Luminescence imaging during carbon-ion irradiation of water is not only possible but also a promising method for range estimation in carbon-ion therapy.

patients with stage I NSCLC were treated with proton therapy or carbon-ion therapy (57 with proton therapy and 23 with carbon-ion therapy) using 3 treatment protocols. In the first protocol, 80 gray equivalents (GyE) of proton therapy was given in 20 fractions, and the second proton therapy protocol used 60 GyE in 10 fractions. For carbon-ion therapy, 52.8 GyE was given in 4 fractions. After achieving promising preliminary results for the first protocol, the authors started to use the second proton therapy protocol to shorten the overall treatment time. Carbon-ion therapy was started in 2005, and thereafter, both proton and carbon-ion therapy plans were made for each patient, and the 1 that appeared superior was adopted. Patient age ranged from 48 to 89 years (median, 76 years). Thirty-seven patients were medically inoperable, and 43 refused surgery. Forty-two patients had T1 tumors, and 38 had T2 tumors. RESULTS: The median follow-up period for living patients was 35.5 months. For all 80 patients, the 3-year overall survival, cause-specific survival, and local control rates were 75% (IA: 74%; IB: 76%), 86% (IA: 84%; IB: 88%), and 82% (IA: 87%; IB: 77%), respectively. There were no significant differences in treatment results among the 3 protocols. Grade 3 pulmonary toxicity was observed in only 1 patient. CONCLUSIONS: Proton therapy and carbon-ion therapy are safe and effective for stage I NSCLC. Further investigation of particle therapy for stage I NSCLC is warranted. Cancer 2010;116:2476-85.

Secondary neutron ambient dose equivalents per the treatment absorbed dose in passive carbon-ion and proton radiotherapies were measured using a rem meter, WENDI-II at two carbon-ion radiotherapy facilities and four proton radiotherapy facilities in Japan. Our measured results showed that (1) neutron ambient dose equivalent in carbon-ion radiotherapy is lower than that in proton radiotherapy, and (2) the difference to the measured neutron ambient dose equivalents among the facilities is within a factor of 3 depending on the operational beam setting used at the facility and the arrangement of the beam line, regardless of the method for making a laterally uniform irradiation field: the double scattering method or the single-ring wobbling method. The reoptimization of the beam line in passive particle radiotherapy is an effective way to reduce the risk of secondary cancer because installing an adjustable precollimator and designing the beam line devices with consideration of their material, thickness and location, etc., can significantly reduce the neutron exposure. It was also found that the neutron ambient dose equivalent in passive particle radiotherapy is equal to or less than that in the photon radiotherapy. This result means that not only scanning particle radiotherapy but also passive particle radiotherapy can provide reduced exposure to normal tissues around the target volume without an accompanied increase in total body dose.

Terashima K, et al. Particle therapy using carbon ions or protons as a definitive therapy for patients with primary sacral chordoma. Br

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Low-energy x-ray imaging of the secondary electron bremsstrahlung (SEB) x-ray emitted during carbon-ion irradiation is a promising method for range estimation. However, it remains unclear whether the method can be used for imaging with the clinical dose levels of carbon-ion and whether the bremsstrahlung x-ray can be detected from the deeper part of the body. To clarify these points, we developed a new high resolution low-energy x-ray camera and conducted imaging of the SEB x-ray during the irradiation of carbon-ions of different energies and intensities. Imaging was also tried with an x-ray camera using a human-head-sized, 17 cm diameter cylindrical phantom. To develop a high resolution imaging detector for a low-energy x-ray, we used a 20  ×  20  ×  0.5 mm thick cerium-doped yttrium aluminum perovskite, YA1O3 (YAP(Ce)) scintillator plate, which was optically coupled to a 25 mm square high quantum efficiency (HQE) type position sensitive photomultiplier tube (PSPMT). The imaging detector was encased in a 2 cm thick tungsten container and a pinhole collimator was attached to its camera head. After evaluating the camera’s performance, SEB x-ray imaging was tried during irradiation of the carbon-ion and compared the results with a Monte Carlo simulation. We imaged the beam tracks by the SEB x-ray in real-time during irradiation of the carbon-ion and imaging and range estimation were possible even with near clinical dose level of 7.5  ×  108 particles of carbon-ion. Clear images of a SEB x-ray were also obtained for a 17 cm diameter cylindrical phantom. The measured images were good agreement with the Monte Carlo simulation. We confirmed that our developed YAP(Ce) camera is promising for imaging SEB x-rays during irradiation of carbon-ions even near clinical conditions.

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