title: Carbon-ion radiotherapy for locally advanced primary or postoperative recurrent epithelial carcinoma of the lacrimal gland.
abstract: OBJECTIVE
  To evaluate the applicability of carbon ion beams for the treatment of carcinoma of the lacrimal gland with regard to normal tissue morbidity and local tumor control.
  
  
  METHODS
  Between April 2002 and January 2011, 21 patients with locally advanced primary epithelial carcinoma of the lacrimal gland were enrolled in a Phase I/II clinical trial of carbon-ion radiotherapy (CIRT) at the National Institute of Radiological Sciences. Acute radiation toxicity was the primary endpoint of this dose-escalation study and the late toxicity, local control, and overall survival were additionally evaluated as secondary endpoints. Of the 21 subjects enrolled, all patients were followed for more than 6 months and analyzed.
  
  
  RESULTS
  The radiation dose was increased from the initial dose of 48.0Gy equivalents (GyE)/12 fractions at 10% increments up to 52.8GyE. Of the 21 patients, five received a total dose of 48.0GyE, and 16 received a total dose of 52.8GyE. No patient developed grade 3 or higher skin toxicity. As late ocular/visual toxicity, three patients had grade 3 retinopathy and seven patients lost their vision. Among the 10 patients treated until May 2005, five patients had local recurrence, three of whom had marginal recurrence. Therefore, the margin for the CTV (clinical target volume) was set to a range according to the orbital exenteration since June 2005. After the application of the extended margin, no local recurrence has been observed. The three-year overall survival and local control rates were 82.2% and 79.0%, respectively.
  
  
  CONCLUSIONS
  CIRT can be applied for primary epithelial carcinoma of the lacrimal gland, with a borderline acceptable morbidity and sufficient antitumor effect when an extended margin is adopted.
authors: Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan; Department of Radiation Oncology, Kanagawa Cancer Center, Japan.
authors: Nobutaka
authors: N
authors: Mizoguchi
authors: Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
authors: Hiroshi
authors: H
authors: Tsuji
authors: Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
authors: Shingo
authors: S
authors: Toyama
authors: Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
authors: Tadashi
authors: T
authors: Kamada
authors: Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
authors: Hirohiko
authors: H
authors: Tsujii
authors: Department of Radiation Oncology, Kanagawa Cancer Center, Japan.
authors: Yuko
authors: Y
authors: Nakayama
authors: Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Mizota
authors: Department of Ophthalmology, Wakayama Medical University, Japan.
authors: Yoshitaka
authors: Y
authors: Ohnishi
mesh_terms: D005134:Eye Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D063193:Heavy Ion Radiotherapy / Q000009:adverse effects; D006801:Humans; D007765:Lacrimal Apparatus / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries; D011879:Radiotherapy Dosage
keywords: Carbon ion radiotherapy; Carcinoma of the lacrimal gland; Charged particle therapy