Gynecological Cancer

Carbon ion radiotherapy for gynecological tumor

Indications

Carbon ion radiotherapy is performed for gynecological tumor in the following cases.

	Disease	Indication
1	Locally advanced cervical cancer	Clinical stage (International Federation of Gynecology and Obstetrics: FIGO 2008) II to IVA cervical adenocarcinoma or bulky (≥6 cm) squamous cell carcinoma
2	Locally advanced endometrial cancer	Clinical stage I to IVA primary endometrial cancer that is unresectable for reasons such as complications or the patient's refusal to undergo surgery
3	Gynecological malignant melanoma	Localized gynecological malignant melanoma

1. Cervical cancer

Carbon ion radiotherapy is indicated for patients with cancer that has invaded beyond the uterus (stage II or higher) without distant metastasis. For squamous cell carcinoma, a tumor size of ≥6 cm is a requirement. For adenocarcinoma, disease of stage II or higher without metastasis is a requirement, but there is no restriction with respect to tumor size.
Patients who have previously undergone surgery or radiation therapy for cervical cancer are not indicated for the treatment.

2. Endometrial cancer

Patients without metastasis and who cannot undergo or do not want surgery are indicated for the treatment.
Patients who have previously undergone surgery or radiation therapy for endometrial cancer are not indicated for the treatment.

3. Gynecological malignant melanoma

Patients with malignant melanoma in the vulva, vagina or uterus and without distant metastasis are indicated for the treatment. (However, the patient is indicated for the treatment in the case of primary uterine melanoma that has metastasized only to the inguinal lymph nodes.) Treatment may also be possible for patients with a postoperative recurrence.

Treatment record in QST hospital

	Disease	Period	Number of Patients
1	Locally advanced cervical cancer	April 1995 to December 2018	Approx. 250
2	Locally advanced endometrial cancer	April 1995 to December 2018	Approx. 20
3	Gynecological malignant melanoma	April 1995 to December 2018	Approx. 40

In squamous cell carcinoma, favorable results were seen, the 5-year local control rate being 70% in giant tumors (i.e., tumors greater than 6 cm in size).^*1 In cervical adenocarcinoma, favorable results have also been reported. The 5-year local control rate and 5-year overall survival rate were 55% and 38%, respectively, with carbon ion radiotherapy alone,^*2 and the 2-year local control rate and 2-year overall survival rate were 71% and 88%, respectively, with carbon ion radiotherapy in combination with cisplatin.^*3
In endometrial cancer, favorable results have been obtained. The 5-year local control rate and 5-year overall survival rate in patients with unresectable endometrial cancer were 86% and 68%, respectively.^*4
In gynecological malignant melanoma, favorable results have been reported, with a 3-year local control rate of 50% and 5-year overall survival rate of 53% in patients with unresectable disease or a postoperative recurrence.^*5

*1 Okonogi N, et al. Anticancer Res. 2018;38(1):457-463.
*2 Wakatsuki M, et al. Cancer. 2014;120(11):1663-1669.
*3 Okonogi N, et al. Cancer Med. 2018;7(2):351-359.
*4 Irie D, et al. Radiat Res. 2018;59(3):309-315.
*5 Karasawa K, et al. J Radiat Res. 2014;55(2):343-350.