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村井 太郎ムライ タロウ

所属部署医学研究科共同研究教育センター
職名助教
メールアドレスtaro8864yahoo.co.jp
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Last Updated :2019/07/06

研究者基本情報

学位

  • 医学博士, 名古屋市立大学

経歴

  •   2014年04月 - 現在, 名古屋市立大学, 放射線科, 助教

研究活動情報

研究分野

  • 内科系臨床医学, 放射線科学

研究キーワード

    子宮頸癌, 乳癌, 画像診断学, 放射線治療

論文

  • Differentiation between malignant and benign musculoskeletal tumors using diffusion kurtosis imaging, Masaki Ogawa, Hirohito Kan, Nobuyuki Arai, Taro Murai, Yoshihiko Manabe, Yusuke Sawada, Yuta Shibamoto, Skeletal Radiology, 1 - 8,   2018年05月, 査読有り, © 2018 ISS Objective: The purpose of this study was to evaluate differences in parameters of diffusion kurtosis imaging (DKI) and minimum apparent diffusion coefficient (ADCmin) between benign and malignant musculoskeletal tumors. Materials and methods: In this prospective study, 43 patients were scanned using a DKI protocol on a 3-T MR scanner. Eligibility criteria were: non-fatty, non-cystic soft tissue or osteolytic tumors; > 2 cm; location in the retroperitoneum, pelvis, leg, or neck; and no prior treatment. They were clinically or histologically diagnosed as benign (n = 27) or malignant (n = 16). In the DKI protocol, diffusion-weighted imaging was performed using four b values (0-2000 s/mm2) and 21 diffusion directions. Mean kurtosis (MK) values were calculated on the MR console. A recently developed software application enabling reliable calculation was used for DKI analysis. Results: MK showed a strong correction with ADCmin(Spearman’s rs = 0.95). Both MK and ADCminvalues differed between benign and malignant tumors (p < 0.01). For benign and malignant tumors, the mean MK values (± SD) were 0.49 ± 0.17 and 1.14 ± 0.30, respectively, and ADCminvalues were 1.54 ± 0.47 and 0.49 ± 0.17 × 10−3mm2/s, respectively. At cutoffs of MK = 0.81 and ADCmin= 0.77 × 10−3mm2/s, the specificity and sensitivity for diagnosis of malignant tumors were 96.3 and 93.8% for MK and 96.3 and 93.8% for ADCmin, respectively. The areas under the curve were 0.97 and 0.99 for MK and ADCmin, respectively (p = 0.31). Conclusions: MK and ADCminshowed high diagnostic accuracy and strong correlation, reflecting the accuracy of MK. However, no clear added value of DKI could be demonstrated in differentiating musculoskeletal tumors.
  • Internal mammary lymph node metastases in breast cancer: what should radiologists know?, Misugi Urano, Fatmaelzahraa Abdelfattah Denewar, Taro Murai, Masaru Mizutani, Masanori Kitase, Kazuya Ohashi, Norio Shiraki, Yuta Shibamoto, Japanese Journal of Radiology,   2018年01月, 査読有り, © 2018, Japan Radiological Society. The internal mammary lymph node (IMLN) chain is a pathway through which breast lymphatic drainage flows. The internal mammary lymphatic vessel runs around the internal mammary artery and veins with IMLN in the parasternal intercostal spaces. IMLN metastasis, which forms a part of clinical TNM staging, may negatively affect the prognosis of primary breast cancer patients. IMLN metastasis is clinically detected using ultrasound, computed tomography, magnetic resonance imaging, and18F-deoxyglucose positron emission tomography computed tomography. The uptake of radioactive tracers in IMLN with clinically negative axillary lymph nodes is often identified using sentinel lymph node mapping (SLNM) in primary breast cancer patients. The indication for IMLN biopsy or resection that is clinically detected or visualized using SLNM is controversial. The clinically suspicious IMLN may be considered for ultrasound-guided fine-needle aspiration. First IMLN recurrence needs to be biopsied. Irradiation of the breast, chest wall, and/or regional nodal irradiation, including IMLN, following lumpectomy or postmastectomy is recommended. Although radiation therapy for IMLN recurrence may improve clinical outcomes, it is also associated with pulmonary and cardiac toxicities. This review covers the local anatomy of IMLN, lymph drainage and image findings of IMLN with a discussion.
  • Definitive radiotherapy for hilar and/or mediastinal lymph node metastases after stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer: 5-year results, Yoshihiko Manabe, Yuta Shibamoto, Fumiya Baba, Takeshi Yanagi, Hiromitsu Iwata, Hiromitsu Iwata, Akifumi Miyakawa, Taro Murai, Katsuhiro Okuda, Japanese Journal of Radiology,   2018年01月, 査読有り, © 2018, Japan Radiological Society. Purpose: The optimal treatment for hilar or mediastinal lymph node (LN) recurrence developing after stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer remains unclear. This study evaluated 5-year results of radiotherapy in such patients in comparison with those for postoperative LN metastases. Materials and methods: Between 2004 and 2013, 27 patients with hilar and/or mediastinal LN metastases without local recurrence and distant metastasis after SBRT (n = 14) or surgery (n = 13) were treated with definitive conventional radiotherapy. The median total dose for treating metastatic LN was 60 Gy for the post-SBRT group and 66 Gy for the post-surgery group. Results: The median follow-up for the 5 surviving patients was 62 months. The overall survival, cause-specific survival, progression-free survival, and local control rates at 5 years after mediastinal irradiation were 14%, 45%, 21%, and 58%, respectively, for the 14 patients in the post-SBRT group. These rates were 36%, 45%, 39%, and 92%, respectively for the post-surgery group (p = 0.066, 0.64, 0.38, and 0.41, respectively). Four patients in the post-SBRT group survived 3 or more years (range 36–92 months) after mediastinal irradiation. Conclusions: A proportion of patients in both groups achieved long-term survival by conventional radiotherapy.
  • Stereotactic body radiotherapy for stage I non-small-cell lung cancer using higher doses for larger tumors: Results of the second study, Akifumi Miyakawa, Yuta Shibamoto, Fumiya Baba, Yoshihiko Manabe, Taro Murai, Chikao Sugie, Takeshi Yanagi, Taiki Takaoka, Radiation Oncology, 12,   2017年09月, 査読有り, © 2017 The Author(s). Background: Efficacy of stereotactic body radiotherapy (SBRT) in stage I non-small-cell lung cancer (NSCLC) has almost been established. In Japan, the protocol of 48Gy in 4 fractions over 4days has been most often employed, but higher doses may be necessary to control large tumors. Previously, we conducted a clinical study using SBRT for stage I NSCLC employing different doses depending on tumor diameter, which was closed in 2008. Thereafter, a new study employing higher doses has been conducted, which is reported here. The purpose of this study was to review the safety and effectiveness of the higher doses. Methods: We escalated the total dose for the improvement of local control for large tumors. In this study, 71 patients underwent SBRT between December 2008 and April 2014. Isocenter doses of 48, 50, and 52Gy were administered for tumors with a longest diameter of <1.5cm, 1.5-3cm, and >3cm, respectively. It was recommended to cover 95% of the PTV with at least 90% of the isocenter dose, and in all but one cases, 95% of the PTV received at least 80% of the prescribed dose. Treatments were delivered in 4 fractions, giving 2 fractions per week. SBRT was performed with 6-MV photons using 4 non-coplanar and 3 coplanar beams. Results: The median follow-up period was 44months for all patients and 61months for living patients. Overall survival (OS) was 65%, progression-free survival (PFS) was 55%, and cumulative incidence of local recurrence (LR) was 15% at 5years. The 5-year OS was 69% for 57 stage IA patients and 53% for 14 stage IB patients (p=0.44). The 5-year PFS was 55 and 54%, respectively (p=0.98). The 5-year cumulative incidence of LR was 11 and 31%, respectively (p=0.09). The cumulative incidence of Grade≥2 radiation pneumonitis was 25%. Conclusions: Our newer SBRT study yielded reasonable local control and overall survival and acceptable toxicity, but escalating the total dose did not lead to improved outcomes. Trial registration:UMIN000027231 , registered on 3 May 2017. Retrospectively registered.
  • Comparison of multileaf collimator and conventional circular collimator systems in Cyberknife stereotactic radiotherapy, Taro Murai, Yukiko Hattori, Chikao Sugie, Hiromitsu Iwata, Michio Iwabuchi, Yuta Shibamoto, Journal of Radiation Research, 58, 693 - 700,   2017年09月, 査読有り, © 2017 The Author. Multileaf collimator (MLC) technology has been newly introduced with the Cyberknife system. This study investigated the advantages of this system compared with the conventional circular collimator (CC) system. Dosimetric comparisons of MLC and CC plans were carried out. First, to investigate suitable target sizes for the MLC mode, MLC and CC plans were generated using computed tomography (CT) images from 5 patients for 1, 3, 5 and 7 cm diameter targets. Second, MLC and CC plans were compared in 10 patients, each with liver and prostate targets. For brain targets, doses to the brain could be spared in MLC plans better than in CC plans (P . 0.02). The MLC mode also achieved more uniform dose delivery to the targets. The conformity index in MLC plans was stable, irrespective of the target size (P = 0.5). For patients with liver tumors, the MLC mode achieved higher target coverage than the CC mode (P = 0.04). For prostate tumors, doses to the rectum and the conformity index were lowered in MLC plans compared with in CC plans (P . 0.04). In all target plans, treatment times in MLC plans were shorter than those in CC plans (P > 0.001). The newly introduced MLC technology can reduce treatment time and provide favorable or comparable dose distribution for 1.7 cm targets. In particular, the MLC mode has dosimetric advantage for targets near organs at risk. Therefore, the MLC mode is recommended as the first option in stereotactic body radiotherapy.
  • Biological effects of hydrogen peroxide administered intratumorally with or without irradiation in murine tumors, Taiki Takaoka, Yuta Shibamoto, Masayuki Matsuo, Chikao Sugie, Taro Murai, Yasutaka Ogawa, Akifumi Miyakawa, Yoshihiko Manabe, Takuhito Kondo, Koichiro Nakajima, Dai Okazaki, Takahiro Tsuchiya, Cancer Science, 108, 1787 - 1792,   2017年09月, 査読有り, © 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association. Despite insufficient laboratory data, radiotherapy after intratumoral injection of hydrogen peroxide (H2O2) is increasingly being used clinically for radioresistant tumors. Especially, this treatment might become an alternative definitive treatment for early and advanced breast cancer in patients who refuse any type of surgery. The purpose of this study was to investigate the biological effects and appropriate combination methods of irradiation and H2O2in vivo. SCCVII tumor cells transplanted into the legs of C3H/HeN mice were used. Chronological changes of intratumoral distribution of oxygen bubbles after injection of H2O2were investigated using computed tomography. The effects of H2O2alone and in combination with single or five-fraction irradiation were investigated using a growth delay assay. The optimal timing of H2O2injection was investigated. Immunostaining of tumors was performed using the hypoxia marker pimonidazole. Oxygen bubbles decreased gradually and almost disappeared after 24 h. Administration of H2O2produced 2–3 days’ tumor growth delay. Tumor regrowth was slowed further when H2O2was injected before irradiation. The group irradiated immediately after H2O2injection showed the longest tumor growth delay. Dose-modifying factors were 1.7–2.0 when combined with single irradiation and 1.3–1.5 with fractionated irradiation. Pimonidazole staining was weaker in tumors injected with H2O2. H2O2injection alone had modest antitumor effects. Greater tumor growth delays were demonstrated by combining irradiation and H2O2injection. The results of the present study could serve as a basis for evaluating results of various clinical studies on this treatment.
  • A phase I/II study on stereotactic body radiotherapy with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm for lung tumors, Hiromitsu Iwata, Hiromitsu Iwata, Satoshi Ishikura, Taro Murai, Michio Iwabuchi, Mitsuhiro Inoue, Koshi Tatewaki, Seiji Ohta, Naoki Yokota, Yuta Shibamoto, International Journal of Clinical Oncology, 22, 706 - 714,   2017年08月, 査読有り, © 2017, Japan Society of Clinical Oncology. Background: In this phase I/II study, we assessed the safety and initial efficacy of stereotactic body radiotherapy (SBRT) for lung tumors with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm. Methods: Study subjects had histologically confirmed primary non-small-cell lung cancer staged as T1a-T2aN0M0 and pulmonary oligometastasis. The primary endpoint was the incidence of Grade ≥3 radiation pneumonitis (RP) within 180 days of the start of SBRT. The secondary endpoint was local control and overall survival rates. Five patients were initially enrolled at level 1 [50 Gy/4 fractions (Fr)]; during the observation period, level 0 (45 Gy/4 Fr) was opened. The dose was escalated to the next level when grade ≥3 RP was observed in 0 out of 5 or 1 out of 10 patients. Virtual quality assurance planning was performed for 60 Gy/4 Fr; however, dose constraints for the organs at risk did not appear to be within acceptable ranges. Therefore, level 2 (55 Gy/4 Fr) was regarded as the upper limit. After the recommended dose (RD) was established, 15 additional patients were enrolled at the RD. The prescribed dose was normalized at the 95% volume border of the planning target volume based on the Monte Carlo algorithm. Results: Between September 2011 and September 2015, 40 patients (primary 30; metastasis 10) were enrolled. Five patients were enrolled at level 0, 15 at level 1, and 20 at level 2. Only one grade 3 RP was observed at level 1. Two-year local control and overall survival rates were 98 and 81%, respectively. Conclusion: The RD was 55 Gy/4 Fr. SBRT with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm was tolerated well and appeared to be effective for solitary lung tumors.
  • 前立腺癌に対するサイバーナイフ超寡分割定位照射のための直腸バルーンカテーテルの初期検討, 村井 太郎, 井上 光広, 田口 純一, 大川 浩平, 廣田 佳史, 稲田 耕作, 岩渕 学緒, 帯刀 光史, 太田 誠志, 芝本 雄太, 臨床放射線, 62, (2) 311 - 316,   2017年02月, 査読有り, 男性健常者3名(20歳代、30歳代、60歳代)を対象とした。直腸バルーンカテーテル(ERB)は、注腸用直腸2連バルーンカテーテル36frおよび46frを用いた。46frのカテーテルにおいて検査直後に軽度の肛門の痛みを訴えた。出血や裂創などはいずれのカテーテルでも認めず、安全にカテーテルを挿入できた。全例において、検査後24時間後には疼痛などの症状は認めなかった。全被験者のデータ解析にて、前立腺の移動(IM)は頭尾方向、前後方向で有意に移動が低減された。ERBの効果については個人差を認めた。20歳代、30歳代の被験者では、全ての方向において有意差はなかったが、60歳代の被験者においては、頭尾方向、前後方向において、有意差がみられた。また、EBR使用中であっても、被験者の肛門括約筋が緊張すると前立腺は、腹背方向に11〜13mm、頭尾方向に9〜13mmの大きな動きを示した。左右方向の動きは1mm以下であった。EBRの使用の有無にかかわらず、安静時には5mmを超える移動は認めなかった。
  • Cyber knife stereotactic radiosurgery and hypofractionated stereotactic radiotherapy as first-line treatments for imaging-diagnosed intracranial meningiomas, Yoshihiko Manabe, Taro Murai, Hiroyuki Ogino, Takeshi Tamura, Michio Iwabuchi, Yoshimasa Mori, Hiromitsu Iwata, Hirochika Suzuki, Yuta Shibamoto, Neurologia Medico-Chirurgica, 57, 627 - 633,   2017年01月, 査読有り, © 2017 by The Japan Neurosurgical Society. Definitive radiotherapy is an important alternative treatment for meningioma patients who are inoperable or refuse surgery. We evaluated the efficacy and toxicity of CyberKnife-based stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hSRT) as first-line treatments for intracranial meningiomas that were diagnosed using magnetic resonance imaging (MRI) and/or computed tomography (CT). Between February 2005 and September 2015, 41 patients with intracranial meningiomas were treated with CyberKnife-based SRS or hSRT. Eleven of those tumors were located in the skull base. The median tumor volume was 10.4 ml (range, 1.4-56.9 ml). The median prescribed radiation dose was 17 Gy (range, 13-20 Gy to the 61-88% isodose line) for SRS (n = 9) and 25 Gy (range, 14-38 Gy to the 44-83% isodose line) for hSRT (n = 32). The hSRT doses were delivered in 2 to 10 daily fractions. The median follow-up period was 49 months (range, 7-138). The 5-year progression-free survival rate (PFS) for all 41 patients was 86%. The 3-year PFS was 69% for the 14 patients with tumor volumes of ≥13.5 ml (30 mm in diameter) and 100% for the 27 patients with tumor volumes of <13.5 ml (P = 0.031). Grade >2 toxicities were observed in 5 patients (all of them had tumor volumes of ≥13.5 ml). SRS and hSRT are safe and effective against relatively small (<13.5 ml) meningiomas.
  • Hypofractionated stereotactic radiotherapy for auditory canal or middle ear cancer, Taro Murai, Taro Murai, Shin Etsu Kamata, Shin Etsu Kamata, Kengo Sato, Kengo Sato, Kouki Miura, Mitsuhiro Inoue, Naoki Yokota, Naoki Yokota, Seiji Ohta, Michio Iwabuchi, Hiromitsu Iwata, Hiromitsu Iwata, Yuta Shibamoto, Cancer Control, 23, 311 - 316,   2016年07月, 査読有り, © 2016, H. Lee Moffitt Cancer Center and Research Institute. All rights reserved. Background: Stereotactic radiotherapy (SRT) may represent a new treatment option for individuals with auditory canal or middle ear cancer. Methods: Study participants with pathologically proven ear cancer were treated with SRT (35 Gy for 3 fractions or 40 Gy for 5 fractions) as first-line therapy. When local tumor recurrence developed following SRT, subtotal temporal bone resection and postoperative chemoradiotherapy were performed as salvage treatment. Boluses were used for the initial 14 study patients. Results: Twenty-nine study participants were enrolled and staged with T1 (n = 3), T2 (n = 7), T3 (n = 14), or T4 disease (n = 5). Three-year overall survival rates were 69% for T1/2 disease, 79% for T3 disease, and 0% for T4 disease. Three-year local control rates were 70% for T1/2 disease, 50% for T3 disease, and 20% for T4 disease. Grade 2 or higher dermatitis or soft-tissue necrosis occurred more frequently in study patients treated with boluses (8/14 vs 2/15; P =. 02). Salvage treatment was safely performed for 12 recurrent cases. Conclusions: These results suggest that SRT outcomes are promising for patients with ear cancer (≤ T3 disease). The rate of toxicity was acceptable in the study patients treated without boluses. Outcomes of salvage surgery and postoperative radiotherapy following SRT were also encouraging.
  • Chemoradiotherapy for localized extranodal natural killer/T-cell lymphoma, nasal type, using a shrinking-field radiation strategy: multi-institutional experience, Yukiko Hattori, Yukiko Hattori, Taro Murai, Hiromitsu Iwata, Hiromitsu Iwata, Kaoru Uchiyama, Mikio Mimura, Eriko Kato, Rumi Murata, Yuta Shibamoto, Japanese Journal of Radiology, 34, 292 - 299,   2016年04月, 査読有り, © 2016, Japan Radiological Society. Purposes: The prognosis of localized extranodal natural killer/T-cell lymphoma, nasal type (ENKTL), has improved with the development of chemoradiotherapy. However, conventional extended-field radiotherapy may cause optic disorders. Our group has employed smaller radiation fields in an attempt to avoid toxicity. The efficacy and toxicity of treatments were evaluated. Materials and methods: Chemoradiotherapy was delivered with a shrinking-field radiotherapy strategy. The endpoints of this study were overall survival (OS), local control (LC), progression-free survival (PFS), and toxicity. Results: Fifteen patients with localized ENKTL were treated. After irradiation (median, 40 Gy) to the tumor plus a prophylactic volume, a reduced treatment volume to the tumor was boosted (median, 10 Gy). Twelve patients underwent chemoradiotherapy and 3 patients received radiotherapy alone. A complete response was achieved in 12 and a partial response in 3 patients. The 5-year OS, PFS, and LC rates were 80, 67, and 93 %, respectively. Distant recurrence occurred in 4 patients and locoregional and distant recurrence in 1 patient. Cataract (grade 3) and dry eye (grade 2) were observed as late adverse events in 1 patient each. Conclusions: Sufficiently high OS and LC were achieved with acceptable toxicities. Appropriate target volumes may be smaller with newer chemotherapy regimens.
  • Percutaneous fiducial marker placement prior to stereotactic body radiotherapy for malignant liver tumors: An initial experience, Kengo Ohta, Masashi Shimohira, Taro Murai, Taro Murai, Junichi Nishimura, Hiromitsu Iwata, Hiromitsu Iwata, Hiroyuki Ogino, Hiroyuki Ogino, Takuya Hashizume, Yuta Shibamoto, Journal of Radiation Research, 57, 174 - 177,   2016年03月, 査読有り, © 2016 The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology. The aim of this study was to describe our initial experience with a gold flexible linear fiducial marker and to evaluate the safety and technical and clinical efficacy of stereotactic body radiotherapy using this marker for malignant liver tumors. Between July 2012 and February 2015, 18 patients underwent percutaneous fiducial marker placement before stereotactic body radiotherapy for malignant liver tumors. We evaluated the technical and clinical success rates of the procedure and the associated complications. Technical success was defined as successful placement of the fiducial marker at the target site, and clinical success was defined as the completion of stereotactic body radiotherapy without the marker dropping out of position. All 18 fiducial markers were placed successfully, so the technical success rate was 100% (18/18). All 18 patients were able to undergo stereotactic body radiotherapy without marker migration. Thus, the clinical success rate was 100% (18/18). Slight pneumothorax occurred as a minor complication in one case. No major complications such as coil migration or bleeding were observed. The examined percutaneous fiducial marker was safely placed in the liver and appeared to be useful for stereotactic body radiotherapy for malignant liver tumors.
  • Re-irradiation of recurrent anaplastic ependymoma using radiosurgery or fractionated stereotactic radiotherapy, Taro Murai, Taro Murai, Kengo Sato, Kengo Sato, Michio Iwabuchi, Yoshihiko Manabe, Hiroyuki Ogino, Hiromitsu Iwata, Koshi Tatewaki, Naoki Yokota, Seiji Ohta, Yuta Shibamoto, Japanese Journal of Radiology, 34, 211 - 218,   2016年03月, 査読有り, © 2015, Japan Radiological Society. Purpose: Recurrent ependymomas were retreated with stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). The efficacy, toxicities, and differences between SRS and FSRT were analyzed. Methods: Eight patients with recurrent ependymomas fulfilling the criteria described below were evaluated. Inclusion criteria were: (1) the patient had previously undergone surgery and conventional radiotherapy as first-line treatment; (2) targets were located in or adjacent to the eloquent area or were deep-seated; and (3) the previously irradiated volume overlapped the target lesion. Results: FSRT was delivered to 18 lesions, SRS to 20 lesions. A median follow-up period was 23 months. The local control rate was 76 % at 3 years. No significant differences in local control were observed due to tumor size or fractionation schedule. Lesions receiving >25 Gy/5 fr or 21 Gy/3 fr did not recur within 1 year, whereas no dose–response relationship was observed in those treated with SRS. No grade ≥2 toxicity was observed. Conclusion: Our treatment protocol provided an acceptable LC rate and minimal toxicities. Because local recurrence of tumors may result in patient death, a minimum dose of 21 Gy/3 fr or 25 Gy/5 fr or higher may be most suitable for treatment of these cases.
  • Evaluation of Dose Uncertainty to the Target Associated With Real-Time Tracking Intensity-Modulated Radiation Therapy Using the CyberKnife Synchrony System, Hiromitsu Iwata, Hiromitsu Iwata, Mitsuhiro Inoue, Hiroya Shiomi, Taro Murai, Koshi Tatewaki, Seiji Ohta, Kohei Okawa, Naoki Yokota, Naoki Yokota, Yuta Shibamoto, Technology in Cancer Research and Treatment, 15, 101 - 106,   2016年02月, 査読有り, © 2014, © The Author(s) 2014. We investigated the dose uncertainty caused by errors in real-time tracking intensity-modulated radiation therapy (IMRT) using the CyberKnife Synchrony Respiratory Tracking System (SRTS). Twenty lung tumors that had been treated with non-IMRT real-time tracking using CyberKnife SRTS were used for this study. After validating the tracking error in each case, we did 40 IMRT planning using 8 different collimator sizes for the 20 patients. The collimator size was determined for each planning target volume (PTV); smaller ones were one-half, and larger ones three-quarters, of the PTV diameter. The planned dose was 45 Gy in 4 fractions prescribed at 95% volume border of the PTV. Thereafter, the tracking error in each case was substituted into calculation software developed in house and randomly added in the setting of each beam. The IMRT planning incorporating tracking errors was simulated 1000 times, and various dose data on the clinical target volume (CTV) were compared with the original data. The same simulation was carried out by changing the fraction number from 1 to 6 in each IMRT plan. Finally, a total of 240 000 plans were analyzed. With 4 fractions, the change in the CTV maximum and minimum doses was within 3.0% (median) for each collimator. The change in D99 and D95 was within 2.0%. With decreases in the fraction number, the CTV coverage rate and the minimum dose decreased and varied greatly. The accuracy of real-time tracking IMRT delivered in 4 fractions using CyberKnife SRTS was considered to be clinically acceptable.
  • Efficacy of stereotactic radiotherapy for brain metastases using dynamic jaws technology in the helical tomotherapy system, Taro Murai, Akihiro Hayashi, Yoshihiko Manabe, Chikao Sugie, Taiki Takaoka, Takeshi Yanagi, Tetsuya Oguri, Masayuki Matsuo, Yoshimasa Mori, Yuta Shibamoto, British Journal of Radiology, 89,   2016年01月, 査読有り, © 2016 The Authors. Objective: Dynamic jaws (DJ) are expected to be useful in stereotactic radiotherapy (SRT) for brain metastases (BM). The efficacy and optimal dose fractionation were investigated. Methods: In a planning study, 63 treatment plans were generated for the following 3 conditions: 1.0-cm fixed jaws (FJ), 2.5-cmFJ and 2.5-cmDJ. In a clinical study, 30Gy/3 fr, 35Gy/5 fr or 37.5Gy/5fr were prescribed depending on tumour size. Clinical results of groups treated with 2.5-cm DJ plans and 1.0-cm FJ were compared. Results: In the planning study, the treatment times in 2.5-cm DJ and FJ plans were less than that in 1.0-cm FJ plans (p,0.001). The brain doses in 1.0-cm FJ plans and 2.5-cm DJ plans were smaller than those in 2.5-cm FJ plans (p,0.05). In the clinical study, 34 patients with 68 BM were treated with SRT. Of those, 15 patients with 34 BM were treated with 2.5-cm DJ plans and 19 patients with 34 BM were treated with 1.0-cm FJ plans. The overall survival and local tumour control (LC) rates were 52 and 93% at 12 months, respectively. The DJ system achieved favourable LC and 29% shorter treatment time compared with the FJ system (p,0.001). Grade 2 or 3 necrosis occurred more frequently in patients with 15 cc or larger tumour volumes (p50.05). Conclusion: DJ technology enables treatment time to be reduced without worsening the dose distribution and clinical efficacy. The prescribed doses in this study may be acceptable for patients with small tumour volumes.
  • 【施設成長につなげる先進の放射線治療[Part 2]】 確実に進む放射線治療の効果と今後 大垣徳洲会病院におけるVero 4DRTの導入, 村井 太郎, 高田 勇馬, 新医療, 43, (1) 134 - 137,   2016年01月, 招待有り, 大垣徳洲会病院は、加療できる患者の拡大とがん治療についても高精度ながん治療を可能にするため、2015年にVero 4DRT(三菱重工業製)を導入した。本稿では、導入の契機と治療機械の詳細、運用について紹介する。(著者抄録)
  • 【放射線治療の最近のトピックス】 強度変調放射線治療の発展と4次元放射線治療 True BeamとVero4DRTについて, 村井 太郎, 現代医学, 63, (2) 77 - 80,   2015年12月, 招待有り, 放射線治療において、がんに放射線を適切に集中させれば、治療に伴う有害事象を低減し、治療効果を高めることができる。強度変調放射線治療や、その発展形というべき強度変調連続回転型照射では、これらを高いレベルで達成できる。また、臓器や病変の呼吸移動による照射範囲の拡大という問題を克服するべく4次元放射線治療という技術が開発された。現在の最新の治療装置、True Beam(バリアン社、米国)とVero4DRT(三菱重工社、日本)には、これらの技術が標準的に装備されており期待が持てる。この2つの治療装置について紹介する。(著者抄録)
  • Stereotactic body radiotherapy using a radiobiology-based regimen for Stage I non-small-cell lung cancer: Five-year mature results, Yuta Shibamoto, Chisa Hashizume, Fumiya Baba, Shiho Ayakawa, Akifumi Miyakawa, Taro Murai, Taiki Takaoka, Yukiko Hattori, Ryuji Asai, Journal of Thoracic Oncology, 10, 960 - 964,   2015年06月, 査読有り, © 2015 by the International Association for the Study of Lung Cancer. Introduction: Although the protocol of 48 Gy in four fractions over 4 days has been most often employed in stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer in Japan, higher doses are necessary to control larger tumors, and interfraction intervals should be longer than 24 hours to take advantage of reoxygenation. We report the final results of our study testing the following regimen: for tumors less than 1.5, 1.5-3, and greater than 3 cm in diameter, 44, 48, and 52 Gy, respectively, were given in four fractions with interfraction intervals of greater than or equal to 3 days. Methods: Among 180 histologically proven patients entered, 120 were medically inoperable and 60 were operable. The median patient age was 77 years (range, 29-89). SBRT was performed with 6-MV photons using four noncoplanar and three coplanar beams. Isocenter doses of 44, 48, and 52 Gy were given to four, 124, and 52 patients, respectively. Results: The 5-year overall survival rate was 52.2% for all 180 patients and 66% for 60 operable patients. The 5-year local control rate was 86% for tumors less than or equal to 3 cm (44/48 Gy) and 73% for tumors greater than 3 cm (52 Gy; p = 0.076). Grade greater than or equal to 2 radiation pneumonitis developed in 13% (10% for the 44/48-Gy group and 21% for the 52-Gy group; p = 0.056). Other grade 2 toxicities were all less than 4%. Conclusions: Our first prospective SBRT study yielded reasonable local control and overall survival rates and acceptable toxicity. Refinement of the protocol including dose escalation may lead to better outcome.
  • Development of system using beam's eye view images to measure respiratory motion tracking errors in image-guided robotic radiosurgery system, Mitsuhiro Inoue, Mitsuhiro Inoue, Hiroya Shiomi, Hiromitsu Iwata, Junichi Taguchi, Kohei Okawa, Chie Kikuchi, Kosaku Inada, Michio Iwabuchi, Michio Iwabuchi, Taro Murai, Izumi Koike, Koshi Tatewaki, Seiji Ohta, Tomio Inoue, Journal of Applied Clinical Medical Physics, 16, 100 - 111,   2015年01月, 査読有り, The accuracy of the CyberKnife Synchrony Respiratory Tracking System (SRTS) is considered to be patient-dependent because the SRTS relies on an individual correlation between the internal tumor position (ITP) and the external marker position (EMP), as well as a prediction method to compensate for the delay incurred to adjust the position of the linear accelerator (linac). We aimed to develop a system for obtaining pretreatment statistical measurements of the SRTS tracking error by using beam's eye view (BEV) images, to enable the prediction of the patient-specific accuracy. The respiratory motion data for the ITP and the EMP were derived from cine MR images obtained from 23 patients. The dynamic motion phantom was used to reproduce both the ITP and EMP motions. The CyberKnife was subsequently operated with the SRTS, with a CCD camera mounted on the head of the linac. BEV images from the CCD camera were recorded during the tracking of a ball target by the linac. The tracking error was measured at 15 Hz using in-house software. To assess the precision of the position detection using an MR image, the positions of test tubes (determined from MR images) were compared with their actual positions. To assess the precision of the position detection of the ball, ball positions measured from BEV images were compared with values measured using a Vernier caliper. The SRTS accuracy was evaluated by determining the tracking error that could be identified with a probability of more than 95% (Ep95). The detection precision of the tumor position (determined from cine MR images) was < 0.2 mm. The detection precision of the tracking error when using the BEV images was < 0.2mm. These two detection precisions were derived from our measurement system and were not obtained from the SRTS. The median of Ep95 was found to be 1.5 (range, 1.0-3.5) mm. The difference between the minimum and maximum Ep95 was 2.5mm, indicating that this provides a better means of evaluating patient-specific SRTS accuracy. A suitable margin, based on the predicted patient-specific SRTS accuracy, can be added to the clinical target volume.
  • Efficacy of the dynamic jaw mode in helical tomotherapy with static ports for breast cancer, Chikao Sugie, Yoshihiko Manabe, Akihiro Hayashi, Akihiro Hayashi, Taro Murai, Taiki Takaoka, Yukiko Hattori, Yukiko Hattori, Hiromitsu Iwata, Ran Takenaka, Ran Takenaka, Yuta Shibamoto, Technology in Cancer Research and Treatment, 14, 459 - 465,   2015年01月, 査読有り, © The Author(s) 2014. The recently developed dynamic jaw technology of tomotherapy can reduce craniocaudal dose spread without much prolonging the treatment time. This study aimed to investigate the efficacy of the dynamic jaw mode for tomotherapy of breast cancer. Static tomotherapy plans of the whole breast and supraclavicular regional lymph nodes, and plans for the whole breast only were generated in 25 patients with left-sided breast cancer. Plans with a field width of 2.5 or 5 cm with the dynamic or fixed jaw modes were made for each patient. The prescribed dose was 50 Gy in 25 fractions. In whole breast and supraclavicular nodal radiotherapy, dose distributions and homogeneity of the planning target volume (PTV) with the dynamic jaw mode were slightly inferior to those with the fixed jaw mode with a 5-cm field width (P < .05). However, lung low-dose volumes and mean doses of the larynx, thyroid, skin, and all the healthy tissues combined were smaller with the dynamic jaw mode than with the fixed jaw mode with a 5-cm field width (P < .001). In whole breast radiotherapy, mean doses of the skin and healthy tissues were lower with the dynamic jaw mode than with the fixed jaw mode with a 5-cm field width (P < .001) without significant differences in PTV dose distributions, homogeneity, and conformity. The dynamic jaw mode provided better sparing of organs at risks with minimal disturbance of dose–volume indices of PTV. Considering the treatment time, the 5-cm-field dynamic jaw mode is more efficient than the 2.5-cm fixed jaw mode.
  • Definitive radiotherapy following induction chemotherapy for hypopharyngeal cancer: Selecting candidates for organ-preserving treatment based on the response to induction chemotherapy, Takeshi Yanagi, Yuta Shibamoto, Hiroyuki Ogino, Fumiya Baba, Taro Murai, Aiko Nagai, Akifumi Miyakawa, Chikao Sugie, Kurume Medical Journal, 62, 1 - 8,   2015年01月, 査読有り, © 2015, Kurume University School of Medicine. All rights reserved. The outcomes of induction chemotherapy followed by radiotherapy for hypopharyngeal carcinoma were analyzed to determine whether response to induction chemotherapy could be a useful parameter for selecting candidates for organ-preserving therapy. Forty-three patients with hypopharyngeal carcinoma were treated with definitive radiotherapy with or without concurrent chemotherapy following induction chemotherapy. The predominant induction chemotherapy regimens involved cisplatin and 5-fluorouracil with or without docetaxel. The patients that responded to the induction chemotherapy received definitive organ-preserving treatment. Patients who did not respond to induction chemotherapy were considered for surgery, but only those patients who underwent definitive radiotherapy were analyzed in this study. Conventional radiotherapy was administered in all patients. The associations between clinical parameters including age, sex, performance status (PS), tumor site, T-category, N-category, stage, the regimen of induction chemotherapy, the response to induction chemotherapy, the presence/absence of concurrent chemotherapy, overall survival (OS), and local control (LC) were analyzed. Among the surviving patients, the follow-up period ranged from 10-145 months (median: 46 months). The 3-year OS and LC rates for all 43 patients were 61% and 70%, respectively. The 3-year OS and LC rates of the responders were 73% and 81%, respectively, whereas those of the non-responders were 29% and 40%, respectively. In multivariate analysis, only PS was correlated with overall survival (p=0.03). The complication rates were acceptable in all groups. Responders to induction chemotherapy appear to be good candidates for definitive organ-preserving treatment. Chemoselection appears to aid treatment selection in patients with hypopharyngeal carcinoma.
  • Helical and static-port tomotherapy using the newly-developed dynamic jaws technology for lung cancer, Yoshihiko Manabe, Yuta Shibamoto, Chikao Sugie, Akihiro Hayashi, Taro Murai, Takeshi Yanagi, Technology in Cancer Research and Treatment, 14, 583 - 591,   2015年01月, 査読有り, © SAGE Publications Inc. 2014. With the newly developed dynamic jaws technology, radiation dose for the cranio-caudal edges of a target can be lowered in the treatment with tomotherapy. We compared dynamicjawand fixed-jaw-mode plans for lung cancer. In 35 patients, four plans using the 2.5-cm dynamic-, 2.5-cm fixed-, 5.0-cm dynamic-, and 5.0-cm fixed-jaw modes were generated. For 10 patients with upper lobe stage I lung cancer, the helical tomotherapy mode was used. Fifty-six Gy in 8 fractions was prescribed as a minimum coverage dose for 95% of the target (D95%). For 25 patients with locally advanced lung cancer, plans using four static ports (TomoDirect® mode) were made. Sixty Gy in 30 daily fractions for the primary tumor and swollen lymph nodes and 51 Gy in 30 fractions for prophylactic lymph node areas were prescribed as median doses. The mean conformity index of the planning target volume were similar among the four plans. The mean V5 Gy of the lung for 2.5-cm dynamic-, 2.5-cm fixed-, 5.0-cm dynamic-, and 5.0-cm fixed-jaw mode plans were 18.5%, 21.8%, 20.1%, and 29.4%, respectively (p, 0.0001), for patients with stage I lung cancer, and 37.3%, 38.7%, 40.4%, and 44.0%, respectively (p, 0.0001), for patients with locally advanced lung cancer. The mean V5 Gy of the whole body was 1,826, 2,143, 1,983, and 2,939 ml, respectively (p, 0.0001), for patients with stage I lung cancer and 4,849, 5,197, 5,220, and 6,154 ml, respectively (p, 0.0001), for patients with locally advanced lung cancer. Treatment time was reduced by 21-39% in 5.0-cm dynamic-jaw plans compared to 2.5-cm plans. Regarding dose distribution, 2.5-cm dynamic-jaw plans were the best, and 5.0-cm dynamic-jaw plans were comparable to 2.5-cm fixed-jaw plans with shorter treatment times. The dynamic-jaw mode should be used instead of the conventional fixed-jaw mode in tomotherapy for lung cancer.
  • Fractionated stereotactic radiotherapy using cyberknife for the treatment of large brain metastases: A dose escalation study, T. Murai, T. Murai, H. Ogino, Y. Manabe, M. Iwabuchi, T. Okumura, Y. Matsushita, Y. Tsuji, H. Suzuki, Y. Shibamoto, Clinical Oncology, 26, 151 - 158,   2014年03月, 査読有り, Aims: To evaluate the toxicity and efficacy of fractionated stereotactic radiotherapy (FSRT) with doses of 18-30Gy in three fractions and 21-35Gy in five fractions against large brain metastases. Materials and methods: Between 2005 and 2012, 61 large brain metastases (≥2.5cm in maximum diameter) of a total of 102 in 54 patients were treated with FSRT as a first-line therapy. Neurological symptoms were observed in 47 of the 54 patients before FSRT. Three fractions were applied to tumours with a maximum diameter ≥2.5cm and <4cm, and five fractions were used for brain metastases ≥4cm. After ensuring that the toxicities were acceptable (≤grade 2), doses were escalated in steps. Doses to the large brain metastases were as follows: level I, 18-22Gy/three fractions or 21-25Gy/five fractions; level II, 22-27Gy/three fractions or 25-31Gy/five fractions; level III, 27-30Gy/three fractions or 31-35Gy/five fractions. Level III was the target dose level. Results: Overall survival rates were 52 and 31% at 6 and 12 months, respectively. Local tumour control rates of the 102 total brain metastases were 84 and 78% at 6 and 12 months, respectively. Local tumour control rates of the 61 large brain metastases were 77 and 69% at 6 and 12 months, respectively. Grade 3 or higher toxicities were not observed. Conclusions: The highest dose levels of 27-30Gy/three fractions and 31-35Gy/five fractions seemed to be tolerable and effective in controlling large brain metastases. These doses can be used in future studies on FSRT for large brain metastases. •With Cyberknife, 61 large brain metastases in 54 patients were treated.•Three levels of prescribed dose were used with the dose escalation design.•Dose levels of 27-30Gy/3 fractions, 31-35Gy/5 fractions were target dose levels.•The median survival was 6 months. Unacceptable toxicities were not observed.•The target dose levels can be used for large brain metastases. © 2013 The Royal College of Radiologists.
  • High-precision radiotherapy for benign brain tumors, Yuta Shibamoto, Hiroyuki Ogino, Yoshihiko Manabe, Gakuo Iwabuchi, Hiromitsu Iwata, Taro Murai, Chisa Hashizume, Japanese Journal of Neurosurgery, 23, 37 - 42,   2014年01月, 査読有り, © 2014, Japanese Congress of Neurological Surgeons. All rights reserved. With the recent advances in technology, the role of radiation therapy is increasing in the treatment of benign brain tumors. In this article, charactristics and potentials of various high-technology radiotherapy modalities and machines are discussed. Gammaknife and cyberknife treatment can minimize irradiation to normal brain tissues, while tomotherapy and new linac-based image-guided radiotherapy (IGRT) machines can produce better dose distribution in the tumor. Nevertheless, all these modalities yield acceptable dose distribution for the treatment of benign brain tumors. One important issue in choosing a new radiation modality is the dose fractionation schedule. Gammaknife treatment is usually completed in one fraction, while any fractionation schedule is available with tomotherapy and new linac-based IGRT machines. The optimal dose fractionation remains unclear for benign brain tumors, and future studies are expected to clarify the issue. Then, the optimal radiation modality would become clearer. Using stereotactic irradiation or intensity-modulated radiation, long-term local control rates of over 90% have been reported for relatively small (<10 cm3) benign brain tumors (acoustic neuroma, craniopharyngioma, pituitary adenoma and meningioma). However, local control rates decrease with an increase in tumor size. Therefore, optimal radiation dose and fractionation schedule should be further investigated, especially for tumors with a large volume. In the future, stereotactic proton therapy and intensity-modulated proton therapy are expected to become popular, with the further development of particle therapy technologies.
  • Intensity modulated stereotactic body radiation therapy for single or multiple vertebral metastases with spinal cord compression, Taro Murai, Taro Murai, Rumi Murata, Yoshihiko Manabe, Chikao Sugie, Takeshi Tamura, Hiroya Ito, Yoshihito Miyoshi, Yuta Shibamoto, Practical Radiation Oncology, 4,   2014年01月, 査読有り, © 2014 American Society for Radiation Oncology. The purpose of this study was to evaluate the efficacy and toxicity of intensity modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) for single or multiple vertebral metastases (VM) with spinal cord compression using tomotherapy. Methods and materials: Thirty patients with 40 VM were treated with SIB-IMRT as initial radiation therapy. Either 40 Gy in 8 fractions or 48 Gy in 16 fractions was prescribed depending on the Katagiri prognostic index. The radiation doses to the spinal cord and other risk organs were reduced to tolerance levels using intensity modulation. One to 4 lesions in consecutive vertebrae were treated in 1 course of SIB-IMRT. Radiologic and physical examinations were performed at 1-3 month intervals after SIB-IMRT. The Barthel index (BI) and numerical rating scale (NRS) were used to evaluate activities of daily living (ADL) and pain status, respectively. Results: The median follow-up period was 8 months. The NRS significantly dropped at 1 month after SIB-IMRT (. P < .0001) and the effect continued for over 2 months. No significant BI decrease was observed at 2 months after SIB-IMRT (. P = .7). The 1-year local control rate was 84% (95% confidence interval, 70%-100%). No grade. ≥. 2 neurologic toxicity resulting from SIB-IMRT was observed. Conclusions: SIB-IMRT could be successfully applied to VM with spinal cord compression in up to 4 consecutive vertebrae. Good ADL preservation and pain control were achieved with acceptable toxicity.
  • Effect of residual patient motion on dose distribution during image-guided robotic radiosurgery for skull tracking based on log file analysis, Mitsuhiro Inoue, Mitsuhiro Inoue, Hiroya Shiomi, Kengo Sato, Junichi Taguchi, Kohei Okawa, Kohei Okawa, Kosaku Inada, Taro Murai, Izumi Koike, Koshi Tatewaki, Seiji Ota, Tomio Inoue, Japanese Journal of Radiology, 32, 461 - 466,   2014年01月, 査読有り, Purpose: The present study aimed to assess the effect of residual patient motion on dose distribution during intracranial image-guided robotic radiosurgery by analyzing the system log files. Materials and methods: The dosimetric effect was analyzed according to the difference between the original and estimated dose distributions, including targeting error, caused by residual patient motion between two successive image acquisitions. One hundred twenty-eight treatments were analyzed. Forty-two patients were treated using the isocentric plan, and 86 patients were treated using the conformal (non-isocentric) plan. Results: The median distance from the imaging center to the target was 55 mm, and the median interval between the acquisitions of sequential images was 79 s. The median translational residual patient motion was 0.1 mm for each axis, and the rotational residual patient motion was 0.1° for Δpitch and Δroll and 0.2° for Δyaw. The dose error for D95was within 1 % in more than 95 % of cases. The maximum dose error for D10to D90was within 2 %. None of the studied parameters, including the interval between the acquisitions of sequential images, was significantly related to the dosimetric effect. Conclusion: The effect of residual patient motion on dose distribution was minimal. © 2014 Japan Radiological Society.
  • 【良性脳腫瘍の基本的治療方針-機能温存のために-】 良性脳腫瘍に対する高精度放射線治療, 芝本 雄太, 荻野 浩幸, 真鍋 良彦, 岩渕 学緒, 岩田 宏満, 村井 太郎, 橋爪 知紗, 脳神経外科ジャーナル, 23, (1) 37 - 42,   2014年01月, 査読有り, 招待有り, 高精度放射線治療の発展によって、正常脳組織に対する照射を大幅に減らして、腫瘍部に線量を集中することが可能となったため、良性脳腫瘍に対する放射線治療の役割が増加している。本稿では、種々の高精度放射線治療装置の特徴を比較し、どの装置が良性脳腫瘍の治療に適しているかを考察する。また聴神経腫瘍、頭蓋咽頭腫、下垂体腺腫、髄膜腫の最新の治療成績について、著者らの経験を中心に紹介する。これらの腫瘍の高精度放射線治療による局所制御率は60〜95%程度であるが、腫瘍が大きい場合は制御率が不十分となる傾向があり、さらに最適な線量分割方法の検討等が必要である。また、さらに新しい粒子線治療の応用も将来の検討課題である。(著者抄録)
  • 前庭神経鞘腫に対するサイバーナイフによる定位照射の中〜長期成績, 帯刀 光史, 村井 太郎, 太田 誠志, 大川 浩平, 稲田 耕作, 井上 光広, 横田 尚樹, 佐藤 健吾, 小池 泉, 定位的放射線治療, 18, 107 - 113,   2014年01月, 査読有り, 28例(男21例、女7例、平均年齢56.4歳)を対象とし、うち9例は照射前に手術を施行し、腫瘍体積は平均5.6立方cmであった。照射辺縁線量は、1回照射5例は12Gy、3回分割照射23例の平均は18.7Gyで、フォロー期間は3年〜7年5ヵ月であった。Kanzakiらの評価法を改変した効果判定では部分寛解13例、不変11例、増悪4例であり、死亡例は0であった。腫瘍制御率は直径2.5cm未満94.7%、2.5cm以上66.7%、有害事象は一過性の顔面のしびれ悪化と水頭症が各1例であった。有効聴力保存率は88.9%であった。
  • Percutaneous fiducial marker placement under CT fluoroscopic guidance for stereotactic body radiotherapy of the lung: An initial experience, Kengo Ohta, Masashi Shimohira, Takuya Hashizume, Akifumi Miyakawa, Taro Murai, Yuta Shibamoto, Hiromitsu Iwata, Hiromitsu Iwata, Hiroyuki Ogino, Hiroyuki Ogino, Journal of Radiation Research, 54, 957 - 961,   2013年09月, 査読有り, The aim of this study is to describe our initial experience with the VISICOIL, which is the first percutaneous fiducial marker approved for stereotactic body radiotherapy in Japan, and to evaluate its technical and clinical efficacy, and safety. Eight patients underwent this procedure under CT fluoroscopic guidance. One patient had two tumors, so the total number of procedures was nine. We evaluated the technical and clinical success rates of the procedure and the frequencies of complications. Technical success was defined as when the fiducial marker could be placed at the target site, and clinical success was defined as when stereotactic body radiotherapy could be performed without the marker dropping out of position. The technical success rate was 78% (7/9). In one of the two failed cases, we aimed to place the marker inside the tumor, but misplaced it beside the tumor. In the other failed case, we successfully placed the marker beside the tumor as planned; however, the marker migrated to near the pleura after the patient stopped holding their breath. None of the markers dropped out of place, so the clinical success rate was 100% (9/9). The complication rates were as follows: pneumothorax: 56% (5/9), pneumothorax necessitating chest tube placement: 44% (4/9), focal intrapulmonary hemorrhaging: 67% (6/9), hemoptysis: 11% (1/9), mild hemothorax 11% (1/9), air embolism 0% (0/9), and death 0% (0/9). In conclusion, this new percutaneous fiducial marker appears to be useful for stereotactic body radiotherapy due to its good stability. © The Author 2013.
  • Intensity-modulated radiation therapy using static ports of tomotherapy (TomoDirect): Comparison with the TomoHelical mode, Taro Murai, Taro Murai, Yuta Shibamoto, Yoshihiko Manabe, Yoshihiko Manabe, Rumi Murata, Chikao Sugie, Akihiro Hayashi, Hiroya Ito, Yoshihito Miyoshi, Radiation Oncology, 8,   2013年03月, 査読有り, Purpose: With the new mode of Tomotherapy, irradiation can be delivered using static ports of the TomoDirect mode. The purpose of this study was to evaluate the characteristics of TomoDirect plans compared to conventional TomoHelical plans.Methods: TomoDirect and TomoHelical plans were compared in 46 patients with a prostate, thoracic wall or lung tumor. The mean target dose was used as the prescription dose. The minimum coverage dose of 95% of the target (D95%), conformity index (CI), uniformity index (UI), dose distribution in organs at risk and treatment time were evaluated. For TomoDirect, 2 to 5 static ports were used depending on the tumor location.Results: For the prostate target volume, TomoDirect plans could not reduce the rectal dose and required a longer treatment time than TomoHelical. For the thoracic wall target volume, the V5Gy of the lung or liver was lower in TomoDirect than in TomoHelical (p = 0.02). For the lung target volume, TomoDirect yielded higher CI (p = 0.009) but smaller V5Gy of the lung (p = 0.005) than TomoHelical. Treatment time did not differ significantly between the thoracic wall and lung plans.Conclusion: Prostate cancers should be treated with the TomoHelical mode. Considering the risk of low-dose radiation to the lung, the TomoDirect mode could be an option for thoracic wall and lung tumors. © 2013 Murai et al.; licensee BioMed Central Ltd.
  • Radiotherapy for hilar or mediastinal lymph node metastases after definitive treatment with stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer, Yoshihiko Manabe, Yuta Shibamoto, Fumiya Baba, Rumi Murata, Takeshi Yanagi, Chisa Hashizume, Hiromitsu Iwata, Katsura Kosaki, Akifumi Miyakawa, Taro Murai, Motoki Yano, Practical Radiation Oncology, 2,   2012年10月, 査読有り, Purpose: Management of regional lymph node (LN) recurrence is an important issue in definitive treatment of non-small cell lung cancer (NSCLC). We evaluated clinical outcomes of conventional radiotherapy for hilar or mediastinal LN metastases developing after stereotactic body radiotherapy (SBRT) or surgery for stage I NSCLC. Methods and Materials: Between 2004 and 2008, 26 patients with hilar or mediastinal LN metastases without local recurrence and distant metastasis after SBRT (n = 14) or surgery (n = 12) were treated with conventional radiotherapy. Twelve of the 14 post-SBRT patients (86%) were judged medically inoperable at the time of SBRT. All patients were treated to the hilum and mediastinum with conventional daily fractions of 2.0 Gy (n = 25) or 2.4 Gy (n = 1). The median total dose for treating metastatic LN was 60 Gy (range, 54-66 Gy) for the post-SBRT patients and 65 Gy (range, 60-66 Gy) for the post-surgery patients. Only 1 of the 14 post-SBRT patients and 8 of the 12 post-surgery patients received chemotherapy. Results: For all 26 patients, the overall and cause-specific survival rates at 3 years from radiation for LN metastases were 36% and 51%, respectively (14% and 39%, respectively, for the 14 post-SBRT patients and both 64% for the 12 post-surgery patients). Three of the SBRT patients were alive at 35 to 43 months with (n = 2) or without (n = 1) further recurrence, and 4 of the post-surgery patients were alive at 36 to 62 months with (n = 2) or without (n = 2) further recurrence. The incidence of ≥grade 2 pulmonary toxicity was 49% at 1 year (53% for post-SBRT patients and 44% for post-surgery patients). A grade 5 pulmonary toxicity was observed in 1 of the post-SBRT patients. Conclusions: Conventional radiotherapy could successfully salvage LN relapses after SBRT as well as after surgery in 7 of 26 patients. Radiotherapy in this setting appears reasonably well tolerated. © 2012 American Society for Radiation Oncology.
  • Organizing pneumonia after stereotactic ablative radiotherapy of the lung, Taro Murai, Yuta Shibamoto, Takeshi Nishiyama, Fumiya Baba, Akifumi Miyakawa, Shiho Ayakawa, Hiroyuki Ogino, Shinya Otsuka, Hiromitsu Iwata, Radiation Oncology, 7,   2012年08月, 査読有り, Background: Organizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR).Methods: Patients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause.Results: Among 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis.Conclusions: This is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP. © 2012 Murai et al.; licensee BioMed Central Ltd.
  • Stereotactic body radiotherapy using a radiobiology-based regimen for stage i nonsmall cell lung cancer: A multicenter study, Yuta Shibamoto, Chisa Hashizume, Fumiya Baba, Shiho Ayakawa, Yoshihiko Manabe, Aiko Nagai, Akifumi Miyakawa, Taro Murai, Hiromitsu Iwata, Yoshimasa Mori, Mikio Mimura, Satoshi Ishikura, Cancer, 118, 2078 - 2084,   2012年04月, 査読有り, Background: The most common regimen of stereotactic body radiotherapy (SBRT) for stage I nonsmall cell lung cancer in Japan is 48 grays (Gy) in 4 fractions over 4 days. Radiobiologically, however, higher doses are necessary to control larger tumors, and interfraction intervals should be >24 hours to take advantage of reoxygenation. In this study, the authors tested the following regimen: For tumors that measured <1.5 cm, 1.5 to 3.0 cm, and >3.0 cm in greatest dimension, radiation doses of 44 Gy, 48 Gy, and 52 Gy, respectively, were given in 4 fractions with interfraction intervals of >yen;3 days. Methods: Among 180 patients with histologically proven disease who entered the study, 120 were medically inoperable, and 60 were operable. The median patient age was 77 years (range, 29-92 years). SBRT was performed with 6-megavolt photons using 4 noncoplanar beams and 3 coplanar beams. Isocenter doses of 44 Gy, 48 Gy, and 52 Gy were received by 4 patients, 124 patients, and 52 patients, respectively. Results: The overall survival rate for all 180 patients was 69% at 3 years and 52% at 5 years. The 3-year survival rate was 74% for operable patients and 59% for medically inoperable patients (P =.080). The 3-year local control rate was 86% for tumors >3 cm (44/48 Gy) and 73% for tumors >3 cm (52 Gy; P =.050). Grade â2 radiation pneumonitis developed in 13% of patients (10% of the 44-Gy/48-Gy group and 21% of the 52-Gy group; P =.056). All other grade 2 toxicities developed in <4% of patients. Conclusions: The SBRT protocol used in this study yielded reasonable local control and overall survival rates and acceptable toxicity. Dose escalation is being investigated. © 2011 American Cancer Society.
  • Progression of non-small-cell lung cancer during the interval before stereotactic body radiotherapy, Taro Murai, Yuta Shibamoto, Fumiya Baba, Chisa Hashizume, Yoshimasa Mori, Shiho Ayakawa, Tatsuya Kawai, Shinya Takemoto, Chikao Sugie, Hiroyuki Ogino, International Journal of Radiation Oncology Biology Physics, 82, 463 - 467,   2012年01月, 査読有り, Purpose: To investigate the relationship between waiting time (WT) and disease progression in patients undergoing stereotactic body radiotherapy (SBRT) for lung adenocarcinoma (AD) or squamous cell carcinoma (SQ). Methods and Materials: 201 patients with Stage I AD or SQ undergoing SBRT between January 2004 and June 2010 were analyzed. The WT was defined as the interval between diagnostic computed tomography before referral and computed tomography for treatment planning or positioning before SBRT. Tumor size was measured on the slice of the longest tumor diameter, and tumor volume was calculated from the longest diameter and the diameter perpendicular to it. Changes in tumor volume and TNM stage progression were evaluated, and volume doubling time (VDT) was estimated. Results: The median WT was 42 days (range, 5-323 days). There was a correlation between WT and rate of increase in volume in both AD and SQ. The median VDTs of AD and SQ were 170 and 93 days, respectively. Thirty-six tumors (23%) did not show volume increase during WTs >25 days. In 41 patients waiting for ≤4 weeks, no patient showed T stage progression, whereas in 25 of 120 (21%) patients waiting for >4 weeks, T stage progressed from T1 to T2 (p = 0.001). In 10 of 110 (9.1%) T1 ADs and 15 of 51 (29%) T1 SQs, T stage progressed (p = 0.002). N stage and M stage progressions were not observed. Conclusion: Generally, a WT of ≤4 weeks seems to be acceptable. The WT seems to be more important in SQ than in AD. Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved.
  • Correlation between the serum KL-6 level and the grade of radiation pneumonitis after stereotactic body radiotherapy for stage i lung cancer or small lung metastasis, Hiromitsu Iwata, Yuta Shibamoto, Fumiya Baba, Chikao Sugie, Hiroyuki Ogino, Rumi Murata, Takeshi Yanagi, Shinya Otsuka, Katsura Kosaki, Taro Murai, Akifumi Miyakawa, Radiotherapy and Oncology, 101, 267 - 270,   2011年11月, 査読有り, Serum levels of a sialylated carbohydrate antigen KL-6, a marker for interstitial pneumonitis, were serially measured before and after stereotactic body radiotherapy (SBRT) for lung tumors. It was suggested that KL-6 levels before and after SBRT would help to predict the occurrence of ≥ Grade 2 radiation pneumonitis. © 2011 Elsevier Ireland Ltd. All rights reserved.
  • Mucinous colloid adenocarcinoma of the lung with lymph node metastasis showing numerous punctate calcifications, Taro Murai, Taro Murai, Taro Murai, Masaki Hara, Masaki Hara, Masaki Hara, Yoshiyuki Ozawa, Yoshiyuki Ozawa, Yoshiyuki Ozawa, Yuta Shibamoto, Yuta Shibamoto, Yuta Shibamoto, Shigeki Shimizu, Shigeki Shimizu, Shigeki Shimizu, Motoki Yano, Motoki Yano, Motoki Yano, Clinical Imaging, 35, 151 - 155,   2011年03月, 査読有り, Mucinous colloid adenocarcinoma (MC) of the lung represents a rare but distinctive variant of primary pulmonary adenocarcinoma, which usually shows favorable prognosis. We describe the case of a 70-year-old man who had a well-demarcated mass with numerous punctuate calcifications in the right middle lobe. Four months after surgery, multiple bone metastases were found and the poor prognosis was suggested. This is the first case of primary pulmonary MC with the characteristic imaging findings and the rare aggressive clinical feature. © 2011 Elsevier Inc.
  • Clinical outcomes of stereotactic body radiotherapy for stage I non-small cell lung cancer using different doses depending on tumor size, Fumiya Baba, Fumiya Baba, Yuta Shibamoto, Hiroyuki Ogino, Rumi Murata, Chikao Sugie, Hiromitsu Iwata, Shinya Otsuka, Katsura Kosaki, Aiko Nagai, Taro Murai, Akifumi Miyakawa, Radiation Oncology, 5,   2010年09月, 査読有り, Background: The treatment schedules for stereotactic body radiotherapy (SBRT) for lung cancer vary from institution to institution. Several reports have indicated that stage IB patients had worse outcomes than stage IA patients when the same dose was used. We evaluated the clinical outcomes of SBRT for stage I non-small cell lung cancer (NSCLC) treated with different doses depending on tumor diameter.Methods: Between February 2004 and November 2008, 124 patients with stage I NSCLC underwent SBRT. Total doses of 44, 48, and 52 Gy were administered for tumors with a longest diameter of less than 1.5 cm, 1.5-3 cm, and larger than 3 cm, respectively. All doses were given in 4 fractions.Results: For all 124 patients, overall survival was 71%, cause-specific survival was 87%, progression-free survival was 60%, and local control was 80%, at 3 years. The 3-year overall survival was 79% for 85 stage IA patients treated with 48 Gy and 56% for 37 stage IB patients treated with 52 Gy (p = 0.05). At 3 years, cause-specific survival was 91% for the former group and 79% for the latter (p = 0.18), and progression-free survival was 62% versus 54% (p = 0.30). The 3-year local control rate was 81% versus 74% (p = 0.35). The cumulative incidence of grade 2 or 3 radiation pneumonitis was 11% in stage IA patients and 30% in stage IB patients (p = 0.02).Conclusions: There was no difference in local control between stage IA and IB tumors despite the difference in tumor size. The benefit of increasing the SBRT dose for larger tumors should be investigated further. © 2010 Baba et al; licensee BioMed Central Ltd.
  • 【治療に役立つ脳実質内腫瘍の画像診断】 放射線治療 脳腫瘍の放射線治療とそれに必要な画像診断, 芝本 雄太, 綾川 志保, 宮川 聡史, 村井 太郎, 杉江 愛生, 日独医報, 54, (3-4) 349 - 358,   2009年12月, 査読有り, 招待有り

書籍等出版物

  • Advances in Radiation Oncology in Lung Cancer, 村井 太郎, 共著, Radiation response of the normal lung tissue and lung tumors, Springer,   2011年


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