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      A retrospective multicenter study of carbon‐ion radiotherapy for major salivary gland carcinomas: Subanalysis of J‐CROS 1402 HN

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          Abstract

          A retrospective multicenter study was carried out to assess the clinical outcomes of carbon‐ion radiotherapy for head and neck malignancies (Japan Carbon‐Ion Radiation Oncology Study Group [J‐ CROS] study: 1402 HN). We evaluated the safety and efficacy of carbon‐ion radiotherapy in patients with major salivary gland carcinoma. Sixty‐nine patients treated with carbon‐ion radiotherapy at four Japanese institutions were analyzed. Thirty‐three patients (48%) had adenoid cystic carcinomas, 10 (14%) had mucoepidermoid carcinomas, and 26 (38%) had other disease types. Three patients (4%) had T1 disease, 8 (12%) had T2, 25 (36%) had T3, and 33 (48%) had T4. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 27  mL. The median follow‐up period was 32.7 months. The 3‐year local control rate and overall survival rate were 81% and 94%, respectively. Regarding acute toxicities, seven patients had grade 3 mucositis and seven had grade 3 dermatitis. Regarding late toxicities, one patient had grade 3 dysphagia and one had a grade 3 brain abscess. No grade 4 or worse late reactions were observed. In conclusion, definitive carbon‐ion radiotherapy was effective with acceptable toxicity for major salivary gland carcinomas.

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          Most cited references26

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          The linear-quadratic formula and progress in fractionated radiotherapy.

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            Biophysical characteristics of HIMAC clinical irradiation system for heavy-ion radiation therapy.

            The irradiation system and biophysical characteristics of carbon beams are examined regarding radiation therapy. An irradiation system was developed for heavy-ion radiotherapy. Wobbler magnets and a scatterer were used for flattening the radiation field. A patient-positioning system using X ray and image intensifiers was also installed in the irradiation system. The depth-dose distributions of the carbon beams were modified to make a spread-out Bragg peak, which was designed based on the biophysical characteristics of monoenergetic beams. A dosimetry system for heavy-ion radiotherapy was established to deliver heavy-ion doses safely to the patients according to the treatment planning. A carbon beam of 80 keV/microm in the spread-out Bragg peak was found to be equivalent in biological responses to the neutron beam that is produced at cyclotron facility in National Institute Radiological Sciences (NIRS) by bombarding 30-MeV deuteron beam on beryllium target. The fractionation schedule of the NIRS neutron therapy was adapted for the first clinical trials using carbon beams. Carbon beams, 290, 350, and 400 MeV/u, were used for a clinical trial from June of 1994. Over 300 patients have already been treated by this irradiation system by the end of 1997.
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              The role of radiotherapy in the treatment of malignant salivary gland tumors.

              We analyzed the role of primary and postoperative low linear energy transfer radiotherapy in 538 patients treated for salivary gland cancer in centers of the Dutch Head and Neck Oncology Cooperative Group, in search for prognostic factors and dose response. The tumor was located in the parotid gland in 59%, submandibular gland in 14%, oral cavity in 23%, and elsewhere in 5%. In 386 of 498 patients surgery was combined with radiotherapy, with a median dose of 62 Gy. Median delay between surgery and radiotherapy was 6 weeks. In the postoperative radiotherapy group, adverse prognostic factors prevailed. Elective radiotherapy to the neck was given in 40%, with a median dose of 50 Gy. Primary radiotherapy (n = 40) was given for unresectable disease or M(1), with a dose range of 28-74 Gy. Postoperative radiotherapy improved 10-year local control significantly compared with surgery alone in T(3-4) tumors (84% vs. 18%), in patients with close (95% vs. 55%) and incomplete resection (82% vs. 44%), in bone invasion (86% vs. 54%), and perineural invasion (88% vs. 60%). Local control was not correlated with interval between surgery and radiotherapy. No dose-response relationship was shown. Postoperative radiotherapy significantly improved regional control in the pN(+) neck (86% vs. 62% for surgery alone). A rating scale for different sites, T stage, and histologic type may be applied to calculate the risk of disease in the neck at presentation, and so indicate the need for elective neck treatment. A marginal dose-response was seen, in favor of a dose > or =46 Gy. A clear dose-response relationship was shown for patients treated with primary radiotherapy. Five-year local control was 50% with a dose of 66-70 Gy. Postoperative radiotherapy with a dose of at least 60 Gy is indicated for patients with T(3-4) tumors, incomplete or close resection, bone invasion, perineural invasion, and pN(+). In unresectable tumors, a dose of at least 66 Gy is advisable.
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                Author and article information

                Contributors
                koto.masashi@qst.go.jp
                Journal
                Cancer Sci
                Cancer Sci
                10.1111/(ISSN)1349-7006
                CAS
                Cancer Science
                John Wiley and Sons Inc. (Hoboken )
                1347-9032
                1349-7006
                27 April 2018
                May 2018
                : 109
                : 5 ( doiID: 10.1111/cas.2018.109.issue-5 )
                : 1576-1582
                Affiliations
                [ 1 ] Hospital of the National Institute of Radiological Sciences National Institutes for Quantum and Radiological Sciences and Technology Chiba Japan
                [ 2 ] Department of Radiology Hyogo Ion Beam Medical Center Tatsuno Japan
                [ 3 ] Medicine and Biology Division Gunma University Heavy Ion Medical Center Maebashi Japan
                [ 4 ] Ion Beam Therapy Center SAGA‐HIMAT Foundation Tosu Japan
                [ 5 ] Department of Oral Srgery Tokyo Dental College Sudobashi Hospital Tokyo Japan
                [ 6 ] Department of Radiation Oncology Faculty of Medicine Yamagata University Yamagata Japan
                Author notes
                [*] [* ] Correspondence

                Masashi Koto, Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan.

                Email: koto.masashi@ 123456qst.go.jp

                Author information
                http://orcid.org/0000-0001-5054-4629
                http://orcid.org/0000-0002-4465-4300
                http://orcid.org/0000-0002-1574-5510
                Article
                CAS13558
                10.1111/cas.13558
                5980152
                29493851
                2c42c40c-60fa-46cb-afdc-45ce26cbab46
                © 2018 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 13 January 2018
                : 21 February 2018
                : 24 February 2018
                Page count
                Figures: 2, Tables: 3, Pages: 7, Words: 4890
                Categories
                Original Article
                Original Articles
                Clinical Research
                Custom metadata
                2.0
                cas13558
                May 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.0 mode:remove_FC converted:31.05.2018

                Oncology & Radiotherapy
                adenoid cystic carcinoma,carbon‐ion radiotherapy,particle therapy,radiotherapy,salivary gland carcinoma

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