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Marchial et al, 1987


Cox et al, 1990
Pinto et al, 1991
EORTC 22791 1992
Lee et al, 1993
Hadded et al, 1997
RTOG 9003, 2000


356
1-3N0M0
( RTC 22791, 1992 .)

1. 1,15
2. 4-6
3. 2
4. 80,5
5. 7 .


( RTC 22791, 1992 .)

60
50

(5 )

59,0

40,0

40
% 30

20
10
0


( .
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1
4 80 .
1,2
4 , 70- 74,4.
1
4 70 .
1,1
4 70 .
1,1
1,25
4 60 .

-
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%

100


80
60

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35,7

40

18

20

25,2

17,5

9,3

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0

10



( - 1,2
4 , 70- 74,4)

16
14
12
10
%

8
6
4
2
0

C (16,0%)

(4,5%)

-

( - 1 4
, 70 )

70
60
50
40
%

30
20
10
0

(62,9%)

(28,0%)

III
( - 1,1
4 70 )

74
72
70
% 68

66
64
62

(74,0%)

(67,0%)



( 1,1 1,25
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35
30
25
20
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10
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80
60
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20

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12,0

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0

10

3-D RTP system


based on a new type of display, called beam's eyes view
(BEV)

?

20 MeV

8 MeV, SSD=1m

200 MeV
Modified Bragg
Peak Length =
5 cm

Bragg peak


-
:

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;
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( 10 , - 120 )

Shizuoka Gantry Treatment Area

Confidential

Proton Therapy Center in ITEP

Multi-Leaf Collimator

Respiration gating
4-d treatment


Respiration gating

Comparison to conventional
radiation therapy

Comparison Dose Distribution :


Medulloblastoma


Example (1)

54y Male Maxillary sinus CA T4pN1M0

Before

37.5GyE

65GyE/26fr/7w

5M

(Courtesy of Hyogo Ion Beam Medical Center)

Local control rate



1-3N0-1M0
( . .. )
11

89

Proton results
1. Ocular melanoma
96% at 10 years at HCL (70 CGE in 5 fractions)
98% at 5 years at PS I, Switzerland
89% at 5 years at Nice, France

2. Hepatocellular carcinoma
94% at 7 years, Tsukuba (72 CGE in 18 fractions)
3. Paranasal sinus (76.6 CGE in 48 fractions)

4. Lung cancer
87% local control
63% disease-free
31% survival

5. Skull Base Chordoma


115 patients (1978-1993)
49 females + 66 males
Prescribed dose 66.6 CGE - 79.2 CGE
Tumor volume 4.6 cm3 - 190 cm3
Median follow-up 61 months (5-174)
Actuarial control rates:
5 years - 59.2%
10 years - 44.4%

1.

.
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.


+
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70,4

1.
,


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:
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Manchester

38

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CRC

29

11

NSABP (B-04)

14

Oslo

16

Stockholm

26

. ..

30

5- %
+

Spangenberg et al

40

27
%

Fourquet A. et al

20

58


(Harvard Joint Center for
Radiation Therapy (JCRT), 2000.)

1.
12-16
.
2.



.

1.
-
-
.
2.



( . .. )

5-
.

32
100%

23
71,8%

6
18,7%

3
9,5%

11
34,3
%

17
53,1
%

4
12,6
%

32,7%

22
+ 100%

18
81,8%

3
13,6%

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4,6%

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40,9
%

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45,4
%

3
13,7
%

44,5%

41
75,9%

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16,7%

4
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20
37,0
%

27
50,0
%

7
13,0
%

38,3%

54
100%

( %)

80%

86%

39%

72%

1-3 N0-1 0

83%

1-3 N0-3 1

50%

:
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Tolerance doses (TD5/5-TD50/5) to


whole-organ irradiation

Organ
Testes
Ovary
Eye (lens)
Lung
Kidney
Liver
Skin
Thyroid
Heart
Bone marrow
Gastrointestinal
Spinal cord
Brain
Bone and cartilage
Muscle

Total dose (Gy)


1-2
6-10
6-12
20-30
20-30
35-40
30-40
30-40
40-50
40-50
50-60
50-60
60-70
>70
>70 Muscle

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3
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III

., 66 , 96/11385
: 1N0M0- I
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25.07.05.
2,52 .
26.08 15.10.86.
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