To Persons Wishing to See If the Conditions Are Applicable for Proton Therapy

The Reason Why You Need to Know Applicability Beforehand

Even if your case is one of the diseases listed as “applicable” for proton therapy, it is still possible that your symptoms are considered as “not applicable.” At the SCC, applicability is evaluated before patient’s first visit, which can be hopefully helpful for both the doctor, who refers a patient, and the patient him/herself.

Patient Data Sheet and Applicability Chart (in Japanese only)

Please download Patient Data Sheet (1) and Applicability Chart (2) from below to prepare information required for the evaluation. Bring these two documents to your doctor, ask him/her to fill them out (in Japanese only).

1. Patient Data Sheet for Proton Therapy (for any diseases)

2. Applicability Chart for Proton Therapy
   ･Liver Cell Carcinoma
   ･Prostate Gland Cancer
   ･Musculoskeletal Tumor
   ･Skull Base Tumor

Fax Number and Mailing Address

After your primary doctor completed the forms, please send them to us by fax at the following number.
Patient Referrals, Shizuoka Cancer Center
Fax 055-989-5623
1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka Pref. 411-8777
For inquiry: Tel. 055-989-5646