Michio Yoshimura

• Kyoto University

Postoperative chemoradiotherapy (POCRT) is the standard treatment for patients with head and neck squamous cell carcinoma (HNSCC) with high-risk features (positive microscopic margins and/or extranodal extensions). We hypothesized that dose escalation using hyperfractionation in intensity-modulated radiotherapy (HF-IMRT) improves POCRT outcomes; ho...

Background For delivering high radiation doses to pancreatic tumors, organ motion management is indispensable; however, studies on this are limited. We aimed to evaluate the efficacy and safety of dynamic tumor tracking (DTT) moderately hypofractionated intensity‐modulated radiotherapy (IMRT) in patients with locally advanced pancreatic cancer (LAP...

Background The efficacy of neoadjuvant chemoradiotherapy for resectable pancreatic ductal adenocarcinoma (R-PDAC) remains unclear. This study was designed to evaluate neoadjuvant chemoradiotherapy by using intensity-modulated radiotherapy (NAC-IMRT) for R-PDAC compared with upfront surgery (UpS). Methods Among 198 patients with R-PDAC who were ind...

Background Functional outcomes after hypopharyngeal cancer (HPC) treatment have a significant effect on patients' quality of life and prognosis. This study aimed to identify the predictive factors associated with laryngo‐esophageal dysfunction in patients with HPC who received definitive radiotherapy. Methods Patients with HPC treated with definit...

Purpose To predict distant metastasis (DM) in patients with borderline resectable pancreatic carcinoma using delta-radiomics features calculated from contrast-enhanced computed tomography (CECT) and non-CECT images. Methods and Materials Among 250 patients who underwent radiation therapy at our institution between February 2013 and December 2021,...

Pancreatic cancer remains a highly lethal disease with a 5-year survival proportion of <10%. Chemoradiotherapy is a treatment option for unresectable locally advanced (UR-LA) or borderline resectable (BR) pancreatic cancer, but its efficacy is not sufficient. Induction of the synergistic effect of irradiation and immune checkpoint inhibitors can be...

Background: Oligometastases were initially described as a concept bridging localized disease with widespread distant metastases, but a consensus on its definition has yet to be reached. Recently, the term "metastasis-directed therapy" (MDT) was coined to encompass local therapy for distant metastases, including surgery and radiation therapy (RT), e...

The applicability of ultra-hypofractionated (ultra-HF) whole-breast irradiation (WBI) remains unknown in Japanese women. This study aimed to evaluate the safety and efficacy of this approach among Japanese women and report the results of an interim analysis performed to assess acute adverse events (AEs) and determine whether it was safe to continue...

The Breast Cancer Clinical Practice Guidelines, organized by the Japanese Breast Cancer Society (JBCS), were published in 2022. We present the English version of the Radiation Therapy (RT) section of the guidelines. The JBCS formed a task force to update the 2018 version of the JBCS Clinical Practice Guidelines. The Background Questions (BQs) conta...

The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer, 2022 Edition was published in June 2022. The guidelines were prepared while conforming as much as possible to the “Minds Manual for Guideline Development 2020 ver. 3.0.” edited by the Minds Manual Development Committee of the Japan Council for Quality Health Care in...

Background The applicability of ultra-hypofractionated (ultra-HF) whole-breast irradiation (WBI) remains unknown in Japanese women. This study aimed to evaluate the safety and efficacy of this approach among Japanese women and report the results of an interim analysis performed to assess acute adverse events (AEs) and determine whether it was safe...

This retrospective study aimed to evaluate the time to recovery from xerostomia and analyze its predictors, along with long-term outcomes of stimulated salivary flow after intensity-modulated radiation therapy (IMRT) for head and neck cancer (HNC). We evaluated patients with HNC who had received IMRT with curative intent between 2012 and 2018 at ou...

Background: Resectable pancreatic cancer (RPC) is potentially resectable on admission, and the impact of neoadjuvant therapy on these tumors is controversial. Moreover, the safety and efficacy of neoadjuvant chemoradiotherapy with moderately hypofractionated intensity-modulated radiation therapy (NACIMRT) for RPC have not been studied. Here, we co...

This study aimed to assess the effectiveness of a new patient-setup procedure using surface-guided imaging during the coronavirus disease 2019 (COVID-19) pandemic for left-sided whole-breast irradiation with deep inspiration breath-hold. Two setup procedures were compared regarding patient positioning accuracy for the first 22 patients. The first w...

Background Both geometric and dosimetric components are commonly considered when determining the margin for planning target volume (PTV). As dose distribution is shaped by controlling beam aperture in peripheral dose prescription and dose‐escalated simultaneously integrated boost techniques, adjusting the margin by incorporating the variable dosime...

Background This study examined the differences in late gastrointestinal (GI) toxicities in moderately hypofractionated intensity-modulated radiation therapy (IMRT) for locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) by changing the planning organs at risk volume (PRV) margin and the target matching method and assessed the causes of adve...

The purpose of this study was to retrospectively assess target localization accuracy across different soft-tissue matching protocols using cone-beam computed tomography (CBCT) in a large sample of patients with pancreatic cancer and to estimate the optimal margin size for each protocol. Fifty-four consecutive patients with pancreatic cancer who und...

Next-generation sequencing (NGS)-based gene profiling can identify patients with pancreatic cancer with homologous recombinant repair gene pathogenic variants (HRRv). Several retrospective studies have reported a positive association between HRRv and the efficacy of platinum-based chemotherapy. However, this association remains to be validated in a...

Objectives: Olfactory neuroblastoma (ONB), also known as esthesioneuroblastoma, is a rare malignant neoplasm of the nasal vault and anterior skull base. The results of treatment for ONB are relatively good; however, regional and distant metastases can develop several years after definitive treatment. This study aimed to validate the treatment modal...

Radiation therapy (RT) can enhance the abscopal effect of immune checkpoint blockade. This phase I/II study investigated the efficacy and safety of nivolumab plus RT in HER2-negative metastatic breast cancer requiring palliative RT for bone metastases. Cohort A included luminal-like disease, and cohort B included both luminal-like and triple-negati...

Purpose: The UK-FAST-Forward study showed that ultra-hypofractionated whole-breast irradiation (ultra-HF-WBI) involving five fractions of 26 Gy radiation over 1 week was not inferior to HF-WBI. However, it is not used in Japan due to safety concerns. In April 2022, we commenced a multi-institutional, single-arm, phase II trial. Our aim is to confi...

Purpose: The purpose of this study was to demonstrate the potential utility of cone-beam computed tomography (CBCT)-guided online adaptive radiotherapy (ART) under end-exhalation breath-hold (EE-BH) conditions for pancreatic cancer (PC). Methods: Eleven PC patients who underwent 15-fraction volumetric-modulated arc therapy under EE-BH conditions...

Background JCOG1015A1 is an ancillary research study to determine the organ-specific dose constraints in head and neck carcinoma treated with intensity-modulated radiation therapy (IMRT) using data from JCOG1015. Methods Individual patient data and dose-volume histograms of organs at risk (OAR) were collected from 74 patients with nasopharyngeal c...

The effects of irradiation on tumor tissue and the host immune system are interrelated. The antitumor effect of irradiation is attenuated in the immunocompromised hosts. In addition, radiation alone positively and negatively influences the host immune system. The positive effects of radiation are summarized by the ability to help induce and enhance...

Background In infrared reflective (IR) marker-based hybrid real-time tumor tracking (RTTT), the internal target position is predicted with the positions of IR markers attached on the patient’s body surface using a prediction model. In this work, we developed two artificial intelligence (AI)-driven prediction models to improve RTTT radiotherapy, nam...

Purpose To investigate the treatment outcome and prognostic factor of volumetric parameters measured by 18F-FDG-PET/CT in squamous cell carcinoma patients of oropharynx, hypopharynx, and larynx treated with definitive intensity modulated radiotherapy. Methods We retrospectively reviewed 63 patients who received definitive radiation therapy for hea...

555 Background: The latest National Comprehensive Cancer Network Guidelines for pancreatic adenocarcinoma recommended platinum-based chemotherapy for the patients with germline BRCA1/2 or PALB2 variants based on retrospective studies. However, the association between the efficacy of oxaliplatin-based chemotherapy and homologous recombination repair...

Background Borderline resectable pancreatic cancer (BRPC) is a category of pancreatic cancer that is anatomically widely spread, and curative resection is uncommon with upfront surgery. Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that delivers precise radiation to a tumor while minimizing the dose to surrounding norm...

Purpose For pancreatic cancer patients, image guided radiation therapy and real‐time tumor tracking (RTTT) techniques can deliver radiation to the target accurately. Currently, for the radiation therapy machine with kV X‐ray imaging systems, internal markers must be implemented to facilitate tumor tracking. The purpose of this study was to develop...

Purpose/Objective(s) We introduced a theoretical margin calculation method based on a combination of the guide to the expression of uncertainty in measurement (GUM) and the probability distribution of the tracking error, and determined the population-based margins in fiducial marker-based real-time tumor tracking (RTTT) radiotherapy. Materials/Met...

Purpose: Flexible positron emission tomography (fxPET) employing a non-local means reconstruction algorithm was designed to fit existing magnetic resonance imaging (MRI) systems. We aimed to compare the qualitative and quantitative performance of fxPET among fxPET with MR-based attenuation correction (MRAC), fxPET with CT-based attenuation correct...

Currently for pancreatic tumor image guided radiation therapy by kV X-ray imaging, internal markers need to be implemented inside patient's body. The implementation is invasive and induce artifacts during planning CT scanning. Deep learning may provide a solution to predict pancreatic tumor contour and position on kV X-ray projection images. A nove...

In addition to its function of innate immunity against invading pathogens, neutrophil extracellular traps (NETs) promote thrombosis, autoimmune disease, and cancer metastasis; therefore, unnecessary exposure to the triggers of infection-independent NET generation should be avoided. We herein show that inhibition of forward-mode Na⁺/Ca²⁺ exchange by...

Introduction: Dose reduction to the duodenum is important to decrease gastrointestinal toxicities in patients with locally advanced pancreatic cancer (LAPC) treated with definitive chemoradiotherapy. We aimed to compare dynamic wave arc (DWA), a volumetric-modulated beam delivery technique with simultaneous gantry/ring rotations passing the waved t...

Purpose: This study aimed to assess dosimetric indices of RapidPlan model-based plans for different energies (6, 8, 10, and 15 MV; 6- and 10-MV flattening filter-free), multileaf collimator (MLC) types (Millennium 120, High Definition 120, dual-layer MLC), and disease sites (head and neck, pancreatic, and rectal cancer) and compare these parameter...

A correction to this paper has been published: https://doi.org/10.1007/s12282-021-01255-8

To propose two artificial intelligence-based prediction models for real-time tumor tracking: a convolutional neural network-based PM with fine tuning and an adaptive neuro-fuzzy inference system-based PM with a pattern search algorithm.

Background This study aimed to quantify errors by using a cine electronic portal imaging device (cine EPID) during deep inspiration breath-hold (DIBH) for left-sided breast cancer and to estimate the planning target volume (PTV) by variance component analysis. Methods This study included 25 consecutive left-sided breast cancer patients treated wit...

Purpose: Positron emission tomography (PET)/computed tomography (CT) using 18F-fluoromisonidazole (FMISO) has been used as an imaging tool for tumour hypoxia. However, it remains unclear whether they are useful when scanning is performed earlier, e.g. at 2-h post-injection with a high sensitivity PET scanner. This study aimed to investigate the re...

Purpose: To introduce the concept of statistical shape model (SSM)-based planning organ-at-risk volume (sPRV) for pancreatic cancer patients. Methods: A total of 120 pancreatic cancer patients were enrolled in this study. After correcting inter-patient variations in the centroid position of the planning target volume (PTV), four different SSMs w...

Objective This is an ancillary study of a multi‐institutional randomized non‐inferiority phase III trial of accelerated fractionation (AF) versus standard fractionation (SF) radiation therapy for T1‐2N0M0 glottic cancer (JCOG0701). Biopsy specimens of tumors from the patients enrolled in the JCOG0701 are collected and the association between clinic...

Background and objectives A postoperative pancreatic fistula (POPF) is a critical complication after surgery for pancreatic cancer. Whether a POPF affects the long-term prognosis of pancreatic cancer cases remains controversial. This study aimed to clarify the effect of a POPF on the long-term prognosis of pancreatic cancer patients, especially aft...

Background It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly cancer patients will increase. However, the optimal treatment for elderly patients with LAPC remains unclear. The purpose of this study was to evaluate the efficacy and safety of hypofraction...

Background: Dose reduction to the duodenum is important to decrease gastrointestinal toxicities in patients with locally advanced pancreatic cancer (LAPC) treated with definitive radiotherapy. We aimed to investigate whether dynamic wave arc (DWA), a volumetric-modulated beam delivery technique with simultaneous gantry/ring rotations passing the wa...

Background: Dose reduction to the duodenum is important to decrease gastrointestinal toxicities in patients with locally advanced pancreatic cancer (LAPC) treated with definitive chemoradiotherapy. We aimed to compare dynamic wave arc (DWA), a volumetric-modulated beam delivery technique with simultaneous gantry/ring rotations passing the waved tra...

The purpose of this study was to assess the positional repeatability of internal and external markers among multiple breath-hold (BH) sessions and evaluate the positional variation of these markers within BH sessions for volumetric-modulated arc therapy (VMAT) for pancreatic cancer patients. A total of 13 consecutive pancreatic cancer patients with...

Background: It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly patients with cancer has been increasing recently. However, the optimal treatment for elderly patients with LAPC is unclear. The purpose of this study was to evaluate the efficacy and safety...

Background: It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly cancer patients will increase. However, the optimal treatment for elderly patients with LAPC remains unclear. The purpose of this study was to evaluate the efficacy and safety of hypofractio...

e15046 Background: Advances in immuno-oncology (IO), i.e., programmed cell-death protein 1 (PD-1) inhibitors, are revolutionizing cancer treatment by offering hope for a cure. However, the benefit of IO agents in metastatic breast cancer (MBC) remains limited. For immunotherapy to be successful, it is essential to understand the tumor immune contex...

Purpose: To investigate the impact of interfractional anatomical changes and setup correction methods on dose distributions in pancreatic cancer patients under breath-hold conditions. Methods: Three intensity-modulated proton therapy (IMPT) plans with different beam arrangements and one volumetric-modulated arc therapy (VMAT) plan prescribing 54...

BackgroundA phase II study of adaptive two-step intensity-modulated radiotherapy (IMRT) with chemotherapy for nasopharyngeal cancer (NPC) (JCOG1015) was conducted to evaluate the efficacy and safety.Methods Patients aged 20–75 years with stages II–IVB NPC were enrolled. As adaptive two-step IMRT, computed tomography planning was performed twice bef...

Background: To assess the positional repeatability of internal and external markers among multiple breath-hold (BH) sessions and assess the positional variation of these markers within BH sessions for volumetric-modulated arc therapy (VMAT) for pancreatic cancer patients. Methods: A total of 13 consecutive pancreatic cancer patients with an interna...

The number of patients with head and neck squamous cell carcinoma (HNC) with mediastinal involvement is small, and appropriate treatment techniques have not been widely discussed. This study aimed to compare the efficacy of radiotherapy planning techniques in reducing lung irradiation while retaining target coverage. Among all HNC patients with med...

BACKGROUND: Advances in imuuno-oncology (IO), i.e., a programmed cell death protein 1 (PD-1) inhibitors are revolutionizing cancer treatment by offering hope for a cure. However, the benefit of IO agents in metastatic breast cancer (MBC) is still limited. For immunotherapy to be successful, it is essential to understand the tumor immune contexture....

BACKGROUND: In metastatic breast cancer, Overall Response Rate (ORR) for checkpoint inhibitor monotherapy has been limited. Since Radiation Therapy (RT) stimulates anti-cancer immune responses, we evaluated safety and efficacy of a combinatorial therapy of RT with Nivolumab (a Programmed cell death protein 1 (PD-1) inhibitor) on HER2-negative metas...

Purpose: To investigate the effects of interfractional variation, such as anatomical changes and setup errors, on dose delivery during treatment for prostate cancer (PC) and head and neck cancer (HNC) by courses of volumetric modulated arc therapy (VMAT) aided by on-treatment electronic portal imaging device (EPID) images. Methods: Seven patient...

Purpose This study aimed to investigate experiences and preferences for disclosure of life expectancy, agreement between them, and the factors associated with preferences for disclosure of life expectancy with physicians among cancer patients undergoing radiation therapy. Methods Cancer patients aged 20 years or older were consecutively sampled wh...

Purpose The Japanese Breast Cancer Society (JBCS) Clinical Practice Guideline was revised in 2018. This article describes the revise points in the section on radiation therapy (RT). Methods and materials The JBCS formed task force to update the JBCS Clinical Practice Guideline 2015 edition. Background questions (BQs) deal with standard treatments...

Base excision repair (BER) plays an essential role in protecting cells from mutagenic base damage caused by oxidative stress, hydrolysis, and environmental factors. POLQ is a DNA polymerase, which appears to be involved in translesion DNA synthesis (TLS) past base damage. We disrupted POLQ, and its homologs HEL308 and POLN in chicken DT40 cells, an...

The chicken DT40 B lymphocyte line diversifies its immunoglobulin (Ig) V genes through translesion DNA synthesis-dependent point mutations (Ig hypermutation) and homologous recombination (HR)-dependent Ig gene conversion. The error-prone biochemical characteristic of the A family DNA polymerases Polnu and Pol led us to explore the role of these pol...

Background: The boost irradiation to the tumor bed following whole-breast irradiation (WBI) reduced the risk of ipsilateral breast tumor recurrence (IBTR). However, in Japan, almost all patients with a margin ≤5 mm receive boost irradiation to the tumor bed, but the decision to perform boost irradiation for those with a margin > 5 mm is dependent...

Background and purpose Inter‐fractional changes of the daily anatomy of the patient are a source of error in radiotherapy. This effect is especially present in the abdomen, where there are daily differences in the filling of the stomach or the intestines. This study investigated the impact of inter‐fractional changes of pancreatic cancer patients w...

Background and purpose We created a scoring system incorporating dosimetric and clinical factors to assess the risk of severe, acute skin reactions in patients undergoing intensity-modulated radiation therapy (IMRT) to treat head and neck cancer (HNC). Materials and methods A total of 101 consecutive patients who received definitive IMRT or volume...

The Breast Cancer Group of the Japanese Radiation Oncology Study Group conducted a nationwide questionnaire survey on the clinical practice of postoperative radiotherapy for breast-conserving treatment for breast cancer. This questionnaire consisted of 18 questions pertaining to the annual number of treated patients, planning method, contouring str...

Abstract Intensity-modulated radiotherapy (IMRT) is now regarded as an important treatment option for patients with locally advanced pancreatic cancer (LAPC). To reduce the underlying tumor motions and dosimetric errors during IMRT as well as the burden of respiratory management for patients, we started to apply a new treatment platform of the dyna...

This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to...

Clinician survey (English). (DOC)

STROBE statement—Checklist of items that should be included in reports of cross-sectional studies. (DOC)

Patient survey (forward and backward IQOLA translation). (DOCX)

Clinician survey (Japanese). (DOCX)

Classification of patients’ and clinicians’ non-mutually exclusive preferences for life expectancy disclosure. (DOCX)