title: The effects of carbon ion irradiation revealed by excised perforated intestines as a late morbidity for uterine cancer treatment.
abstract: OBJECTIVE
  Clinical trials of carbon ion therapy have been performed due to the advantages of high-dose energy delivery with precise localization control to targeted organs and strong cell-killing activities to cancers. Perforated intestines as a late morbidity after carbon ion radiotherapy for uterine cancers were examined to reveal the biological characteristics of carbon ion for future applications for the treatment of gastrointestinal cancers.
  
  
  METHODS
  Between June 1995 and December 2004, 94 patients with carcinoma of the uterine cervix or corpus were treated with carbon ion therapy. Among them, 9 patients (9.6%) developed major late gastrointestinal (GI) complications. Four out of 9 patients had intestinal perforations excised operatively at our institute. The postoperative clinical courses and histopathological findings of the excised intestine were investigated.
  
  
  RESULTS
  Carbon ion irradiation severely damaged smooth muscle layers by coagulation necrosis as well as atrophy of the intestinal epithelium and middle-sized arterial thromboses of the intestines. After evaluating late complications, the dose constraints on the GI tracts were set under 60 GyE to prevent major complications. Thereafter, the incidence of major GI complications markedly decreased.
  
  
  CONCLUSIONS
  Our findings demonstrated the characteristic histopathological effects of carbon ion radiotherapy and thus are expected to facilitate future additional applications of carbon ion radiotherapy for the treatment of gastrointestinal cancers.
authors.affiliation: Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Matsushita
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ohno
authors.forename: Takashi
authors.initials: T
authors.lastname: Nikaido
authors.forename: Shigeru
authors.initials: S
authors.lastname: Yamada
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.forename: Wataru
authors.initials: W
authors.lastname: Takayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishikura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsujii
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001284:Atrophy; D002247:Carbon Isotopes / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009336:Necrosis; D014594:Uterine Neoplasms / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D002247:Carbon Isotopes