Table 4.
A summary of recommendations of international experts to the NIRS and current progress.
| Recommendation | Progress |
|---|---|
| Clinical | |
| “Continued research in ultra-short fractionation” | Significant milestones achieved (single fraction NSCLC) and multiple clinical trials in progress |
| “Continued research in combined modalities” | Ongoing work in pancreas, melanoma, uterine, and esophageal cancers |
| “Reduction in size and cost of technology” | Significant milestones achieved (Section 9.4) and more work in progress |
| “Improving patient throughput including use of gantry, immobilization devices” | Patients, including those with moving tumors, are currently being treated in the gantry room |
| “Analyzing incidence of SMN after CIRT” | Ongoing work |
| “Publish studies in peer reviewed journals and provide detailed reporting of methods in studies” | Tens of papers have been published with updated reporting of results and methodology |
| “Increase use of QOL assessment” | QOL studies are in progress [119] |
| “Announce and register clinical trials internationally” | Clinical trials are announced online at www.umin.ac.jp/ctr |
| “Analysis of relations between dose and local recurrence to estimate potential of dose-painting” | Ongoing work |
| “Start scanning beams CIRT for moving targets” | Patients with moving tumors are treated regularly with scanning beams |
| “Use MRI for adaptive therapy for cervical cancer” | MRI is now standard practice for adaptive planning in cervical cancer |
| “Start randomized phase III trials” | CIPHER trial will start accruing soon (Section 9.4) |
| “Start trials on GBM” | No ongoing trials at the NIRS for GBM |
| Radiobiology | |
| “Intensify international collaborations and harmonize reporting of data/methods” | Ongoing work |
| “Achieve international standard for biophysical modeling in treatment planning” | Ongoing work with European teams [54] |
| “Establish dose-dependent RBE especially for hypofractionation” | Ongoing work [48] |
| “Continue work on combinations of CIRT and immunotherapy” | Ongoing preclinical studies |
| Medical physics | |
| “Continue commissioning of moving target irradiation, PCR and tumor tracking gating system” and “continue research on the interplay effect of scanning beams” | Patients with moving tumors are treated regularly using PCR and respiratory gating |
| “Continue work on optimization of multiple energy operations of synchrotrons” | Significant progress achieved [22] |
| “Continue work on gantry commissioning” | Patients, including those with moving tumors, are currently being treated in the gantry room |
Abbreviations: NIRS, National Institute of Radiological Sciences; NSCLC, non-small cell lung cancer; SMN, second malignant neoplasms; CIRT, carbon ion radiotherapy; QOL, quality of life; MRI, magnetic resonance imaging; GBM, Glioblastoma Multiforme; RBE, relative biological effectiveness; PCR, phase-controlled rescanning.