Lung Cancer

Carbon ion radiotherapy for lung cancer

What lung cancer will we treat with carbon-ion radiotherapy?

Carbon ion radiotherapy is performed for lung cancer in the cases below. Detailed explanation follows the table.

	Disease	Indication
1	Lung cancer without metastasis or invasion of adjacent organs	Clinical stage Tis, T1-T4N0 primary lung cancer (excluding T4 due to invasion of nearby organs)
2	Primary non-small cell lung cancer with regional lymph node metastasis or invasion of adjacent organs, and tracheal/bronchial cancer without distant metastasis	Clinical stage Tany N1-N3M0 or T4N0M0 (invasion of nearby organs)
3	Metastatic lung tumors	Oligometastatic lung tumors (3 or fewer)

1. Lung cancer without metastasis or invasion of adjacent organs

The targeted condition is lung cancer without metastasis to lymph nodes or other organs and without direct invasion of nearby organs (diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, brachial plexus, esophagus, vertebral bodies).
Treatment is completed in 1 day in nearly all cases. If there is an important organ close to the target, however, it may take approximately 3 weeks.

2. Primary non-small cell lung cancer with regional lymph node metastasis or invasion of adjacent organs, and tracheal/bronchial cancer without distant metastasis

The targeted condition is lung cancer with no metastasis to lymph nodes or metastasis limited to the chest lymph nodes, no distant metastasis, and no pleural or pericardial effusion. Although treatment may also be indicated in some cases in which the cancer has invaded an nearby organ, it cannot be performed if it would be dangerous given the status of invasion.
The treatment consists of 16 fractions (over 4 weeks).

3. Metastatic lung tumors

The lungs are a common organ for the spread of cancers from other organs. If tumors that initially form at another site have spread to the lung, they are called metastatic lung tumor, to distinguish them from primary lung cancer that start in the lung.
Metastatic lung tumors in which the primary lesion has been treated, there is no metastasis outside the lungs and there are 3 or fewer lung metastases are targeted for carbon ion radiotherapy. Radical local treatment to such metastases are supposed to contributes to overall survival.

Treatment record in QST hospital

	Disease	Period	Number of Patients
1	Lung cancer without metastasis or invasion of adjacent organs	1994 to 2017	700
2	Primary non-small cell lung cancer with regional lymph node metastasis or invasion of adjacent organs, and tracheal/bronchial cancer without distant metastasis	1995 to 2015	141
3	Metastatic lung tumors	2003 to 2015	83

In stage I lung cancer, Miyamoto et al.^*1 reported a 5-year survival rate of 45%, and Yamamoto et al.^*2 reported a 5-year survival rate of 56% in a dose escalation trial of single-fraction carbon ion radiotherapy. In advanced lung cancer, the 2-year survival rate was 52% in a study by Takahashi et al.,^*3 but a report of recent results is planned to be published by Hayashi et al. For overall metastatic lung tumors, Yamamoto et al.^*4 reported a 2-year survival rate of 71%, and Takahashi et al.^*5 reported a 2-year survival rate of 65% in 34 patients with lung metastasis from colorectal cancer.

*1 Miyamoto T, et al. J Thorac Oncol. 2007;2:916-926.
*2 Yamamoto N, et al. J Thorac Oncol. 2017;12:673-680.
*3 Takahashi W, et al. Cancer. 2015;121:1321-1327.
*4 Yamamoto N, et al. Pulmonary Med. 2013;219746, 6.
*5 Takahashi W, et al. Radiat Oncol. 2014;9:68.