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@#Performing external beam radiotherapy alone without chemotherapy or brachytherapy for locally advanced cervical cancer with multiple lymph node metastases is challenging. The purpose of this case report is to present the efficacy of high‑dose adaptive extended‑field intensity‑modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in treating locally advanced cervical cancer with multiple lymph node metastases. A 67‑year‑old woman with locally advanced squamous cell carcinoma of the uterine cervix was treated by external beam radiotherapy alone due to the refusal of chemotherapy and intracavitary brachytherapy. In order to maximize the efficacy of treatment, extended‑field radiotherapy that includes the paraaortic lymph nodes as well as an adaptive IMRT‑SIB plan, was applied. The treatment was successful, resulting in complete tumor disappearance without severe adverse events. In conclusion, high‑dose adaptive IMRT‑SIB may be an alternative treatment option for locally advanced cervical cancer with multiple lymph node metastases.
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Radiation Dosage , Uterine Cervical NeoplasmsABSTRACT
Objective To analyze the effect of the fixed-jaw technique on dosimetric parameters during dynamic intensity-modulated radiotherapy (DIMRT) planning. Methods Ten patients each with nasopharyngeal carcinoma, postoperative cervical cancer, and right breast cancer after radical surgery were selected for this study; all patients underwent DIMRT in our hospital in 2020. After administration at the prescribed dose, two methods were used to design the radiotherapy plan for each patient: split-field technique (SFT) and fixed-jaw technique (FJT). The two plans were compared for the differences in the dosimetric parameters and plan verification pass rate. Results Compared with SFT, FJT showed significant decreases (P <0.05) in the following parameters for patients with nasopharyngeal carcinoma, postoperative cervical cancer, and right breast cancer after radical surgery: number of radiation fields (down by 41.5%, 47.3%, and 34.9%, respectively, t = 7.954, 24.2, and 4.949, respectively), total number of monitor units (MUs) (down by 5.6%, 5.3%, and 13.5%, respectively, t = 3.211, 2.423, and 5.481, respectively), and actual beam-on time (down by 25.3%, 23.8%, and 13.6%, respectively, t = 5.814, 9.208, and 5.655, respectively). There were significant differences in some of the dosimetric parameters for all three types of cancer patients between the two plans (P <0.05). There were no significant differences in the plan verification pass rate (P >0.05). Conclusion FJT can reduce the total number of MUs and actual beam-on time while meeting the requirements for clinically prescribed doses in DIMRT planning.
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Objective To investigate the effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy (IMRT) plan for gastric cancer and to provide a reference for clinical planning. Methods A retrospective analysis was conducted on patients who recently underwent postoperative IMRT for gastric cancer. Twenty patients who received radiotherapy in the centre of Radiation Oncology of Huanggang Central Hospital from August 2022 to January 2023 were selected. That were selected to receive a seven-field coplanar static IMRT plan based on a couch rotation angle of 0° as the control group. Then, based on the coplanar IMRT plan, only the couch rotation angle of gantry angles 30° and 330° was changed to 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, and 90°, respectively, and nine different non-coplanar plans were established. The homogeneity index (HI), conformity index (CI) of the target volume, and monitor unit (MU), as well as Dmean, V20, and V30 of the left and right kidneys, Dmax, Dmean, V10, V20, and V30 of the spinal cord, and Dmax, Dmean, V10, V20, V30, and V40 of the small intestine and liver were compared among the 10 plans. The MU and the dosimetric parameters of the target volumes and When the couch rotation angle was 60°, the minimum HI and maximum CI of the target volume were 0.0714±0.0089 and 0.9271±0.0108, respectively, and the minimum MU was 438±26, with the best homogeneity and conformity in the target volume and the shortest machine treatment time (P＜0.05). When the couch rotation angle was 10°, the Dmax of the small intestine was lowest, being (4620.73±99.27) cGy. When the couch rotation angle was 60°, the Dmean of the left and right kidneys was lowest, being (1246.30±130.35) cGy and (1001.52±103.33) cGy, respectively; the V20 of the left and right kidneys was lowest, being 22.87±6.29 and 19.69±1.84, respectively; the V10 and V30 of the spinal cord were lowest, being 40.08±4.92 and 1.68±0.34, respectively (P＜0.05). Conclusion The couch rotation angle has some influence on the postoperative treatment planning for patients with gastric cancer. In the design of non-coplanar plan for gastric cancer, the couch rotation angle of 60° contributes to establishing a better radiotherapy plan.
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Objective:To explore the efficacy and adverse reactions of image-guided hypofractionated intensity-modulated radiotherapy (Ig-HypoRT) conbined with contralateral esophageal protection in treatment of patients with unresectable stage Ⅲ non-small cell lung cancer (NSCLC).Methods:The clinical data of 45 patients with unresectable stage Ⅲ NSCLC who were admitted to Xuzhou Cancer Hospital from January 2016 to January 2019 were retrospectively analyzed. Patients received induction chemotherapy with a platinum-based dual-drug combination regimen, followed by Ig-HypoRT with a total dose of tumor of 60-63 Gy/12- 18 times at 3.5-5.0 Gy/time. Contralateral esophagus was delineated as an organ at risk during radiotherapy, limiting V 45 Gy≤1.8 cc and V 55 Gy ≤0.4 cc. Patients' efficacy, survival and the occurrence of adverse reactions were observed. Results:Among 45 patients, there were 9 cases of complete remission, 31 cases of partial remission, 4 cases of stable disease and 1 case of disease progression, and the effective rate was 88.8% (40/45). The median follow-up time was 34 months, 45 patients had a median overall survival (OS) time of 25.0 months (95% CI 21.7-28.8 months), with 1-, 2-, and 3-year OS rates of 78.9%, 56.8% and 47.7%, respectively; the median progression-free survival (PFS) time was 18.5 months (95% CI 15.0-22.0 months), with 1-, 2- and 3-year PFS rates of 59.8%, 32.6% and 18.6%, respectively. The 3-year local recurrence rate was 9% (4/45). The incidence of grade 1-2 radioactive esophagitis was 80% (36/45); the incidence of grade 1-2 chest pain was 20% (9/45). The incidence of grade 3-4 adverse reactions were 13% (6/45), including 7% (3/45) of grade 3 pulmonary atelectasis, 4% (2/45) of grade 3 radioactive pneumonia, and 2% (1/45) of grade 4 hemoptysis. Conclusions:Ig-HypoRT combined with contralateral esophageal protection for unresectable stage Ⅲ NSCLC can improve survival rate and reduce esophageal adverse reactions of patients.
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Objective:To evaluate the efficacy and safety of hippocampal avoidance whole-brain irradiation with simultaneous integrated boost in the treatment of brain metastases of lung cancer.Methods:Forty lung cancer patients with brain metastases who received whole-brain radiotherapy with simultaneous integrated boost and hippocampal avoidance in Cancer Hospital, Chinese Academy of Medical Sciences from 2014 to 2020 were enrolled in this study. Brain MRI, survival follow-up and evaluation of side effects were performed before radiotherapy and at 1, 3, 6 and 12 months after radiotherapy, respectively. Overall survival (OS), progression-free survival (PFS) and changes in cognitive function were analyzed. Continuous data were described as Mean ± SD. Categorical data were described by frequency and composition ratio or percentage. Survival analysis was conducted by Kaplan-Meier method. Influencing factors of survival were identified by univariate and multivariate Cox's regression analyses.Results:A total of 40 patients were enrolled in the study. The median follow-up time was 14.2 months and the median OS, PFS and intracranial PFS of all patients were 14.8 months, 6.7 months and 14.8 months, respectively. Multivariate analysis showed that male gender and newly diagnosed stage Ⅳ disease were associated with worse OS and PFS, respectively. The Hopkins verbal learning test-revised (HVLT-R) scores at baseline and 1, 3 and 6 months after radiotherapy were 21.94±2.99, 20.88±3.12, 20.03±3.14, and 19.78±2.98, respectively. The HVLT-R score at 6 months after radiotherapy was decreased by approximately 9.8% compared with the baseline. No grade 3 or above toxic and side effect occurred in the entire cohort.Conclusion:Hippocampal avoidance whole-brain irradiation with simultaneous integrated boost is a safe and effective treatment for brain metastases of lung cancer, which is expected to reduce the impact of radiotherapy on cognitive function.
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Objective:To explore the effects of Onodera′s prognostic nutritional index (PNI) on the prognosis of locally advanced oropharyngeal squamous cell carcinoma (LA-OPSCC) after induction chemotherapy followed by sequential chemoradiotherapy.Methods:A retrospective analysis was conducted on the clinical data of 52 LA-OPSCC patients receiving induction chemotherapy followed by sequential chemoradiotherapy in The Affiliated Cancer Hospital of Guizhou Medical University during 2014-2018. The PNI values of all the patients at different treatment phases were statistically analyzed, and the ROC curve was employed to determine the optimal critical value of PNI. The patients in this study were divided into a well-nourished group ( n = 27) and a poorly-nourished group ( n = 25). The Kaplan-Meier method was used for survival analysis. The Cox proportional hazards model was utilized to analyze the relationships between different nutritional status and prognosis. Clinical features and adverse reactions were compared between the two groups. Results:The PNI values decreased significantly after radiotherapy, with an optimal critical value of 42.4. The 5-year overall survival (OS) and progression-free survival (PFS) of the well-nourished group (PNI ≥ 42.4) were 62.6% and 60.9%, respectively, which were significantly higher than those (30.1% and 29.7%) of the poorly-nourished group (PNI < 42.4, χ2 = 11.12, 5.74, P < 0.05). The multivariate analysis showed that PNI was an independent prognostic factor for the OS after radiotherapy ( HR = 2.752, 95% CI: 1.095-6.917, P = 0.031). The LA-OPSCC patients aged over 60 years or those who did not respond to induction chemotherapy accounted for a higher proportion of malnutrition after chemoradiotherapy ( χ2 = 4.89, 5.05, P < 0.05). Conclusions:PNI after radiotherapy can be used as a prognostic factor in the evaluation of LA-OPSCC patients receiving induction chemotherapy followed by sequential chemoradiotherapy. The LA-OPSCC patients aged over 60 years or those who do not respond to induction chemotherapy should receive more nutritional support during the chemoradiotherapy.
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Objective:Based on radiomics characteristics, different machine learning classification models are constructed to predict the gamma pass rate of dose verification in intensity-modulated radiotherapy for pelvic tumors, and to explore the best prediction model.Methods:The results of three-dimensional dose verification based on phantom measurement were retrospectively analyzed in 196 patients with pelvic tumor intensity-modulated radiotherapy plans. The gamma pass rate standard was 3%/2 mm and 10% dose threshold. Prediction models were constructed by extracting radiomic features based on dose documentation. Four machine learning algorithms, random forest, support vector machine, adaptive boosting, and gradient boosting decision tree were used to calculate the AUC value, sensitivity, and specificity respectively. The classification performance of the four prediction models was evaluated.Results:The sensitivity and specificity of the random forest, support vector machine, adaptive boosting, and gradient boosting decision tree models were 0.93, 0.85, 0.93, 0.96, 0.38, 0.69, 0.46, and 0.46, respectively. The AUC values were 0.81 and 0.82 for the random forest and adaptive boosting models, respectively, and 0.87 for the support vector machine and gradient boosting decision tree models.Conclusions:Machine learning method based on radiomics can be used to construct a prediction model of gamma pass rate for specific dosimetric verification of pelvic intensity-modulated radiotherapy. The classification performance of the support vector machine model and gradient boosting decision tree model is better than that of the random forest model and adaptive boosting model.
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Purpose: Data regarding the efficacy of various radiotherapy techniques for post mastectomy chest-wall radiotherapy (PMRT) using hypofractionation is scarce and cardiac toxicity remains a concern. This study aims to compare effect of IMRT (Intensity Modulated Radiation Therapy) and 3D-CRT (3-Dimensional Conformal Radiation Therapy) techniques on cardiac dose. Materials and Methods: In this retrospective study, we compared IMRT and 3DCRT plans of 20 patients who received PMRT to a dose of 42.56Gy/16# and the dosimetric parameters in terms of planning target volume (PTV) coverage and dose to organ at risk (OARs) including heart and ipsilateral lung were recorded and analyzed. Result: PTV coverage were comparable with both techniques. IMRT planning provided a better conformity index as compared with 3DCRT (0.95 vs 0.91, p<0.001). The mean dose to the heart significantly reduced with IMRT (4.36Gy vs 8.2Gy, p<0.00001). Conclusion: IMRT offers a significant reduction in mean heart dose than 3DCRT in patients treated with hypofractionated post-mastectomy irradiation.
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Objective:To retrospectively analyze the differences of survival, recurrence, acute side effects and prognostic factors between early stage (stage ⅠB-ⅡA) cervical cancer patients with intermediate risk factors receiving postoperative concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone.Methods:Clinical data of 211 patients with intermediate risk factors after early stage cervical cancer surgery admitted to Department of Radiation Oncology of General Hospital of Ningxia Medical University from January 2016 to December 2018, were retrospectively analyzed. Among them, 91 cases were assigned in the RT group and 120 cases in CCRT group. The 3- and 5-year overall survival (OS), progression-free survival (PFS), recurrence and acute side effects were compared between two groups by Chi-square test. Univariate analysis of OS and PFS was performed by Kaplan-Meier method and log-rank test was performed. Multivariate prognostic analysis was conducted by using Cox model. Results:The 3- and 5-year OS of 211 patients were 95.0% and 93.8%, respectively. The 3- and 5-year PFS were 86.8% and 83.2%, respectively. The OS of CCRT and RT group were 93.9%, 96.5% (3-year), 91.8%, 96.5% (5-year) respectively ( χ2=1.763, P=0.184), and the PFS were 84.4%, 89.9% (3-year), 79.3%, 88.3% (5-year) ( χ2=2.619 ,P=0.106), with no difference between the two groups. The total recurrence rate was 15.64%, and there was no significant difference in the recurrence rate and recurrence area between two groups ( χ2=2.623 ,P=0.105; χ2=6.745 ,P=0.080). Locoregional recurrence and lung metastasis were the main patterns of failure. Multivariate prognostic analysis showed that pathological type might significantly affect the OS ( χ2=3.849, P=0.05), and depth of invasion significantly affected the PFS ( χ2=4.095, P=0.043). The incidence of acute gastrointestinal side effect and bone marrow suppression in the CCRT group was significantly higher than that in the RT group ( χ2=56.425, 27.833; both P<0.001). Conclusions:Patients with intermediate risk factors after early cervical cancer surgery obtain high efficacy after radiotherapy. The main patterns of failure are locoregional recurrence and lung metastasis. The pathological type may be an independent prognostic factor of OS and the depth of invasion is an independent prognostic factor of PFS. Compared with RT, CCRT increases the risk of acute gastrointestinal side effects and myelosuppression, which can be tolerated. There is no significant difference in the clinical efficacy between RT and CCRT, which remains to be validated by large sample size studies.
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Objective:To determine the safety of prophylactic irradiation dose CTV 60Gy optimized to CTV 50Gy for II b region in patients with stage N 0-N 1 nasopharyngeal carcinoma (NPC) and the dose advantage and clinical value for parotid gland protection, and to understand the diagnostic value of PET-CT and diffusion-weighted imaging (DWI) for suspicious positive lymph nodes in the neck (5 mm≤maximum short diameter<10 mm). Methods:Clinical data of 157 patients with primary non-metastatic NPC (N 0-N 1) admitted to our hospital from June 2015 to March 2017 were retrospectively analyzed. 104 patients underwent II b clinical target volume optimization guided by multimodal imaging system. Survival analysis was performed by Kaplan - Meier method. Univariate/multivariate regression analysis was performed to analyze the pattern of cervical lymph node recurrence. Paired t-test was used to compare the differences in target volume and parotid gland dose parameters before and after dose optimization. Results:Sixty patients underwent single-neck optimization in stage N 1, 25 patients received double-neck optimization (only those with retropharyngeal lymph node metastasis), and 19 patients underwent double-neck optimization in stage N 0. Three patients had cervical regional recurrence, all in-field. The 5-year overall survival rate was 93.3%. The lymph node recurrence-free survival rate, local recurrence-free survival rate, distant metastasis-free survival rate and disease-free survival rate were 97.1%, 91.3%, 88.5% and 80.8%, respectively. Cervical lymph node recurrence was associated with local recurrence in the nasopharynx, regardless of retropharyngeal lymph node status. Fourteen patients had suspicious positive cervical lymph nodes in II b region, with a mean maximum short diameter of 7.1 (5~9) mm on the largest cross-sectional plane, and 11 of them were positive on PET-CT, with a mean SUV max of 2.96 (2.5~3.3). There was no significant difference in GTV after optimization ( P>0.05). D mean, D max, D 50% and V 26Gy of parotid gland were significantly lower than those of conventional plan (all P<0.01). Conclusions:It is safe to optimize CTV 60Gy to CTV 50Gy in II b region in patients with N 0-N 1 NPC, and the exposure dose to normal tissues around the parotid gland and neck is significantly reduced. For small lymph nodes that do not meet the diagnostic criteria, it needs to be individualized in combination with multimodality imaging systems, such as PET-CT and DWI.
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The prognosis of patients with clinical stage Ⅱ nasopharyngeal carcinoma has been significantly improved by the application of intensity-modulated radiotherapy (IMRT). Although the NCCN guidelines recommend concurrent chemoradiotherapy strategies for clinical stage Ⅱ nasopharyngeal carcinoma, the evidence is mostly based on the research results under the condition of two-dimensional conventional radiotherapy, and whether combined chemotherapy is required under the condition of IMRT faces challenges. In this article, current research progress on chemotherapy for clinical phase Ⅱ nasopharyngeal carcinoma was reviewed. Several studies have shown that concurrent, adjuvant and induction chemotherapy failed to improve the efficacy but significantly increased the incidence of toxic and side effects. Because of the heterogeneity in clinical stage Ⅱ nasopharyngeal carcinoma, some studies have found that high-risk patients could benefit from chemotherapy. Currently, how to distinguish high-risk patients in clinical stage Ⅱ nasopharyngeal carcinoma is a hot spot. The characteristics of metastatic lymph nodes, EB virus DNA, inflammatory markers, and other factors have certain reference value for screening high-risk patients, which needs further verification. The prediction model integrating multiple tumor characteristics seems to better identify high-risk groups and guide the treatment decision of high-risk stage Ⅱ nasopharyngeal carcinoma.
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Objective:To investigate the feasibility of applying the ArcherQA three-dimensional (3D) dosimetric verification system in intensity-modulated radiotherapy (IMRT) plans for nasopharyngeal carcinoma (NPC).Methods:A retrospective analysis was conducted for 105 NPC patients′ IMRT plans developed using the Eclipse treatment planning system (TPS). Dose verification was conducted using the ArcherQA system and through portal dosimetry (PD). Moreover, this study compared γ passing rates (criteria: 3 mm/3%, TH = 10%) between ArcherQA and PD and the doses delivered to the target volume ( Dmean, D90%) and organs at risk (OARs) ( Dmean) between ArcherQA and TPS, and analyzed the 3D γ passing rates of each organ at risk calculated by ArcherQA. Results:The average 3D γ passing rate calculated by ArcherQA was (99.04±1.01)%, and the average 2D γ passing rate measured by PD was (99.49±0.78)%, with statistically significant differences ( t=-3.35, P< 0.05). The dosimetric differences to the target volume between ArcherQA and TPS were as follows: the average difference in Dmean to the gross tumor volume (GTV) was (0.57±0.48)%, and the average difference in D90% was (0.65±0.56)%. For the target volume, the average γ passing rate was (97.67±3.43)% for GTV, (97.80±4.35)% for GTVnd-L, (97.82±4.07)% for GTVnd-R, (97.88±2.44)% for CTV1, and (96.64±4.32)% for CTV2. The mean dose difference of each target volume was CTV1 (0.57±0.46)%, GTVnd-L (0.85±0.55)%, GTVnd-R (0.73±0.55)%, and CTV2 (0.88±0.52)%. For OARs, the mean γ passing rate was (99.93±0.22)% for the brainstem, (99.17±2.82)% for the optic chiasm, (100±0)% for the lens, (99.56±1.05)% for the spinal cord, (99.00±2.06)% for the thyroid, and (87.86±10.42)% for the trachea. Statistically significant differences in the average doses to OARs were observed ( t=-14.62 to 4.82, P<0.05), except for those to the left optic nerve, the right hippocampus, and the right parotid gland. Conclusions:Based on the high-performance GPU platform and the Monte Carlo dose algorithm, ArcherQA can provide accurate 3D dose distribution and 3D γ passing rates inside patients according to CT images and provide the dose volume histogram (DVH) of various regions of interest (ROIs). Therefore, the ArcherQA three-dimensional dose verification system can be applied to IMRT plans for NPC. Moreover, it is inducive to improve the treatment efficiency since it does not occupy the accelerator operation time.
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Objective:To retrospectively analyze the prognosis and related risk factors of lymph node metastasis in early-stage (Ⅰ B-Ⅱ A) cervical cancer patients with postoperative positive lymph nodes who were treated with intensity modulated radiotherapy (IMRT). Methods:A retrospective analysis was conducted for 292 early-stage cervical cancer patients with postoperative high and/or moderate risk factors who were treated with pelvic-abdominal IMRT with/without concurrent chemotherapy in Ningxia Medical University General Hospital from January 2016 to December 2018. These patients included 239 with negative pelvic lymph nodes and 53 with positive lymph nodes, who were incorporated into the negative group and the positive group, respectively. Multivariate and univariate analyses of the risk factors of lymph node metastasis and prognosis were performed for both groups.Results:The univariate and multivariate analyses showed that the lesion ≥4 cm, deep interstitial invasion, and the number of risk factors were independent factors influencing pelvic lymph node metastasis ( χ2 = 7.11, 9.05, 90.08, P < 0.05). There was no statistically significant difference in the 3- and 5-year OS ( P>0.05) between both groups. The 3-year disease-free survival (DFS) and 5-year DFS of the negative group were 87.6% and 84.5%, respectively, and those of the positive group were 72.5% and 69.3%, respectively ( χ2=8.59, P=0.003). Regarding failure modes, distant metastasis mainly occurred in the positive group, while local recurrence was dominant in the negative group ( χ2=9.40, P<0.05). The univariate analysis of the DFS in 53 patients with postoperative positive lymph nodes showed that deep interstitial invasion affected DFS, with statistically significant differences ( χ2 = 7.25, P < 0.05). The result of the multivariate analysis showed that the lesion size >4 cm, positive residual, and deep interstitial invasion significantly influenced the DFS ( χ2 = 4.37, 4.69, 4.39, P < 0.05). Conclusions:The lesion size, deep interstitial invasion, and risk factor number were independent factors influencing lymph node metastasis, and the DFS after radiotherapy of patients with pelvic lymph node metastasis was significantly lower than the patients with negative lymph nodes. The main recurrence type of patients with lymph node metastasis was distant metastasis. Moreover, the deep interstitial invasion was independent factor affecting the DFS of early-stage cervical cancer patients with postoperative positive lymph nodes.
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Objective:To assess the long-term follow-up results of intensity-modulated radiotherapy (IMRT) combined with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitor (TKI) in patients with hepatocellular carcinoma (HCC) showing macrovascular invasion (MVI).Methods:A retrospective analysis was conducted for 63 patients with HCC showing MVI without distant metastasis treated in Peking University Cancer Hospital from October 2015 to October 2018. Among them 28 patients were treated with IMRT combined with TACE and sorafenib (Group A) and 35 patients were treated with IMRT combined with TACE (Group B). Propensity score matching (PSM) was applied to assess the progression-free survival (PFS) and the overall survival (OS) of both groups.Results:The median follow-up time was 62 months. Before PSM, the median OS of group A and B were 19.0 months and 15.2 months ( χ2=3.15, P=0.076), respectively, and the median PFS of groups A (10.7 months) was longer than that of group B (8.6 months; χ2=3.99, P=0.046). After PSM, the median OS of group A (30.6 months) was significantly longer than that of group B (15.2 months; χ2=5.34, P=0.023), and the PFS of groups A (12.5 months) was still longer than that of group B (8.3 months; χ2=4.79, P=0.026). In the whole group, 10 patients (15.9%) suffered from grade-3 hematologic toxicity, and seven patients (11.1%) experienced grade-3 hepatic toxicity. The incidence of skin reactions, hand-foot syndrome, and diarrhea in group A was higher than that in group B, but all these adverse events were grade 1-2. Moreover, no grade-4 adverse events, radiation-induced liver disease, and treatment-related mortality occurred in both groups. Conclusions:As demonstrated by the long-term follow-up result, IMRT combined with TACE and TKI could improve both the PFS and the OS of patients with HCC showing MVI after PSM.
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Objective To analyze the recurrence of breast cancer without use of chest wall bolus during adjuvant intensity modulated radiotherapy after modified radical mastectomy, so as to investigate the necessity of bolus use. Methods A total of 218 patients undergoing adjuvant intensity modulated radiotherapy after modified radical mastectomy during the period from January 2013 to June 2019 were enrolled as the study subjects. The chest wall bolus was not used during the whole period of radiotherapy after modified radical mastectomy, and the recurrence of breast cancer in the chest wall was analyzed after radiotherapy. Results The post-surgical follow-up through outpatient records, inpatients records, local residents’ health system and telephone was performed until June 31, 2021. The proportion of follow-up was 100%, and the mean follow-up period was 48.9 months. There were three cases with breast cancer recurrence in the chest wall, including one case with recurrence in the chest wall alone and two cases with recurrence in the chest wall and regional lymph nodes, and the overall recurrence of breast cancer was 1.4% in the chest wall. Among the 3 cases with breast cancer recurrence in the chest wall, there were two cases with N3 stage and positive for HER2, and one triple-negative breast cancer case, and all three cases developed distal metastases upon local recurrence. Among 218 study subjects, there were 5 cases with grade Ⅰ radioactive skin reaction, 3 cases with grade Ⅱ radioactive skin reaction, and no grade Ⅲ or Ⅳ radioactive skin reaction occurred. In addition, no grade Ⅲ or Ⅳ acute radioactive injury was seen in the chest wall skin among the 218 study subjects. Conclusion No use of chest wall bolus may be considered during adjuvant intensity modulated radiotherapy after modified radical mastectomy in presence of systemic therapy if tumor invasion into skin is not observed prior to therapy.
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Objective To investigate the effects of bolus thickness and use frequency on skin dose in postmastectomy intensity-modulated radiotherapy. Methods We retrospectively reviewed 20 cases receiving postmastectomy fixed-field intensity-modulated radiotherapy, to analyze the homogeneity index (HI) and conformity index (CI) of the target volume and the skin dose (Dmax, Dmean, and Dmin) of radiotherapy plans with 0.5 cm-thick bolus or 1 cm-thick bolus alone at a use frequency of 5 F, 10 F, 15 F, 20 F, and 25 F versus a combination of 0.5 cm and 1 cm-thick bolus, and fit the relationship between skin dose and bolus use frequency. Results As the bolus use frequency increased, the skin dose increased, the hot spot of the target volume decreased, and the low-dose volume decreased. The HI of the target volume with the 1 cm bolus was better than that with the 0.5 cm bolus at all use frequencies (P < 0.05), and HI decreased with the increase of bolus use frequency. For both 0.5 cm and 1 cm bolus, the CI of the target volume increased initially and then decreased, reaching the maximum value at a frequency of around 15 F; the CI showed significant differences only at 20 F and 25 F between the two types of bolus (P < 0.05). The skin Dmax and Dmean were significant higher with the 0.5 cm bolus than with the 1 cm bolus (P < 0.05). The equation for the relationship between skin dose (D) and bolus use frequency (F) was D = A × F + B × F2 + C. The Dmax and HI with the combination of 0.5 cm bolus (6 F) plus 1 cm bolus (8 F) fell between those with the 0.5 cm bolus (15 F) and those with the 1 cm bolus (15 F) (P < 0.05). Conclusion In postmastectomy fixed-field intensity-modulated radiotherapy, skin dose can be calculated based on bolus use frequency. Mixed use of bolus may be more suitable than use of 0.5 cm bolus or 1 cm bolus alone.
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Objective To study the irradiation dose of organs at risk (OAR) in involved field radiation and extended field radiation in patients with thoracic esophageal cancer who received intensity modulated radiotherapy (IMRT). Methods A total of 40 patients with thoracic esophageal cancer were treated with IMRT. The involved field, extended field, and OAR were outlined to generate IMRT plans. The conformity index (CI) and homogeneity index (HI) of planning target volume (PTV) and the irradiation parameters of OAR were evaluated for the two plans. Paired t-test was used for comparison of irradiation parameters. Results The PTV of both plans received the prescribed dose. There were no significant differences in CI and HI of PTV between the two groups (P = 0.317, 0.130). There were significant differences in average lung dose, lung V5, lung V20, lung V30, spinal cord Dmean, heart Dmean, heart Dmax, heart V30, heart V40, and heart V60 between the two groups (P < 0.01). Conclusion Compared with the extended field, the involved field can reduce the irradiation dose of ORA in patients with thoracic esophageal cancer, thus reducing the risk of radiation.
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Objective To evaluate the clinical efficacy and safety of simultaneous enhanced accelerated radiation therapy for brain metastases (SMART-Brain) combined with functional area protection. Methods SMART-Brain was planned for 60 patients with multiple brain metastases. Using the whole brain intensity modulation technique, important functional areas such as hippocampus were protected against irradiation by delivering a dose of 30 Gy in 10 fractions. Meanwhile, a high dose of 40 Gy was delivered to brain metastases in 10 fractions. All patients were followed up to evaluate the efficacy, incidence of adverse reactions, median overall survival (OS), and intracranial progression-free survival (IPFS). Results The effective rate was 73.33% (44 cases), the disease control rate was 91.67% (55 cases), median OS was 15.2 months, and IPFS was 12 months. The 1 and 2-year OS was 66.7% and 26.4%, and the 1-year IPFS was 46.7%. The MMSE scores at 1, 3, and 6 months after SMART showed no significant differences compared with baseline scores (P > 0.05). Grade 2 and above inner ear damage such as otitis media, hearing loss, and dizziness was absent. Conclusion Smart-Brain can significantly reduce the treatment time and better protect the organs at risk, and serves as an economical, safe, and effective radiotherapy regimen in areas with limited technical conditions.
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Objective:To compare the efficacy and side effects between simultaneous and sequential integrated boost intensity-modulated radiotherapy after operation for high-grade glioma.Methods:We retrospectively analyzed 142 patients with high-grade glioma who underwent postoperative radiotherapy from January 2010 to December 2017. All patients were divided into the simultaneous and sequential integrated boost intensity-modulated radiotherapy groups. Concurrent temozolomide chemotherapy was delivered during radiotherapy in two groups. The follow-up outcomes were statistically compared between two groups.Results:For the whole group, the median overall survival (OS) was 24 months, the median progression-free survival (PFS) was 17 months, and the median disease-free survival (DFS) was 25 months. In the simultaneous and sequential integrated boost intensity-modulated radiotherapy groups, the median OS were 27.2 and 21.0 months ( P=0.950), the median PFS were 21.2 and 15.0 months ( P=0.21), and the median DFS were 28.0 and 18.0 months ( P=0.171), and the disease control rates were 92.86% and 85.17%( P=0.541), respectively. There was no statistical difference in OS, PFS, DFS, short-term efficacy and side effects between two groups. However, the conformity index in the simultaneous integrated boost intensity-modulated radiotherapy group was better than that in the sequential integrated boost intensity-modulated radiotherapy group ( P=0.032). Conclusions:Postoperative simultaneous and sequential integrated boost intensity-modulated radiotherapy yield no statistical differences in the survival, short-term efficacy and side effects in the treatment of high-grade glioma. However, the conformity index in the simultaneous integrated boost intensity-modulated radiotherapy group is significantly better, which can be recommended for postoperative radiotherapy of high-grade glioma.
ABSTRACT
Accurate delineation of clinical target volume (CTV) of nasopharyngeal carcinoma is of significance to prevent local recurrence and improve the survival rate of patients. When intensity-modulated radiotherapy (IMRT) was first introduced, CTV was delineated based on two-dimensional radiotherapy experience. The local recurrence-free survival is high, but the adverse reactions induced by radiotherapy are severe and the patients’ quality of life is poor. How to reduce CTV to alleviate acute and late radiotherapy-induced adverse reactions without deteriorating therapeutic effect has currently become a research hotspot. Despite the 2010 Chinese Nasopharyngeal Carcinoma IMRT Target and Dose Design Guideline Expert Consensus and the International Guideline for the Delineation of the CTV for Nasopharyngeal Carcinoma as references, the optimal individualized and standardized delineation of CTV remains controversial. This review summarizes the progress on the delineation of CTV of primary tumour of nasopharyngeal carcinoma, aiming to provide practical reference for clinicians.