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Clinical experience of craniospinal intensity-modulated spot-scanning proton therapy using large fields for central nervous system medulloblastomas and germ cell tumors in children, adolescents, and young adults

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Title: Clinical experience of craniospinal intensity-modulated spot-scanning proton therapy using large fields for central nervous system medulloblastomas and germ cell tumors in children, adolescents, and young adults
Authors: Hashimoto, Takayuki Browse this author →KAKEN DB
Shimizu, Shinichi Browse this author →KAKEN DB
Takao, Seishin Browse this author →KAKEN DB
Terasaka, Shunsuke Browse this author →KAKEN DB
Iguchi, Akihiro Browse this author
Kobayashi, Hiroyuki Browse this author →KAKEN DB
Mori, Takashi Browse this author
Yoshimura, Takaaki Browse this author
Matsuo, Yuto Browse this author
Tamura, Masaya Browse this author →KAKEN DB
Matsuura, Taeko Browse this author →KAKEN DB
Ito, Yoichi M. Browse this author →KAKEN DB
Onimaru, Rikiya Browse this author →KAKEN DB
Shirato, Hiroki Browse this author →KAKEN DB
Keywords: Craniospinal irradiation
Intensity-modulated spot-scanning proton therapy
Adolescents and young adults
Vertebral body sparing
Hematologic toxicity
Beam delivery time
Issue Date: Jul-2019
Publisher: Oxford University Press
Journal Title: Journal of Radiation Research
Volume: 60
Issue: 4
Start Page: 527
End Page: 537
Publisher DOI: 10.1093/jrr/rrz022
PMID: 31111946
Abstract: The outcomes of intensity-modulated proton craniospinal irradiation (ipCSI) are unclear. We evaluated the clinical benefit of our newly developed ipCSI system that incorporates two gantry-mounted orthogonal online X-ray imagers with a robotic six-degrees-of-freedom patient table. Nine patients (7-19 years old) were treated with ipCSI. The prescribed dose for CSI ranged from 23.4 to 36.0 Gy (relative biological effectiveness) in 13-20 fractions. Four adolescent and young adult (AYA) patients (15 years or older) were treated with vertebral-bodysparing ipCSI (VBSipCSI). Myelosuppression following VBSipCSI was compared with that of eight AYA patients treated with photon CSI at the same institution previously. The mean homogeneity index (HI) in the nine patients was 0.056 (95% confidence interval: 0.044-0.068). The mean time from the start to the end of all beam delivery was 37 min 39 s +/- 2 min 24 s (minimum to maximum: 22 min 49 s - 42 min 51 s). The nadir white blood cell, hemoglobin, and platelet levels during the 4 weeks following the end of the CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0071, 0.0453, 0.0024, respectively). The levels at 4 weeks after the end of CSI were significantly higher in the VBSipCSI group than in the photon CSI group (P = 0.0023, 0.0414, 0.0061). Image-guided ipCSI was deliverable in a reasonable time with sufficient HI. Using VBSipCSI, AYA patients experienced a lower incidence of serious acute hematological toxicity than AYA patients treated with photon CSI.
Rights: https://creativecommons.org/licenses/by/4.0/
Type: article
URI: http://hdl.handle.net/2115/76343
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
国際連携研究教育局 : GI-CoRE (Global Institution for Collaborative Research and Education : GI-CoRE) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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