Heavy Ion
Cancer Therapy
Gunma-chan

Gunma University, Gunma Prefecture（Information provided by Gunma University）

Cancer :the Leading Cause ofDeath in Japan

Number of deaths per 100,000 (population).
320300280
260Cancer（malignant tumor）

240

Cancer is the leading cause of death in Japan.
Therefore, cancer control is the most important
issue in the ﬁeld of public health. Cancer
therapy in the future should provide a highrate of cure and a low incidence of adverse
effects for the patients.

220200180160Heart disease

140
120
100

Cerebrovascular disease

80

Pneumonia

6040Liver disease2001965 1970

1980

1990

Tuberculosis

2000

2010

2018 year

What are Heavy Ions?
Radiation releases energy while traveling through space or matters in the form of waves or particles.
Radiation composed of particles heavier than electrons is called a particle beam, and radiation
composed of particles heavier than helium is speciﬁcally called a“heavy-ion”beam.
Currently, carbon ion beams are used in heavy ion facilities.

electronnegativepion

protonneutronheliumcarbonneon

siliconargon

X raysGamma rays

General radiation

Heavy Ions

Heavy Ion Therapy
Heavy ions are accelerated to approximately 70% of the speed of light andapplied to patients in order to treat deep-seated cancer within the bodies.
Heavy ion cancer therapy allows the tumors to be treated with
non-invasive procedures such as surgery.
Heavy ion beams(Carbon ion 12C6＋)

Accelerated to about 70%of the speed of light by aspecial accelerator.

X-ray

Carbon ion beam
(Heavy ion beam)

Target (canser)

Damage(%)

Accelerate
NeutronProtonBy making individually customized treatment devices,
the irradiation can be adjusted to the shape and depthof the cancer to be treated.

2Depth from the skin surface(cm)3 Advantages of Heavy Ion Therapy
1 Superior Dose Localization
Heavy ion therapy can severely damage thetumor while minimizing damage to surrounding
tissues. Heavy ion therapy has less toxicity（adverse effects）than conventional radiotherapy.

Carbon ions
BolusCancer

2 Eﬀective Against Cancers

Correction material to adjust thedistribution of the radiation doseto the shape of the cancer

Cancer is irradiatedwithout damaging thesurrounding criticalorgans(ex.spinal cord).

Which are Resistant toConventional Radiations

Heavy ion beams have stronger biological effects
than X-ray. For example, heavy ion therapy ismore effective against tumors such as
osteosarcoma, which are difﬁcult to cure withconventional X-ray radiotherapy.

3 Short Treatment Period

Carbonions
Spinal cord

Bolus

Types of cancers which heavy ion
therapy is expected to be eﬀective.

The treatment Period for heavy-ion radiotherapy
is relatively short（3 weeks on average）.
Compared to conventional X-ray radiotherapy,
which requires 6-7 weeks, the treatment time canbe reduced dramatically.

Brain tumors
Skull-base tumors ◎Head and neck cancer ◎Lung cancer（StageⅠ）◎
Liver cancer ◎Pancreatic cancer ◎Uterine cancer
Rectal cancer ◎Earlier Returnto Daily Life(post-operative recurrence)

Prostate cancer
Bone tumors ◎(especially in pelvis and spine)

Soft tissue tumors ◎◎ Heavy-ion therapy proven eﬀective

Comparison with other therapies
Indications

Surgery

Particle/Radiation Therapy

Chemotherapy

・Localized Cancer (mainly early-stagediseases)

・Localized Cancer(from early-stage toadvanced-stage diseases)

・Systemic cancer (Cancer with metastasis& hematological cancer such as leukemia)
・Used in combination with other therapies
for localized cancer

・Relativly smaller damage to organ function
and morphology.
・Relatively smaller damage to the patient.
・The treatment results for early-stage cancer
in selected sites are equivalent to those ofsurgery.

・Can sometimes prolong patients'lives bysuppressing the progression of cancer.

・The ﬁnancial cost for particle therapy is more
expensive compared to other therapies.
・Adverse eﬀects can occur in organs near thetumors.

・Can cause systemic adverse eﬀects.

Advantage ・Considered more likely to be curative.

Disadvantage

・Relatively large deprivation of organfunction and morphology
・Indication for surgery can be limited due
to location of cancer and conditions ofpatients (age, concomitant diseases, etc)

3

Processes of Heavy Ion Therapy
This ﬂow chart is an example of heavy ion therapy. The processes can differ depending on facilities andindividual disease.

Step0Referral

If a patient is diagnosed with cancer by a primary care physician or in a hospital and found thathe/she is likely to be indicated for heavy ion therapy, the patient should be referred by thephysician to facilities which are offering heavy ion therapy.
out-patient

The patient is checked in detail by his/her history,
physical examination, and other diagnostic tests,
and the treatment method will be discussed. It is
possible that the patient is considered not to beindicated for heavy ion therapy at this time.

About 1 day to 5 weeks

About 1-2 weeks

Diagnosis
Step1 Detailed/ Tests

Step3 Heavy Ion Therapy

After the area to be treated is precisely
positioned using X-ray imaging, andthe patient will be irradiated withheavy ion beams.
The treatment will be once a day, and theirradiation will take about a few minutes. The
total treatment time will be about 20 minutes to
1 hour including the preparation.

The patient will
not feel any painor heat during thetreatment.

The patient will be informed about the therapy indetail (Informed consent will be obtained before thestart of therapy).
for
Step2 Preparation
Heavy Ion Therapy

In-patient or out-patient

In-patient or out-patient

Preparation for Treatment Planning
An immobilization
devices will beprepared in order toachieve accurate
body position for thetreatment. Using theimmobilization
device, CT scan will
be performed fortreatment planning.

Treatment Planning
Using the obtained CT
scan images, the staff
will complete thetreatment planning sucha s d i ﬁ n i n g t r ea t m e n t
area and its dose. The
treatment plan will bediscussed and approvedby multidisciplinary teamstaff in a cancer board.
Based on the shapes of the body and the tumor to
be treated, devices will be custom-made for eachpatient to create a desirable irradiation dose.

4

Step4 Patient Follow-Up

out-patient

The patient will be followed up after
the treatment.
The patient will be followed carefully bycontinuing regular out-patient visits andscheduled tests.

Case Reports of Heavy Ion Therapy
Head and Neck Cancer（Adenoid cystic carcinoma）
Irradiated dose: 64.0Gy（RBE）
Irradiated fractions: 16 fraction
Total treatment duration: 4weeks

Lung cancer
Irradiated dose: 60.0Gy（RBE）
Irradiated fractions: 4 fraction
Total treatment duration: 1weeks
photograph; FDG/PET-CT

photograph; contrast-enhanced MRI

Before the treatment

2 months after the treatment

Rectal cancer（Postoperative local recurrence）
Before the treatment

6 months after the treatment

Pancreatic cancer（Surgery not supported）

Irradiated dose: 73.6Gy（RBE）
Irradiated fractions: 16 fraction
Total treatment duration: 4weeks

photograph; FDG/PET-CT

Irradiated dose: 52.8Gy（RBE） ※chemotherapy combination
Irradiated fractions: 12 fraction
Total treatment duration: 3weeks
photograph; contrast-enhanced MRI

Before the treatment

6 months after the treatment
The drug accumulation toa tumor disappears

Lymph node recurrence of endometrial cancer
Before the treatment

8 months after the treatment

Sacral chordoma（bone tumor）

Irradiated dose: 52.80Gy（RBE）
Irradiated fractions: 12 fraction
Total treatment duration: 3weeks

photograph; FDG/PET-CT

Irradiated dose: 67.2Gy（RBE）
Irradiated fractions: 16 fraction
Total treatment duration: 4weeks
photograph; contrast-enhanced MRI

Before the treatment

3 months after the treatment

Hepatocellular carcinoma

Before the treatment

3 years after the treatmentIrradiated dose: 52.8Gy（RBE）
Irradiated fractions: 4 fraction
Total treatment duration: 1weeks

photograph; contrast-enhanced CT

Tumor becomes
small slowly

Gy（RBE）：
The unit of irradiated dose for heavy ion therapy

Before the treatment

12 months after the treatment

5

Results of Heavy Ion Therapy
Breakdown of a Heavy Ion Therapy ofGunma University（A total of 3,821 cases）
Data From March, 2010 to December, 2019

Cervical cancer（23）After surgery for rectal（Pelvic recurrence）（88）

Lymph node recurrence（118）Child hood（18）Skull base tumor（7）Head and neck（217）pancreaticOverseas（54）Chiba（11）
Ibaraki（27）Kanagawa（41）Tokyo（111）
Niigata（133）（228）

Others（215）

NaganoLung（239）（238）（2,099）（274）（2,337）

（240）

Gunma

Tochigi

Prostate

Bone and soft-tissue tumor

Saitama

Liver（618）（306）

Disease distinction

Address distinction

Change in the number of patients（2010～2019）

700
600
500

448

501
423

400

100
0

650

366

322

266

300
200

574

180
91
2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

Treatment Fees (for Overseas Patients)
The Cost of Heavy Ion Radiotherapy
CostItems6Heavy ion radiotherapy

JPY3,140,000

Medical services other than heavy ion radiotherapy

Variable(depends upon patient requirements)

Equipment depreciation costs

JPY260,000

Administration

JPY850,000

Total

JPY4,250,000+medical service costCurrent Situation of Heavy Ion Therapy Facilities（December,2019）

In the World

Marburg
Heidelberg

Caen

Busan

Wiener Neustadt
Gansu

Seoul

Lanzhou
Shanghai

Pavia

Taipei

Yamagata
Gunma
Chiba
Kanagawa
Osaka
HyogoSaga● In Operation● Under Construction

In JapanGunma University
Heavy Ion MedicalCenter
Yamagata University Hospital
Hyogo Ion Beam Medical Center

SAGA Heavy Ion Medical
Accelerator in Tosu

National Institutes for Quantum andRadiological Science and Technology
National Institute of Radiological Sciences
Kanagawa Cancer Center
Osaka Heavy Ion Therapy Center● In Operation● Under Construction

7

Inside the heavy ion irradiation facility
In order to accelerate heavy ions（carbon ions）up to about 70% of the speed of light and irradiate acancer which is deep inside a body,the facility has the following equipments.

Treatment room:

The patients are irradiated with accelerated
heavy ions in this room. The patients feel nopain during the irradiation.

Ion source:

Carbon ions are extracted from methane gas.

For information:
Gunma University Heavy Ion Medical Center

Address : 3-39-22, Showa-machi, Maebashi, Gunma,371-8511 JAPAN+81 27-220-7891 (Japanese Language only）+81 27-220-7720

Webpage https://heavy-ion.showa.gunma-u.ac.jp/en/

Synchrotron:

The carbon ions which are sent from thelinear accelerator are accelerated up to 70%of the speed of light while circulating in thesynchrotron.

Linear Accelerator:

The linear accelerator provides preliminary
acceleration to the carbon ions before they
are sent into the synchrotron.

Gunma Prefecture Department of Health andWelfare Medical Management Division
Address : 1-1-1, Ote-machi, Maebashi, Gunma,
371-8570 JAPAN+81 27-226-2535+81 27-223-0531

imuka@pref.gunma.lg.jp

For overseas patients:
Please make a contact with the company of Medical coordinates which makes a contract withCHMC Check the list on Website.
Webpage https://heavy-ion.showa.gunma-u.ac.jp/en/page.php?id=31
Issued March 2020