Real-time tumor tracking radiotherapy for patients with hypoxic primary lung cancer

• Project/Area Number: 16K10378
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Radiation science
• Research Institution: Hokkaido University
• Principal Investigator: INOUE TETSUYA 北海道大学, 医学研究院, 非常勤講師 (10431363)
• Co-Investigator(Kenkyū-buntansha): 榊原 純 (小西純) 北海道大学, 大学病院, 講師 (50374278) ; 志賀 哲 北海道大学, 医学研究院, 准教授 (80374495)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Project Status: Completed (Fiscal Year 2018)
• Budget Amount: ¥4,550,000 (Direct Cost: ¥3,500,000、Indirect Cost: ¥1,050,000); Fiscal Year 2018: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2017: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2016: ¥2,080,000 (Direct Cost: ¥1,600,000、Indirect Cost: ¥480,000)
• Keywords: 原発性肺癌 / 体幹部定位放射線治療 / 低酸素 / 低酸素イメージング / FMISO / 放射線

Outline of Final Research Achievements

Hypoxic regions in tumors are known to be radio-resistant. Hypoxic imaging became possible by positron emission tomography (PET) using 18F-fluoromisonidazole (FMISO). Here we sought to determine whether FMISO-PET/CT can be used to predict the outcome for stage I non-small cell lung cancer (NSCLC) patients treated by stereotactic body radiotherapy (SBRT). From September 2013 to August 2017, 29 patients at Hokkaido university hospital with histopathologically confirmed stage I NSCLC were enrolled. FMISO-PET/CT was performed before SBRT for all patients. 18F-fluorodeoxy glucose (FDG)-PET/CT was also performed before SBRT. Four patients had a relapse. They were both FDG- and FMISO-positive. The proportion of recurrence in FMISO was 4/12 in positive and 0/17 in negative (p=0.01), whereas that in FDG was 4/19 in positive and 0/10 in negative (p=0.12). FMISO-PET/CT can be considered useful for predicting the outcome for stage I NSCLC patients treated by SBRT rather than FDG-PET/CT.

Academic Significance and Societal Importance of the Research Achievements

早期の非小細胞肺癌への体幹部定位放射線治療は手術に匹敵する有効な治療法として確立されてきたが、少なからず再発症例も経験し、治療成績改善の余地がある。本研究により低酸素細胞を有する原発性肺癌においては、低酸素細胞を有しないものよりも再発リスクが高い可能性が示された。早期原発性肺癌に対して、再発リスクの高い症例群が選別可能となったが、それらの群に対してより適切な治療法を模索していくことが今後の課題である。

Research Products

• [Journal Article] Stereotactic body radiotherapy to treat small lung lesions clinicallydiagnosed as primary lung cancer by radiological examination: a prospective observational study. (2018)
  • Author(s): Tetsuya Inoue, Norio Katoh, Yoichi M Ito, Tomoki Kimura, Yasushi Nagata, Kengo Kuriyama, Hiroshi Onishi, Tadamasa Yoshitake, Yoshiyuki Shioyama, Yusuke Iizuka, Koji Inaba, Koji Konishi, Masaki Kokubo, Katsuyuki Karasawa, Takuyo Kozuka, Kensuke Tanaka, Jun Sakakibara-Konishi, Ichiro Kinoshita, Hiroki Shirato
  • Journal Title: Lung Cancer Volume: 122 Pages: 107-112
  • DOI: 10.1016/j.lungcan.2018.05.025
  • Peer Reviewed
• [Presentation] Can 18F-fluoromisonidazole PET/CT predict the clinical outcome for stage I non-small cell lung cancer treated by stereotactic body radiotherapy? (2017)
  • Author(s): Inoue T, Watanabe S, Okamoto S, Yasuda K, Katoh N, Harada K, Shiga T, Tamaki N, Kuge Y, Shirato H
  • Organizer: The 59th Annual Meeting, American Society for Therapeutic Radiology and Oncology, San Diego, 2017.9.25
  • Int'l Joint Research
• [Presentation] 18F-fluoromisonidazole PET/CT for stage I non-small cell lung cancer treated by stereotactic body radiotherapy (2016)
  • Author(s): 井上哲也、岡本祥三、渡邊史郎、安田耕一、加藤徳雄、原田慶一、志賀哲、玉木長良、白土博樹
  • Organizer: 第75回日本医学放射線学会総会
  • Place of Presentation: パシフィコ横浜（横浜市）
  • Year and Date: 2016-04-14