Division of Radiation Oncology
　 Our Division has three linear accelerators, one high dose rate brachytherapy machine, one hyperthermia apparatus, one CT-simulator and 5 radiotherapy treatment planning computers. There are 5 full time equivalent (FTE) Radiation Oncologists（RO）,two part-time ROs, one part-time physicist, 11 FTE therapists and a nurse.
　 We have more than 900 new patients yearly for these two years and still more patients are expected to come this year.
　 The main concept of our Division is “to concentrate radiation dose to the tumor selectively”.Our motto is “to treat patients gently, to heal the lesions clearly, and to control the tumor surely”.
　 We are able to give a variety of special treatments; not only conventional ones, such as, chemoradiotherapy, intraoperative radiotherapy, brachytherapy, hyperfractionated radiotherapy, hyperthermia, but also newly developed ones, such as, 3-dimensional conformal radiotherapy, stereotactic radiosurgery, stereotactic body radiotherapy, etc. We can give the patients the best option from the broad treatment options. Our broadness of the treatment options might be one of the best in our country, and perhaps also in the world.
Of course we are doing ordinal treatments such as postoperative irradiation following breast conservation surgery, and certain postoperative, definitive, and palliative treatment as well.
　 Typical special treatments are as follows,

1)Stereotactic Body radiotherapy (SBRT) and 3-dimensional conformal radiotherapy (3DCRT) for solitary lung tumors
Recent publications reported the promising results of SBRT for small lung tumors. In our hospital we began these two kinds of highly conformal technique since 1999. As for SBRT we treat 4 times of 12Gy in one week using fixation by stereotactic body frame. The other thechnique, 3DCRT, which was developed by us, treats 25times of 3Gy in 5 weeks (total dose 75Gy). The latter technique is mainly used for those tumors located near certain critical structures such as heart, large vessels, esophagus, etc. which are sensitive to large fraction radiation dose. So far, we have treated about 180 cases. Among them, the 3-year survival rate for stage I non-small cell lung cancer, mostly inoperable, is nearly 80%, which is quite promising.

2)Low dose rate brachytherapy(LDRBT) for localized prostate cancer
From April this year, we began LDRBT for localized prostate cancer using iodine-125 seeds. The present indication for the treatment is only for low risk group (AJCC Stage ? T2b and GS ? 6 and PSA ? 10ng/ml). (Contact information: Dr Mitsuru Shinohara, Director of Urology Department)

3)Radiotherapy combined with arterial infusion chemotherapy (AIChT)
For certain localized tumors AIChT has a rationale to enhance the therapeutic ratio. In our hospital, under the good collaboration of highly experienced Diagnostic (Interventional) Radiologists, we give concurrent chemoradiotherapy for lung cancer, bladder cancer, and advanced head and neck cancer. Results so far have been very promising.

4)Hyperfractionated radiation therapy (HFRT) w/o chemotherapy (ChT) forhead and neck cancers
We treat head and neck cancers under the following protocolsT1-2N0M0:HFRT for 66 to 72Gy in 1.2Gy fractions b.i.d.T4 and/or N3: Neoadjuvant AIChT followed by concurrent HFRT+ChT up to 72-79.2Gy in 1.2Gy fractions b.i.dOthers: Neoadjuvant systemic ChT followed by concurrent HFRT+ChT up to 72-79.2Gy in 1.2Gy fractions b.i.dOur results of laryngeal preservation rate for laryngeal and hypopharyngeal patients have been promising (nearly 100% for T1-T2).

5)Intraoperative Radiation Therapy (IORT) for pancreatic cancers and spinal metastases
Our hospital is one of the major IORT in Japan. Total number of patients treated will reach 1000 within one year. We mainly treat pancreatic cancers and spinal metastases. Pancreatic cancer carries dismal prognosis and because of the high radiosensitivity of surrounded critical organs sufficient radiation dose is difficult to deliver by external beam (EBRT) alone. Therefore, we add IORT to EBRT to enhance the local control rate. Recently with the addition of AIChT the prognosis of pancreatic cancer patients has been improving.The other disease for which we use IORT is metastatic spinal tumors. Following laminectomy, we put the lead shield above the spinal cord and irradiate the spine. We developed this technique 14 years ago and so far nearly 300 cases have been treated. The pain control rate, neurological function recovery rate and local control rate so far have been excellent.

6)Radioactive Iodine treatment for thyroid disease
Thyroid is the only organ that takes in iodines actively. Therefore, radioactive iodines have been used for various thyroid diseases. Well-differentiated thyroid cancer may have the same nature and accumulate radioactive iodines and be treated by radiation radiated from the iodines. Our indications for this treatment are following ATA guidelines: Postoperative treatment of locally advanced cancer, postoperative treatment of locally recurrent cancer, and treatment of metastatic disease (lung, bone, etc.)We also treat Basedow disease.

7)Hyperthermia for soft tissue sarcoma (STS) and malignant pleural mesothelioma (MPM)
We are still using hyperthermic treatment for STS and MPM. Both diseases are radioresistant, chemoresistant, and mostly unresectable. As for unresectable cases, no single standard treatment, if any, gives satisfactory survival or local control results. On the other hand, STS and MPM are expected to be thermosensitive. Combined with radiotherapy, we sometimes experience CR cases for STS. For MPM we developed intrathoracic thermochemoradiotherapy and the MST for these patients has been satisfactory.