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Objective@#This study aimed to systematically analyze the effect and stability of miniscrew-assisted rapid palatal expansion (MARPE) to provide a reference for the clinical treatment of patients with maxillary transverse deficiency (MTD). @*Methods@#We searched PubMed, Science Direct, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang Database for relevant studies published before February 18, 2021 and selected them according to the eligibility criteria. The Cochrane Handbook for Systematic Reviews (version 5.1.0) criteria were used for the quality assessment of randomized controlled trials, while the scoring protocol of the methodological index for non-randomized studies was used for non-randomized controlled trials. Statistical analysis was performed using the RevMan5.3 software. @*Results@#All the included studies showed a relatively high success rate of expansion. The changes in both the intermolar and alveolar widths after MARPE were statistically significant. MARPE exhibited greater skeletal expansion effects than did conventional RPE. The midpalatal suture was opened in parallel after MARPE. A small amount of relapse was observed 1 year after expansion. MARPE caused tooth inclination and a decrease in alveolar height, but it was less significant than in conventional RPE. @*Conclusions@#MARPE may be an effective treatment modality for patients with MTD. It causes great transverse skeletal expansion in late adolescence. In comparison to conventional RPE, MARPE has lower detrimental periodontal effects and has certain clinical advantages.
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Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.Methods A total of 150 AJCC 7th stage Ⅱ-ⅣB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study.Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure.A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria.The prediction value of two methods for A-ROM was statistically compared.Results The incidence rate of ≥ 3 grade A-ROM was 33.3％.In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P＜0.05).In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs.female:OR=0.141,95％CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95％CI=1.413-18.470,P=0.013).For MSC,gender,smoking,N stage and MSC-V55 were the independent predictors (male vs.female:OR=0.129,95％CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95％CI=1.224-16.164,P=0.023;N stage:OR=2.291,95％CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95％CI=1.008-2.033,P=0.045).The cutoff value of MSC-V55 was 7.70％,the area under ROC curve was 0.754,the sensitivity and specificity were 0.680 and 0.740,retrospectively (all P＜0.001).Conclusions Compared with OCC,MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.
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Objective@#To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.@*Methods@#A total of 150 AJCC 7th stage Ⅱ-IVB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study. Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure. A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria. The prediction value of two methods for A-ROM was statistically compared.@*Results@#The incidence rate of ≥3 grade A-ROM was 33.3%. In univariate analysis, V5, V10, V15, V45, V50, V55, V60, V65 and V70 of OCC and V5, V10, V50, V55, V60, V65, V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P<0.05). In binary logistic regression analysis, gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs. female: OR=0.141, 95%CI=0.037-0.538, P=0.004; smoking vs.non-smoking: OR=5.109, 95%CI=1.413-18.470, P=0.013). For MSC, gender, smoking, N stage and MSC- V55 were the independent predictors (male vs. female: OR=0.129, 95%CI=0.032-0.519, P=0.004; smoking vs.non-smoking: OR=4.448, 95%CI=1.224-16.164, P=0.023; N stage: OR=2.291, 95%CI=1.268-4.137, P=0.006; MSC-V55: OR=1.432, 95%CI=1.008-2.033, P=0.045). The cutoff value of MSC-V55 was 7.70%, the area under ROC curve was 0.754, the sensitivity and specificity were 0.680 and 0.740, retrospectively (all P<0.001).@*Conclusions@#Compared with OCC, MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.
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Objective To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients.Methods By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT,the overall survival,progression-free survival,cancer-specific survival and adverse effects were determined.Results The median follow-up was 18.4 months.The 1-,2-,and 3-year overall survival rates were 92.2％,92.2％ and 80.6％,respectively.The corresponding cause-specific survivals were 95.7％,95.7％ and 83.7％.The progression-free survivals were 70.2％,54.1％ and 40.6％.The local control rates were 100％,94.4％,and 94.4％.The regional controls were 84.2％,72.1％,and 54.1％;and distant controls were 84.6％,72.4％ and 64.3％,respectively.Twenty patients (66.7％) developed symptoms of grade 1 radiation-related toxicities:dyspnea,chest pain,fatigue,cough,esophagitis,or pneumonia.Among these,5 patients suffered grade ≥ 2 radiation pneumonitis,and one patient experienced grade 4 radiation pneumonitis.Conclusions SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC,imposing tolerable toxicities.
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Objective@#To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients.@*Methods@#By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT, the overall survival, progression-free survival, cancer-specific survival and adverse effects were determined.@*Results@#The median follow-up was 18.4 months. The 1-, 2-, and 3-year overall survival rates were 92.2%, 92.2% and 80.6%, respectively. The corresponding cause-specific survivals were 95.7%, 95.7% and 83.7%. The progression-free survivals were 70.2%, 54.1% and 40.6%. The local control rates were 100%, 94.4%, and 94.4%. The regional controls were 84.2%, 72.1%, and 54.1%; and distant controls were 84.6%, 72.4% and 64.3%, respectively. Twenty patients (66.7%) developed symptoms of grade 1 radiation-related toxicities: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 radiation pneumonitis, and one patient experienced grade 4 radiation pneumonitis.@*Conclusions@#SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities.
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Objective To evaluate the inter-fraction setup error during the treatment with megavoltage computed tomography (MVCT) and provide theoretical basis for clinical target volume-planning target volume (CTV-PTV) margins for nasopharyngeal carcinoma (NPC) patients treated with tomotherapy.Methods Thirty-seven consecutive NPC patients treated with tomotherapy were prospectively enrolled for the study between February 2015 and September 2015.For each patient,one MVCT scan was obtained after conventional positioning,online correction and tomotherapy delivery daily,and the scan was registered to the planning CT to determine inter-fraction setup error.The expanding margin for PTV (MPTV) was calculated with the recipe:MPTV =2.5∑ + 0.76 (∑:systematic error;6:random error).Results The average absolute errors of the inter-fraction were (2.102 ± 0.040 6) mm,(1.490 ± 0.034 8) mm,(1.306 ± 0.335) mm and (1.392 ± 0.038 4) ° in the three dimensions.Gradual increases in both inter-fraction three-dimensional displacement were observed with time and treatment (P ＜ 0.05).The total MPTV ac counting for inter-error were 3.467 5 mm,2.979 5 mm and 2.888 5 mm.Conclusions Tomotherapy irradiation technology personalized MPTV should be adopted for the design of tomotherapy plan.Displacement increased as a function of time.
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Objective To explore the inter-fraction setup errors and affecting factors from data of daily fan-beam megavoltage computed tomography(MVCT). Methods A total of 37consecutive NPC patients treated with tomotherapy were hospitalized during the period of February 2015 to September 2015. For each patient,one MVCT scan was obtained after conventional positioning ,online correction and tomotherapy delivery daily ,and the scans were put into the planning computed tomography to determine inter-fraction setup errors. The MPTV was calculated with the equation:MPTV=2.5∑+0.7σ(∑:systematic error;σ:random error). Results The average absolute errors of the inter-fraction were(2.102 ± 0.0406)mm,(1.490 ± 0.0348)mm,(1.306 ± 0.335)mm and(1.392 ± 0.0384)° at three dimensions. The total MPTV accounting for inter-error was 3.4675 mm,2.9795 mm,and 2.8885 mm. Gradual increases in both inter-fraction three-dimensional displacement were observed with time and treatment(P < 0.05). Univariate analysis revealed that weight loss and retraction of neck lymph nodes were affecting factors of set-up errors. Conclusions 3 mm margins uniformly expended from clinical target volume to planning target volume may not be suitable. The personalized margin should be adopted for the design of IMRT planning. Displacement increases as a treatment course is prolonged.
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Objective To compare the dosimetric differences in heart and lung among three radiotherapy techniques in the treatment of thoracic esophageal cancer. Methods A total of 15 thoracic esophageal cancer patients treated in Zhejiang Cancer Hospital during the period of January 2015 to February 2016 were enrolled in this retrospective dosimetric study. Three radiotherapy treatment plans, including intensity-modulated radiotherapy ( IMRT) , volumetric intensity modulated arc therapy ( VMAT) with Raystation 4. 0v TPS, and tomotherapy (TOMO) plans with TomoTTM v2. 0. 5 TPS were generated for each patient with a prescribed dose of 60 Gy at 2 Gy per fraction. Dosimetric differences in planning target volume ( PTV) , heart, cardiac subunits and lung were compared. Results The mean volumes of PTV, heart and lung were (399 ±355), (671 ±274) and (3907 ±1717)cm3, respectively. Compared with VMAT and IMRT, TOMO reduced the maximum dose of PTV, heart, left atrium and lung ( H=10. 889, 7. 433, 12. 080, 11. 401, P <0. 05). No difference was observed in conformity or homogeneity among these three plans. Conclusions TOMO reduced the maximum dose to PTV, heart, left atrium and lung compared with VMAT and IMRT, However, no difference in conformity and homogeneity was observed. The impact of dosimetric advantage of TOMO needs further verification due to the interaction between heart and lung for thoracic esophageal cancer patients.
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Objective To assess the variation in patient setup corrections for three different anatomic treat-ment sites using daily pretreatment megavoltage CT(MVCT)in helical tomotherapy,and to analyze alternative refer-ence margins for specific tumor site.Methods Sixty patients treated for three anatomical sites on helical tomotherapy were analyzed.Daily MVCT was carried out for registration and setup corrections before each treatment fraction.Setup errors and rotational setup corrections from 587 head and neck,500 thoracic,371 abdomen and gynecology MCVT imaging were input to statistical analysis.Incidences of three dimensional vector error lengths were calculated for each anatomic site.Overall distribution histograms of the three -dimensionally error was presented using GraphPad Prism 5.The distributions of systematic and random setup errors were quantitative analyzed and the additional margins required were also taken into account.Results 1 458 MVCT scans were implemented for sixty patients.Head and neck had lower frequencies of translational setup errors than others.Frequency of at least 3mm three -dimensional setup errors for head and neck,thoracic,abdomen and gynecology was 55.3%,70.8%,79.8%,respectively.This fre-quency decreased to 17.5%,40.6%,47.2% if 3D vector distance ≥5mm was scored.Overall systematic errors ranged from -1.4mm to 2.7mm,abdomen and gynecology had the largest setup errors in the vertical direction which was statistically significant(χ2 =19.3,P <0.05).The suggested margins should be increased by 4 -7 mm in three -dimensional direction for head and neck,9 -14mm for thoracic,10 -17mm for abdomen and gynecology.Conclusion Differences in setup corrections are perceived between head and neck,thoracic,abdomen and gynecology.The accura-cy of patient positioning can be improved if pre -treatment daily MVCT scans are put into use.Results from setup cor-rection can provide evidence for tumor treatment margin and improve the accuracy of regular radiotherapy.