Radiomics-based prediction of gamma pass rates for different intensity-modulated radiation therapy techniques for pelvic tumors / 中华放射医学与防护杂志

Objective:To explore the feasibility of a classification prediction model for gamma pass rates (GPRs) under different intensity-modulated radiation therapy techniques for pelvic tumors using a radiomics-based machine learning approach, and compare the classification performance of four integrated tree models.Methods:With a retrospective collection of 409 plans using different IMRT techniques, the three-dimensional dose validation results were adopted based on modality measurements, with a GPR criterion of 3%/2 mm and 10% dose threshold. Then prediction were built models by extracting radiomics features based on dose documentation. Four machine learning algorithms were used, namely random forest (RF), adaptive boosting (AdaBoost), extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM). Their classification performance was evaluated by calculating sensitivity, specificity, F1 score, and AUC value. Results:The RF, AdaBoost, XGBoost, and LightGBM models had sensitivities of 0.96, 0.82, 0.93, and 0.89, specificities of 0.38, 0.54, 0.62, and 0.62, F1 scores of 0.86, 0.81, 0.88, and 0.86, and AUC values of 0.81, 0.77, 0.85, and 0.83, respectively. XGBoost model showed the highest sensitivity, specificity, F1 score, and AUC value, outperforming the other three models. Conclusions:To build a GPR classification prediction model using a radiomics-based machine learning approach is feasible for plans using different intensity-modulated radiotherapy techniques for pelvic tumors, providing a basis for future multi-institutional collaborative research on GPR prediction.

Three-dimensional-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of three-dimensional (3D)-printed hemi-pelvic prosthesis for revision of aseptic loosening or screw fracture of modular hemi-pelvic prosthesis.@*METHODS@#Between February 2017 and January 2020, 11 patients with aseptic loosening or screw fracture of modular hemi-pelvic prosthesis were revised using 3D-printed hemi-pelvic prostheses. There were 7 males and 4 females with an average age of 44 years (range, 25-60 years). In the first operation, all patients underwent total tumor resection, modular hemi-pelvic prosthesis reconstruction, and autologous femoral head transplantation. According to the Enneking pelvic partition system, 8 cases were resected in zones Ⅰ+Ⅱ and 3 cases in zones Ⅰ+Ⅱ+Ⅲ. The interval from the initial operation to this revision ranged from 14.3-66.2 months, with an average of 35.8 months. The operation time, the amount of intraoperative bleeding, and the occurrence of complications were recorded. At 6 months after the first operation, before revision, and at last follow-up, the American Musculoskeletal Tumor Society (MSTS) score and Harris score were used to evaluate the recovery of lower limb function. The pain-free walking distance of patients without brace assistance was recorded at last follow-up. X-ray films were taken at 1 month after the first operation, before revision, and at 1 month after revision, the acetabulum position was assessed by the differences in weight arm and cup height between bilateral hip joints. At last follow-up, the digital X-ray tomography was taken to evaluate the prosthesis-bone integration and the occurrence of aseptic loosening.@*RESULTS@#The operation time was 182.6-238.0 minutes (mean, 197.4 minutes). The amount of intraoperative bleeding was 400-860 mL (mean, 550.0 mL). All incisions healed by first intention with no infection, hip dislocation, nerve damage, or vascular-related adverse events. The MSTS score and Harris score at last follow-up were significantly higher than those at 6 months after the first operation and before revision ( P<0.05), while the score before revision was significantly lower than that at 6 months after the first operation ( P<0.05). At last follow-up, the patients were able to walk more than 1 000 meters painlessly without brace assistance. Imaging review showed that the difference of cup height at 1 month after revision was significantly lower than that at 1 month after the first operation and before revision, and at 1 month after the first operation than before revision operation, and the differences were significant ( P<0.05). There was no significant difference in the difference of weight arm among three time points ( P>0.05). All prostheses were well integrated, and no aseptic loosening of the prosthesis or screw fracture occurred.@*CONCLUSION@#Revision with 3D-printed hemi-pelvic prostheses benefited in reconstructing stable pelvic ring and natural bodyweight transmission for patients encountering the aseptic loosening or screw fracture of modular hemi-pelvic prosthesis. Early postoperative rehabilitation training can maximize the recovery of patient limb function, reduce pain during walking, and reduce the incidence of complications.

Fibromatosis mesentérica solitaria. Reporte de caso y revisión de la literatura / Sporadic mesenteric fibromatosis. A case report. Literature review / Fibromatose mesentérica solitária. Relato de caso. Revisão da literatura

Resumen: La fibromatosis mesentérica es un subtipo profundo de tumor desmoide (TD), un tumor benigno de origen fibroblástico localmente agresivo por su tendencia a infiltrar los tejidos adyacentes. Son raros, esporádicos y pueden asociarse con el síndrome de Gardner. El tratamiento de elección es la resección completa, evitando la recurrencia local. Comunicamos el caso clínico de una paciente con fibromatosis intrabdominal mesentérica única, bien circunscripta, que simulaba por la imagenología una masa de origen pelviano.

Summary: Mesenteric fibromatosis is a deep sub-type of desmoid tumors consisting of a benign tumor of fibroblastic origin which is locally aggressive given its tendency to infiltrate adjacent tissues. They are unusual and sporadic, and may be associated to Gardner's Syndrome. Complete resection is the treatment of choice, avoiding local recurrence. The study reports the clinical case of a patient with intra-abdominal sporadic mesenteric fibromatosis, well circumscribed that appeared to be a pelvic mass in MR imaging.

Resumo: A fibromatose mesentérica é um subtipo profundo de tumor desmóide (DT); é um tumor benigno de origem fibroblástica que é localmente agressivo devido à sua tendência a infiltrar tecidos adjacentes. São raros, esporádicos e podem estar associados à síndrome de Gardner. O tratamento de escolha é a ressecção completa, evitando recidiva local. Relatamos o caso clínico de uma paciente com fibromatose mesentérica intra-abdominal única e bem circunscrita que simulava uma massa de origem pélvica na imagem.

Current Research of Traditional Chinese Medicine and Western Medicine on Chronic Pelvic Pain Caused by Gynecological Pelvic Tumors / 肿瘤防治研究

Chronic pelvic pain with pelvis pain as its main manifestation often occurs in the process of the occurrence, development and treatment of gynecologic pelvic tumors which mainly include ovarian cancer, cervical cancer and endometrial cancer. It seriously affects the physical health, mental health and quality of life of female pelvic cancer patients. At present, there are few relevant studies on chronic pelvic pain caused by gynecological pelvic tumors and lack of research on TCM syndromes. There is no targeted diagnosis and therapy until now. This paper discusses the related concepts of chronic pelvic pain, the characteristics of chronic pelvic pain caused by different pelvic tumors and the current status of diagnosis and therapy of chronic pelvic pain, to provide a reference for further research on the symptoms and clinical diagnosis and treatment of chronic pelvic pain caused by gynecological pelvic tumor.

Research progress in insufficient fracture after pelvic radiotherapy / 中华放射医学与防护杂志

Pelvic radiotherapy is a way for treatment of most pelvic tumors, of which the pelvic insufficiency fracture (PIF) is a long-term complication. In this review, research progress of pelvic insufficiency fracture is summarized and discussed. The pathogenesis of PIF is mainly about inhibition of osteoblasts and the risk factors of PIF include old age, postmenopausal status, absence of hormonal replacement therapy, high number of births, smoking history, low body mass index (BMI), concurrent rheumatoid arthritis, concurrent diabetes mellitus, intracavitary brachytherapy of the high dose rate (HDR-ICBT), high dose of radiotherapy, etc. Effective drugs for prevention or treatment of PIF have not been found yet. Delayed diagnosis and misdiagnosis of PIF can cause serious consequences. As a result, further studies are needed to guide clinical work.

Expert Concensus on Triune Personalized Treatment of Pelvic Tumor Based on Three-Dimensional Printing / 医用生物力学

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Angiomixoma pélvico agresivo. Reporte de un caso / Aggressive pelvic angiomyxoma. A case report

El Angiomixoma Agresivo (AA) del suelo pélvico es una rara neoplasia mesenquimal de histología benigna, pero con un comportamiento característico localmente agresivo, que frecuentemente se presenta en mujeres en edad reproductiva. Suele presentar un crecimiento insidioso desde su origen en la musculatura perineal, lo que conlleva una clínica inespecífica, sutil y generalmente de larga evolución. El diagnóstico por la imagen, principalmente a expensas de la Tomografía Computarizada (TC) y la Resonancia Magnética (RM) con contraste, es de notable importancia, tanto por permitir detectar y caracterizar fiablemente una entidad poco frecuente, como por facilitar una planificación quirúrgica adecuada que permita obtener márgenes de resección libres de enfermedad, incluso en aquellos con infiltración de las estructuras vecinas. Presentamos el caso de una paciente adolescente con antecedente de tumoración en región vulvar derecha, en relación con extensión de un gran tumor retroperitoneal cuyo estudio histológico confirmó un Angiomixoma Agresivo.

Aggressive angiomyxoma of the pelvic floor is a rare mesenchymal neoplasm of benign histology, but with a characteristic locally aggressive behavior, which mostly occurs in women of reproductive age. It usually presents an insidious growth from its origin in the perineal musculature, which leads to a non-specific, subtle and generally long-lasting clinical course. Diagnostic imaging, mainly at the expense of CT and MRI with contrast, is of notable importance, both for allowing detection and reliable characterization of a rare entity, and for facilitating adequate surgical planning to obtain disease-free resection margins, even in those with infiltration of neighboring structures. We present the case of an adolescent patient with a history of tumor in the right vulvar region, which imaging studies confirmed to be the extension of a large retroperitoneal tumor whose pathological anatomy describes as an aggressive pelvic an angiomyxoma.

125I implantation under computed tomography guidance to treat patients with recurrent pelvic tumors: Retrospective analysis of clinical results

Objective: The objective of the study was to evaluate computed tomography (CT)-guided 125I implantation for the treatment of recurrent and malignant pelvic tumors. Materials and Methods: Fifteen cases of pelvic malignant tumors were studied. Tumor length/diameter was 4–10 cm (average: 6.8 ± 2.3 cm). In patients with pelvic recurrence or metastasis of malignant tumors, comprehensive treatment, including surgery, chemotherapy, or radiotherapy, was performed alongside CT-guided 125I implantation. The follow-up clinical benefit rate, rate of pain relief, quality of life score, and status of any complications were analyzed. Results: The patients were followed up for 6 months after the operation, and evaluation of lesions revealed complete response (CR) in 3/15 cases, partial response (PR) in 8/15 cases, stable disease in 3/15 cases, and progressive disease in 1/15 cases. The total effective rate (CR + PR) was 73.3% (11/15), and the pain relief rate was 86.6% (13/15). No bleeding, pelvic abscesses, intestinal fistulas, intestinal perforations, or other complications were reported. Conclusions: When using CT-guided 125I implantation, patients with malignant abdominal tumors undergo a convenient operation, sustain little trauma, and have an improved quality of life

Mioma intraligamentario de gran tamaño en una adolescente / Intra-ligamentary leiomyoma of giant elements in adolescent patient

Resumen ANTECEDENTES: Los leiomiomas uterinos son los tumores benignos ginecológicos más frecuentes en las mujeres en edad reproductiva; por tanto, son extremadamente raros en las adolescentes (menos de 1%) y solo se encuentran reportes de caso en la bibliografía. CASO CLÍNICO: Paciente de 16 años, con tumor suprapúbico de rápido crecimiento, acompañado de dolor abdominal generalizado, enviada a la unidad médica con diagnóstico de miomatosis uterina para descartar su malignidad. El ultrasonido pélvico reportó múltiples lesiones hipoecoicas diseminadas en el miometrio, similares a metástasis. La tomografía abdomino-pélvica informó hepatomegalia, a expensas del lóbulo izquierdo y leiomiomas intramurales de medianos y grandes elementos; los marcadores tumorales se encontraron en límites normales. En la laparotomía se encontró una tumoración interligamentaria izquierda de 25 cm; el estudio histopatológico reportó: leiomioma uterino de patrón histológico convencional. CONCLUSIONES: El cuadro clínico de los leiomiomas en adolescentes representa un reto clínico por la edad, signos, síntomas y necesidad de preservación de la función reproductiva, aspectos decisivos a la hora de decidir el tratamiento.

Abstract BACKGROUND: The uterine leiomyomas are the most common gynecological benign tumors in fertile females; however, they are very rare in adolescents (less than 1%) and there are only a few reports in the literature. CLINICAL CASE: A 16-year-old patient with a fast-growing suprapubic tumor, accompanied by generalized abdominal pain, sent to the hospital with diagnosis of pelvic tumor probable uterine miomatosis, to rule out malignant tumor. Pelvic ultrasound was performed with a report of multiple disseminated hypoechoic lesions in myometrium giving appearance of metastasis, without being the characteristic images of myomas, pelvic abdominal tomography reported hepatomegaly of the left lobe, intramural leiomyomas of medium and large elements, tumor markers within normal limits. The laparotomy was performed, left intraligamentary myoma of giant elements was located; and the histopathological study reported uterine leiomyoma of conventional histological pattern. CONCLUSIONS: The clinical of leiomyomas in adolescent patients represents a challenge for the gynecologist. The age, symptomatology, and preservation of reproductive function are important aspects to decide the therapeutic regimen.

Clinical observation of CT-guided Ad-P53 intratumoral injection for treatment of recurrent and metastatic female pelvic tumor / 西安交通大学学报(医学版)

Objective: To observe the clinical efficacy and toxic side effects of CT-guided Ad-P53 intratumoral injection in patient with recurrent and metastatic female pelvic tumor. Methods: From October 2012 to July 2014, the Gynecological Oncology Division, Tumor Radiotherapy Department of The First Affiliated Hospital of Xi'an Jiaotong University, received 79 patients with recurrent and metastatic pelvic tumor, of whom 28 were subjected to CT-guided Ad-P53 injection therapy. The 28 patients were treated by CT-guided local multi-point injection into the tumor. In each injection, (1-2)×1012VP (viral particles) were used and diluted to 4-8 mL with normal saline; administration once a week and 1-6 times altogether. The 28 patients received treatment 41 times in total, with dosage of (3±1) pieces on average. The treatment was performed with no more radiotherapy or chemotherapy, and considered to come to an end when the tumor regressed or the patient could not tolerate or refused further treatment. Therapeutic evaluation: ① Objective therapeutic evaluation: The efficacy was evaluated one month before and after the treatment, according to the WHO's Response Evaluation Criteria in Solid Tumors in combination with the maximum sectional area of the tumor measured through pelvis MRI scanning and the regression rate (%) obtained. ② Subjective therapeutic evaluation: It was based on the extent of pain relief and vaginal discharge of the patient. Results: The 28 patients all received regular follow-up, with the duration of 6-27 months, and median follow-up time of 17 months by December 2014. Therapeutic evaluation, both subjective and objective, was made one month after completion of the treatment. The results showed that 24 patients achieved notable remission (24/28, 85.7%), with objective clinical benefit ratio (CR+PR+SD> one month) of 82.1% (23/28), and median survival time of 11 months. Twenty-one patients, comprising 91.3% (21/23), experienced worsened conditions, with median progression-free survival of five months. Two patients, whose appetite and sleeping quality were improved after pain relief, received palliative chemotherapy again. Thirteen patients died, comprising 46.4% (13/28). Conclusion: Management of recurrent and metastatic gynecological tumors by CT-guided intratumoral injection of Gendicine allows effective pain relief and improvement in patients' quality of life, and at the same time exhibits high safety level and minor side effects and reduces costs.

Analysis of setup error in pelvic tumor radiotherapy and its relation with subcutaneous fat thickness / 医疗卫生装备

Objective To analyze the setup error during tumor radiotherapy by linear accelerator cone beam CT(CBCT),and to determine the presence of correlation between subcutaneous fat thickness and setup error. Methods From May 2016 to June 2017 59 patients with pelvic tumors underwent CT scan after body positioning with thermoplastic model,CBCT images were obtained before treatment and registered automatically and manually along with localizable CT images. The displacement data at X(left-right), Y(head-foot) and Z(front-back) directions as well as pelvic subcutaneous fat thickness were recorded,and SPSS 18.0 was used for data statistics.Results The 59 patients had the mean setup errors at X,Y and Z directions being(1.07±2.18),(-0.07±5.00)and(1.15±2.38)mm respectively,and the subcutaneous fat thickness ranging from 0.3 to 2.9 cm with a mean value of 1.6 cm.Spearman analysis showed the correlations between the absolute value of the errors and the subcutaneous fat thickness being 0.15, 0.11 and 0.20 respectively at X, Y and Z directions, and there were no significant differences between the correlations(P>0.05).Conclusion The setup method verifies its feasibility by restraining its errors at X, Y and Z directions between -5 and +5 mm, and there is a weak correlation between the setup error and subcutaneous fat thickness.[Chinese Medical Equipment Journal,2018,39(5):64-67]

Clinical values of nuclear magnetic resonance and B-ultrasonography in diagnoses of gynecological pelvic tumors / 医疗卫生装备

Objective To study the clinical values of MRI and B-ultrasonography in the diagnoses of gynecological pelvic tumors.Methods From September 2014 to September 2016,130 patients with gynecological pelvic tumors were randomly selected and examined by MRI and B-ultrasonography respectively.MRI and B-uhrasonography were compared on the misdiagnosis and missed diagnosis rate,detection rate of malignant tumor as well as diagnosis coincidence rate.Results The detection rate of malignant tumor,the misdiagnosis and missed diagnosis rate and the diagnosis coincidence rate of MRI were 96.15％,10.77％ and 89.23％ respectively,those of B-ultrasonography were 76.92％,24.62％ and 75.38％ respectively,and there were significant differences between all the rates of MRI and B-ultrasonography (P＜0.05).Conclusion MRI diagnoses pelvic tumors effectively,while behaves not so well as B-ultrasonography in cost,timeliness and scan time.

3D-printing non-coplanar template assisted 125I seed implantation for pelvic tumor: individual template design method / 中华放射医学与防护杂志

Objective To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography (CT)-guided and 3D-printing non-coplanar templateassisted 125I seed implantation for pelvic tumor,and to explore the feasibility and accuracy of the personalized template designmethod.Methods A total of 51 patients registered from Dec 2015 to Dec 2016 who were applied with 3D-printing guided template assisted radioactive seed implantations in the hospital were included in this study.A prescribed dose of 110-160 Gy was adopted.3D-printing templates were designed and produced for 51 cases.The dosimetric parameters:Dg0,minimum peripheral dose (mPD),V100,V150,V200,conformal index (CI),external index (EI),and homogeneity index (HI) were compared between pre-and post-plans.Results 51 cases' templates were in place well during the operations.Compared with the preoperative planning,the postoperative D90,V100,V150,V200,CI,EI and HI differences had no statistical difference (P ＞ 0.05);mPD is larger than before (t =-2.96,P ＜ 0.05).Conclusions The main dosimetric parameters of postoperative verification were consistent well with the preoperative planning and have good accuracy,which could meet the clinical requirements.

Analysis on setup errors of volumetric modulated arc therapy in pelvic tumors based on X-ray volumetric images / 医疗卫生装备

Objective To acquire setup error with X-ray volumetric images (XVI) technique during volumetric modulated arc therapy (VMAT) of pelvic tumors in order to provide guidance for the doctor to determine the interval between clinical target volume (CTV) and planning target volume (PTV).~ Totally 20 pelvic tumor patients accepting radiation oncology underwent CBCT scan before the first treatment,and auto registration was executed between CBCT images and planning CT images to determine the setup errors at X,Y and Z directions.Then the patients experienced another CBCT scan to obtain residual setup errors,VMAT was carried out after auto on-line correction by the treatment couch,and the third CBCT scan was performed after the treatment.Totally three times of CBCT scans were implemented every week hereafter.The setup errors were analyzed before and after the treatment,and the target volume margin (MPTV) was calculated accordingly.Results The setup errors at X,Y and Z directions were significantly decreased after correction.The values of MPTV at X,Y and Z directions before correction were 3.89,6.20 and 5.24 mm respectively,and the ones after correction were 1.42,2.42 and 2.40 mm respectively.The decreased values of MPTV were between 2.47 and 3.78 mm,which showed the most significant trend at Y direction.Conclusion VMAT of pelvic tumors based on XVI contributes to decreasing the setup errors and enhancing treatment quality.

Application of cryoablation in treating recurrent pelvic and retroperitoneal tumors / 介入放射学杂志

Objective To investigate the safety and curative effect of CT-guided percutaneous cryoablation in treating recurrent tumors in pelvic cavity and retroperitoneal space.Methods A total of 100 patients with recurrent tumors in pelvic cavity or retroperitoneal space were included in this study.CT-guided percutaneous cryoablation treatment was carried out in all patients.Results ① Of the 100 patients,complete cryoablation treatment was performed in 9 and palliative cryoablation treatment was adopted in 91.The following-up time ranged from 3 years to 11 years.The one-,3-and 5-year survival rates were 87.0％ (87/100),17％ (17/100) and 9％ (9/100) respectively.The pain relief rate after cryoablation treatment was 84.0％ (70/83).② Contrast-enhanced CT scan performed one month after cryoablation treatment showed that complete cryoablation was seen in 9 patients,presenting as no enhancement in the tumor frozen area on CT image;palliative cryoablation was seen in 91 patients,the ablation extent ≥90％ was obtained in 48 patients,the ablation extent of 80-90％ in 25 patients,the ablation extent of 70-80％ in 12 patients,the ablation extent of 60-70％ in 4 patients,and the ablation extent ＜60％ in 3 patients.③ Postoperative complications included local infection (n=3),which was cured after anti-infective therapy;intestinal fistula at upper rectum (n=1),which was gradually healed after enterostomy;transient dysuresia (n=5),which was recovered through retention catheterization for 3-5 days;fever lasting 3-5 days;and skin frostbite (n=3),which was cured after symptomatic treatment.Conclusion For the treatment of recurrent tumors in pelvic cavity and retroperitoneal space,CT-guided percutaneous cryoablation is quite safe.Complete cryoablation is very helpful for improving local tumor control and prolonging survival time.

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors / 上海交通大学学报（医学版）

Objective·To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods·A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results·A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification,there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zonesⅠ + Ⅱ + Ⅲ + Ⅳ , 1 in zones Ⅰ + Ⅳ , 1 in zones Ⅱ + Ⅳ , and 1 in zone Ⅳ. The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion·CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors / 上海交通大学学报（医学版）

Objective·To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods·A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results·A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification,there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zonesⅠ + Ⅱ + Ⅲ + Ⅳ , 1 in zones Ⅰ + Ⅳ , 1 in zones Ⅱ + Ⅳ , and 1 in zone Ⅳ. The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion·CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.

The application of ureteral stents for prevention of ureteral injury in complex pelvic tumor operation / 实用肿瘤学杂志

Objective To investigate the clinical value and adverse reactions of indwelling ureteral stentsinthepreventionofureteralinjurybeforecomplexpelvictumorsurgery.Methods 145casesofpatients with rectal cancer ,cervical cancer ,ovarian cancer and pelvic sarcomas were retrospectively analyzed ,and 53 pa-tients with complex pelvic tumor surgery ,preoperative were under cystoscope unilateral or bilateral ureteral stent tube,pulled out according to the intraoperative situation after surgery or lien ,92 patients as control group .Results Ureteral injury was found in 10 of the 145 patients,2 cases in ureteral catheter group and 8 cases in control group .3 cases of postoperative ureteral fistula occurred in the control group .Indwelling ureteral stents could cause adverse reactions such as hematuria ,osphyalgia and urinary irritation ,and the adverse reactions of catheter group was obviously higher than that of control group (P<0.05).Conclusion Cystoscopic ureteral stent placement has important clinical significance for prevention of ureteral injury despite certain adverse reactions ,which can be used in operation of complex pelvic tumor .

Surgical management of huge pelvic tumor: a report of 56 cases / 中华消化外科杂志

Objective To investigate the surgical management of huge pelvic tumor.Methods The clinical data of 56 patients with huge pelvic tumor who were admitted to the Cancer Hospital of Henan Province from February 2005 to January 2012 were retrospectively analyzed.Tumor resectability was assessed via enhanced computed tomography or three-dimensional reconstruction,and the tumors were freed and resected by combination of muliiple surgical approaches.All the patients were followed up via telephone or re-examination at the out-patient department to learn the recurrence and metastasis of tumor.The survival rate was calculated using the life table.Results Fifty patients received preoperative computed tomography examination,and the imaging data of 6 patients were three-dimensionally reconstructed.Preoperative evaluation showed that 49 patients needed combined multivisceral resection,5 needed tumor resection,and the tumors of 2 patients were unresectable.Fourteen patients were diagnosed preoperatively,and 8 patients were diagnosed by intraoperative rapid frozen section examination,and the rest 34 patients were diagnosed by postoperative pathological examination.The surgical approaches including anterior median sacral approach combined with transperineal coccyx anterior approach (21 patients),anterior median sacral approach (11 patients),obturator approach (8 patients),retropubic approach (8 patients) and obturator approach combined with transperineal approach of coccyx (8 patients).Tumor and rectum resection was carried out on 18 patients,tumor and partial bladder resection on 12 patients,tumor,uterus and ovariectomization on 12 patients,tumor,part of the small intestine and colorectal resection on 10 patients,tumor and total pelvic exenteration on 4 patients.In all the 56 patients,53 achieved R0 resection,2 cases reached naked eye clean,1 case had residual tumor.The mean operation time was 100 minutes.Fifty patients recovered uneventfully.Six patients had postoperative complications,including 3 patients with intestinal obstruction (2 patients were cured by conservative treatment,and 1 patient was cured by surgery),2 patients with pelvic infection and 1 patient with colostomy hernia,and they were cured by drainage and nutritional support.One patient died of postoperative myocardial infarction.The results of postoperative pathologic study showed that 25 patients were with adenocarcinoma,16 with sarcoma and 15 with gastrointestinal stromal tumor.Forty-seven patients were followup to December 2012,and the 5-year survival rate was 26.7％ for patients with adenocarcinoma,18.9％ for patients with sarcoma,and 52.6％ for patients with gastrointestinal stromal tumor.Conclusion Preoperative assessment of resectability of huge pelvic tumor can reduce unnecessary laparotomy and improve the safety of operation.

Clinical application of transperitoneal laparoendoscopic single-site nephrectomy / 中华泌尿外科杂志

Objective　To verify the safety and feasibility of applying transperitoneal laparoendoscopic single-site surgery (LESS) nephrectomy in the treatment of kidney malignant and benign diseases.Methods　From Nov.2010 to Jun.2012,we had used LESS nephrectomy technique treated four kidney tumors,one renal pelvic tumor and one atrophic kidney. Quadport was introduced into abdominal cavity through a paraumbilical incision. Conventional laparoscopic instruments,prebent laparoscopic instruments and flexible tip 5mm laparoscope were used. The standard laparoscopic transperitoneal nephrectomy technique was then performed.We evaluated this technique in respects of operative time,estimated blood loss,intraoperative complications,1st post-operative day pain (VAPS),drainage time,post-operative hospital stay and pathological results.　Results　The 6 procedures in this group were completed successfully with LESS nephrectomy. There was no additional trocar added,no conversion to conventional laparoscopic or open surgery.Application of Quadport and prebent instruments reduced the clash of instruments,both intracorporally and extracorporally.The average operative time were 181.7 (145.0 -235.0) min,average estimated blood loss were 78.3 (20.0 - 150.0) ml.There was no severe intraoperative complication.The average VAPS in the first post - operative day was 1.7 ( 1.0 - 2.0).The average drainage time was 2.8 ( 1.0 -4.0) d,post-operative hospital stays was 6.8 ( 1.0 - 10.0) d.There was no secondary bleeding or wound infection.Pathological results showed 3 cases of renal clear cell carcinoma,1 case of chromophobic carcinoma,1 case of high-grade urothelial carcinoma and 1 case of atrophic kidney.All the specimens in this group were surgical margin negative.　Conclusions　LESS nephrectomy is a safe and feasible treatment option for the treatment of kidney surgical diseases.