase bin (phase range), and a mathematical model of sinusoidal function. Each volume size and the motion range of TV in the cranial-caudal (CC) direction were measured. Subsequently, cross-correlation coefficients between TV size and motion velocity as well as phase range were calculated. Both misalignment and motion-blurring artifacts were caused by high motion velocity. Less than 6% phase range was needed to construct the 4D CT data set, except for T of 2.0 s. While the positional differences between the TV and ideal centroid in the CC direction were within the voxel size for T >= 6.0 s, the differences were up to 2.43 and 4.15 mm for (A,T)=(5.0 mm,2.0 s) and (10.0 mm, 2.0 s), respectively. The maximum volumetric deviations between TV sizes and V(0) were 43.68% and 91.41% for A of 5.0 and 10.0 mm, respectively. TV(MIV) sizes were slightly larger than TV(4D) sizes. Volumetric deviation between TV size and V(0) had a stronger correlation with motion velocity rather than phase range. This phantom study demonstrated that motion artifacts were substantially reduced when the phantom moved longitudinally at low motion velocity during 4D CT image acquisition; therefore, geometrical uncertainties due to motion artifacts should be recognized when determining TVs, especially with a fast period.
  • 京都大学におけるIMRT 【IMRTの標準化に向けて】.
    松尾幸憲; 則久佳毅; 楢林正流; 高山賢二; 堀井直敏; 溝脇尚志; 平岡真寛; 矢野慎輔; 中田学
    臨床放射線. 2009年
  • Matsuo, Y.; Norihisa, Y.; Narabayashi, M.; Takayama, K.; Horii, N.; Mizowaki, N.; Hiraoka, M.; Yano, S.; Nakata, M.
    Japanese Journal of Clinical Radiology 54 5 2009年
  • Shiinoki, T.; Narita, Y.; Nakamura, M.; Shibuya, K.; Sawada, A.; Matsuo, Y.; Mizowaki, T.; Ito, A.; Hiraoka, M.
    Medical Physics 36 6 2820 - 2820 2009年
  • 松尾 幸憲; 成田 雄一郎; 中田 学; 中村 光宏; 永田 靖; 溝脇 尚志; 高山 賢二; 則久 佳毅; 楢林 正流; 平岡 真寛
    日本放射線腫瘍学会誌 20 4 151 - 154 (公社)日本放射線腫瘍学会 2008年12月 
    【目的】肺定位放射線治療(SBRT)計画における不均質補正法の違いが治療計画装置上の線量分布に与える影響を評価した。【方法】当院にてアイソセンター1回線量12Gy、総線量48GyのSBRTが実施された。孤立性肺腫瘍28症例の治療計画を対象とした。不均質補正法を3条件[pencil beam convolution-Batho power law不均質補正あり(PBC-BPL群)、pencil beam convolution-不均質補正なし(PBC-NC群)、anisotropic analytical algorithm-不均質補正あり(AAA群)]に変更し、再計算を行い、線量指標を評価した。【結果】いずれの線量指標においても、不均質補正法の要因効果は有意であった。アイソセンター線量は48.0Gy、44.6Gy、48.4Gy(それぞれPBC-BPL、PBC-NC、AAA群における平均。以下、同じ)、PTV D95は45.2Gy、41.1Gy、42.1Gy、肺V20は4.1%、3.7%、3.9%であった。【結論】不均質補正法の違いにより、治療計画装置上で表示される線量分布が有意に異なり、十分な注意が必要である。(著者抄録)
  • Yoshiki Norihisa; Yasushi Nagata; Kenji Takayama; Yukinori Matsuo; Takashi Sakamoto; Masato Sakamoto; Takashi Mizowaki; Shinsuke Yano; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 72 2 398 - 403 2008年10月 [査読有り]
     
    Purpose: Since 1998, we have treated primary and oligometastatic lung tumors with stereotactic body radiotherapy (SBRT). The term "oligometastasis" is used to indicate a small number of metastases limited to an organ. We evaluated our clinical experience of SBRT for oligometastatic lung tumors. Methods and Materials: A total of 34 patients with oligometastatic lung tumors were included in this study. The primary involved organs were the lung (n = 15), colorectum (n = 9), head and neck (n = 5), kidney (n = 3), breast (n = 1), and bone (n = 1). Five to seven, noncoplanar, static 6-MV photon beams were used to deliver 48 Gy (n = 18) or 60 Gy (n = 16) at the isocenter, with 12 Gy/fraction within 4-18 days (median, 12 days). Results: The overall survival rate, local relapse-free rate, and progression-free rate at 2 years was 84.3%, 90.0%, and 34.8%, respectively. No local progression was observed in tumors irradiated with 60 Gy. SBRT-related pulmonary toxicities were observed in 4 (12%) Grade 2 cases and 1 (3%) Grade 3 case. Patients with a longer disease-free interval had a greater overall survival rate. Conclusion: The clinical result of SBRT for oligometastatic lung tumors in our institute was comparable to that after surgical metastasectomy; thus, SBRT could be an effective treatment of pulmonary oligometastases. (c) 2008 Elsevier Inc.
  • Mitsuhiro Nakamura; Yuichiro Narita; Yukinori Matsuo; Masaru Narabayashi; Manabu Nakata; Shinsuke Yano; Yuki Miyabe; Kiyotomo Matsugi; Akira Sawada; Yoshiki Norihisa; Takashi Mizowaki; Yasushi Nagata; Masahiro Hiraoka
    MEDICAL PHYSICS 35 9 4142 - 4148 2008年09月 [査読有り]
     
    Since stereotactic body radiotherapy (SBRT) was started for patients with lung tumor in 1998 in our institution, x-ray fluoroscopic examination and slow computed tomography (CT) scan with a rotation time of 4 s have been routinely applied to determine target volumes. When lung tumor motion observed with x-ray fluoroscopy is larger than 8 mm, diaphragm control (DC) is used to reduce tumor motion during respiration. After the installation of a four-dimensional (4D) CT scanner in 2006, 4D CT images have been supplementarily acquired to determine target volumes. It was found that target volumes based on slow CT images were substantially different from those on 4D CT images, even for patients with lung tumor motion no larger than 8 mm. Although slow CT scan might be expected to fare well for lung tumors with motion range of 8 mm or less, the potential limitations of slow CT scan are unknown. The purpose of this study was to evaluate the geometrical differences in target volumes between slow CT and 4D CT imaging for lung tumors with motion range no larger than 8 mm in the upper and middle lobe. Of the patients who underwent SBRT between October 2006 and April 2008, 32 patients who had lung tumor with motion range no larger than 8 mm and did not need to use DC were enrolled in this study. Slow CT and 4D CT images were acquired under free breathing for each patient. Target volumes were manually delineated on slow CT images (TVslow CT). Gross tumor volumes were also delineated on each of the 4D CT volumes and their union (TV4D CT) was constructed. Volumetric and statistical analyses were performed for each patient. The mean +/- standard deviation (S.D.) of TVslow CT/TV4D CT was 0.75 +/- 0.17 (range, 0.38-1.10). The difference between sizes of TVslow CT and TV4D CT was not statistically significant (P=0.096). A mean of 8% volume of TVslow CT was not encompassed in TV4D CT (mean +/- S.D.=0.92 +/- 0.07). The patients were separated into two groups to test whether the quality of target delineation on slow CT scans depends on respiratory periods below or above the CT rotation time of 4 s. No significant difference was observed between these groups (P=0.229). Even lung tumors with motion range no larger than 8 mm might not be accurately depicted on slow CT images. When only a single slow CT scan was used for lung tumors with motion range of 8 mm or less, 95% confidence values for additional margins for TVslow CT to encompass TV4D CT were 4.0, 5.4, 4.9, 5.1, 1.8, and 1.7 mm for lateral, medial, ventral, dorsal, cranial, and caudal directions, respectively. (C) 2008 American Association of Physicists in Medicine.
  • 中村 光宏; 成田 雄一郎; 松尾 幸憲; 楢林 正流; 中田 学; 矢野 慎輔; 澤田 晃; 溝脇 尚志; 永田 靖; 平岡 眞寛
    日本放射線腫瘍学会誌 20 3 119 - 125 (公社)日本放射線腫瘍学会 2008年09月 
    【目的】本研究の目的は、商用の呼吸同期照射システムで得た背腹方向の腹壁変位量とX線シミュレーターで観測した頭尾方向の肺腫瘍変位量の位相相関性を評価し、腹壁変位量が予測した腫瘍位置と測定した腫瘍位置のずれ量(以下、腫瘍位置ずれ量)を算出することであった。【方法】2006年12月から2008年3月までの間に、当院で肺定位放射線治療を施行した11症例を対象とした。そのうち6症例は倫理審査委員会の承認の下、3日間にわたって測定を行った。Real-time Positioning Managementシステム(Varian Medical Systems,Inc.,Palo Alto,CA)で計測した腹壁変位量の画面と肺腫瘍変位量が投影されたX線シミュレーター(Acuity;Varian Medical Systems,Inc.)の画面を並列に表示し、自由呼吸下で60秒間計測した。取得した並列画像に対して画像処理を行った後、テンプレートマッチングで肺腫瘍の位置を検出した。腹壁変位量と肺腫瘍変位量から位相相関性を評価した。また、位相ずれを補正した回帰直線を用いて、腹壁運動が予測した肺腫瘍位置を求め、これと測定した肺腫瘍位置を比較することで、腫瘍位置ずれ量を算出した。【結果】相関係数の絶対値は0.89から0.97の範囲内にあり、これらの日々の変動も安定していた。腹壁変位量と肺腫瘍変位量の位相ずれが原因で生じるヒステリシス曲線を描く症例も存在した。腫瘍位置ずれ量の平均値は最大で1.78mmであった。【結論】多くの症例で、腹壁変位量と肺腫瘍変位量との位相相関性は良好であったが、腹壁変位量が予測した肺腫瘍位置と測定した肺腫瘍位置の間にずれが生じていた。(著者抄録)
  • 永田 靖; 松尾 幸憲; 則久 佳毅
    日本臨床 66 0 468 - 474 日本臨床社 2008年08月
  • 高山 賢二; 松尾 幸憲; 溝脇 尚志; 永田 靖; 則久 佳毅; 中村 光宏; 成田 雄一郎; 平岡 真寛
    断層映像研究会雑誌 35 1 12,48 - 21,48 断層映像研究会 2008年04月 
    画像は肺定位照射の治療計画から照射の各プロセスにおいて重要な役割を担っている。ターゲット輪郭抽出においては照射法に応じて呼吸停止CTや四次元CT、slow scan CT等が用いられ、呼吸性移動を考慮したターゲットが設定される。ときにPET画像はCTの限界を補い正確なターゲット設定に役立つ。これらPET画像やMRI画像などを治療計画に有効利用する上で、image fusion機能は重要である。その他にも三次元表示機能など治療計画装置に備わった様々な機能を活用することが求められる。照射時においては、定位照射の鍵となるセットアップ精度確保を目的に、治療室内で診断用kV X線画像やCTが用いられるようになり、画像誘導放射線治療(IGRT)と呼ばれる。更に、照射中における呼吸性移動への対応として、透視画像を用いてターゲットを追跡しながら照射する動体追跡照射など、画像を用いた高精度照射法が臨床応用されている。今後も、肺定位照射への画像応用へ向けての研究・開発が益々進められるものと思われる。(著者抄録)
  • 低侵襲かつ高精度を目指す局所療法 肺癌に対する体幹部定位放射線治療.
    松尾幸憲; 平岡真寛
    カレントテラピー. 2008年
  • Nakamura, M.; Narita, Y.; Matsuo, Y.; Narabayashi, M.; Nakata, M.; Yano, S.; Sawada, A.; Mizowaki, T.; Nagata, Y.; Hiraoka, M.
    Journal of JASTRO 20 3 119 - 125 2008年 [査読有り]
  • Matsuo, Y.; Narita, Y.; Nakata, M.; Nakamura, M.; Nagata, Y.; Mizowaki, T.; Takayama, K.; Norihisa, Y.; Narabayashi, M.; Hiraoka, M.
    Journal of JASTRO 20 4 151 - 154 2008年 [査読有り]
  • Nakamura, M.; Narita, Y.; Matsugi, K.; Matsuo, Y.; Nakata, M.; Mizowaki, T.; Hiraoka, M.
    Medical Physics 35 6 2913 - 2913 2008年
  • 中村光宏; 成田雄一郎; 宮部結城; 松尾幸憲; 溝脇尚志; 則久佳毅; 高山賢二; 永田靖; 平岡眞寛
    The Journal of JASTRO = 日本放射線腫瘍学会誌 19 4 263 - 271 2007年12月 [査読有り]
  • Yukinori Matsuo; Yasushi Nagata; Takashi Mizowaki; Kenji Takayama; Takashi Sakamoto; Masato Sakamoto; Yoshiki Norihisa; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 12 5 356 - 362 2007年10月 [査読有り]
     
    Background The purpose of this study was to evaluate the characteristics of mass-like consolidation of the lung on computed tomography (CT) after stercotactic body radiation therapy (SBRT) retrospectively. Methods. Forty lung tumors in 37 patients who underwent SBRT were evaluated. Mass-like consolidation was defined as a dense consolidation that newly appeared over or around the original tumor, which included radiation-induced lung injury (RILI) and local recurrence. Time of appearance, initial CT findings (ectatic bronchi and conformity to dose distribution) and serial changes in the size of the mass-like consolidation were evaluated. Results. Mass-like consolidation appeared in 27 (68%) of 40 tumors at a median of 5 months after SBRT. Follow-up examination revealed that 24 (89%) of the 27 mass-like consolidations were RILI and 3 (11%) were local recurrence. There were no significant differences in the initial CT findings between RILI and local recurrence. The size of the mass-like consolidation varied in the 12 months after SBRT. After 12 months or more, however, the size did not increase in any of the RILI cases, but it did increase in all recurrence cases. Conclusion. Mass-like consolidations were observed in 68 % of cases at a median of 5 months after SBRT. Although most of the mass-like consolidations were RILI, local recurrence was observed in a few cases. Early detection of local recurrence after SBRT was difficult.
  • 【放射線治療Up to date】 体幹部領域における定位放射線治療
    永田 靖; 松尾 幸憲; 高山 賢二; 則久 佳毅; 溝脇 尚志; 矢野 慎輔; 成田 雄一郎; 山本 時裕; 平岡 眞寛
    Radiology Frontier 10 3 167 - 172 (株)メディカルレビュー社 2007年08月 
    近年、体幹部領域特にI期肺癌(T1N0M0,T2N0M0)に対する定位放射線照射技術が実用化されている。この治療法は特殊な体幹部固定用フレームや同期照射技術や追尾照射技術を用いることにより、従来は頭蓋内腫瘍のみに可能であった大線量での照射を可能とした。この技術は現在までに世界的にみてもわが国が中心となって開発され、臨床応用成果もわが国から主に報告されている。現在までの報告では、1回線量が10〜15Gyで3〜5回照射する方法が一般的であるが、それらのほとんどの報告で局所制御率は90%以上であり、合併症も重篤なものはほとんどみられない。しかし縦隔近傍の腫瘍や間質性肺炎併発例には注意が必要である。これは早期肺癌に対して非常に注目されている技術であり、多施設共同臨床試験JCOG0403が開始され、その結果が注目されている。(著者抄録)
  • Yukinori Matsuo; Kenji Takayama; Yasushi Nagata; Etsuo Kunieda; Kunihiko Tateoka; Naoki Ishizuka; Takashi Mizowaki; Yoshiki Norihisa; Masato Sakamoto; Yuichiro Narita; Satoshi Ishikura; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 68 2 416 - 425 2007年06月 [査読有り]
     
    Purpose: The aim of this study was to assess interinstitutional variations in planning for stereotactic body radiation therapy (SBRT) for lung cancer before the start of the Japan Clinical Oncology Group (JCOG) 0403 trial. Methods and Materials: Eleven. institutions created virtual plans for four cases of solitary lung cancer. The created plans should satisfy the target definitions and the dose constraints for the JCOG 0403 protocol. Results: FOCUS/XiO (CMS) was used in six institutions, Eclipse (Varian) in 3, Cadplan (Varian) in one, and Pinnacle3 (Philips/ADAC) in one. Dose calculation algorithms of Clarkson with effective path length correction and superposition were used in FOCUS/XiO; pencil beam convolution with Batho power law correction was used in Eclipse and Cadplan; and collapsed cone convolution superposition was used in Pinnacle3. For the target volumes, the overall coefficient of variation was 16.6%, and the interinstitutional variations were not significant. For maximal dose, minimal dose, D95, and the homogeneity index of the planning target volume, the interinstitutional variations were significant. The dose calculation algorithm was a significant factor in these variations. No violation of the dose constraints for the protocol was observed. Conclusion: There can be notable interinstitutional variations in planning for SBRT, including both interobserver variations in the estimate of target volumes as well as dose calculation effects related to the use of different dose calculation algorithms. (C) 2007 Elsevier Inc.
  • 体幹部定位照射の現況
    永田 靖; 高山 賢二; 松尾 幸憲; 則久 佳毅; 溝脇 尚志; 坂本 匡人; 矢野 慎輔; 成田 雄一郎; 山本 時裕; 平岡 眞寛
    Radiology Frontier 10 2 140 - 141 (株)メディカルレビュー社 2007年05月
  • 【ここが知りたい他科知識】 悪性腫瘍について知っておきたいこと 定位放射線照射の現状は?
    永田 靖; 高山 賢二; 松尾 幸憲; 則久 佳毅; 溝脇 尚志; 坂本 匡人; 矢野 慎輔; 成田 雄一郎; 山本 時裕; 平岡 真寛
    JOHNS 23 3 468 - 469 (株)東京医学社 2007年03月
  • 治療(非小細胞肺癌) I期肺癌に対する体幹部定位照射 重粒子線、陽子線を含む
    永田 靖; 松尾 幸憲; 高山 賢二; 則久 佳毅; 溝脇 尚志; 坂本 匡人; 矢野 伸輔; 成田 雄一郎; 山本 時裕; 平岡 眞寛
    MOOK肺癌の臨床 2007-2008 187 - 194 (株)篠原出版新社 2007年03月
  • Yasushi Nagata; Yukinori Matsuo; Kenji Takayama; Yoshiki Norihisa; Takashi Mizowaki; Michibide Mitsumori; Keiko Shibuya; Shinsuke Yano; Yuichiroh Narita; Masahiro Hiraoka
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 12 1 3 - 7 2007年02月 [査読有り]
     
    Stereotactic radiotherapy (SRT) for extracranial tumors has been recently performed to treat lung and liver cancers, and has subsequently been named stereotactic body radiotherapy (SBRT). The advantages of hypofractionated radiotherapy for treating lung tumors are a shortened treatment course that requires fewer trips to the clinic than a conventional program, and the adoption of a smaller irradiated volume allowed by greater setup precision. This treatment is possible because the lung and liver are considered parallel organs at risk. The preliminary clinical results, mostly reported on lung cancer, have been very promising, including a local control rate of more than 90%, and a relatively low complication rate. The final results of a few clinical trials are awaited. SBRT may be useful for the treatment of stage I lung tumors.
  • Hiraoka M; Matsuo Y; Nagata Y
    Cancer radioth?rapie?: journal de la Soci?t? fran?aise de radioth?rapie oncologique. 2007年 [査読有り]
  • MATSUO Yukinori; NAGATA Yasushi; MIZOWAKI Takashi; TAKAYAMA Kenji; SAKAMOTO Takashi; SAKAMOTO Masato; NORIHISA Yoshiki; HIRAOKA Masahiro
    International journal of clinical oncology : official journal of the Japan Society of Clinical Oncology 12 5 356 - 362 2007年 [査読有り]
  • M. Hiraoka; Y. Matsuo; Y. Nagata
    CANCER RADIOTHERAPIE 11 1-2 32 - 35 2007年01月 [査読有り]
     
    Stereotactic body radiation therapy (SBRT) is a new treatment modality for early-stage non-small-cell lung cancer, and has been developed in the United States, the European Union, and Japan. We started a feasibility study of this therapy in July 1998, using a stereotactic body frame. The eligibility criteria for primary lung cancer were: 1) solitary tumor less than 4 cm (T1-3N0M); 2) inoperable, or the patient refused operation; 3) no necessity for oxygen support; 4) performance status equal to or less than 2; 5) the peripheral tumor which dose constraints of mediastinal organs are maintained. A total dose of 48 Gy was delivered in four fractions in 2 weeks in most patients. Lung toxicity was minimal. No grade 11 toxicities for spinal cord, bronchus, pulmonary artery, or esophagus were observed. The 3 years overall survival for 32 patients with stage IA, and 13 patients with stage IB were 83% and 72%, respectively. Only one local recurrence was observed in a follow-up of 6-71 months. We retrospectively analyzed 241 patients from 13 Japanese institutions. The local recurrence rate was 20% when the biological equivalent dose (BED) was less than 100 Gy, and 6.5% when the BED was over 100 Gy. Overall survival at 3 years was 42% when the BED was less than 100 Gy, and 46% when it was over 100 Gy. In tumors, which received a BED of more than 100 Gy, overall survival at 3 years was 91% for operable patients, and 50% for inoperable patients. Long-term results, in terms of local control, regional recurrence, survival, and complications, are not yet evaluated. However, this treatment modality is highly expected to be a standard treatment for inoperable patients, and it may be an alternative to lobectomy for operative patients. A prospective trial, which is now ongoing, will, answer these questions. (c) 2006 Elsevier Masson SAS. All rights reserved.
  • Yasushi Nagata; Kenji Takayama; Yukinori Matsuo; Yoshiki Norihisa; Takashi Mizowaki; Shinsuke Yano; Yuichiro Narita; Masahiro Hiraoka
    Journal of Thoracic Oncology 2 Supplement 4 S264 - S265 2007年
  • Nakamura, M.; Narita, Y.; Miyabe, Y.; Matsuo, Y.; Mizowaki, T.; Norihisa, Y.; Takayama, K.; Nagata, Y.; Hiraoka, M.
    Journal of JASTRO 19 4 2007年
  • 松尾 幸憲; 平岡 眞寛
    最新医学 61 11 2258 - 2263 最新医学社 2006年11月
  • Nagata Y; Takayama K; Matsuo Y; Norihisa Y; Mizowaki T; Sakamoto M; Yano S; Narita Y; Yamamoto T; Hiraoka M
    Gan to kagaku ryoho. Cancer & chemotherapy. 33 4 455 - 461 2006年04月 [査読有り]
  • 【最近の放射線治療法の進歩】 体幹部定位照射
    永田 靖; 高山 賢二; 松尾 幸憲; 則久 佳毅; 溝脇 尚志; 坂本 匡人; 矢野 伸輔; 成田 雄一郎; 山本 時裕; 平岡 真寛
    癌と化学療法 33 4 455 - 461 (株)癌と化学療法社 2006年04月 
    近年,I期肺癌(T1N0M0,T2N0M0)に対する定位放射線照射技術が実用化されている.この治療法は特殊な体幹部固定用フレームや同期照射技術や追尾照射技術を用いることにより,従来は頭蓋内腫瘍のみに可能であった1回10Gy以上の大線量での小分割照射法を可能とした.この技術は現在までに世界的にみても日本を中心にして開発され,臨床応用成果も日本から主に報告されている.現在までの報告では,1回線量が10〜15Gyで3〜5回照射する方法が一般的であるが,それらのほとんどの報告で局所制御率は90%以上であり,合併症も重篤なものはまれである.これは国外からも非常に注目されている技術であり,多施設共同研究JCOG0403が開始されている(著者抄録)
  • 治療 非小細胞肺癌 放射線治療技術の進歩(定位放射線治療)
    永田 靖; 高山 賢二; 松尾 幸憲; 則久 佳毅; 溝脇 尚志; 坂本 匡人; 矢野 伸輔; 成田 雄一郎; 山本 時裕; 平岡 眞寛
    MOOK肺癌の臨床 2005-2006 403 - 408 (株)篠原出版新社 2006年03月
  • Y Nagata; K Takayama; Y Matsuo; Y Norihisa; T Mizowaki; T Sakamoto; M Sakamoto; M Mitsumori; K Shibuya; N Araki; S Yano; M Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 63 5 1427 - 1431 2005年12月 [査読有り]
     
    Purpose: To evaluate the clinical outcomes of 48 Gy of three-dimensional stereotactic radiotherapy in four fractions for treating Stage I lung cancer using a stereotactic body frame. Methods and Materials: Forty-five patients who were treated between September 1998 and February 2004 were included in this study. Thirty-two patients had Stage IA lung cancer, and the other 13 had Stage IB lung cancer where tumor size was less than 4 cm in diameter. Three-dimensional treatment planning using 6-10 noncoplanar beams was performed to maintain the target dose homogeneity and to decrease the irradiated lung volume > 20 Gy. All patients were irradiated using a stereotactic body frame and received four single 12 Gy high doses of radiation at the isocenter over 5-13 (median = 12) days. Results: Seven tumors (16%) completely disappeared after treatment (CR) and 38 tumors (84%) decreased in size by 30% or more (PR). Therefore, all tumors showed local response. During the follow-up of 6-71 (median = 30) months, no pulmonary complications greater than an National Cancer Institute-Common Toxicity Criteria of Grade 3 were noted. No other vascular, cardiac, esophageal, or neurologic toxicities were encountered. Forty-four (98%) of 45 tumors were locally controlled during the follow-up period. However, regional recurrences and distant metastases occurred in 3 and 5 of T1 patients and zero and 4 of T2 patients, respectively. For Stage IA lung cancer, the disease-free survival and overall survival rates after 1 and 3 years were 80% and 72%, and 92% and 83%, respectively, whereas for Stage 113 lung cancer, the disease-free survival and overall survival rates were 92% and 71%, and 82% and 72%, respectively. Conclusion: Forty-eight Gy of 3D stereotactic radiotherapy in 4 fractions using a stereotactic body frame is useful for the treatment of Stage I lung tumors. (c) 2005 Elsevier Inc.
  • 治療 非小細胞肺癌 肺野末梢型孤立性肺腫瘍に対する定位放射線治療の現況と展望(臨床試験)
    永田 靖; 高山 賢二; 松尾 幸憲; 則久 佳毅; 溝脇 尚志; 坂本 隆吏; 坂本 匡人; 矢野 慎輔; 平岡 眞寛
    MOOK肺癌の臨床 2004-2005 189 - 195 (株)篠原出版新社 2005年04月
  • 永田 靖; 高山 賢二; 則久 佳毅; 松尾 幸憲; 坂本 隆吏; 坂本 匡人; 溝脇 尚志; 矢野 伸輔; 平岡 真寛
    新医療 31 12 107 - 109 (株)エムイー振興協会 2004年12月
  • 【放射線治療 切らずに治す】 高精度放射線治療
    永田 靖; 高山 賢二; 溝脇 尚志; 坂本 隆吏; 坂本 匡人; 松尾 幸憲; 則久 佳毅; 矢野 慎輔; 平岡 眞寛
    日独医報 49 2 286 - 292 バイエル薬品(株) 2004年06月
  • Akira Takahashi; Ryuichi Nishiyama; Mitsuteru Kitahara; Masaru Hiura; Toshio Kanaoka; Tadashi Hayashi; Genhachi Hyotani; Yukinori Matsuo; Kazushige Tsutsui
    Acta Urologica Japonica 50 1 53 - 56 2004年01月 [査読有り]
     
    A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. Hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.

書籍

  • Yukinori Matsuo; Hideki Hanazawa; Noriko Kishi; Kazuhito Ueki; Takashi Mizowaki Springer International Publishing 2022年09月 ISBN: 9783031348464
  • 伊達, 洋至; 平井, 豊博 (担当:分担執筆範囲:F. 放射線治療- 1. 放射線治療; J. 原発性肺癌- 5. 治療- (2) 放射線療法)メディカルレビュー社 2019年10月 ISBN: 9784779223150 x, 902p, 図版16p
  • 日本放射線腫瘍学会 (担当:共編者(共編著者)範囲:)学研メディカル秀潤社,学研プラス (発売) 2018年10月 ISBN: 9784780909753 209p
  • 大西, 洋(医学); 唐澤, 久美子; 唐澤, 克之 (担当:分担執筆範囲:6-7 体幹部定位放射線治療（肺）)学研メディカル秀潤社,学研プラス (発売) 2017年07月 ISBN: 9784780909432 lxxx, 1255p
  • Stereotactic Body Radiotherapy for the Lung. In: De Salles AAF, Gorgulho A, Agazaryan N, Slotman B, Selch M, Burwick AJ, Schulz R, eds. Shaped Beam Radiosurgery.
    Matsuo Y; Shibuya K; Narabayashi M; Hiraoka M Springer Berlin Heidelberg 2011年
  • 大西, 洋(医学); 唐澤, 久美子; 唐澤, 克之 (担当:分担執筆範囲:肺転移)篠原出版新社 2010年11月 ISBN: 9784884123444 xxvii, 1247p
  • Case Study in Lung SBRT: Long-term Follow-up in a Patient with a History of Tuberculosis. In: Kavanagh BD, Timmerman RD, eds. Stereotactic Body Radiation Therapy.
    Nagata Y; Takayama K; Mizowaki T; Aoki T; Sakamoto T; Sakamoto M; Matsuo Y; Norihisa Y; Yano S; Hiraoka M Lippincott Williams & Wilkins 2004年

講演・口頭発表等

  • 松尾 幸憲
    肺癌 2022年11月 (NPO)日本肺癌学会
  • 松尾 幸憲
    肺癌 2022年11月 (NPO)日本肺癌学会
  • 岸 徳子; 松尾 幸憲
    肺癌 2022年11月 (NPO)日本肺癌学会
  • 田浦 康二朗; 伊藤 孝司; 波多野 悦朗; 穴澤 貴行; 長井 和之; 福光 剣; 内田 洋一朗; 石井 隆道; 瀬尾 智; 秦 浩一郎; 清水 大功; 宇座 徳光; 松尾 幸憲; 南口 早智子; 金井 雅史
    胆道 2022年09月 (一社)日本胆道学会
  • 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- 非小細胞肺癌に対する放射線治療 最近の進歩
    松尾 幸憲
    日本医学放射線学会秋季臨床大会抄録集 2022年08月 (公社)日本医学放射線学会
  • 小坂 恭弘; 松尾 幸憲; 田久保 康隆
    肺癌 2021年10月 (NPO)日本肺癌学会
  • 濱路 政嗣; 岸 徳子; 松尾 幸憲; 毛受 暁史; 中倉 章祥; 花澤 豪樹; 竹花 恵一; 田中 里奈; 山田 義人; 豊 洋次郎; 大角 明宏; 中島 大輔; 溝脇 尚志; 伊達 洋至
    日本胸部外科学会定期学術集会 2021年10月 (一社)日本胸部外科学会
  • 岸 徳子; 松尾 幸憲
    肺癌 2021年10月 (NPO)日本肺癌学会
  • 小型肺癌に対する治療 手術vs定位放射線治療(SBRT) Propensity score-weighted analysisを用いたI期NSCLC高齢患者における治療成績の検討
    濱路 政嗣; 岸 徳子; 松尾 幸憲; 毛受 暁史; 中倉 章祥; 花澤 豪樹; 竹花 恵一; 田中 里奈; 山田 義人; 豊 洋次郎; 大角 明宏; 中島 大輔; 溝脇 尚志; 伊達 洋至
    日本胸部外科学会定期学術集会 2021年10月 (一社)日本胸部外科学会
  • 80歳以上の頭頸部扁平上皮癌患者に対する放射線治療の検討
    中嶋 綾; 吉村 通央; 松尾 幸憲
    頭頸部癌 2021年05月 (一社)日本頭頸部癌学会
  • 小坂 恭弘; 奥野 翔子; 田久保 康隆; 野口 哲男; 高木 順平; 中川 雅登; 上林 憲司; 松尾 幸憲
    肺癌 2020年10月 (NPO)日本肺癌学会
  • 松尾 幸憲; 金 永学; 花澤 豪樹; 岸 徳子
    肺癌 2020年10月 (NPO)日本肺癌学会
  • 花澤 豪樹; 松尾 幸憲; 岸 徳子
    肺癌 2020年10月 (NPO)日本肺癌学会
  • 岸 徳子; 松尾 幸憲; 毛受 暁史; 花澤 豪樹; 伊達 洋至
    肺癌 2020年10月 (NPO)日本肺癌学会
  • 肺腺癌術前CTにおけるRadiomics特徴量を用いたSTAS予測モデル
    竹花 恵一; 坂本 亮; 藤本 晃司; 松尾 幸憲; 毛受 暁史; 中島 直樹; 吉澤 明彦; 山田 亮; 中村 光宏; 溝脇 尚志; 富樫 かおり
    日本癌治療学会学術集会抄録集 2020年10月 (一社)日本癌治療学会
  • Propensity score-weighted analysisを用いたI期NSCLC高齢患者における治療成績の検討
    岸 徳子; 松尾 幸憲; 毛受 暁史; 濱路 政嗣; 中倉 章祥; 花澤 豪樹; 竹花 恵一; 伊達 洋至; 溝脇 尚志
    日本癌治療学会学術集会抄録集 2020年10月 (一社)日本癌治療学会
  • 中咽頭癌に対するIMRTの治療成績
    中嶋 綾; 吉村 通央; 松尾 幸憲
    頭頸部癌 2020年07月 (一社)日本頭頸部癌学会
  • 小宮山 貴史; 唐澤 克之; 原田 英幸; 山本 貴也; 松本 康男; 小久保 雅樹; 光吉 隆真; 松尾 幸憲; 辻野 佳世子; 木村 智樹; 鬼丸 力也; 中松 清志; 大西 洋
    肺癌 2019年11月 (NPO)日本肺癌学会
  • 花澤 豪樹; 松尾 幸憲; 宇藤 恵; 岸 徳子; 金 永学
    肺癌 2019年11月 (NPO)日本肺癌学会
  • 岸 徳子; 松尾 幸憲; 光吉 隆真; 新谷 尭; 花澤 豪樹; 金 永学
    肺癌 2019年11月 (NPO)日本肺癌学会
  • 子宮頸癌に対する三次元画像誘導小線源治療の成績
    平岡 伸也; 岸 徳子; 竹花 恵一; 花澤 豪樹; 中嶋 綾; 松尾 幸憲; 溝脇 尚志
    日本癌治療学会学術集会抄録集 2019年10月 (一社)日本癌治療学会
  • 当院における非小細胞肺癌脳転移に対する放射線治療成績
    花澤 豪樹; 松尾 幸憲; 宇藤 恵; 竹花 恵一; 岸 徳子; 溝脇 尚志; 金 永学; 阪森 優一
    肺癌 2019年08月 (NPO)日本肺癌学会
  • 池上 直弥; 佐藤 晋; 半田 知宏; 松尾 幸憲; 佐藤 篤靖; 渡邉 創; 島 寛; 庭本 崇史; 伊藤 功朗; 松本 久子; 平井 豊博
    気管支学 2019年06月 (NPO)日本呼吸器内視鏡学会
  • VMATによって治療した肺気腫に基づくstage II肺癌(A Case of Emphysema Based Stage II Lung Cancer Treated with VMAT)
    謝 明秀; 松尾 幸憲; 光吉 隆真; 新谷 尭; 溝脇 尚志
    Japanese Journal of Radiology 2019年02月 (公社)日本医学放射線学会
  • Onishi, H.; Shioyama, Y.; Matsuo, Y.; Takayama, K.; Miyakawa, A.; Yamashita, H.; Nomiya, T.; Matsumo, Y.; Matsushita, H.; Kimura, T.; Murakami, N.; Ishiyama, H.; Uno, T.; Takanaka, T.; Katoh, N.; Takeda, A.; Nakata, K.; Ogawa, K.; Nihei, K.; Aoki, M.; Kuriyama, K.; Komiyama, T.; Marino, K.; Araya, M.; Aoki, S.; Saito, R.; Maehata, Y.; Tominaga, R.; Nonaka, H.; Oguri, M.; Matsuda, M.; Yamada, T.; Akita, T.; Hiraoka, M.
    International Journal of Radiation Oncology Biology Physics 2019年 Elsevier BV
  • 宇藤 恵; 光吉 隆真; 新谷 尭; 松尾 幸憲
    肺癌 2018年10月 (NPO)日本肺癌学会
  • 陳 豊史; 松尾 幸憲; 濱路 政嗣; 豊 洋次郎; 中島 大輔; 大角 明宏; 毛受 暁史; 佐藤 寿彦; 園部 誠; 吉澤 明彦; 伊達 洋至
    肺癌 2018年10月 (NPO)日本肺癌学会
  • 新谷 尭; 松尾 幸憲; 光吉 隆真; 飯塚 裕介
    肺癌 2018年10月 (NPO)日本肺癌学会
  • 松尾 幸憲; 陳 豊史; 濱路 政嗣; 光吉 隆真; 新谷 尭; 飯塚 裕介; 園部 誠; 伊達 洋至
    肺癌 2018年10月 (NPO)日本肺癌学会
  • 光吉 隆真; 松尾 幸憲; 新谷 尭; 飯塚 裕介
    肺癌 2018年10月 (NPO)日本肺癌学会
  • 画像誘導放射線治療におけるkV-X線被ばく線量計算システムの開発
    石原 佳知; 中村 光宏; 飯塚 祐介; 松尾 幸憲; 溝脇 尚志; 平岡 真寛
    日本放射線技術学会近畿部会雑誌 2018年06月 (公社)日本放射線技術学会-近畿支部
  • 拡散強調MRI(DW-MRI)は、肺癌に対する定位放射線治療(SBRT)後の治療効果予測因子となりうるか?
    新谷 尭; 松尾 幸憲; 飯塚 裕介; 光吉 隆真; 溝脇 尚志; 梅岡 成章; 中本 裕士
    Japanese Journal of Radiology 2018年02月 (公社)日本医学放射線学会
  • 松尾 幸憲
    診断と治療 2017年11月 (株)診断と治療社
     
    ＜Headline＞ 1 放射線治療のおもな適応は、早期肺がんに対する体幹部定位放射線治療、局所進行がんに対する化学放射線療法および転移がんに対する緩和照射である。転移性脳腫瘍の治療にあたっては、予後に応じた治療法選択が必要である。2 体幹部定位放射線治療は、標準手術不能のI期症例においては標準治療に位置づけられる。高齢などの理由で手術を希望されない場合や、医学的な理由で縮小手術しか耐容できない症例においても検討される 3 局所進行がんに対する化学放射線療法では、プラチナ製剤を含む2剤以上の化学療法とともに放射線治療60Gy以上の投与が標準治療とされる 4 体幹部定位放射線治療および強度変調放射線治療は、近年肺がんへの適用が広がっている。前者は優れた局所制御、後者は有害事象の低減を得るのに有用である。陽子線治療の肺がんにおける有用性は今後の検討課題である。(著者抄録)
  • Updated Results of Propensity-Based Analysis of Stereotactic Body Radiation Therapy and Sublobar Resection for Stage I Non-small Cell Lung Cancer in Patients at High Risk for Lobectomy  [通常講演]
    Y. Matsuo; T. F. Chen-Yoshikawa; M. Hamaji; T. Mitsuyoshi; T. Shintani; Y. Iizuka; M. Sonobe; H. Date; T. Mizowaki
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 2017年10月 ELSEVIER SCIENCE INC
  • Comparison of Target Delineation Methods in Dynamic Tumor Tracking Radiation Therapy for Lung Tumors Based on Internal Fiducial Markers  [通常講演]
    Y. Iizuka; Y. Matsuo; T. Mitsuyoshi; T. Shintani; T. Mizowaki
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 2017年10月 ELSEVIER SCIENCE INC
  • 松尾 幸憲; 陳 豊史; 濱路 政嗣; 光吉 隆真; 新谷 尭; 飯塚 裕介; 園部 誠; 伊達 洋至
    肺癌 2017年09月 (NPO)日本肺癌学会
  • 肝門部に放射線治療を受けた進行胆道癌症例の長期予後に関する検討  [通常講演]
    土井 恵太郎; 金井 雅史; 松尾 幸憲; 松本 繁己; 武藤 学
    日本内科学会雑誌 2017年02月 (一社)日本内科学会
  • Excellent Survival Achieved by Stereotactic Body Radiotherapy for Medically Operable and Young (< 75 Years) Patients with Stage I Lung Cancer  [通常講演]
    Hiroshi Onishi; Yoshiyuki Shioyama; Yasuo Matsumoto; Kenji Takayama; Yukinori Matsuo; Akifumi Miyakawa; Hideomi Yamashita; Haruo Matsushita; Masahiko Aoki; Keiji Nihei
    JOURNAL OF THORACIC ONCOLOGY 2017年01月 ELSEVIER SCIENCE INC
  • Impact of Inflammation and Sarcopenia on Outcomes after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer  [通常講演]
    Yukinori Matsuo; Yasushi Nagata; Masashi Wakabayashi; Junko Eba; Satoshi Ishikura; Hiroshi Onishi; Masaki Kokubo; Katsuyuki Karasawa; Yoshiyuki Shioyama; Rikiya Onimaru; Masahiro Hiraoka
    JOURNAL OF THORACIC ONCOLOGY 2017年01月 ELSEVIER SCIENCE INC
  • Salvage Surgery for Isolated Local Recurrence after Stereotactic Body Radiotherapy for Clinical Stage I Non-Small Cell Lung Cancer  [通常講演]
    Hiroshi Date; Masatsugu Hamaji; Yukinori Matsuo; Akihiko Yoshizawa; Toshi Menju; Toyofumi Chen-Yoshikawa
    JOURNAL OF THORACIC ONCOLOGY 2017年01月 ELSEVIER SCIENCE INC
  • For down Staged Clinical N3 M0 Non-Small Cell Lung Cancer Patients Chemo-Radiotherapy Followed by Surgery Can Improve Survival  [通常講演]
    Jitian Zhang; Toshihiko Sato; Makoto Sonobe; Toyofumi Chen-Yoshikawa; Akihiro Aoyama; Toshi Menju; Kyoko Hijiya; Hideki Motoyama; Yukinori Matsuo; Young Kim; Hiroshi Date
    JOURNAL OF THORACIC ONCOLOGY 2017年01月 ELSEVIER SCIENCE INC
  • 局所進行非小細胞肺癌に対する術前化学放射線療法(CRT)後の腫瘍体積縮小率(TVRR)による病理学的治療効果(Ef)の予測  [通常講演]
    光吉 隆真; 松尾 幸憲; 新谷 尭; 飯塚 裕介; 溝脇 尚志; 金 永学; 陳 豊史; 園部 誠; 伊達 洋至
    肺癌 2016年12月 (NPO)日本肺癌学会
  • 拡散強調MRI(DW-MRI)は、肺癌に対する定位放射線治療(SBRT)後の治療効果予測因子となりうるか?  [通常講演]
    新谷 尭; 松尾 幸憲; 飯塚 裕介; 光吉 隆真; 溝脇 尚志; 梅岡 成章; 中本 裕士
    肺癌 2016年12月 (NPO)日本肺癌学会
  • 大西洋; 塩山善之; 松本康男; 高山賢二; 松尾幸憲; 宮川聡史; 山下英臣; 松下晴雄; 青山昌彦; 二瓶圭二; 木村智樹; 村上直也; 中田健生
    日本肺癌学会総会号 2016年11月
  • 陳豊史; 濱路政嗣; 松尾幸憲; 本山秀樹; 土屋恭子; 毛受暁史; 青山晃博; 佐藤寿彦; 園部誠; 伊達洋至
    日本肺癌学会総会号 2016年11月
  • 光吉 隆真; 松尾 幸憲; 新谷 尭; 飯塚 裕介; 小笹 裕晃; 永井 宏樹; 金 永学; 陳 豊史; 園部 誠; 伊達 洋至; 中島 直樹; 吉澤 明彦
    肺癌 2016年11月 (NPO)日本肺癌学会
  • 膵臓 耐容性の低い患者に対する包括的がん治療 局所進行膵癌に対する化学放射線療法におけるサルコペニアの予後因子としての有用性  [通常講演]
    岸 高宏; 松尾 幸憲; 中村 晶; 板坂 聡; 澁谷 景子; 後藤 容子; 坂中 克行; 溝脇 尚志; 平岡 眞寛
    日本癌治療学会学術集会抄録集 2016年10月 (一社)日本癌治療学会
  • 肺 次世代の肺がん治療戦略 肺腫瘍に対するリアルタイムモニタリング下動体追尾SBRTの初期治療成績  [通常講演]
    光吉 隆真; 松尾 幸憲; 高山 賢二; 植木 奈美; 飯塚 裕介; 新谷 尭; 田邊 裕朗; 中村 光宏; 小久保 雅樹; 溝脇 尚志; 平岡 真寛
    日本癌治療学会学術集会抄録集 2016年10月 (一社)日本癌治療学会
  • 膵臓 耐容性の低い患者に対する包括的がん治療 局所進行膵癌に対する化学放射線療法におけるサルコペニアの予後因子としての有用性  [通常講演]
    岸 高宏; 松尾 幸憲; 中村 晶; 板坂 聡; 澁谷 景子; 後藤 容子; 坂中 克行; 溝脇 尚志; 平岡 眞寛
    日本癌治療学会学術集会抄録集 2016年10月 (一社)日本癌治療学会
  • 飯塚 裕介; 松尾 幸憲; 高山 賢二; 植木 奈美; 光吉 隆真; 植木 一仁; 田邊 裕朗; 中村 光宏; 小久保 雅樹; 溝脇 尚志; 平岡 眞寛
    日本癌治療学会学術集会抄録集 2016年10月 (一社)日本癌治療学会
  • Accuracy of Target Motion Trajectory in 4-Dimensional Cone Beam Computed Tomography for Lung Cancer Patients  [通常講演]
    H. Iramina; M. Nakamura; Y. Iizuka; T. Mitsuyoshi; Y. Matsuo; T. Mizowaki; M. Hiraoka; I. Kanno
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 2016年10月 ELSEVIER SCIENCE INC
  • Clinical Result of Dynamic Tumor-Tracking Stereotactic Body Radiation Therapy With Real-Time Monitoring for Liver Tumors Using a Gimbal Mounted Linear Accelerator  [通常講演]
    Y. Iizuka; Y. Matsuo; K. Takayama; N. Ueki; T. Mitsuyoshi; K. Ueki; H. Tanabe; M. Nakamura; T. Mizowaki; M. Kokubo
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 2016年10月 ELSEVIER SCIENCE INC
  • Evaluation of the Prevalence of Burnout and Psychological Morbidity Among Japanese Radiation Oncologists Practicing in Kyoto University Hospital and Affiliated Institutions  [通常講演]
    A. W. Mampuya; Y. Matsuo; A. Nakamura; M. Hiraoka
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 2016年10月 ELSEVIER SCIENCE INC
  • M. Nakamura; M. Nakao; Y. Matsuo; N. Mukumoto; Y. Iizuka; K. Yokota; T. Mizowaki; M. Hiraoka
    MEDICAL PHYSICS 2016年06月 WILEY
  • 中村 光宏; 植木 奈美; 中村 晶; 飯塚 裕介; 椋本 宜学; 石原 佳知; 秋元 麻未; 宮部 結城; 松尾 幸憲; 溝脇 尚志; 平岡 真寛
    臨床放射線 2016年02月 金原出版(株)
  • 局所進行NSCLCに対するCRT後の予後因子の検討  [通常講演]
    光吉 隆真; 松尾 幸憲; 伊藤 仁; 岸 高宏; 飯塚 裕介; 中村 晶; Mampuya Ange Wambaka; 溝脇 尚志; 平岡 真寛
    日本癌治療学会誌 2015年09月 (一社)日本癌治療学会
  • 【高精度放射線治療の最新トピックス】 Vero4DRTを用いた動体追尾強度変調放射線治療の臨床適用  [通常講演]
    中村 光宏; 中村 晶; 飯塚 裕介; 松尾 幸憲; 溝脇 尚志; 平岡 真寛
    Rad Fan 2015年02月 (株)メディカルアイ
     
    当院では2011年9月に肺癌に対してVero4DRTによるリアルタイムモニタリング下の動体追尾定位照射を開始し、2013年3月には肝癌に対して本照射法を適応拡大した。さらに、2013年6月からは膵癌に対して、2014年9月からは肝癌に対してリアルタイムモニタリング下の動体追尾強度変調放射線治療を開始している。本稿では、動体追尾強度変調放射線治療の使用経験について報告する。(著者抄録)
  • 膵癌に対する動体追尾強度変調放射線治療の実現  [通常講演]
    中村 晶; 溝脇 尚志; 板坂 聡; 中村 光宏; 石原 佳知; 椋本 宜学; 秋元 麻未; 松尾 幸憲; 門前 一; 平岡 真寛; 小久保 雅樹
    Japanese Journal of Radiology 2015年02月 (公社)日本医学放射線学会
  • 悪性胸膜中皮腫に対する胸膜肺全摘後局所再発制御におけるIMRTの有効性  [通常講演]
    青山 晃博; 松尾 幸憲; 山田 徹; 佐藤 雅昭; 毛受 暁史; 佐藤 寿彦; 陳 豊史; 園部 誠; 大政 貢; 板東 徹; 澁谷 景子; 大久保 憲一; 伊達 洋至
    日本呼吸器外科学会雑誌 2014年04月 (NPO)日本呼吸器外科学会
  • 術前導入化学放射線療法により放射線肺臓炎を発症した肺癌手術症例の検討  [通常講演]
    横山 雄平; 山田 徹; 大政 貢; 陳 豊史; 佐藤 雅昭; 毛受 暁史; 青山 晃博; 佐藤 寿彦; 園部 誠; 板東 徹; 伊達 洋至; 松尾 幸憲; 久保 武; 小笹 裕晃
    肺癌 2014年04月 (NPO)日本肺癌学会
  • Vero4DRT(MHI-TM2000)を用いた動体追尾照射の初期経験  [通常講演]
    植木 奈美; 松尾 幸憲; 宮部 結城; 中村 光宏; 金子 周史; 溝脇 尚志; 平岡 真寛; 矢野 慎輔; 澤田 晃; 小久保 雅樹
    Japanese Journal of Radiology 2014年02月 (公社)日本医学放射線学会
  • Vero4DRTを用いた動体追尾肺定位放射線治療の初期治療成績  [通常講演]
    植木 奈美; 松尾 幸憲; 高山 賢二; 中村 光宏; 宮部 結城; 田邊 裕朗; 金子 周史; 溝脇 尚志; 門前 一; 澤田 晃; 小久保 雅樹; 平岡 真寛
    日本癌治療学会誌 2013年09月 (一社)日本癌治療学会
  • 早期肺癌に対する体幹部定位放射線治療  [通常講演]
    第28回日本肺癌学会ワークショップ 2013年06月 口頭発表（招待・特別） 日本肺癌学会
  • 肺がんおよび肝がんに対する定位放射線療法.  [通常講演]
    滋賀県立成人病センター 第40回がん診療セミナー 2013年04月 口頭発表（招待・特別）
  • Stereotactic Body Radiotherapy for the Lung.  [通常講演]
    37th Annual MD Anderson Radiation Oncology/Gilbert H. Fletcher Society Meeting. 2013年04月 口頭発表（招待・特別）
  • Vero4DRTを用いた リアルタイムモニタリング下の動体追尾放射線治療.  [通常講演]
    第26回日本高精度放射線外部照射研究会 2013年02月 口頭発表（招待・特別）
  • Image-guided Radiotherapy and Dynamic Tumor Tracking with Real-time Monitoring using Vero4DRT (MHI-TM2000).  [通常講演]
    The 6th S. Takahashi Memorial Symposium and the 6th Japan-US Cancer Therapy International Joint Symposium. 2012年07月 口頭発表（招待・特別）
  • Dynamic Tumor Tracking with Real-time Monitoring using a Gimbaled Linac of Vero4DRT (MHI-TM2000).  [通常講演]
    EPI2k12. 2012年03月 口頭発表（招待・特別）
  • 小細胞肺癌に対する体幹部定位放射線治療の初期経験  [通常講演]
    平田 希美子; 松尾 幸憲; 植木 奈美; 澁谷 景子; 坂中 克行; 楢林 正流; 溝脇 尚志; 平岡 真寛
    Japanese Journal of Radiology 2012年02月 (公社)日本医学放射線学会
  • 転移性肺腫瘍に対する定位放射線治療成績の検討  [通常講演]
    宮城 健; 松尾 幸憲; 植木 奈美; 則久 佳毅; 溝脇 尚志; 平岡 眞寛
    日本医学放射線学会学術集会抄録集 2012年02月 (公社)日本医学放射線学会
  • MHI-TM2000(Vero)を用いたリアルタイムモニタリング動体追尾照射の初期経験  [通常講演]
    松尾 幸憲; 金子 周史; 中村 光宏; 植木 奈美; 椋本 宜学; 矢野 慎輔; 澤田 晃; 溝脇 尚志; 小久保 雅樹; 平岡 真寛
    日本医学放射線学会学術集会抄録集 2012年02月 (公社)日本医学放射線学会
  • 肺癌定位放射線治療における呼吸性移動対策：MHI-TM2000（Vero）を用いた動体追尾照射を中心に シンポジウム２「高精度放射線治療の現状と今後の展望」.  [通常講演]
    第24回日本高精度放射線外部照射研究会. 2012年 シンポジウム・ワークショップパネル（公募）
  • 定位放射線治療 T2N0M0非小細胞肺癌に対する体幹部定位放射線治療第I相試験(JCOG0702)のデザインと進捗状況  [通常講演]
    鬼丸 力也; 大西 洋; 松尾 幸憲; 小久保 雅樹; 唐澤 克之; 松下 晴雄; 塩山 善之; 石倉 聡; 伊藤 芳紀; 平岡 真寛; 白土 博樹
    肺癌 2011年10月 (NPO)日本肺癌学会
  • 下咽頭癌に対するIMRTの初期治療経験
    吉村通央; 松尾幸憲; 中村晶; 楢林正流; 溝脇尚志; 平岡真寛; 堀井直敏; 永田靖
    日本医学放射線学会総会抄録集 2011年
  • MHI-TM2000 (Vero) を用いた動体追尾照射の実施に向けた取り組み パネルディスカッション：体幹部照射の呼吸移動対策.  [通常講演]
    第23回日本高精度放射線外部照射研究会 2011年 シンポジウム・ワークショップパネル（公募）
  • 肺癌に対する高精度放射線治療の現状 最新放射線治療装置の現状  [通常講演]
    高山 賢二; 小久保 雅樹; 溝脇 尚志; 松尾 幸憲; 小坂 恭弘; 澤田 晃; 平岡 眞寛
    肺癌 2010年10月 (NPO)日本肺癌学会
  • 頸部食道癌の治療 手術と化学放射線療法の接点 頸部食道癌に対する強度変調放射線治療の試み  [通常講演]
    板坂 聡; 松尾 幸憲; 宮部 結城; 溝脇 尚志; 光森 通英; 平岡 真寛
    日本食道学会学術集会プログラム・抄録集 2010年08月 (NPO)日本食道学会
  • 京都大学における肺定位放射線治療の高度化 ～放射線腫瘍医の立場から～ シンポジウム：放射線治療の高度化が臨床に与える影響.  [通常講演]
    日本放射線腫瘍学会第23回学術大会. 2010年 シンポジウム・ワークショップパネル（公募）
  • アスベスト関連疾患 中皮腫の診断から治療 悪性胸膜中皮腫に対する放射線治療  [通常講演]
    澁谷 景子; 松尾 幸憲; 中村 光宏; 成田 雄一郎; 中村 晶; 椎木 健裕; 澤田 晃; 溝脇 尚志; 平岡 真寛; 大久保 憲一; 伊達 洋至
    国立病院総合医学会講演抄録集 2009年10月 国立病院総合医学会
  • 膠原病を背景疾患として持つ喉頭癌患者に対する放射線治療経験  [通常講演]
    廣瀬 瑞樹; 永田 靖; 今葷倍 敏行; 松尾 幸憲; 板坂 聡; 澁谷 景子; 山内 智香子; 荒木 則雄; 溝脇 尚志; 光森 通英; 平岡 眞寛; 牛呂 幸司; 平野 滋; 田中 信三
    Japanese Journal of Radiology 2009年04月 (公社)日本医学放射線学会
  • 肺癌定位照射後のまれな合併症の1例  [通常講演]
    田川 裕美子; 永田 靖; 松尾 幸憲; 澁谷 景子; 今葷倍 敏行; 廣瀬 瑞樹; 則久 佳毅; 溝脇 尚志; 阿部 英輔; 板坂 聡; 山内 智香子; 光森 通英; 平岡 真寛
    Japanese Journal of Radiology 2009年04月 (公社)日本医学放射線学会
  • 画像上肺癌と診断した小結節への体幹部定位放射線治療  [通常講演]
    久保田 紗代; 永田 靖; 松尾 幸憲; 澁谷 景子; 今葷倍 敏行; 楢林 正流; 則久 佳毅; 溝脇 尚志; 山内 智香子; 板坂 聡; 光森 通英; 平岡 眞寛
    Japanese Journal of Radiology 2009年04月 (公社)日本医学放射線学会
  • 小細胞性肺癌に対して予防的全脳照射を行った症例に対する検討  [通常講演]
    蓮池 史画; 永田 靖; 澁谷 景子; 山内 智香子; 松尾 幸憲; 廣瀬 瑞樹; 板坂 聡; 溝脇 尚志; 光森 通英; 平岡 眞寛
    Japanese Journal of Radiology 2009年04月 (公社)日本医学放射線学会
  • 当院における頭頸部IMRTの初期治療成績  [通常講演]
    堀井 直敏; 松尾 幸憲; 則久 佳毅; 楢林 正流; 坂中 克行; 溝脇 尚志; 平岡 真寛; 永田 靖; 坂本 隆吏; 青木 徹哉
    日本医学放射線学会学術集会抄録集 2009年02月 (公社)日本医学放射線学会
  • 原発性肺癌に対する定位放射線治療における予後因子の検討  [通常講演]
    松尾 幸憲; 澁谷 景子; 永田 靖; 楢林 正流; 溝脇 尚志; 高山 賢二; 則久 佳毅; 堀井 直敏; 坂中 克行; 平岡 真寛
    日本医学放射線学会学術集会抄録集 2009年02月 (公社)日本医学放射線学会
  • T2腫瘍について シンポジウム：肺定位放射線治療の適応と課題.  [通常講演]
    日本放射線腫瘍学会第22回学術大会 2009年 シンポジウム・ワークショップパネル（公募）
  • 難聴で発症した上咽頭癌の1男児例  [通常講演]
    甲原 貴子; 松原 央; 森嶋 達也; 新里 亜紀; 才田 聡; 梅田 雄嗣; 渡邉 健一郎; 足立 壮一; 中畑 龍俊; 石川 正昭; 渡邉 佳紀; 平野 滋; 松尾 幸憲
    小児がん 2008年11月 (NPO)日本小児がん学会
  • 肺腫瘍に対する体幹部定位放射線治療成績  [通常講演]
    永田 靖; 松尾 幸憲; 高山 賢二; 則久 佳毅; 楢林 正流; 澁谷 景子; 山内 智香子; 久保田 紗代; 光森 通英; 平岡 眞寛
    日本医学放射線学会学術集会抄録集 2008年02月 (公社)日本医学放射線学会
  • 画像上肺癌と診断した肺腫瘍への体幹部定位放射線治療  [通常講演]
    久保田 紗代; 永田 靖; 松尾 幸憲; 澁谷 景子; 今葷倍 敏行; 楢林 正流; 則久 佳毅; 溝脇 尚志; 山内 智香子; 平岡 眞寛
    日本医学放射線学会学術集会抄録集 2008年02月 (公社)日本医学放射線学会
  • Novalis肺定位放射線治療における治療計画装置の比較  [通常講演]
    松尾 幸憲; 成田 雄一郎; 中田 学; 楢林 正流; 永田 靖; 溝脇 尚志; 則久 佳毅; 伊東 宏之; 平岡 眞寛
    日本医学放射線学会学術集会抄録集 2008年02月 (公社)日本医学放射線学会
  • 京都大学におけるIMRT シンポジウム3 「IMRTの標準治療法の確立に向けて」.  [通常講演]
    日本放射線腫瘍学会第21回学術大会 2008年 シンポジウム・ワークショップパネル（公募）
  • 肺定位放射線治療の治療計画における施設間格差の検討  [通常講演]
    松尾 幸憲; 高山 賢二; 永田 靖; 溝脇 尚志; 則久 佳毅; 坂本 匡人; 成田 雄一郎; 平岡 真寛
    Radiation Medicine 2007年04月 (公社)日本医学放射線学会
  • 肺癌の治療に必要な画像診断 保存的治療に必要な画像診断 放射線腫瘍医より見て  [通常講演]
    永田 靖; 澁谷 景子; 山内 智香子; 溝脇 尚志; 光森 通英; 荒木 則雄; 板坂 聡; 松尾 幸憲; 平岡 真寛
    日本医学放射線学会学術集会抄録集 2007年02月 (公社)日本医学放射線学会
  • 癌放射線治療の現状と将来 体幹部定位放射線治療  [通常講演]
    永田 靖; 松尾 幸憲; 則久 佳毅; 高山 賢二; 溝脇 尚志; 平岡 真寛
    日本癌治療学会誌 2006年09月 (一社)日本癌治療学会
  • 頭頸部癌に対する強度変調放射線治療  [通常講演]
    永田 靖; 松尾 幸憲; 溝脇 尚志; 平岡 真寛; 田中 信三; 安里 亮; 伊藤 壽一
    頭頸部癌 2006年05月 日本頭頸部癌学会
  • C期前立腺癌に対するIMRT後の一過性PSA上昇に関する検討  [通常講演]
    溝脇 尚志; 光森 通英; 高山 賢二; 則久 佳毅; 坂本 匡人; 松尾 幸憲; 永田 靖; 平岡 眞寛
    日本医学放射線学会学術集会抄録集 2006年02月 (公社)日本医学放射線学会
  • 前立腺がんIMRTにおける患者位置照合法による投与線量への影響  [通常講演]
    成田 雄一郎; 幡野 和男; 溝脇 尚志; 高山 賢二; 則久 佳毅; 松尾 幸憲; 永田 靖; 平岡 真寛
    日本放射線腫瘍学会誌 2005年10月 (公社)日本放射線腫瘍学会
  • 体内線量分布評価を目的とした三次元動体ファントムの開発  [通常講演]
    中山 博之; 川田 則幸; 高山 賢二; 成田 雄一郎; 溝脇 尚志; 高橋 邦夫; 則久 佳毅; 松尾 幸憲; 小久保 雅樹; 平岡 眞寛
    日本放射線腫瘍学会誌 2005年10月 (公社)日本放射線腫瘍学会
  • 肺定位放射線治療計画における施設間較差の検討  [通常講演]
    松尾 幸憲; 高山 賢二; 永田 靖; 国枝 悦夫; 舘岡 邦彦; 溝脇 尚志; 則久 佳毅; 坂本 匡人; 成田 雄一郎; 平岡 真寛
    日本放射線腫瘍学会誌 2005年10月 (公社)日本放射線腫瘍学会
  • 粒子線,IMRTのあたらしい放射線治療 前立腺癌に対する全骨盤領域を含むSimultaneous Integrated Boost(SIB)-IMRT  [通常講演]
    則久 佳毅; 溝脇 尚志; 高山 賢二; 坂本 匡人; 松尾 幸憲; 光森 通英; 永田 靖; 平岡 眞寛
    日本癌治療学会誌 2005年09月 (一社)日本癌治療学会
  • 肺定位放射線治療後の腫瘤様陰影に関する検討  [通常講演]
    松尾 幸憲; 永田 靖; 溝脇 尚志; 高山 賢二; 則久 佳毅; 坂本 隆吏; 坂本 匡人; 平岡 真寛
    日本放射線腫瘍学会誌 2004年10月 (公社)日本放射線腫瘍学会
  • 定位放射線照射技術を用いた肺腫瘍に対する1回大線量小分割照射法(5年間の初期臨床成績)  [通常講演]
    永田 靖; 高山 賢二; 坂本 隆吏; 坂本 匡人; 溝脇 尚志; 則久 佳毅; 松尾 幸憲; 平岡 真寛
    日本医学放射線学会雑誌 2004年02月 (公社)日本医学放射線学会
  • CTを用いた膵頭部癌の呼吸性移動に関する検討  [通常講演]
    松尾 幸憲; 青木 徹哉; 溝脇 尚志; 永田 靖; 高山 賢二; 坂本 隆吏; 坂本 匡人; 則久 佳毅; 平岡 真寛
    日本医学放射線学会雑誌 2004年02月 (公社)日本医学放射線学会
  • 前立腺癌IMRT治療期間中における膀胱体積と臓器移動  [通常講演]
    則久 佳毅; 溝脇 尚志; 高山 賢二; 坂本 隆吏; 坂本 匡人; 松尾 幸憲; 永田 靖; 平岡 真寛
    日本医学放射線学会雑誌 2004年02月 (公社)日本医学放射線学会

MISC

  • 岸 徳子; 松尾 幸憲 肺癌 61 (6) 593 -593 2021年10月
  • 局所進行非小細胞肺癌に対する術前化学放射線療法(CRT)後の腫瘍体積縮小率(TVRR)による病理学的治療効果(Ef)の予測
    光吉 隆真; 松尾 幸憲; 新谷 尭; 飯塚 裕介; 溝脇 尚志; 金 永学; 陳 豊史; 園部 誠; 伊達 洋至 肺癌 56 (7) 1071 -1071 2016年12月
  • 拡散強調MRI(DW-MRI)は、肺癌に対する定位放射線治療(SBRT)後の治療効果予測因子となりうるか?
    新谷 尭; 松尾 幸憲; 飯塚 裕介; 光吉 隆真; 溝脇 尚志; 梅岡 成章; 中本 裕士 肺癌 56 (7) 1070 -1070 2016年12月
  • 膵臓 耐容性の低い患者に対する包括的がん治療 局所進行膵癌に対する化学放射線療法におけるサルコペニアの予後因子としての有用性
    岸 高宏; 松尾 幸憲; 中村 晶; 板坂 聡; 澁谷 景子; 後藤 容子; 坂中 克行; 溝脇 尚志; 平岡 眞寛 日本癌治療学会学術集会抄録集 54回 WS5 -5 2016年10月
  • 膵臓 耐容性の低い患者に対する包括的がん治療 局所進行膵癌に対する化学放射線療法におけるサルコペニアの予後因子としての有用性
    岸 高宏; 松尾 幸憲; 中村 晶; 板坂 聡; 澁谷 景子; 後藤 容子; 坂中 克行; 溝脇 尚志; 平岡 眞寛 日本癌治療学会学術集会抄録集 54回 WS5 -5 2016年10月
  • 肺 次世代の肺がん治療戦略 肺腫瘍に対するリアルタイムモニタリング下動体追尾SBRTの初期治療成績
    光吉 隆真; 松尾 幸憲; 高山 賢二; 植木 奈美; 飯塚 裕介; 新谷 尭; 田邊 裕朗; 中村 光宏; 小久保 雅樹; 溝脇 尚志; 平岡 真寛 日本癌治療学会学術集会抄録集 54回 MS46 -2 2016年10月
  • 肝臓 限局性肝がんに対する新たな治療選択肢 肝腫瘍に対するリアルタイムモニタリング下動体追尾定位放射線治療の臨床成績
    飯塚 裕介; 松尾 幸憲; 高山 賢二; 植木 奈美; 光吉 隆真; 植木 一仁; 田邊 裕朗; 中村 光宏; 小久保 雅樹; 溝脇 尚志; 平岡 眞寛 日本癌治療学会学術集会抄録集 54回 WS35 -1 2016年10月
  • 局所進行NSCLCに対するCRT後の予後因子の検討
    光吉 隆真; 松尾 幸憲; 伊藤 仁; 岸 高宏; 飯塚 裕介; 中村 晶; Mampuya Ange Wambaka; 溝脇 尚志; 平岡 真寛 日本癌治療学会誌 50 (3) 1781 -1781 2015年09月
  • 膵癌に対する動体追尾強度変調放射線治療の実現
    中村 晶; 溝脇 尚志; 板坂 聡; 中村 光宏; 石原 佳知; 椋本 宜学; 秋元 麻未; 松尾 幸憲; 門前 一; 平岡 真寛; 小久保 雅樹 Japanese Journal of Radiology 33 (Suppl.) 76 -76 2015年02月
  • 悪性胸膜中皮腫に対する胸膜肺全摘後局所再発制御におけるIMRTの有効性
    青山 晃博; 松尾 幸憲; 山田 徹; 佐藤 雅昭; 毛受 暁史; 佐藤 寿彦; 陳 豊史; 園部 誠; 大政 貢; 板東 徹; 澁谷 景子; 大久保 憲一; 伊達 洋至 日本呼吸器外科学会雑誌 28 (3) RS4 -3 2014年04月
  • 術前導入化学放射線療法により放射線肺臓炎を発症した肺癌手術症例の検討
    横山 雄平; 山田 徹; 大政 貢; 陳 豊史; 佐藤 雅昭; 毛受 暁史; 青山 晃博; 佐藤 寿彦; 園部 誠; 板東 徹; 伊達 洋至; 松尾 幸憲; 久保 武; 小笹 裕晃 肺癌 54 (2) 92 -92 2014年04月
  • Vero4DRT(MHI-TM2000)を用いた動体追尾照射の初期経験
    植木 奈美; 松尾 幸憲; 宮部 結城; 中村 光宏; 金子 周史; 溝脇 尚志; 平岡 真寛; 矢野 慎輔; 澤田 晃; 小久保 雅樹 Japanese Journal of Radiology 32 (Suppl.) 31 -31 2014年02月
  • Vero4DRTを用いた動体追尾肺定位放射線治療の初期治療成績
    植木 奈美; 松尾 幸憲; 高山 賢二; 中村 光宏; 宮部 結城; 田邊 裕朗; 金子 周史; 溝脇 尚志; 門前 一; 澤田 晃; 小久保 雅樹; 平岡 真寛 日本癌治療学会誌 48 (3) 1172 -1172 2013年09月
  • 転移性肺腫瘍に対する定位放射線治療成績の検討
    宮城 健; 松尾 幸憲; 植木 奈美; 則久 佳毅; 溝脇 尚志; 平岡 眞寛 日本医学放射線学会学術集会抄録集 71回 S221 -S221 2012年02月
  • 小細胞肺癌に対する体幹部定位放射線治療の初期経験
    平田 希美子; 松尾 幸憲; 植木 奈美; 澁谷 景子; 坂中 克行; 楢林 正流; 溝脇 尚志; 平岡 真寛 Japanese Journal of Radiology 30 (Suppl.I) 50 -50 2012年02月
  • MHI-TM2000(Vero)を用いたリアルタイムモニタリング動体追尾照射の初期経験
    松尾 幸憲; 金子 周史; 中村 光宏; 植木 奈美; 椋本 宜学; 矢野 慎輔; 澤田 晃; 溝脇 尚志; 小久保 雅樹; 平岡 真寛 日本医学放射線学会学術集会抄録集 71回 S260 -S260 2012年02月
  • 定位放射線治療 T2N0M0非小細胞肺癌に対する体幹部定位放射線治療第I相試験(JCOG0702)のデザインと進捗状況
    鬼丸 力也; 大西 洋; 松尾 幸憲; 小久保 雅樹; 唐澤 克之; 松下 晴雄; 塩山 善之; 石倉 聡; 伊藤 芳紀; 平岡 真寛; 白土 博樹 肺癌 51 (5) 356 -356 2011年10月
  • 肺癌に対する高精度放射線治療の現状 最新放射線治療装置の現状
    高山 賢二; 小久保 雅樹; 溝脇 尚志; 松尾 幸憲; 小坂 恭弘; 澤田 晃; 平岡 眞寛 肺癌 50 (5) 457 -457 2010年10月
  • 頸部食道癌の治療 手術と化学放射線療法の接点 頸部食道癌に対する強度変調放射線治療の試み
    板坂 聡; 松尾 幸憲; 宮部 結城; 溝脇 尚志; 光森 通英; 平岡 真寛 日本食道学会学術集会プログラム・抄録集 64回 117 -117 2010年08月
  • アスベスト関連疾患 中皮腫の診断から治療 悪性胸膜中皮腫に対する放射線治療
    澁谷 景子; 松尾 幸憲; 中村 光宏; 成田 雄一郎; 中村 晶; 椎木 健裕; 澤田 晃; 溝脇 尚志; 平岡 真寛; 大久保 憲一; 伊達 洋至 国立病院総合医学会講演抄録集 63回 283 -283 2009年10月
  • 膠原病を背景疾患として持つ喉頭癌患者に対する放射線治療経験
    廣瀬 瑞樹; 永田 靖; 今葷倍 敏行; 松尾 幸憲; 板坂 聡; 澁谷 景子; 山内 智香子; 荒木 則雄; 溝脇 尚志; 光森 通英; 平岡 眞寛; 牛呂 幸司; 平野 滋; 田中 信三 Japanese Journal of Radiology 27 (Suppl.) 48 -48 2009年04月
  • 肺癌定位照射後のまれな合併症の1例
    田川 裕美子; 永田 靖; 松尾 幸憲; 澁谷 景子; 今葷倍 敏行; 廣瀬 瑞樹; 則久 佳毅; 溝脇 尚志; 阿部 英輔; 板坂 聡; 山内 智香子; 光森 通英; 平岡 真寛 Japanese Journal of Radiology 27 (Suppl.) 53 -53 2009年04月
  • 画像上肺癌と診断した小結節への体幹部定位放射線治療
    久保田 紗代; 永田 靖; 松尾 幸憲; 澁谷 景子; 今葷倍 敏行; 楢林 正流; 則久 佳毅; 溝脇 尚志; 山内 智香子; 板坂 聡; 光森 通英; 平岡 眞寛 Japanese Journal of Radiology 27 (Suppl.) 59 -59 2009年04月
  • 小細胞性肺癌に対して予防的全脳照射を行った症例に対する検討
    蓮池 史画; 永田 靖; 澁谷 景子; 山内 智香子; 松尾 幸憲; 廣瀬 瑞樹; 板坂 聡; 溝脇 尚志; 光森 通英; 平岡 眞寛 Japanese Journal of Radiology 27 (Suppl.) 59 -59 2009年04月
  • 当院における頭頸部IMRTの初期治療成績
    堀井 直敏; 松尾 幸憲; 則久 佳毅; 楢林 正流; 坂中 克行; 溝脇 尚志; 平岡 真寛; 永田 靖; 坂本 隆吏; 青木 徹哉 日本医学放射線学会学術集会抄録集 68回 S199 -S199 2009年02月
  • 原発性肺癌に対する定位放射線治療における予後因子の検討
    松尾 幸憲; 澁谷 景子; 永田 靖; 楢林 正流; 溝脇 尚志; 高山 賢二; 則久 佳毅; 堀井 直敏; 坂中 克行; 平岡 真寛 日本医学放射線学会学術集会抄録集 68回 S203 -S204 2009年02月
  • 難聴で発症した上咽頭癌の1男児例
    甲原 貴子; 松原 央; 森嶋 達也; 新里 亜紀; 才田 聡; 梅田 雄嗣; 渡邉 健一郎; 足立 壮一; 中畑 龍俊; 石川 正昭; 渡邉 佳紀; 平野 滋; 松尾 幸憲 小児がん 45 (プログラム・総会号) 375 -375 2008年11月
  • Novalis肺定位放射線治療における治療計画装置の比較
    松尾 幸憲; 成田 雄一郎; 中田 学; 楢林 正流; 永田 靖; 溝脇 尚志; 則久 佳毅; 伊東 宏之; 平岡 眞寛 日本医学放射線学会学術集会抄録集 67回 S391 -S391 2008年02月
  • 肺腫瘍に対する体幹部定位放射線治療成績
    永田 靖; 松尾 幸憲; 高山 賢二; 則久 佳毅; 楢林 正流; 澁谷 景子; 山内 智香子; 久保田 紗代; 光森 通英; 平岡 眞寛 日本医学放射線学会学術集会抄録集 67回 S194 -S194 2008年02月
  • 画像上肺癌と診断した肺腫瘍への体幹部定位放射線治療
    久保田 紗代; 永田 靖; 松尾 幸憲; 澁谷 景子; 今葷倍 敏行; 楢林 正流; 則久 佳毅; 溝脇 尚志; 山内 智香子; 平岡 眞寛 日本医学放射線学会学術集会抄録集 67回 S195 -S195 2008年02月
  • 肺定位放射線治療の治療計画における施設間格差の検討
    松尾 幸憲; 高山 賢二; 永田 靖; 溝脇 尚志; 則久 佳毅; 坂本 匡人; 成田 雄一郎; 平岡 真寛 Radiation Medicine 25 (Suppl.I) 71 -71 2007年04月
  • 肺癌の治療に必要な画像診断 保存的治療に必要な画像診断 放射線腫瘍医より見て
    永田 靖; 澁谷 景子; 山内 智香子; 溝脇 尚志; 光森 通英; 荒木 則雄; 板坂 聡; 松尾 幸憲; 平岡 真寛 日本医学放射線学会学術集会抄録集 66回 S86 -S86 2007年02月
  • 癌放射線治療の現状と将来 体幹部定位放射線治療
    永田 靖; 松尾 幸憲; 則久 佳毅; 高山 賢二; 溝脇 尚志; 平岡 真寛 日本癌治療学会誌 41 (2) 261 -261 2006年09月
  • 頭頸部癌に対する強度変調放射線治療
    永田 靖; 松尾 幸憲; 溝脇 尚志; 平岡 真寛; 田中 信三; 安里 亮; 伊藤 壽一 頭頸部癌 32 (2) 171 -171 2006年05月
  • C期前立腺癌に対するIMRT後の一過性PSA上昇に関する検討
    溝脇 尚志; 光森 通英; 高山 賢二; 則久 佳毅; 坂本 匡人; 松尾 幸憲; 永田 靖; 平岡 眞寛 日本医学放射線学会学術集会抄録集 65回 S210 -S210 2006年02月
  • 肺定位放射線治療計画における施設間較差の検討
    松尾 幸憲; 高山 賢二; 永田 靖; 国枝 悦夫; 舘岡 邦彦; 溝脇 尚志; 則久 佳毅; 坂本 匡人; 成田 雄一郎; 平岡 真寛 日本放射線腫瘍学会誌 17 (Suppl.1) 101 -101 2005年10月
  • 前立腺がんIMRTにおける患者位置照合法による投与線量への影響
    成田 雄一郎; 幡野 和男; 溝脇 尚志; 高山 賢二; 則久 佳毅; 松尾 幸憲; 永田 靖; 平岡 真寛 日本放射線腫瘍学会誌 17 (Suppl.1) 73 -73 2005年10月
  • 体内線量分布評価を目的とした三次元動体ファントムの開発
    中山 博之; 川田 則幸; 高山 賢二; 成田 雄一郎; 溝脇 尚志; 高橋 邦夫; 則久 佳毅; 松尾 幸憲; 小久保 雅樹; 平岡 眞寛 日本放射線腫瘍学会誌 17 (Suppl.1) 100 -100 2005年10月
  • 粒子線,IMRTのあたらしい放射線治療 前立腺癌に対する全骨盤領域を含むSimultaneous Integrated Boost(SIB)-IMRT
    則久 佳毅; 溝脇 尚志; 高山 賢二; 坂本 匡人; 松尾 幸憲; 光森 通英; 永田 靖; 平岡 眞寛 日本癌治療学会誌 40 (2) 210 -210 2005年09月
  • 肺定位放射線治療後の腫瘤様陰影に関する検討
    松尾 幸憲; 永田 靖; 溝脇 尚志; 高山 賢二; 則久 佳毅; 坂本 隆吏; 坂本 匡人; 平岡 真寛 日本放射線腫瘍学会誌 16 (Suppl.1) 110 -110 2004年10月
  • 定位放射線照射技術を用いた肺腫瘍に対する1回大線量小分割照射法(5年間の初期臨床成績)
    永田 靖; 高山 賢二; 坂本 隆吏; 坂本 匡人; 溝脇 尚志; 則久 佳毅; 松尾 幸憲; 平岡 真寛 日本医学放射線学会雑誌 64 (2) S153 -S154 2004年02月
  • CTを用いた膵頭部癌の呼吸性移動に関する検討
    松尾 幸憲; 青木 徹哉; 溝脇 尚志; 永田 靖; 高山 賢二; 坂本 隆吏; 坂本 匡人; 則久 佳毅; 平岡 真寛 日本医学放射線学会雑誌 64 (2) S310 -S311 2004年02月
  • 前立腺癌IMRT治療期間中における膀胱体積と臓器移動
    則久 佳毅; 溝脇 尚志; 高山 賢二; 坂本 隆吏; 坂本 匡人; 松尾 幸憲; 永田 靖; 平岡 真寛 日本医学放射線学会雑誌 64 (2) S313 -S313 2004年02月

産業財産権

受賞

  • 2017年11月 日本放射線腫瘍学会 優秀教育講演者賞
  • 2016年10月 日本癌学会 JCA-CHAAO賞
     リアルタイムモニタリング動体追尾放射線治療の開発 
    受賞者: 平岡 真寛 小久保 雅樹 高山 賢二 中村 光宏 松尾 幸憲 溝脇 尚志 宮部 結城
  • 2015年05月 公益財団法人 後藤喜代子・ポールブルダリ癌基金協会 第３回後藤喜代子・ポールブルダリ科学賞 特別賞
     Evaluation of dynamic tumour tracking radiotherapy with real-time monitoring for lung tumours using a gimbal mounted linac
  • 2013年01月 平成24年度 新機械振興賞 機械振興協会会長賞
     動体追尾放射線治療装置
  • 2011年11月 日本放射線腫瘍学会 優秀演題賞

共同研究・競争的資金等の研究課題

  • 日本学術振興会：科学研究費助成事業 基盤研究(C)
    研究期間 : 2022年04月 -2025年03月 
    代表者 : 松尾 幸憲
  • 動体追尾強度変調回転放射線治療技術の開発と実行可能性臨床試験
    国立研究開発法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2021年04月 -2024年03月
  • 難治がんに対する動体追尾放射線治療の臨床評価に関する研究
    国立研究開発法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2020年04月 -2023年03月
  • 早期非小細胞肺癌に対する体幹部定位放射線治療線量増加ランダム化比較試験
    国立研究開発法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2020年04月 -2023年03月
  • 高齢者Ⅰ期肺癌における治療選択個別化に資するモデルの構築と前向き妥当性評価研究
    京都大学教育研究振興財団：令和３年度研究活動推進助成
    研究期間 : 2021年04月 -2022年03月
  • 日本学術振興会：科学研究費助成事業 基盤研究(B)
    研究期間 : 2016年04月 -2021年03月 
    代表者 : 大西 洋; 神宮 啓一; 根本 建二; 塩山 善之; 芝本 雄太; 中村 和正; 松下 晴雄; 小岩井 慶一郎; 佐藤 啓; 宇野 隆; 鈴木 修; 伊丹 純; 原田 英幸; 石川 仁; 山下 英臣; 唐澤 克之; 松尾 幸憲; 馬屋原 博; 小久保 雅樹; 木村 智樹; 高山 賢二; 大賀 才路; 野宮 琢磨; 加藤 徳雄; 吉武 忠正
     
    【会議の開催】第5回全体会議：2019年4月13日、第6回全体会議：2019年11月22日、メール会議随時開催 【既存多施設研究の遂行】1.有転移性肺癌患者におけるNivolumabと定位放射線治療の併用の安全性試験（NIVOSTLUC-I)、2.保険外臓器腫瘍に対する定位放射線治療の観察研究、3.有転移性腎癌多発患者におけるNivolumabと定位放射線治療の併用の有無による治療効果の差についての比較研究（NIVOIGERCC)（phase II/III） 【新規多施設研究の検討】1.中枢型IA（UICC 7版）期非小細胞肺癌に対する高精度少分割放射線治療の多施設前向き登録、2.III期非小細胞肺癌の従来型化学放射線療法後の残存腫瘍に対する定位放射線治療 【各分担研究者による臨床試験継続】1. 保険適応外臓器に対する定位放射線治療の調査研究、観察研究、 2. 有転移性前立腺癌の定位照射のI/II相臨床試験、アンケート調査、 3. (1) M1前立腺癌, (2) 前立腺癌放射線治療後局所再発, (3) 前立腺癌術後マクロ再発に対する救済 定位放射線治療、 4. 膵臓癌に対する定位放射線治療、5. 子宮頸癌に対する定位放射線治療、6. 婦人科がんのPALN孤発転移へ の定位放射線治療)、7. 直腸がん術後の吻合部以外の再発（仙骨前面の軟部組織）への定位放射線治療、8. 乳癌 の根治的照射としてのブースト定位照射、9. リンパ節転移、胆管癌への定位照射、10. オリゴリンパ節転移に対する定位放射線治 療の第II相研究、11. 5cm以上の肝癌・肺癌に対する定位放射線治療 【研究発表】1.腎癌の定位放射線治療成績をまとめた。2.I期非小細胞肺癌の定位放射線治療と手術との比較論文のレビューを論文化した。3.定位放射線治療ｂにおけるマルチリーフコリメータ位置の医学物理的評価を行った。
  • 次世代Dynamic Wave Arc照射法の開発と長期有効性・安全性の評価
    国立研究開発法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2018年04月 -2021年03月
  • 早期肺癌における体幹部定位放射線治療の最適利用を目指した包括的研究
    京都大学教育研究振興財団：平成３１年度 研究活動推進助成
    研究期間 : 2019年04月 -2020年03月
  • 難治がんに対する動体追尾放射線治療の臨床評価に関する研究
    国立研究開発法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2017年04月 -2020年03月
  • 早期非小細胞肺癌に対する体幹部定位放射線治療線量増加ランダム化比較試験
    国立研究開発法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2017年04月 -2020年03月 
    代表者 : 永田 靖
  • 肺癌の個別化放射線治療実現にむけた包括的検討
    京都大学：リサーチ・ディベロップメントプログラム【いしずえ】
    研究期間 : 2018年04月 -2019年03月
  • 日本学術振興会：科学研究費助成事業 基盤研究(C)
    研究期間 : 2015年04月 -2018年03月 
    代表者 : 松尾 幸憲; 中村 晶
     
    慢性炎症や筋肉量減少（サルコペニア）が、がん治療後の生存率に関連しているか否かを評価した。早期肺癌の体幹部定位放射線治療症例をおいては、慢性炎症が肺癌死（特に遠隔転移死）に、サルコペニアが非肺癌死に、それぞれ関連することが判明した。局所進行非小細胞肺癌症例においては、治療前に全身炎症所見を認める症例および体格指数が低い（BMI＜18.5）症例で予後不良の傾向にあった。これらの結果に基づくと、従来の年齢や肺癌病期に加えて、慢性炎症およびサルコペニアが重要な予後因子であることを示すことができた。
  • 日本学術振興会：科学研究費助成事業 基盤研究(A)
    研究期間 : 2013年04月 -2018年03月 
    代表者 : 平岡 眞寛; 佐治 英郎; 富樫 かおり; 溝脇 尚志; 松尾 幸憲; 吉村 通央; 中村 光宏; 小久保 雅樹; 澤田 晃; 門前 一; 板坂 聡
     
    放射線治療の成績向上には、生物学的画像情報の治療計画への統合と腫瘍や正常臓器の動きへの対応が必要と考えられた。我々は、放射線治療計画における生物・機能画像情報の有用性の評価、腫瘍動体評価と生物・機能画像の4次元化法の確立、および動体追尾SIB-IMRT治療の実現に向けた基盤技術開発の３つの要素に分けて研究を行った。それぞれF-MISO-PETによる低酸素イメージングにおける最適な撮像タイミング、呼吸同期FDG-PETの有用性、４次元線量計算モジュールの開発などの研究成果を挙げた。今後これらの研究成果が放射線治療の高度化と成績向上につながるものと期待される。
  • Dynamic WaveArc照射技法を用いた革新的放射線治療法の確立
    独立行政法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2015年04月 -2018年03月
  • 難治がんに対する動体追尾放射線治療の臨床評価に関する研究
    国立研究開発法人日本医療研究開発機構：革新的がん医療実用化研究事業
    研究期間 : 2015年04月 -2017年03月
  • 日本学術振興会：科学研究費助成事業 基盤研究(C)
    研究期間 : 2012年04月 -2016年03月 
    代表者 : 大西 洋; 塩山 善之; 吉武 忠正; 伊藤 陽一; 白土 博樹; 今井 高志; 鬼丸 力也; 小久保 雅樹; 栗山 健吾; 小宮山 貴史; 冨永 理人; 大栗 実彦; 野中 穂高; 青木 真一; 松本 康男; 松下 晴雄; 高山 賢二; 井上 哲也; 加藤 徳雄; 山下 英臣; 唐澤 克之; 江原 威; 植木 奈美; 松尾 幸憲
     
    早期の非小細胞肺癌に対する定位放射線治療は、高い有効性と安全性から期待の大きい治療法である。重症の放射線肺炎のリスク因子の一つとして肺線維症が挙げられているが、詳細は明らかにされていない。そこで、放射線肺炎との関連が報告されているTGFb1遺伝子上または周辺の多型および、炎症関連遺伝子多型が定位放射線治療後の肺臓炎発症リスクと関連するか検証した。その結果、肺炎症状（CTCEA grade2以上）についてはステロイド使用歴、平均肺線量、遺伝子多型：rs1801270,rs1800470が、CT上の肺炎所見（照射体積外に発生）についてはステロイドの使用歴と遺伝子多型rs1800470が挙げられた。
  • 四次元コーンビームCTを利用した次世代型非侵襲動体追尾照射法の開発
    独立行政法人日本医療研究開発機構：日本医療研究開発機構研究費
    研究期間 : 2015年04月 -2016年03月
  • 難治がんに対する動体追尾放射線治療の臨床評価に関する研究
    厚生労働省：厚生労働科学研究費補助金
    研究期間 : 2014年04月 -2015年03月
  • Veroシステムを用いた動体追尾放射線治療
    京都大学：平成25年度 京都大学若手人材海外派遣事業 ジョン万プログラム
    研究期間 : 2014年01月 -2015年01月
  • 日本学術振興会：科学研究費助成事業 若手研究(B)
    研究期間 : 2011年 -2013年 
    代表者 : 松尾 幸憲
     
    研究期間を通じて、肝臓癌に対する定位放射線治療の実施フロー（マーカー挿入、治療計画用CT撮像、治療計画と線量計算、動体追尾定位放射線の実施）確立は達成された。これにより肝臓癌の局所治療として定位放射線治療の選択肢を提供できるようになったことは我が国のがん治療にとって大変意義深いと考える。しかしながら、今回の研究期間では十分な症例数を経験できなかったため、もう一つの研究目的である治療後の経過観察手法の確立は達成されなかった。これに関しては今後の課題としたい。
  • 日本学術振興会：科学研究費助成事業 基盤研究(S)
    研究期間 : 2008年 -2012年 
    代表者 : 平岡 眞寛; 溝脇 尚志; 澁谷 景子; 松尾 幸憲; 板坂 聡; 門前 一; 澤田 晃; 千田 道雄; 小久保 雅樹; 成田 雄一郎
     
    Deformable Registrationソフトウェアと4次元線量分布評価システムを開発した。また、新規に一筆書き照射法を考案し、その有用性を膵臓癌および頭蓋底腫瘍において確認した。さらに、膵臓癌において臓器移動や変形が線量分布に及ぼす影響を評価し、呼吸停止下強度変調放射線治療を開発して第一相線量増加試験を開始するとともに、悪性胸膜中皮腫および頸部食道癌に対する強度変調放射線治療を用いた臨床試験プロトコールをそれぞれ立案し実施中である。
  • 肺癌定位放射線治療後の肺臓炎リスク因子に関する研究
    財団法人 藤原記念財団：平成22年度研究奨励金
    研究期間 : 2010年04月 -2011年03月
  • 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
    厚生労働省：厚生労働科学研究費補助金
    研究期間 : 2008年04月 -2011年03月
  • 定位放射線治療による予後改善に関する研究
    がん集学的治療研究財団：がん臨床研究推進事業 外国への日本人研究者派遣事業
    研究期間 : 2010年01月 -2010年03月
  • 日本学術振興会：科学研究費助成事業 若手研究(B)
    研究期間 : 2009年 -2010年 
    代表者 : 松尾 幸憲
     
    体幹部定位放射線治療は手術不能の早期肺癌患者における治療法として大変な注目を集めている。しかしながら同治療の中枢存在型肺癌に対する適応は確立したものではない。今回中枢存在型肺癌に対する定位放射線治療の実現に向けた基礎的検討を行った。具体的には、局所制御に関する線量効果関係、治療期間中の腫瘍移動量、線量計算アルゴリズム、固定精度の評価を行った。また、中枢存在型肺癌に対する定位放射線治療の多施設共同プロトコル策定に参画した。

委員歴

  • 2023年08月 - 現在   日本癌治療学会   代議員
  • 2023年06月 - 現在   日本がん治療認定医機構   理事
  • 2023年05月 - 現在   近畿がん診療推進ネットワーク   理事
  • 2022年12月 - 現在   日本肺癌学会   評議員
  • 2020年11月   日本肺癌学会   ガイドライン検討委員会放射線治療及び集学的治療小委員会副委員長
  • 2018年04月   日本医学放射線学会   代議員
  • 2012年   日本放射線腫瘍学会   代議員

社会貢献活動

  • こんなに役立つ！放射線治療
    期間 : 2021年02月15日 - 2021年02月15日
    役割 : その他
    主催者・発行元 : 京都薬科大学がんプロ 第６回市民公開講座
  • 肺がんの放射線治療
    期間 : 2019年03月23日 - 2019年03月23日
    役割 : その他
    主催者・発行元 : 肺がん治療の最前線 みんなで学ぼう in 京都
  • -
    期間 : 2019年02月 - 2019年02月
    役割 : その他
    主催者・発行元 : IAEA-RCA-CC International Training Course on Advanced Radiation Therapy
  • 肺がんの放射線治療
    期間 : 2016年07月17日 - 2016年07月17日
    役割 : その他
    主催者・発行元 : 肺癌学会市民公開講座
  • 知っておきたいがん放射線療法
    期間 : 2011年10月24日 - 2011年10月24日
    役割 : その他
    主催者・発行元 : 第74回らくわ健康教室

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