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Objective To compare the setup errors between single-site and two-site image guidance in treating multiple metastases using Tomotherapy.Methods A total of 1 220 sets of megavoltage CT (MVCT) images from 50 multiple metastases patients were collected.The setup errors of two anatomic sites were determined by registration of MVCT images with planning images.Bland-Altman plot analysis was used to assess the coincidence of these two methods.Pearson correlation analysis was performed to evaluate the correlation of the setup errors determined by two sets of data and to analyze the deviation values of setup errors.Results The deviation values of setup errors more than 3 mm between two sites were 34％,46％ and 28％ in lateral (x),longitudinal (y),vertical (z) directions,respectively.The deviation values of setup errors more than 5 mm were 10％,16％ and 8％,respectively.The BlandAltman plot analysis showed that the 95％ agreement limits of agreement were (9.3,-10.6),(10.5,-11.7),(7.3,-6.9) mm in x,y,z directions,respectively,which were all out of 5 mm tolerance.The Pearson coefficient of correlation along all three directions was less than 0.05,and R2 was 0.074,0.475,and 0.178 in x,y,z directions,respectively.Conclusions To determine the setup errors for patients with multiple metastases,single-site image guidance method is not consistent,and the two site image guidance method would be recommended.
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Objective To evaluate the therapeutic effects of three-dimensional conformal radiotherapy(3D-CRT) for malignant tumors.Methods From July 1999 to October 2006,830 patients with malignant tumors received non-coplanarity multifield 3D-CRT by using Leibinger three-dimensional stereotactic conformal radiotherapy machine,Varian 600C/D 6MeV X liner accelerator and multileaf collimator.Single dose was 4-8Gy per fraction,once every two days and total dose was 50-82Gy.Results All 830 cases underwent 3D-CRT.According to the WHO evaluation standard for therapeutic effects,CT results showed that complete response(CR),partial response(PR),no change(NC),and progression(PD) rates were 20.7%(172/830),68.7%(570/830),10.2%(85/830),and 0.3%(3/830),respectively.Overall response rate(CR+PR) was 89.4%(742/830).No patients suffered from serious adverse effects.The incidence of radiation penumonia was 9%.Conclusions For patients with malignant tumors who could not endure operations due to existing contraindications or other conditions,3D-RCT was a relatively effective treatment because the method could deliver an increased therapeutic dose to tumors,enhance survival rate,improve life quality,decrease injuries to adjacent normal tissue,and reduce the incidence of complications.
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Objective To evaluate the therapeutic effects and adverse effects of three-dimensional conformal radiotherapy(3D-CRT) for elderly patients with non-small cell lung cancer(NSCLC).Methods From August 2001 to October 2006,36 patients over 70 years old with NSCLC were treated with 3D-CRT.Leibinger treatment planning system was used for drafting radiotherapy plan,the prescription dose was 40-80Gy(median,60Gy).Twenty-four patients received hypofractionated radiation every two days in 8-12 fractions at a dose of 5-8Gy per fraction;12 patients accepted conventional fractionated radiation with 30-40 fractions during 6 to 7 weeks.With median follow-up time of 11 months(range,5-54 mon.),tumor volume response rate,1-year and 2-year survival rate were investigated,adverse effects of the treatment were also recorded in present research.Results Of the 36 patients,clinical symptoms were improved in 33 cases,while no changes were observed in 3 cases.According to follow-up CT results 2-3 months after radiotherapy,8 patients showed complete response(CR),22 cases with partial response(PR),with the overall tumor response rate of 83.33%(30/36).In this group,1-year and 2-year survival rate was 66.67% and 36.11% with median survival time of 8 months(range,2-53 months).No patients suffered from serious adverse effects.Conclusions 3D-CRT was an effective and safe treatment for elderly patients with NSCLC,which could raise the survival rate and improve the quality of life with little adverse effects.
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Objective To evaluate the short-term therapeutic effects for patients with primary liver cancer using three-dimensional stereotactic conformal radiotherapy(3D-CRT).Methods Twenty-eight patients with primary hepatic cancer were treated with 3D-CRT(the average overall dose was 38Gy,localized by Elscint twin flash slice CT,radiotherapy plan was designed by Leibinger three-dimensional radiotherapy planning system and operated on Varian 600C/D liner accelerator).The average follow-up time was 12 months(5-17mon.).Tumor volume response rate,rate of free from tumor progression and survival rate were analyzed.The adverse effects were studied simultaneously.Results According to follow-up CT results 3 months after radiotherapy,2 cases had full responses with disappearance of the tumors,while partial responses with decreased tumors mass were seen in 22 cases,and no response in 4 cases.Tumor volume response rate was 85.7%.The last follow-up CT results showed that in 5 patients there was tumor progression in planning target volume(PTV),in 10 cases there was intrahepatic progression but not in PTV,and in 4 cases extrahepatic tumor growth.Intrahepatic tumor free rates 6 months and 12 months after radiotherapy were 66.5% and 38.4%,respectively.6-month survival rate after radiotherapy was 88.6%,12-month survival rate was 70.5% after radiotherapy.During 3 months of radiotherapy,manifestations of subacute radiation injuries occurred in six patients:gastrointestinal hemorrhage in 2 cases,jaundice in 3 cases and subacute radiation hepatitis in 1 patient.No survivors suffered from long-term liver injury.Conclusions With little adverse effect,3D-CRT could raise the control rate of the hepatic tumor,and also short-term survival rate.There fore,3D-CRT is a valuable treatment for patients with primary liver cancer.
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Objective To evaluate the efficacy of three-dimensional conformal radiotherapy(3D-CRT) combined with transcatheter hepatic arterial chemoembolization(TACE) for patients with primary liver cancer.Methods From July 2003 to July 2006,followed by transcatheter hepatic arterial chemoembolization(TACE,mitomycin + 5-fluorouracil + pirarubicin) 3 times in 6 weeks,59 patients with primary hepatic cancer received noncoplanarity multifield 3D-CRT by using Leibinger three-dimensional stereotactic conformal radiotherapy planning system,Varian 600C/D 6MeV X liner accelerator and multileaf collimator at a dose of 60-65Gy/9-11 fractions/15-22 days.Results Of 59 patients,58 cases received a complete course of 3D-CRT combined with TACE.CT results showed that the rates of complete response(CR),partial response(PR),no change(NC) and progression(PD) rate were 57.6%(34/59),35.6%(21/59),3.4%(2/59) and 3.4%(2/59),respectively.Overall response rate(CR+PR) was 93.2%(55/59).Jaundice occurred one week after treatment in one patient,who died of acute hepatic function failure.No serious adverse effects or intoxication were found in the remaining 58 patients.Conclusions The combination of 3D-RCT with TACE was an effective treatment for patients with primary hepatic cancer.
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Purpose:To study the efficacy and toxicity of paclitaxel in the treatment of patients with advanced head and neck cancer. Methods:51 patients with stage Ⅲ-Ⅳadvanced head and neck cancer were enrolled, including l9 patients who had no prior chemotherapy, 32 patients who had recurrent head and neck cancer after surgery and/or radiation therapy, and then had become resistant after about two cycles of chemotherapy with fluorouracil plus cisplatin. Three to six cycles of chemotherapy with paclitaxel plus carboplatin or cisplatin were administered: paclitaxel 75-l00mg/m2, qd. d 1?d 8?d 15 plus carboplatin 300-350 mg/m2, qd. d 2 (or cisplatin 20 mg/m2,qd. d 1-5 ), q 4 wk.Results:The total response rate in 51 patents was 19 (37.2%), with 4 (7.8%) complete response, 15 (29.4%) partial respond, l8(35.3%) stable disease and 14 (27.4%) progression. Major toxicities were neutropenia, GI tract reactions and alopecia. One patient had allergic shock and patient died at the beginning of the second cycle of chemotherapy. Conclusions:Paclitaxel is efficient in treating the advanced head and neck cancer. Except for rare cases of allergy, major toxic effects can be tore rated by the patients.
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Objective To evaluate the clinical characteristics,efficacy and toxicity of three dimensional conformal radiotherapy(3D-CRT)for elderly patients suffering from advanced stage of non-small cell lung cancer(NSCLC).Methods From September 1999 to October 2006,with the use of Leibinger planning system,the authors performed 3-dimensional conformal radiotherapy(3D-CRT)for 108 elderly patients suffering from advanced stage of non-small cell lung cancer who had not received operation because of medical contraindications such as cardiac insufficiency,impaired pulmonary function,etc.For the patients with positive lymph metastasis,the primary tumor was treated with high dosages.Conventional radiotherapy was delivered,and the tumor site and draining lymphatic areas received 40~45Gy of radiation,followed by 3D-CRT.Results All patients received whole course of radiotherapy,and the total survival rate for 1,2,3 years was 65%,33% and 28%,respectively.Meanwhile,the radioreaction did not exceed grade 2 in all 108 cases.Conclusions 3-dimensional conformal radiotherapy was relatively an effective treatment for non-small cell lung cancer in elderly patients who could not withstand operations because of medical contraindications or other problems.The treatment was proved to improve total survival rate and life quality,relieve complications such as radiation pneumonia and radiation esophagitis.Therefore,3-dimensional conformal radiotherapy was recommended for elderly patients with advanced stage of lnon-small cell lung cancer.