ABSTRACT
Objective:To explore the potential of dosiomics in predicting the incidence of radiation pneumonitis by extracting dosiomic features of definitive radiotherapy for lung cancer, and building a machine learning model.Methods:The clinical data, dose files of radiotherapy, planning CT and follow-up CT of 314 patients with lung cancer undergoing definitive radiotherapy were collected retrospectively. According to the clinical data and follow-up CT, the radiation pneumonia was graded, and the dosiomic features of the whole lung were extracted to establish a machine learning model. Dosiomic features associated with radiation pneumonia by LASSO-LR with 1000 bootstrap and AIC backward method with 1000 bootstraps were selected. Training cohort and validation cohort were randomly divided on the basis of 7:3.Logistic regression was used to establish the prediction model, and ROC curve and calibration curve were adopted to evaluate the performance of the model.Results:A total of 120 dosiomic features were extracted. After LASSO-LR dimensionality reduction, 12 features were selected into the "feature pool".After AIC, 6 dosiomic features were finally selected for model construction. The AUC of training cohort was 0.77(95% CI: 0.65 to 0.87), and the AUC of validation cohort was 0.72 (95% CI: 0.64 to 0.81). Conclusion:The dosiomics prediction model has the potential to predict the incidence of radiation pneumonia, but it still needs to include multicenter data and prospective data.
ABSTRACT
As the development of radiotherapy, the plan making that depends on CT image information and staff skills limits its further development. Whereas virtual reality (VR) based on computer technology is a simulation system for human-machine interaction in 3D environment. VR can provide 3D information on the radiotherapy environment, patient anatomy, isodose distribution, etc. VR has been used to guide patient positioning, automatic collision detection of non-coplanar treatment plans, holographic imaging system to optimize radiotherapy plans, teaching and training, and patient publicity and education. The purpose is to improve the quality of radiotherapy on a safe and effective basis, and provide practical tools for radiotherapy technical training, teaching and publicity education.
ABSTRACT
Objective:To identify the radiomics features related to the occurrence of radiation pneumonitis based on localized CT images of the chest in lung cancer patients, establish a machine learning model and investigate the value of radiomics technology in predicting the incidence of radiation pneumonitis.Methods:Clinical data of 86 patients with stage Ⅲ non-small cell lung cancer who received radical intensity-modulated radiation therapy (IMRT) were retrospectively analyzed. The radiation pneumonitis was graded by follow-up imaging data and clinical information. The planning CT images were collected. The lung was used as the volume of interest for extraction of radiomics features. The radiomics features, clinical and dosimetric parameters associated with the incidence of radiation pneumonitis were analyzed. Using the support vector machine to construct the model, the prediction performance of the model was evaluated by the five-fold verification method.Results:A total of 1029 radiomics features were extracted from CT images and 5 features were selected by ANOVA and LASSO. Two validation sets showed differences between adopting radiomics features alone and incorporating clinical and dosimetric parameters and radiomics features (AUC=0.67 and 0.71, respectively).Conclusions:The radiomics model constructed by planning CT images of lung cancer patients has the potential to predict the occurrence of radiation pneumonitis. Addition of clinical and dosimetric parameters can further improve the prediction performance of the model.
ABSTRACT
Objective To study the occurrence of anxiety in patients with malignant tumor, and in further explore the scientificity and clinical application value of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI) technology in anxiety detection. Methods 1 000 patients with malignant tumor were selected as research objects, the self-rating anxiety scale (SAS) was used to evaluate the anxiety on the first day of admission, the fasting venous blood of patients was taken on the next day morning. The SAS score and SELDI result were compared and analyzed. Results The effective sample number was 988. The SAS score was 56.32± 9.665, there were 454 cases of anxiety, the incidence rate of anxiety was 45.95 %. 470 cases were SELDI test positive, and the incidence rate of anxiety was 47.57 %. SAS was used as the gold standard to judge anxiety, the sensitivity and specificity of SELDI technology were 93.17 % and 91.20 %, the positive predictive value and negative predictive value were 90.00 % and 94.02 %, the total coincidence rate was 92.11 %. SAS score highly correlated with the abundance of SELDI, the fitting curve showed an up trend, and the correlation coefficient was 0.837. Conclusions The incidence of malignant tumor patients ' anxiety is relatively high. SELDI technique shows high sensitivity, specificity, total coincidence rate and correlation in anxiety detection, it can be used as an objective evaluation of anxiety.
ABSTRACT
Objective To implement the finite discontinuity?volumetric modulated arc therapy ( FD?VMAT) in the Pinnacle planning system, and to investigate its clinical significance. Methods Eight patients with thoracic esophageal cancer in our hospital were enrolled as subjects. FD?VMAT was fulfilled in the Pinnacle planning system using a developed program. FD?VMAT, VMAT, and fixed?field intensity?modulated radiotherapy ( IMRT ) plans were designed for each patient. The conformity index ( CI ) and homogeneity index ( HI) of the planning target volume ( PTV) ,doses to organs at risk,passing rate for plan verification,number of monitor units,and treatment time were used to evaluate the plans. Comparison between different plans was made by paired t test. Results For the PTV,there was no significant difference in CI between FD?VMAT and VAMT ( P=0?186 );FD?VMAT had a significantly worse HI than VMAT ( P=0?001);however,both the CI and HI were significantly improved in FD?VMAT than in IMRT ( P=0?006, 0?002) . Compared with IMRT, FD?VMAT, retaining the advantage of VMAT, had pulmonary V20 and V30 significantly reduced by 19?79% and 20?32%,respectively (P=0?000,0?000).For the pulmonary low?dose regions (≤V5 ) ,FD?VMAT retained the advantage of IMRT and had lower doses than VMAT. Particularly, pulmonary V2 was significantly reduced by 16?79%(P=0?000).The mean lung dose was significantly lower in FD?VMAT than in VMAT or IMRT (P=0?001,0?000).There were no significant differences in D1cc to spinal cord PRV,heart V30,or passing rate for plan verification between the three therapies. The heart V40 and mean heart dose in FD?VMAT were similar to those in VMAT (P=0?175,0?468),but significantly lower than those in IMRT ( P=0?021,0?002) . FD?VMAT had a larger number of monitor units and longer treatment time than VMAT. Compared with IMRT, the number of monitor units and treatment time were reduced by 13?6% and 49?6% in FD?VMAT,respectively. Conclusions Compared with VMAT and IMRT, the application of the developed FD?VMAT in the treatment of thoracic esophageal cancer can further reduce the lung dose while keeping the PTV coverage,protection of the heart and spinal cord,and high efficacy. FD?VMAT is a new therapy available for thoracic esophageal cancer.
ABSTRACT
Objective To compare target dosimetric distribution and normal tissue radiation between different static intensity?modulated radiation therapy ( IMRT) plans and volumetric modulated arc therapy ( VMAT) and to identify the best IMRT plan for patients with primary mediastinal B?cell lymphoma ( PMBCL) . Methods A total of 16 patients ( 8 males and 8 females) with early?stage ( Ann?Arbor stageⅠ) PMBCL were enrolled in this study,with doses of 45 Gy for primary gross tumor volume ( PGTV) and 40 Gy for planning target volume (PTV).Four plans were designed for each patient,consisting of static IMRT (5F?IMRT,7F?IMRT,9F?IMRT) and VMAT,and the target dosimetric distribution,normal tissue radiation dose,and efficiency of each plan were evaluated. The difference of dose was analyzed by analysis of variance. Results The mean conformity index ( CI) and homogeneity index ( HI) for PGTV in 5F?,7F?,9F?IMRT and VMAT were 1. 01 and 1. 10, 1. 01 and 1. 10, 1. 01 and 1. 10, and 1. 01 and 1. 11 ( P= 0. 963 and 0. 843) ,respectively,while these two indices for PTV were 1. 04 and 1. 22,1. 03 and 1. 19,1. 03 and 1. 17, and 1. 08 and 1. 14( P=0. 964 and 0. 969) ,respectively. The parameters of volume and dose were similar on normal tissue ( P= 0. 192?1. 000 ) . The treatment time and number of monitor units in 9F?IMRT were significantly higher than those in other static IMRT plans and VMAT ( P=0. 000,0. 000) ,and among these plans,VMAT had the lowest number of monitor units ( 13 345. 0 MU) and the shortest treatment time ( 5. 9 min) . Conclusions The target volume coverage of 7F?and 9F?IMRT is better than that of 5F?IMRT and VMAT.For early?stage PMBCL,VMAT is not superior to IMRT in terms of dosimetry,especially with a larger area of low?dose radiation to the breast,but it is highly efficient in practice.
ABSTRACT
Objective To investigate the incidence of anxiety in patients with breast cancer,and further explore the surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI) technology' s clinical value in the diagnosis of anxiety.Methods 121 breast cancer patients were selected as research objects by using convenience sampling method.Self-rating anxiety scale (SAS) was used to evaluate the anxiety on the first day of admission and SELDI was used on the next day to detect the serum from patients' fasting venous blood sample got in the morning after their consent,then anxiety-related protein fingerprints spectrums were selected.The SAS score and SELDI result were finally compared and analyzed.Results SAS score in 121 patients was 53.45±9.78,anxiety occurred in 63 cases (52.07 ％).Established the diagnostic model between 15 000+H and 16 800+H protein fingerprints abundance ≥5 ％,that was to say,abundance ≥5 ％ was judged as positive,otherwise negative.On this basis,patients can accurately be distinguished between anxious group and non-anxious group.Correct rate (total coincidence rate) was 91.74 ％,specificity and sensitivity respectively were 89.66 ％ (52/58) and 93.65 ％ (59/63),the positive predictive value was 90.77 ％ (59/65),and negative predictive value was 92.86 ％ (52/56).Conclusions Breast cancer patients have a high incidence of anxiety.SELDI technology has showed high sensitivity and specificity in anxiety detecting.As an objective assessment tool,it could have better prospects for clinical use.
ABSTRACT
Objective To evaluate the sensitivity of patient-specific volumetric-modulated arc therapy (VMAT) quality assurance (QA) to minor multileaf collimator (M LC) positioning errors.Methods Systematic multileaf collimator (MLC) positioning errors (+0.5 mm,+ 1 mm and +2 mm) were introduced into the clinical VMAT patient plans with 2 types of MLC positioning errors:systematic MLC gap width errors and systematic MLC shift errors for 6 cases,including 3 cases with prostatic cancer and 3 cases with nasopharyngeal cancer.The planar dose distributions of the original and modified plans were measured using ArcCheck array.The coincidence between the measured results and the calculated results was evaluated using both absolute distance-to-agreement (AD-DTA) analysis with 3％/3 mm and 2％/2 mm criteria.Results The average passing rate of the 6 original VMAT plans was 96.0％ with the ADDTA criteria of 3％/3 mm which was commonly adopted in clinical practice.For the MLC gap width errors of + 1 mm,+2 mm,and-2 mm and the MLC shift errors of 2 mm,the drop levels in average passing rate with the AD-DTA criteria of 3％/3 mm were 8.8％,15.5％,6.1％ and 7.9％,respectively.The + 2 mm MLC positioning errors and + 1 mm MLC gap width errors could be detected by the patient-specific VMAT QA procedure.The AD-DTA criteria of 2％/2 mm was more sensitive compared with the criteria of 3％/3 mm.Conclusions Patient-specific VMAT QA is not sensitive enough to detect the systematic MLC positioning errors within 1 mm.Additional MLC QA is needed to guarantee the accuracy of VMAT delivery.
ABSTRACT
Objective To investigate uncertainty in illness of family members of patients with malignant tumor,to explore the factors that affect uncertainty in illness of family members of patients with malignant tumor,and to provide clinical basis for clinical doctors and nurses implementing effective interventions for their patients.Methods Questionnaires were conduted to investigate uncertainty in illness of family members of patients with malignant tumor and explore the related factors.The measurements included three parts,Chinese version of Mishel uncertainty in illness scale for family member,self-designed questionnaire about family general condition,patients disease information.Results The total score of uncertainty in illness was 82.71±9.93,more than 50 ％ (75 score) of the highest PPUS-FM score.There were statistical significances of uncertainty in illness in education (F =8.06,P ＜ 0.05),family income (F=3.14,P ＜ 0.05),residence place (F =3.99,P ＜ 0.05) and frequency of hospitalization (F =4.85,P ＜ 0.05).Conclusion Family members of patients with malignant tumor have a higher level of uncertainty in illness.Education,family income,residence place and frequency of hospitalization have a certain effect on uncertainty in illness of family members of patients with malignant tumor.
ABSTRACT
Objective A preliminary study on a new discovered proteomic fingerprint correlated with anxiety disorders, which M/Z range from 15000 to 16800. Methods 221 cases of neoplasm patients from April of 2004 to now were divided into anxious group and non-anxious group according to their scores using self-rating anxiety scale (SAS), and all the patients' sera were detected utilizing SELDI-TOF-MS. The data were analyzed with supported softwares. Results Compared the mass spectra of anxious group(n=49) and non-anxious group (n=172), 2 clusters were captured which M/Z range from 15 000 to 15 380 and 15 700 to 16 800 respectively. The coincidence with SAS was 75.51%. The M/Z range from 15 700 to 16 800 was the most frequent, then the second range from 15 000 to 15 380 and 15 700 to 16 800 which was doublet cluster, the least range from 15 000 to 15 380. The same fingerprints were captured in non-anxious group and their intensity was different. Conclusion The M/Z range from 15 000 to 16 800 was protein fingerprint correlated with anxiety disorders.
ABSTRACT
Objective To evaluate Satoh typing for tumor thrombi in the bile duct in patients of hepatocellular carcinoma.Methods A retrospective analysis was made on clinical data of 51 hepatocellular carcinoma patients with tumor thrombi in the bile duct undergoing hepatectomy in Eastern Hepatobiliary Surgery Hospital from Jan 2004 to Dec 2005.The cumulative disease-free survival by the three Satoh types were compared by Kaplain-Meire analysis.and log-rank test.Results There was no operationrelated motality and the postoperative complication rate was 22%(11/5 1).The overall survival rates at 1-and 2-years were respectively 76%(39/51)and 55%(28/51).The overall disease-free survival rates at 1-and 2-years were respectively 53%(27/51)and 22%(11/51).The disease-free survival rates at 1-and 2-years in type Ⅰ patients were respectively 61%(19/31)and 29%(19/31).The disease-free survival rates at 1-and 2-years in type Ⅱ and Ⅲ patients were respectively 35%(7/20)and 10%(2/20).The cumulative disease-free survival rates at 2-years was statistically different between type Ⅰ,type Ⅱ and Ⅲ (v=7.489,P=0.006)).Conclusions Satoh typing of tumor thrombi helps to determine the surgery plan and assess the prognosis of hepatocellular carcinoma with tumor thrombi in the bile duct.
ABSTRACT
This article introduces the definition of quality of Life.How do the quality of life questionnaires apply in the clinical situations.This paper provides an overview of the factors that influence cancer patients quality of life.These research will give inspirations to our nurses and provide some reference for nursing interfere measurement.In order to improve quality of life of cancer patients,the clinical nurses should pay attention to these influencing factors.