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Objective@#To verify the safety and efficacy of IONTRIS particle therapy system (IONTRIS) in clinical implementation.@*Methods@#Between 6.2014 and 8.2014, a total of 35 patients were enrolled into this trial: 31 males and 4 females with a median age of 69 yrs (range 39-80). Ten patients had locally recurrent head and neck tumors after surgery, 4 cases with thoracic malignancies, 1 case with hepatocellular carcinoma, 1 case with retroperitoneal sarcoma, and 19 cases with non-metastatic prostate carcinomas. Phantom dose verification was mandatory for each field before the start of radiation.@*Results@#Twenty-two patients received carbon ion and 13 had proton irradiation. With a median follow-up time of 1 year, all patients were alive. Among the 16 patients with head and neck, thoracic, and abdominal/pelvic tumors, 2, 1, 12, and 1 cases developed complete response, partial response, stable disease, or disease progression, respectively. Progression-free survival rate was 93.8% (15/16). Among the 19 patients with prostate cancer, biological-recurrence free survival was 100%. Particle therapy was well tolerated in all 35 patients. Twenty-five patients (71.4%) experienced 33 grade 1 acute adverse effects, which subsided at 1 year follow-up. Six (17.1%) patients developed grade 1 late adverse effects. No significant change in ECOG or body weight was observed.@*Conclusions@#IONTRIS is safe and effective for clinical use. However, long term follow-up is needed to observe the late toxicity and long term result.
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Objective To analyze the setup errors by cone-beam computed tomography (CBCT) for breast cancer patients who were immobilized with neck and breast thermoplastic mask and received intensity modulated radiation therapy (IMRT), and to calculate the external margins from the clinical target volume (CTV) to the planning target volume (PTV) (MPTV) of tumors. Methods Twenty-five breast cancer patients who were immobilized with neck and breast thermoplastic mask and received IMRT in the Oncology Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from November 2016 to June 2017 were enrolled. The position of the patients were verified by CBCT before treatment . The linear and rotation errors of the X, Y and Z axes were analyzed by online bone registration. The systematic errors (Σ) and random errors (σ) of the patients were also calculated, and then the margins from CTV to PTV margins were calculated based on MPTV=2.5Σ+0.7σ. 25 patients'height, weight, body mass index (BMI) and the maximum diameters of CTV in the lateral, longitudinal and vertical directions were recorded, and the relation between the setup errors and the above mentioned was analyzed by using Spearman method. Results A total of 174 CBCT scans for 25 breast cancer patients were completed. The group Σ were 1.40 mm, 1.50 mm and 1.20 mm, and rotation errors were 0.9°, 0.7° and 0.8° at the X, Y and Z axes, respectively. The group σ were 2.20 mm, 3.00 mm and 1.40 mm, and rotation errors were 0.7°, 0.6° and 0.7° at the X, Y and Z axes, respectively. MPTVwas recommended as 4.90 mm, 6.00 mm and 3.90 mm at the X, Y and Z axes, respectively. There was no correlation between the height, weight, BMI of the patients and the setup errors (all P ＞ 0.05). However, there was a significant correlation between the maximum lateral, longitudinal diameters of the CTV and the setup errors (rs= 0.406, P= 0.044; rs= 0.512, P= 0.009). Conclusions The neck and breast thermoplastic mask can improve the diagnostic accuracy of radiotherapy in breast cancer patients. The data of setup errors verified by CBCT can provide meaningful references for the setting of MPTV.
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Objective To compare the application values and setup errors between vacuum bag plus body mask and customized alpha cradle duringproton and carbon therapy using Siemens 6D robotic couch in prostate cancer patients.Methods Nineteen patients received vacuum bag plus body mask setup were allocated into the vacuum bag group andl9 patients with alpha cradle were assigned into the alpha cradle group.Orthogonal X-ray portals were performed to verify the treatment position before beam delivery in every fraction.The couch correction between the portal and reference DRR through manual image registration was recorded as setup errors in 6 directions including the lateral,supine-inferior,anterior-posterior,yaws,roll and pitch,respectively.Two-tail t-test was used to analyze the setup error data from each direction between two groups.Results In total,452 and 436 sets of data errors were collected from the vacuum bag and alpha cradle groups.The average setup errors and standard deviation in the vacuum bag and alpha cradle groups in the lateral,supine-inferior,anterior-posterior,yaws,roll and pitch directions were (0.63±0.48) cm vs.(0.33±0.24) cm (P=0.000),(0.40±0.3) cm vs.(0.31±0.25) cm (P=0.000),(0.69±0.61) cm vs.(0.82±0.69) cm (P=0.006),0.65°±0.47°vs 0.32°±0.25°(P=0.000),1.05°±0.95°vs 1.16°±0.94° (P=0.100) and 0.67°±0.56°vs 0.40°±0.36° (P=0.000),respectively.The maximum setup errors were detected in the pitch direction for both groups.Conclusions During the proton and carbon therapy using Siemens 6D robotic couch,two setup methods using vacuum bag plus body mask and customized alpha cradle should be selected according to the individual conditions of patients.A customized foot fixer should be utilized to reduce the uncertainty in the femoral head region.
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Nanotechnology has been extensively applied in the diagnosis and treatment of cancer, and is currently a major focus of research worldwide.Among the various nanomaterials, gold nanoparticles (GNPs) are of particular interest to many researchers due to their superior properties of low cytotoxicity, good biocompatibility, and preferential accumulation in tumors (the enhanced permeability and retention effect), which in turn gives GNPs a potential application in cancer diagnostics, imaging, photothermal therapy, and radiotherapy.Many published studies have shown that GNPs can be used as a new ideal radiosensitizer, and therefore understanding the radiosensitizing effects of GNPs both in vitro and in vivo will be of great significance in the clinical translation of nanomedicine.
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Objective To evaluate the accuracy of the patient positioning in prostate cancer therapy with the kilo-volt X-ray imaging system. Methods From June to August in 2014,14 patients with prostate cancer were treated by carbon ion beam with the Siemens proton and carbon ion equipment. X-ray orthogonal images was made twice by the imaging system before treatment. All the images were fused with the planning digitally reconstructed radiograph ones by automatic and manual method. We got positioning error data in six directions:lateral, longitudinal, vertical, isocentre, roll and pitch. The data were analyzed to study the situation. Results A total of 644 pairs of images from 14 patients were obtained during treatment. The average error in six directions is 0. 34 cm,0. 30 cm,0. 79 cm,0. 3°,1. 1° and 0. 5°.The patients′positioning error had no obvious change in all directions with fractions. There was no significant deviation between the two groups of images,either. But error in pitch and vertical direction is much larger. Conclusions The bony landmarks of the orthogonal filed images are clear. Photography lasts short time by the imaging system. DRR images are 3D and we can get images in six directions,but the development of soft tissue is weak. Positioning error we get cannot be match with the one of actual situation.
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The cancer stem cell theory suggests that cancer develops from a subset of tumor cells that possess characteristics of stem cells. Breast cancer stem cells comprise a sub-population, which possesses the capacity of self-renewal and the potential for differentiation and high tumorigenicity. Evidence from bothin vitro andin vivo studies demonstrates breast cancer stem cells are responsible for tumor relapse, invasion and metastasis, chemo- and radio-resistance and epithelial-mesenchymal transition (EMT). Herein, this review highlighted the recent advances in breast cancer stem cells.
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Radiotherapy is one of the main means of local treatment of breast cancer. Triple negative breast cancer (TNBC) as a molecular subtypes of breast cancer, its biological behavior is special and existing multiple molecular targets, these molecular targets inlfuence the response of ionization radiation through different mechanisms and regulate radiotherapy sensitivity of TNBC This article reviewed the recent advances in radiotherapy and radiosensitivity related molecular targets of TNBC.
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Breast cancer is the most common disease in women worldwide, which not only threatened the women’s survival time, but also inlfuenced their quality of life as well. Within this challenge, it’s important to optimize the current multidisciplinary treatment stratagem for breast cancer. Radiotherapy is one of the most important treatment modality for patients with breast cancer, with the trend to shrink the irradiated volume and shorten the total fraction times in recent years. Intraoperative radiation therapy (IORT) as a fast and convenient procedure has the ability to deliver a high, single-fraction radiation dose to tumor beds with minimal exposure of surrounding tissues (lung, heart, etc.), which could be displaced or shielded right after the tumor removal during the surgical procedure. Right now, IORT has been either integrated as a boost technique in multimodal approaches using postoperative EBRT in the treatment of early breast cancer patients undergoing breast conservation surgery or used as a single dose accelerated partial breast irradiation technique for these patients. This review discussed the rationale of IORT, the beneifts and limitations of IORT, the indication and the clinical results of this procedure, including treatment related side-effects as well in order to provide the preliminary evidence based approach for early breast cancer patients.
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BACKGROUND: Bone cementoplasty can elevate the life quality of patients by instant alleviating pain and stable fracture. However, the effects of bone cementoplasty should be further analyzed due to it is lack of long-term follow-up and clinical practices.OBJECTIVE: To retrospectively analyze the therapeutic effect of bone cementoplasty accompanied by radiotherapy for malignant tumor patients with bone metastaese.METHODS: Totally 60 malignant tumor patients with bone metastaese treated in Shanghai Sixth Peoples' Hospital from September 2006 to February 2009 were randomly divided into 2 group, with 30 cases in each group. In the radiotherapy group, patients were exposed to 6 MV X-ray, 2 Gy once, 5 times per week, for 4 successive weeks. In the combination group, patients were underwent bone cementoplasty accompanied by radiotherapy. The combination of verbal rating scale (VRS) and visual analogue scale (VAS) were used to assess bone pain. The onset times of two groups were compared. RESULTS AND CONCLUSION: The scores of bone pain were similar between before and after treatment (P > 0.05). Compared with the radiotherapy group, the bone pain of combination group was significantly relieved after treatment (P<0.05). There were 13 patients were ineffective to treatment in the radiotherapy group, which was 8 patients in the combination group. In addition, the onset time of radiotherapy group was later than that of the combination group. In the 10-month follow-up, 25 patients in the radiotherapy group and 21 patients in the combination group were dead. The survival patients of combination group were greater that those of radiotherapy group. No evidence showed that the death was correlated to bone cement, namely, bone cementoplasty accompanied by radiotherapy can be more effective in the treatment of bone metastases than simple radiotherapy,and it might be the first choice in clinical practice.Huang YF, Fu S, Wu CG.Bone cementoplasty accompanied by radiotherapy for malignant tumor patients with bone metastaese:
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Objective:To analyze and compare the results and precision of three different methods to measure the surface dose of Intra-operative radiotherapy,and conclude some experience of clinical application in Intra- operative radiotherapy.Methods:The study compared the results of measurement surface dose in phantom through three ways:cylindrical ionization chamber with 3D water scanner,plane-parallel ionization chamber,and MOSFET detector.Results:the measurement results of plane-parallel-chamber and MOSFET detector have a better consistency,and the maximum deviation is -1.13%.The method with cylindrical ionization chamber and 3D water scanner has larger deviation compare to the other two methods,the deviation range from-5.55%to 4.55%.Conclusion:The methods of plane-parallel chamber and MOSFET detector to measure the surface dose of Intra-operative radiotherapy can obtain accurate results.
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Objective To explore an effective method for preventing and treating oral mucosal complications of radiotherapy for head and neck cancer. Methods Fifty head and neck cancer patients who were receiving radiotherapy were enrolled between March, 2008 and March, 2010. These patients were randomly assigned to the treatment group and the control group. During the radiotherapy, patients in the treatment group were given IL-11 in the form of atomization inhalation,whereas patients in the control group were not. Results IL-1 1 was well tolerated by the patients. It significantly decreased the level of oral mucosal complications and pains and improved patients' appetites ( P < 0.05 ). In addition, the duration of pain was significantly ( P <0.05 ) reduced from 4.5 ± 1.3 days ( in control group) to 2.3 ± 1.0 ( in treatment group), and the healing period was also significantly ( P < 0.05) reduced from 7.3 ± 1.5 days ( in control group) to 4.1 ± 1.7 ( in treatment group). Conclusion IL-11 is effective in preventing and treating oral mucosal complications of radiotherapy for head and neck cancer,relieving associated pains, and therefore improving patients' quality of life.
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The application of KV, MV real-time digital images and 3D reconstructed radiography in quality assurance of radiotherapy, provides effective means to verify the beam center and therapeutic range, calibrate the positioning accuracy and inspect the characteristics of radiotherapy equipment and radiation physics, greatly improves the quality and accuracy of radiotherapy.
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Quality Assurance, Health Care , Methods , Radiographic Image Enhancement , Radiotherapy , MethodsABSTRACT
The strategies and methods of the total quality management (TQM) need to applied in quality management of radiation therapy. We should improve the level of quality control and quality assurance in radiation therapy. By establishing quality control system in radiation therapy, standardization of radiation therapy workflow, strengthening quality control of devices and physical technique and paying attention to safety protection and staff training.
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Quality Assurance, Health Care , Quality Control , Radiotherapy , Total Quality ManagementABSTRACT
The similarity and difference between stationary and mobile electronic linear accelerators in intra-operative radiation therapy are introduced. The contents and methods of quality assurance for stationary and mobile electronic linear accelerators and the key points to deliver intra-operative radiation therapy are described.
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Canine distemper virus (CDV) neutralizing antibody (NT) titer was examined against the sera from 7 giant pandas aged between 8 to 21 years housed at Chengdu Research Base of Giant Panda Breeding,China.Anti-CDV NT titer against the Onderstepoort strain showed a wide range from × 2 to×256 (median=16),even though the ani-mals had been receiving an attenuated live vaccine made from an anonymous domestic CDV strain twice a year since 2003.A single administration of attenuated morbillivirus antigen often be enough to give corresponding host a steady immunogenicity.Anti-CDV-NT variation in the giant panda suggests some deficiency in the relationship between the vaccine and the host.
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Objective To study the effect of a distal protection device (Pereusurge GuardWire: GW) on epicardial blood flow and myocardial perfusion in primary percutaneous coronary intervention. Method Acute STEMI patients treated with primary PCI were eligible to be studied. Inclusion criteria were: (1) within 12 hours from the onset of chest pain;(2) culprit leision with diameter stenosis≥70% and TIMI flow grade≤2. Exclusion criteria were:(1) patients undergoing thrombolytic therapy before PCI; (2) a culprit lesion in the left main coronary artery;(3)reference vessel diameter
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Multiple modality treatment has been adapted for the treatment of various cancers,the outcome has been dramatically improved,but some of unique side effects due to the modalities like chemotherapy combined with radiotherapy have been observed in the clinic. Radiation recall dermatitis(RRD) is one of the side effects. In this paper,the etiology,clinical features,diagnosis,treatment and related factors of the radiation recall dermatitis are discussed.
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Objective To evaluate whether Ly294002,suppressing phosphatidylinositol 3 kinase (PI3K)/AKT survival signaling pathway,can change the sensitivity of breast cancer cells to radiotherapy. Methods Breast cancer cultured MCF7 cells treated with:radiation alone;Ly294002;or the combination of radiation and Ly294002.The inhibition of PI3K/AKT by Ly294002 was confirmed by Western blot.Clo- nogenic assay was used quantitatively to measure the mitotic cell death,and caspase-3 assay was used to e- valuate apoptosis.Results 1.Ly29400 could partially inhibit phosphorylated AKT but not radiation,the combination of both could enhance the inhibition of phosphorylated AKT,2.Timing of exposing cells to Ly294002 had some impact on clonogenic survival by radiation,one hour pre-radiation and 10 days post-ra- diation exposing to Ly294002 could maximally sensitize the cells to irradiation,3.Ly29400 combined with radiation could synergistically enhance mitotic death and apoptosis of MCF7 cells,with SER of SF_4 and D_0, being equal to 1.25 and 1.42.Conclusions PI3K/AKT pathway may be a potential target for enhancing the response of breast cancer cells to radiotherapy.
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Bone is the most common site for metastasis from prostate cancer, and bone metastases also is one of the main causes for the death of the patients with prostate cancer. Since the patients with bone metastases from prostate cancer still have relatively long survival periods after treatmemt, how to properly choose the treatment option for the metastatic patients is imperative in terms of improvements in both quality of life and life expectation. This paper summary pathophysiology, risk evaluation clinical assessment and the current status of the treatment options of prostate cancer with bone metastases, it also lays out the background for the individualized treatment plan that still needs to be further investigated.
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Purpose:To study whether the inhibition of phosphatidylinositol 3-kinase (PI3K)/Akt survival pathway could sensitize the response of tumor cells to some chemotherapyeutic agents. Methods:The different tumor cells has been treated with the combination of isoform specific Akt inhibitor and either adriamycin or camptothecin; the quantitation of the induction of apoptosis by drugs has been estimated with caspase 3 assay; immunoprecipitation western blotting has been used to evaluate the inhibition of the phosphorylation of different isoforms of Akt after the treatment. Results:①The inhibitors could reduce the phosphorylation of Threonine 308 and Serine 473 of isoform specific Akt. ②The inhibition of any one isoform specific Akt could not reverse the resistance of tumor cells tested to chemotherapeutic drugs, but it is not the same case if blocking of two isoforms of both Akt1 and Akt2 was done at the same time. ③The synergistic effects of Akt inhibitors is maybe relative to the level of endogenous PTEN(phosphatase and tensin homolog deleted on chromosome 10) expression. Conclusions:It is required to inhibit two isoforms of both Akt1 and Akt2 in order to maximally sensitize the tumor cells to chemotherapy.