Carbon-ion radiotherapy for inoperable upper tract ureteral cancer

Tatsuji Mizukami; Hidemasa Kawamura; Nobuteru Kubo; Hiro Sato; Masahiro Kawahara; Akiko Adachi; Hiroshi Matsui; Kazuhiro Suzuki; Jun-Ichi Saitoh; Takashi Nakano; Tatsuya Ohno

doi:10.1111/ajco.13960

Carbon-ion radiotherapy for inoperable upper tract ureteral cancer

Asia Pac J Clin Oncol. 2023 Apr 23. doi: 10.1111/ajco.13960. Online ahead of print.

Authors

Tatsuji Mizukami^{1

2}, Hidemasa Kawamura^{2

3}, Nobuteru Kubo^{2

3}, Hiro Sato^{2

3}, Masahiro Kawahara^{2

4}, Akiko Adachi^{2

3}, Hiroshi Matsui^{3

5}, Kazuhiro Suzuki^{3

5}, Jun-Ichi Saitoh¹, Takashi Nakano^{2

6}, Tatsuya Ohno^{2

3}

Affiliations

¹ Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan.
² Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan.
³ Gunma University Heavy Ion Medical Center, Gunma, Japan.
⁴ Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
⁵ Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan.
⁶ Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.

PMID: 37088970
DOI: 10.1111/ajco.13960

Abstract

Aim: This study aimed to report initial results of hypofractionated carbon-ion radiotherapy (C-ion RT) for inoperable upper tract ureteral cancer.

Methods: Retrospective chart review was performed for five consecutive patients with medically inoperable ureter cancer that was treated with radical C-ion RT between December 2013 and December 2014. The median age of the patients was 80 years (range, 68-84 years). The reasons for inoperability were advanced age, post-contralateral nephrectomy, alcoholic cirrhosis, both advanced age and contralateral renal function degeneracy, and pneumonia. The median size of tumor was 2.8 cm (range, 2.2-4.0 cm). Diagnostic imaging did not identify lymph node metastases or distant metastases in any case. All patients underwent C-ion RT (52.8 Gy relative biological effectiveness; 12 fractions in 3 weeks). The clinical target volume encompassed the growth tumor volume with a 5-mm margin bilaterally; there was a 40-mm margin craniocaudally but the clinical target volume did not encompass the whole ureter.

Results: Within a median follow-up time of 32.9 months (range, 24-36 months), two patients died and three remained alive. Neither local recurrence nor regional lymph node metastases were observed. Secondary bladder tumor was observed in four patients, and one patient had a liver metastasis. Grade 1 hematuria was observed in two patients, and Grade 3 pyelonephritis was observed in one patient as acute toxicity. Ureteral obstruction was observed in two patients.

Conclusion: C-ion RT might be a useful treatment option for inoperable ureter cancer.

Keywords: carbon ion radiotherapy; heavy ion radiotherapy; radiation therapy; upper tract ureteral cancer; ureter cancer.