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Creation, evolution, and future challenges of ion beam therapy from a medical physicist’s viewpoint (Part 3): Chapter 3. Clinical research, Chapter 4. Future challenges, Chapter 5. Discussion, and Conclusion

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Abstract

Clinical studies of ion beam therapy have been performed at the Lawrence Berkeley Laboratory (LBL), National Institute of Radiological Sciences (NIRS), Gesellschaft für Schwerionenforschung (GSI), and Deutsches Krebsforschungszentrum (DKFZ), in addition to the development of equipment, biophysical models, and treatment planning systems. Although cancers, including brain tumors and pancreatic cancer, have been treated with the Bevalac’s neon-ion beam at the LBL (where the first clinical research was conducted), insufficient results were obtained owing to the limited availability of neon-ion beams and immaturity of related technologies. However, the 184-Inch Cyclotron’s helium-ion beam yielded promising results for chordomas and chondrosarcomas at the base of the skull. Using carbon-ion beams, NIRS has conducted clinical trials for the treatment of common cancers for which radiotherapy is indicated. Because better results than X-ray therapy results have been obtained for lung, liver, pancreas, and prostate cancers, as well as pelvic recurrences of rectal cancer, the Japanese government recently approved the use of public medical insurance for carbon-ion radiotherapy, except for lung cancer. GSI obtained better results than LBL for bone and soft tissue tumors, owing to dose enhancement enabled by scanning irradiation. In addition, DKFZ compared treatment results of proton and carbon-ion radiotherapy for these tumors. This article summarizes a series of articles (Parts 1–3) and describes future issues of immune ion beam therapy and linear energy transfer optimization.

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Abbreviations

3D CRT:

Three-dimensional conformal radiotherapy

ACC:

Adenoid cystic carcinoma

ART:

Adaptive radiotherapy

AVM:

Arteriovenous malformation

bRFS:

Biochemical recurrent-free survival

CIRT:

Carbon-ion radiotherapy

CMT:

Combined modality therapy

CSS:

Cause-specific survival

CTV:

Clinical target volume

DKFZ:

Deutsches Krebsforschungszentrum (German Cancer Research Center)

GSI:

Gesellschaft für Schwerionenforschung (Society for Heavy Ion Research)

GTV:

Gross tumor volume

HIT:

Heidelberg Ion-Beam Therapy Center

HIMAC:

Heavy Ion Medical Accelerator in Chiba

HCC:

Hepatocellular carcinoma

ICI:

Immune checkpoint inhibitor

ICRU:

International Commission on Radiation Units and Measurements

IHC:

Intrahepatic cholangiocarcinoma

IMRT:

Intensity-modulated radiotherapy

JASTRO:

Japanese Society for Radiation Oncology

J-CROS:

Japan Carbon-ion Radiation Oncology Study Group

LBL:

Lawrence Berkeley Laboratory

LC:

Local control

LEM:

Local effect model

LET:

Linear energy transfer

MGH:

Massachusetts General Hospital

MKM:

Microdosimetric kinetic model

MST:

Median survival time

NIRS:

National Institute of Radiological Sciences

NSCLC:

Non-small-cell lung cancer

OAR:

Organ at risk

OER:

Oxygen enhancement ratio

OS:

Overall survival

PHC:

Perihilar cholangiocarcinoma

PSA:

Prostate-specific antigen

RBE:

Relative biological effectiveness

SOBP:

Spread-out Bragg peak

SBRT:

Stereotactic body radiotherapy

TACE:

Transcatheter arterial chemoembolization

WEL:

Water equivalent length

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Acknowledgements

I thank the editors of Radiological Physics and Technology and the Japanese Journal of Medical Physics (JJMP) for their consent to use the materials originally reported in the JJMP. I also would like to thank the anonymous reviewers for productive peer review comments.

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  1. Association for Nuclear Technology in Medicine, Nikkei Bldg., 7-16 Nihombashi-Kodemmacho, Chuo-ku, Tokyo, 103-0001, Japan

    Masahiro Endo

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ME conceived the idea for the article, searched the literature, and drafted and revised the manuscript.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article includes materials originally reported by the same author in the Japanese Journal of Medical Physics [1,2,3,4] with the consent of the editors of both journals. The above articles are referred to in the corresponding sections when these materials are used.

This review consists of: Introduction; Chapter 1. Accelerator and beam delivery system; Chapter 2. Biophysical model and treatment planning system; Chapter 3. Clinical research; Chapter 4. Future challenges; Chapter 5. Discussion; Conclusion. Introduction and Chapter 1 have been published as Part 1 [5], and Chapter 2 has been published as Part 2 [6]. Chapter 3, Chapter 4, Chapter 5, and Conclusion are included in this article as Part 3. Because the Heading Number is attached independently to each article for production reasons, it does not necessarily match the above configuration.

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Endo, M. Creation, evolution, and future challenges of ion beam therapy from a medical physicist’s viewpoint (Part 3): Chapter 3. Clinical research, Chapter 4. Future challenges, Chapter 5. Discussion, and Conclusion. Radiol Phys Technol 16, 443–470 (2023). https://doi.org/10.1007/s12194-023-00748-9

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