Reirradiation presents a significant challenge despite recent advances in modern radiation therapy. Carbon ion radiotherapy has garnered increasing attention among radiation oncologists due to its potentially superior physical dosimetric distribution and radiobiological advantages. This systematic review comprehensively evaluated clinical outcomes from 27 original studies on the use of carbon ion reirradiation for locoregional recurrent malignancies, including those affecting the central nervous system, lung, head and neck, pancreas, liver, rectum, and gynecological sites. The findings suggest that carbon ion reirradiation for locoregional recurrent malignancies yields favorable clinical outcomes with a relatively low incidence of high-grade toxicities. For recurrent nasopharyngeal carcinoma, the reported 2-year overall survival, local control, regional control, and metastasis-free survival rates were 83.7%, 58.0%, 87.3%, and 94.7%, respectively. Grade ≥3 late nasopharyngeal necrosis occurred in 16% (33/206) of cases. In the case of recurrent glioblastoma, median overall survival and local control survival were reported at 13 and 7 months, respectively, with minimal high-grade complications; observed low-grade toxicities included acute involuntary movements, incomplete hemiparesis, and late-onset dysphasia. For recurrent lung cancer, 2-year local control and overall survival rates were reported as 54.0% and 61.9%, respectively. Grade ≥3 toxicities included two cases of radiation pneumonitis and one case of bronchopleural fistula. In recurrent pancreatic cancer, 1-year local control, progression-free survival, and overall survival rates were 53.5%, 24.5%, and 48.7%, respectively. A high-grade complication of Grade 3 acute duodenal stenosis was observed in one patient. Additionally, concurrent chemotherapy with carbon ion reirradiation was associated with minimal high-grade additive toxicities. Overall, carbon ion reirradiation appears to be a potentially safe and effective reirradiation modality for treating locoregional recurrent malignancies, though data remains limited.

Heavy ion radiotherapy is an emerging technology for treating radioresistant solid tumors. Unlike current low-linear energy transfer techniques, heavy ion radiotherapy, such as carbon ion radiotherapy, enhances the biologic effects related to cancer therapy. Prospective clinical evidence has demonstrated feasibility and efficacy in several disease sites, including head and neck, thoracic, central nervous system, gastrointestinal, pelvic tumors, and sarcomas. Although presently unavailable in the Americas, Mayo Clinic is constructing a heavy ion facility in the United States that is planned for clinical operation in 2028.

Carbon Ion Radiation Therapy is operated in several countries because of its advantage to have high dose concentration and/or high linear energy transfer (LET). To estimate the beam performance of Carbon Ion Radiation Therapy, we target the 1% energy and 1 mm2 position resolutions of the beam monitoring system. The beam monitoring system consists of a scintillation crystal and fiber hodoscope. The scintillation crystal is 20 × 20 × 120mm3 and its candidates are LYSO, CsI and BGO. The fiber hodoscope is composed of 1 mm thickness scintillation fibers and the fibers are arranged vertically for 2D reconstruction. With GEANT4 simulation, we verify the performance of our beam monitoring system. The energy response of the LYSO and BGO scintillators is linear within ± 2%. The energy resolution of each crystal candidate achieves the goal; LYSO (0.061%), CsI (0.20%) and BGO (0.10%). The position is reconstructed via fiber hodoscope within 5% uncertainty.

In this editorial, I would like to comment on the article, recently published in the World Journal of Clinical Oncology. The article focuses on non-surgical treatments for locally recurrent rectal cancer, including the watch-and-wait (WW) strategy after total neoadjuvant therapy (TNT) and particle beam therapy. As treatment options for rectal cancer continue to evolve, the high complete response rate achieved with TNT has led to the development of a new non-surgical approach: WW. Chemoradiotherapy followed by consolidation chemotherapy, in particular, has a low rate of tumor growth and is a treatment aimed at achieving a cure without surgery. However, the risk of recurrence within two years is significant, necessitating careful follow-up. Establishing standardized follow-up methods that can be implemented by many physicians is essential. Carbon ion radiotherapy has demonstrated high local control with a low incidence of severe late toxicities, even after previous pelvic radiotherapy. While these new non-surgical curative treatments for rectal cancer require further investigation, future advancements in this field are anticipated.

According to the indexes of serum and anal function, acupuncture therapy was applied to patients with low rectal cancer in order to avoid the occurrence of anal incontinence and reduce complications.

To explore the clinical application and evaluate the effect of acupuncture therapy for anal function rehabilitation after low-tension rectal cancer surgery.

From the anorectal surgery cases, we selected 120 patients who underwent colorectal cancer surgery between January 2020 and December 2022 and randomly divided them into a control group (n = 60), observation group (n = 60), and control group after surgery for lifestyle intervention (including smoking cessation and exercise), dietary factor adjustment, anal movement, and oral loperamide treatment. The serum levels of motilin, 5-hydroxytryptamine, and vasoactive intestinal peptide (VIP), Wexner score for anal incontinence, and incidence of complications were compared between groups.

After treatment, the VIP and 5-hydroxytryptamine levels in the observation group were lower than those in the control group (P < 0.05). The motilin level was higher than that in the control group (P < 0.05). Postoperative anal incontinence was better in the observation group than in the control group (P < 0.05). The incidence of complications in the observation group was 6.67%, which was significantly lower than that in the control group (21.67%; P < 0.05).

Acupuncture therapy has a positive effect on the rehabilitation of anal function after low-tension rectal cancer surgery; it can effectively help to improve the serum indices of patients, avoid the occurrence of anal incontinence, and reduce the incidence of complications. Popularizing and applying it will be valuable.

It is difficult to effectively cure patients with unresectable locally recurrent colorectal cancers (LRCRCs) using conventional chemotherapy or chemoradiation therapy. Furthermore, treatment options vary depending on the patient's history of radiation therapy. Carbon-ion radiation therapy (CIRT) is a potentially curative treatment for these patients. Here, we compare the treatment outcomes of radiation therapy-naïve cases (nRT) and re-irradiation cases (reRT).

Patients with LRCRC treated with CIRT at QST Hospital between 2003 and 2019 were eligible. CIRT was administered daily 4 d/wk for 16 fractions. The total irradiated dose was set at 73.6 Gy (relative biologic effectiveness-weighted dose [RBE]) for nRT and 70.4 Gy (RBE) for reRT patients.

We included 390 nRT cases and 83 reRT cases. The median follow-up period from the initiation of CIRT was 48 (5-208) months. The 3-year overall survival (OS) rates for nRT and reRT were 73% (95% CI, 68%-77%) and 76% (65%-84%), respectively. The 5-year OS rates were 50% (45%-55%) and 50% (38%-61%), respectively. These rates did not differ significantly (P = .55). The 3-year local control (LC) rates for nRT (73.6 Gy) and reRT (70.4 Gy) cases were 80% (75%-84%) and 80% (68%-88%), respectively. The 5-year LC rates were 72% (67%-78%) and 69% (55%-81%), respectively, without a significant difference (P = .56).

Our results suggest that CIRT for LRCRC is a very effective and promising treatment for both nRT and reRT cases.

This study aimed to evaluate the oncological outcomes and safety of carbon ion re-irradiation with pencil beam scanning (PBS) delivery technique for previously irradiated and unresectable locally recurrent rectal cancer (LRRC). Between June 2017 and September 2021, 24 patients of unresectable LRRC with prior pelvic photon radiotherapy who underwent carbon ion re-irradiation at our institute were retrospectively analyzed. Carbon ion radiotherapy was delivered by raster scanning with a median relative biological effectiveness-weighted dose of 72 Gy in 20 fractions. Weekly CT reviews were carried out, and offline adaptive replanning was performed whenever required. The median follow-up duration was 23.8 months (range, 6.2-47.1 months). At the last follow-up, two patients had a local disease progression, and 11 patients developed distant metastases. The 1- and 2-year local control, progression-free survival and overall survival rates were 100 and 93.3%, 70.8 and 45.0% and 86.7 and 81.3%, respectively. There were no Grade 3 or higher acute toxicities observed. Three patients developed Grade 3 late toxicities, one each with gastrointestinal toxicity, skin reaction and pelvic infection. In conclusion, definitive carbon ion re-irradiation with PBS provided superior oncologic results with tolerable toxicities and may be served as a curative treatment strategy in unresectable LRRC.

Despite the extensive implementation of an organized multidisciplinary team (MDT) approach in cancer treatment, there is little evidence regarding the optimal format of MDT. We aimed to investigate the impact of patient participation in MDT care on the actual application rate of metastasis-directed local therapy.

We identified all 1211 patients with locally advanced rectal cancer treated with neoadjuvant radiochemotherapy at a single institution from 2006 to 2018. Practice patterns, tumor burden and OMD state were analyzed in recurrent, metastatic cases.

With a median follow-up of 60.7 months, 281 patients developed metastases, and 96 (34.2%), 92 (32.7%), and 93 (33.1%) patients had 1, 2-5, and >5 lesions, respectively. In our study, 27.1% were managed in the MDT clinic that mandated the participation of at least four to five board-certified multidisciplinary experts and patients in decision-making processes, while the rest were managed through diverse MDT approaches such as conferences, tumor board meetings, and discussions conducted via phone calls or email. Management in MDT clinic was significantly associated with more use of radiotherapy (p = 0.003) and more sessions of local therapy (p < 0.001). At the time of MDT clinic, the number of lesions was 1, 2-5, and >5 in 9 (13.6%), 35 (53.1%), and 19 (28.8%) patients, respectively. The most common states were repeat OMD (28.8%) and de novo OMD (27.3%), followed by oligoprogression (15%) and induced OMD (10.6%).

Our findings suggest that active involvement of patients and radiation oncologists, and surgeons in MDT care has boosted the probability of using local therapies for various types of OMD throughout the course of the disease.

Radiotherapy (RT) plays an important role in the treatment of patients with previously irradiated locally recurrent rectal cancer (LRRC). Over the years, numerous technologies and different types of RT have emerged. The aim of our systematic literature review was to determine whether the new techniques have led to improvements in both outcomes and toxicities.

A computerized search was performed by MEDLINE and the Cochrane database. The studies reported data from patients treated with carbon ion radiotherapy (CIRT), intensity-modulated photon radiotherapy (IMRT), and stereotactic radiotherapy (SBRT).

Seven publications of the 126 titles/abstracts that emerged from our search met the inclusion criteria and presented outcomes of 230 patients. OS was reported with rates of 90.0% and 73.0% at 1 and 2 years, respectively; LC was 89.0% and 71.6% at 1 and 2 years after re-RT, respectively. Toxicity data vary widely, with emphasis on acute and chronic gastrointestinal and urogenital toxicity, even with modern techniques.

data on toxicity and outcomes of re-RT for LRRC with new technologies are promising compared with 3D techniques. Comparative studies are needed to define the best technique, also in relation to the site of recurrence.

No standard treatment paradigm exists for previously irradiated locally recurrent rectal cancer (PILRRC). Carbon-ion radiotherapy (CIRT) may improve oncologic outcomes and reduce toxicity compared with combined modality therapy (CMT). Eighty-five patients treated at Institution A with CIRT alone (70.4 Gy/16 fx) and eighty-six at Institution B with CMT (30 Gy/15 fx chemoradiation, resection, intraoperative electron radiotherapy (IOERT)) between 2006 and 2019 were retrospectively compared. Overall survival (OS), pelvic re-recurrence (PR), distant metastasis (DM), or any disease progression (DP) were analyzed with the Kaplan-Meier model, with outcomes compared using the Cox proportional hazards model. Acute and late toxicities were compared, as was the 2-year cost. The median time to follow-up or death was 6.5 years. Median OS in the CIRT and CMT cohorts were 4.5 and 2.6 years, respectively (p ≤ 0.01). No difference was seen in the cumulative incidence of PR (p = 0.17), DM (p = 0.39), or DP (p = 0.19). Lower acute grade ≥ 2 skin and GI/GU toxicity and lower late grade ≥ 2 GU toxicities were associated with CIRT. Higher 2-year cumulative costs were associated with CMT. Oncologic outcomes were similar for patients treated with CIRT or CMT, although patient morbidity and cost were lower with CIRT, and CIRT was associated with longer OS. Prospective comparative studies are needed.

Standard treatments for gynecological cancers include surgery, chemotherapy, and radiation therapy. However, there are limitations associated with the chemotherapeutic drugs used to treat advanced and recurrent gynecological cancers, and it is difficult to identify additional treatments. Therefore, immune checkpoint inhibitor (ICI) therapy products, including PD-1/PD-L1 inhibitors and CTLA-4 inhibitors, are in the spotlight as alternatives for the treatment of advanced gynecological cancers. Although the ICI monotherapy response rate in gynecological cancers is lower than that in melanoma or non-small cell lung cancer, the response rates are approximately 13-52%, 7-22%, and 4-17% for endometrial, ovarian, and cervical cancers, respectively. Several studies are being conducted to compare the outcomes of combining ICI therapy with chemotherapy, radiation therapy, and antiangiogenesis agents. Therefore, it is critical to determine the mechanism underlying ICI therapy-mediated anti-tumor activity and its application in gynecological cancers. Additionally, understanding the possible immune-related adverse events induced post-immunotherapy, as well as the appropriate management of diagnosis and treatment, are necessary to create a quality environment for immunotherapy in patients with gynecological cancers. Therefore, in this review, we summarize the ICI mechanisms, ICIs applied to gynecological cancers, and appropriate diagnosis and treatment of immune-related side effects to help gynecologists treat gynecological cancers using immunotherapy.