case_images: PMC11830115_01
case_images: Target delineation of total lung carbon ion radiotherapy (CIRT) of Case 1 presented in coronal CT images with the lung window.. Because the lesions were spread three-dimensionally, not all the 16 targets are visible in the figures. The targets of the left lung (upper panel) and right lung (lower panel) are shown separately. Red: gross target volume (GTV); blue: planning target volume (PTV).
case_images: cureus-0017-00000079069-i01.jpg
case_images: PMC11830115_02_cureus-0017-00000079069-i01.jpg
case_images: FIG1
case_images: The targets of Case 1 are shown in Figure 1, and the isodose distributions of Cases 1 and 2 are shown in Figure 2.
case_images: PMC11830115_02
case_images: Target delineation of total lung carbon ion radiotherapy (CIRT) of Case 1 presented in coronal CT images with the lung window.. Because the lesions were spread three-dimensionally, not all the 16 targets are visible in the figures. The targets of the left lung (upper panel) and right lung (lower panel) are shown separately. Red: gross target volume (GTV); blue: planning target volume (PTV).
case_images: cureus-0017-00000079069-i01.jpg
case_images: PMC11830115_02_cureus-0017-00000079069-i01.jpg
case_images: FIG1
case_images: The targets of Case 1 are shown in Figure 1, and the isodose distributions of Cases 1 and 2 are shown in Figure 2.
case_images: The dose distribution of carbon ion radiotherapy (CIRT) with a single dose of 50 Gy(RBE). The upper panel shows the dose distribution of Case 1, who had CIRT to bilateral lung lesions, showing a sharp dose fall-off. The V30, V20, V10, and V5 of total lung were 3.57%, 6.06%, 10.7%, and 14.95%, respectively. Because of the design of the treatment planning system, the right and left lung CIRT were planned separately. The lower panel shows the dose distribution of CIRT of Case 2, who had a left lung lesion CIRT, showing a sharp dose fall-off. The V30, V20, V10, and V5 of the total lung were 12.35%, 15.3%, 18.48%, and 21.05%. In an in silico run of photon radiotherapy planning, the V20 was 20% and V5 was 51.7% for total lung volume.. RBE: relative biological effectiveness; V30: volume of the normal lung that receives 30 Gy or more carbon radiation; V20: volume of the normal lung that receives 30 Gy or more carbon radiation; V10: volume of the normal lung that receives 10 Gy or more carbon radiation; V5: volume of the normal lung that receives 5 Gy or more carbon radiation
case_images: cureus-0017-00000079069-i02.jpg
case_images: PMC11830115_02_cureus-0017-00000079069-i02.jpg
case_images: FIG2
case_images: The targets of Case 1 are shown in Figure 1, and the isodose distributions of Cases 1 and 2 are shown in Figure 2.
case_images: CT images of Case 1 before, three months, and one year after carbon ion radiotherapy (CIRT) to the bilateral lung. Figure 3A demonstrates the CT images with lung window before CIRT. Eight lesions of each lung (red circles) were irradiated with a single dose of 50 Gy(RBE) (one small lesion near the heart had 40 Gy(RBE)). Figure 3B shows complete tumor regression three months after CIRT. There were radiopaque lesions along the path of carbon ions, representing radiation pneumonitis. Figure 3C shows linear tracts of lung fibrosis along the carbon ion path and complete regression of irradiated lesions one year post CIRT. By December 2024, 22 months after the initial total lung lesion CIRT, he has had another three CIRT courses for lung, liver, and bone progressions and is alive with good quality of life.. RBE: relative biological effectiveness
case_images: cureus-0017-00000079069-i03.jpg
case_images: PMC11830115_02_cureus-0017-00000079069-i03.jpg
case_images: FIG3
case_images: A CT of the chest showed a complete response three and 12 months after CIRT (Figure 3).
case_images: CT images of Case 2 before and after carbon ion radiotherapy (CIRT). Figure 4A demonstrates the CT images with the lung window before CIRT. A total of 15 lesions of the left lung were irradiated (blue circle) with a single dose of 50 Gy(RBE). The lesions of the right lung were not irradiated due to the concern of overdosing the normal lung. Figure 4B shows the partial tumor response (blue circle) of the irradiated lesions three months after CIRT. The unirradiated right lung lesions (red circle) also show a significant size reduction, demonstrating a possible abscopal effect (the patient started oral capecitabine two weeks after CIRT). There were no signs of radiation pneumonitis. Figure 4C reveals continuing tumor control at the irradiated left lung nine months after CIRT, but a few unirradiated lesions at the right lung become larger. By December 2024, 22 months after CIRT, he has had disease progression at the primary colon and right lung with elevated CEA and no cancer treatment. There is no radiation pneumonitis or lung fibrosis. He is under hospice care presently.. RBE: relative biological effectiveness; CEA: carcinoembryonic antigen
case_images: cureus-0017-00000079069-i04.jpg
case_images: PMC11830115_02_cureus-0017-00000079069-i04.jpg
case_images: FIG4
case_images: The unirradiated right lung lesions also showed a significant reduction in size (Figure 4).