@article{oai:repo.qst.go.jp:00045838,
 author = {Niwa, Akihiro and Suzuki, Kyosuke and Kato, Shingo and Kajiyama, Hiraki and Shibata, Kiyosumi and Ino, Kazuhiko and Nakamura, Hisao and Kikkawa, Fumitaka and et.al and 加藤 眞吾},
 issue = {1},
 journal = {Annals of Oncology},
 month = {Jan},
 note = {Ovarian cancer results in more deaths than any other gynecologic malignancy. In the
United States and Japan, there are over 15,000 and 4,000 deaths from ovarian cancer per
year, respectively [1]. This high mortality rate can be attributed to the approximately
75% of patients who are diagnosed with stage III and IV disease with intraperitoneal
carcinomatosis [2]. Although the five-year survival rate of patients in whom lymph
nodes are the only site of metastasis, the so-called "retroperitoneal stage IIIc", ranges
from 84 to 96%, higher than the 20-30% of intraperitoneal stage IIIc patients [3], we
have sometimes encountered cases of ovarian cancer with local recurrence in the lymph
nodes which was completely unresectable at surgery and chemoresistant, resulting in
salvage chemotherapy. Therefore, a more potent treatment should be introduced for this
situation to achieve either disease-free survival or local control.
High linear energy transfer (LET) particle therapy has various advantages in terms of
radiobiological effects as well as dose distribution and has been expected to offer a
therapeutic advantage over conventional photon therapy. The biological advantages of
high LET radiation, including carbon beam therapy, are summarized as a decreased
oxygen enhancement ratio, diminished capacity for sublethal and potentially lethal
damage repair, and diminished cell cycle-dependent radiosensitivity [4]. Thus, these
advantages prompted us to use carbon beam therapy for bulky recurrent ovarian tumor,
which is considered to have a large fraction of hypoxic tumor.
The patient was a 68-year-old woman with ovarian cancer who was optimally treated
by hysterectomy, bilateral salpingo-oophorectomy, omentectomy and pelvic and
para-aortic lymphadenectomy in Feb.2003, followed by three courses of paclitaxel and
carboplatin (TJ) for right ovarian cancer, endometrioid type, grade 2, pT1cN0M0. Since
local recurrence of ovarian cancer at the site of the right internal-iliac artery lymph node was detected in Nov.2004, six more courses of TJ were performed. The recurrent tumor
had grown to a maximum 8 cm in diameter despite several protocols of chemotherapy,
including platinium, taxane, CPT-11 and gemcitabine. After we had confirmed no
metastasis besides the recurrence site with positron emission tomography using
fluorine-18 fluorodeoxyglucose /CT (FDG-PET/CT), we decided to treat the lesion with
carbon beam therapy. Before the therapy, the patient gave written informed consent,
and the study was approved by the local ethics committee and institutional review board
of our hospital. Moreover, the patient underwent an operation in which a Goretex sheet
was inserted, the lesion was partially excised and an artificial anus was constructed to
protect the intestine and rectum adjacent to the tumor from injury by high LET particles.
The heavy-ion medical accelerator in Chiba is the first heavy ion accelerator specially
dedicated to medicine in the world, and its design variables are based on the
radiological requirements [5]. The carbon beam energy used was 350 to 400 MeV. As
shown in Figs. A and B, anteroposterior, posteroanterior and lateral opposing ports were
used for 16 fractions over 4 weeks with 4 fractions weekly, consequently, the total dose
was a 57.6 Gy equivalent dose. Through out the treatment, no severe side effects were
observed. At ten months after treatment, the pelvic tumor had drastically shrunk (Fig.C),
and the patient has continued clinical disease free for 2 years.
This is the first report, to our knowledge, showing that carbon beam therapy was effective for recurrent ovarian cancer. The result is sufficiently encouraging to continue
the therapy in patients with metastatic, anti-cancer-drug-resistant ovarian cancer, as well
as other types of gynecologic cancer.},
 pages = {192--194},
 title = {Carbon beam therapy in recurrent ovarian cancer},
 volume = {19},
 year = {2008}
}