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Objective:To explore the reasonable timing of radiotherapy for epidermal growth factor receptor ( EGFR) mutation-positive non-small cell lung cancer patients with brain metastasis in the era of third-generation targeted drugs. Methods:Clinical data of EGFR mutation-positive non-small cell lung cancer patients with brain metastasis who received first-line treatment with third-generation targeted drugs and stereotactic radiotherapy at Shanghai Armed Police Corps Hospital from September 2019 to May 2022 were retrospectively analyzed. According to the timing of radiotherapy before / after targeted drug resistance, all patients were divided into the early and salvage radiotherapy groups. The proportion of brain metastasis, physical fitness, complete response rate, objective response rate, delaying the progression of brain metastasis and overall survival (OS) were compared between two groups. Kaplan-Meier method was used for survival analysis, log-rank test was used for univariate prognostic analysis, and factors with P <0.1 were included in Cox multivariate analysis. Results:A total of 85 patients were included, including 51 (60%) cases receiving early radiotherapy. Patients who participated in early radiotherapy had a higher proportion of symptomatic brain metastasis (82% vs. 56%, P=0.013) and poorer physical fitness (Kanofsky performance score <70: 61% vs. 26%, P=0.002) compared to patients who underwent salvage radiotherapy. Early radiotherapy significantly improved the complete response rate of intracranial lesions (35% vs. 12%, P=0.015) and objective response rate (88% vs. 71%, P=0.041), delayed the progression of brain metastasis (median intracranial progression free survival: 23.0 months vs. 16.0 months, P=0.005; median intracranial secondary progression free survival: 31.0 months vs. 22.0 months, P=0.021), and improved OS (median OS: 44.0 months vs. 35.0 months, P=0.046). In multivariate analysis, diagnosis-specific graded prognostic assessment score <2.5, mutation of EGFR exon 21, and salvage brain radiotherapy were adverse prognostic factors for OS. Conclusion:In the era of third-generation targeted drugs therapy, early involvement of stereotactic radiotherapy in non-small cell lung cancer patients with brain metastasis can bring greater clinical benefits.
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With the development of radiotherapy technology, the role of radiotherapy in the treatment of primary liver cancer has been gradually recognized. In recent years, precision radiotherapy for hepatocellular carcinoma has become a research hotspot. A number of clinical trials have shown that precision radiotherapy can significantly improve clinical prognosis of patients with hepatocellular carcinoma. In this article, the research progress and existing problems of radiotherapy in the treatment of hepatocellular carcinoma were reviewed, aiming to provide literature support for the application of radiotherapy in the treatment of hepatocellular carcinoma.
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Objective To explore the dosimetric effects of a self-developed planning mode of boundary range scattering dose(BRSD)on Cyberknife treatment of lung cancer brain metastases.Methods The positioning images of 15 patients with lung cancer brain metastases treated in the radiotherapy department of some institution from January 1,2021 to December 31,2021 were selected and introduced into Cyberknife Multiplan 4.0.3 treatment planning system.A fractionated stereotactic radiotherapy(FSRT)plan(as the FSRT planning group)and a BRSD plan(as the BRSD planning group)were developed for each patient.The FSRT planning group developed a plan for the planning target volume(PTV)in the conventional way,so that V100 covered more than 95％of the PTV;the BRSD planning group prepared a plan for the gross tumor volume(GTV)with the same parameter conditions as the FSRT planning group and the prescription dose was normalized to the PTV so that V100 covered more than 95％of the PTV.The dosimetric parameters of the target area and normal tissue of the 2 groups were compared by dose-volume histograms and isodose curves.Statistical analysis was performed using SPSS 24.0 software.Results The D98,Dmax and Dmean in the target area of the BRSD planning group were significantly higher than those of the FSRT planning group,and the differences were statistically significant(P<0.05);the differences in the conformity index,dose gradient index,and Dmean,V30,V24 and D3cc in normal tissue of the 2 groups were not statistically significant(P>0.05);the BRSD planning group gained a denser dose distribution when compared with the FSRT planning group.Conclusion The BRSD planning mode gains significant dosimetric advantage by enhancing the absorbed dose to the target area without increasing or decreasing the dose to normal tissue.
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Objective:To investigate the efficacy and safety of fractionated stereotactic radiotherapy (FSRT) based on linear accelerator for small volume brain metastases.Methods:A total of 21 patients with small volume brain metastases who received FSRT from August 2020 to June 2022 were enrolled as subjects, including 45 lesions. Small-volume brain metastases were defined as ≤3 cm in diameter and ≤6 cm 3 in volume, and the dose/fractionation scheme was 27-30 Gy/3 F or 30-40 Gy/5 F. Three months after radiotherpy, the efficacy of FSRT in small brain metastases and the incidence of radiation brain injury were evaluated, and the incidence of radiation brain injury in subgroup analysis was performed according to the diameter, volume, dose/fractionation scheme, biological effective dose (BED) 10, and location of lesions. Results:Twenty-four lesions (53.33%, 24/45) were evaluated as complete response, another 13 lesions (28.89%, 13/45) were evaluated as partial response, and in the remaining 8 lesions (17.78%, 8/45) were evaluated as stable disease. The local control rate was 100% (45/45), the objective remission rate was 82.22% (37/45), and the intracranial distant progression rate was 23.81% (5/21). During the treatment and follow-up, there were 7 lesions (15.56%, 7/45) of radiation-induced brain injury, and the incidence of symptomatic radiation-induced brain injury was 11.11% (5/45). Subgroup analysis showed that the incidence of radiation brain injury in the group with a lesion diameter of 2-3 cm was higher than that with a lesion diameter of <2 cm group, with a statistically significant difference [80.00% (4/5) vs. 7.50% (3/40), χ2=12.69, P<0.001]; the incidence rate of radiation brain injury in the group with lesion volume of 4-6 cm 3 was higher than that with lesion volume of <4 cm 3 group, with a statistically significant difference [57.14% (4/7) vs. 7.89% (3/38), χ2=7.49, P=0.006]. There was no significant difference in the incidence of radiation brain injury between the dose/fractionation scheme of lesions 27-30 Gy/3 F and 30-40 Gy/5 F [9.52% (2/21) vs. 20.83% (5/24), χ2=0.40, P=0.527]. There was no significant difference in the incidence of radiation brain injury between the BED 10<60 Gy and ≥60 Gy [28.57% (2/7) vs. 13.16% (5/38), χ2=0.22, P=0.641]. There was no significant difference in the incidence of radiation brain injury between the lesions in the same lobe and the single or multiple lesions in different lobes [28.57% (4/14) vs. 9.68% (3/31), χ2=1.38, P=0.240) . Conclusion:FSRT based on linear accelerator is effective for small volume brain metastases. Brain metastases with the diameter <2 cm or volume <4 cm 3 are associated with a lower incidence of radiation brain injury than that of lesions with the diameter of 2-3 cm or volume of 4-6 cm 3.
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With the continuous improvement of cancer treatment, the survival of patients with spinal metastases has been significantly prolonged. Currently, the treatment of spinal metastases presents a trend of multi-mode. Clinical surgical methods include vertebral tumor resecting spinal canal decompression and internal fixation surgery, separation surgery, minimally invasive surgery and percutaneous ablation technology, etc. Radiotherapy techniques include traditional external radiation therapy, stereotactic radiotherapy and brachytherapy, etc. The risk of vertebral tumor resecting spinal canal decompression and internal fixation surgery, and the incidence of intraoperative and postoperative complications is high. The extension of postoperative recovery period may lead to delay of follow-up radiotherapy and other medical treatment, which has a serious impact on patients' survival and treatment confidence. However, the precision of traditional external radiation therapy is not high, and the limitation of tolerance of spinal cord makes it difficult to achieve the goal of controlling insensitive tumor. With the development of radiotherapy and surgical technology, stereotactic radiotherapy with higher accuracy and separation surgery with smaller surgical strike have become the focus of many clinical experts at present. This article reviews the progress of Hybrid treatment of separation surgery combined with stereotactic radiotherapy.
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Humans , Radiosurgery , Spinal Neoplasms/surgery , Spine , Decompression, Surgical , Fracture Fixation, InternalABSTRACT
Objective:To explore the clinical application value of personalized positioning using a cervical collar combined with a vacuum pad in the Cyberknife radiosurgery for cervical spine metastases.Methods:This study enrolled 68 patients with cervical spine metastases to be treated with Cyberknife stereotactic radiotherapy for cervical spines. These patients consisted of 41 males and 27 females, aged from 43 to 78 years (average: 51.5 years). They were divided into groups A, B, and C using the random number table method. The patient positioning in these groups was achieved using a cervical collar combined with a vacuum pad (personalized positioning), a vacuum pad, and a small head mold, respectively. After the first treatment, the comfort levels of the positioning molds during treatment were investigated. After radiotherapy, the average deviations in translational and rotational directions, the minimum tolerance distance (dxAB), the minimum rotational deviation angle (drAB), the proportion of false nodes, and the comfort level of the three positioning method were acquired for analysis.Results:The three groups showed statistically significant differences in the inf-sup, left-right, ant-post, pitch, roll, and yaw directions during the first treatment ( F = 7.13, 2.56, 3.41, 4.21, 2.71, 8.14, P < 0.05). Compared with groups B and C, Group A had significantly lower dxAB, drAB, and the proportion of false nodes, showing statistically significant differences ( F = 5.06, 4.31, 3.30, P < 0.05). Furthermore, patients in groups A and B felt more comfortable with the positioning molds than those in Group C ( χ2 = 12.46, P < 0.05), with no statistically significant differences between groups A and B ( P > 0.05). Conclusions:For patients with cervical spine metastases undergoing Cyberknife radiosurgery for cervical spines, the personalized positioning using a cervical collar combined with a vacuum pad can improve the accuracy and safety of Cyberknife spinal tracking while remaining the comfort level.
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Objective:To investigate the efficacy of stereotactic body radiotherapy (SBRT) combined with modified FOLFOXIRI (mFOLFOXIRI, irinotecan, oxaliplatin, leucovorin and fluorouracil) and cetuximab in the treatment of postoperative liver metastases in patients with KRAS, BRAF and NRAS gene wild-type colorectal cancer, and to evaluate treatment-related adverse reactions.Methods:A total of 86 patients with postoperative liver metastases from colorectal cancer diagnosed in Shandong Daizhuang Hospital from January 2018 to January 2021 were selected, all of whom were KRAS, BRAF and NRAS gene wild-type. All patients were divided into control group and study group according to the random number table method, with 43 cases in each group. The patients in the control group were treated with mFOLFOXIRI and cetuximab, 14 days a cycle, for a total of 12 cycles. The patients in the study group were treated with SBRT for liver metastases on the basis of the control group. Two patients in the control group were withdrawn from the study due to intolerance of myelosuppression (grade 4), and patients in the study group were withdrawn from the study due to intolerance of 1 case of myelosuppression, 1 case of gastrointestinal reaction and 1 case of abnormal liver function (all grade 4). The efficacy, median progression-free survival (PFS), median overall survival (OS) and adverse reactions were compared between the two groups after treatment.Results:After 12 cycles of treatment, the objective response rate (ORR) and disease control rate (DCR) of the study group were 55.00% (22/40) and 80.00% (32/40) respectively, which were higher than 31.71% (13/41) and 58.54% (24/41) of the control group, with statistically significant differences ( χ2=4.48, P=0.034; χ2=4.37, P=0.037). After treatment, 14 patients (35.00%) in the study group were resectable, which was higher than 6 patients (14.63%) in the control group, with a statistically significant difference ( χ2=4.52, P=0.034). The median PFS and median OS of the study group were 9.2 months and 19.5 months respectively, which were longer than 6.5 months and 15.2 months of the control group, with statistically significant differences ( χ2=8.83, P=0.015; χ2=7.52, P=0.027). There were no significant differences in incidences of leukopenia [55.00% (22/40) vs. 46.34% (19/41), χ2=0.61, P=0.436], anemia [45.00% (18/40) vs. 39.02% (16/41), χ2=0.30, P=0.585], thrombocytopenia [37.50% (15/40) vs. 31.71% (13/41), χ2=0.30, P=0.584], nausea and vomiting [55.00% (22/40) vs. 48.78% (20/41), χ2=0.31, P=0.575], constipation and diarrhea [20.00% (8/40) vs. 17.07% (7/41), χ2=0.12, P=0.734], liver function damage [35.00% (14/40) vs. 29.27% (12/41), χ2=0.31, P=0.581], peripheral sensory neuropathy [30.00% (12/40) vs. 26.83% (11/41) ), χ2=0.10, P=0.752], acute cholinergic syndrome [12.50% (5/40) vs. 14.63% (6/41), χ2=0.08, P=0.779] and fatigue [52.50% (21/40) vs. 43.90% (18/41), χ2=0.60, P=0.439]. Conclusion:SBRT combined with mFOLFOXIRI and cetuximab is more effective than drug therapy alone in patients with liver metastases after colorectal cancer surgery, which can effectively prolong the survival period, and the adverse reactions are tolerable.
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Objective:To evaluate the effects of the changes in respiratory status on gated stereotactic radiotherapy under free breathing guided by real-time position management (RPM).Methods:This study simulated the baseline shift, change in respiratory rate, end-expiratory delay, end-inspiratory delay, and irregular breathing using an in-house developed motion phantom. Moreover, this study analyzed the correlation between the changes in the above states of three plans, three-dimensional conformal radiotherapy(3D-CRT), intensity modulated radiotherapy(IMRT), and volumetric modulated arc therapy(VMAT) and the position of the ball at the center of the motion phantom (L) and the exposed dose of the phantom in the ionization chamber (the dose).Results:The in-house developed phantom presented high setup repeatability and measurement stability. There was a positive correlation between L and the baseline shift ( r = 0.99, P < 0.01). The change in the dose was less than 4% when the baseline shift was less than the setup error, while the dose declined rapidly and was negatively correlated with the baseline shift otherwise ( r= -0.95, P < 0.01). Moreover, there was statistically significant difference in dose when the baseline shift exceeded the setup error or not ( Z = -3.06, P < 0.01). There was no significant difference in the rate of the dose affected by baseline shift in the three plans ( P > 0.05). The changes in respiratory rate had little effect on L and the dose. Both end-inspiratory delay and end-expiratory delay reduced the planned dose of the three plans, with a maximum decrease of up to -1.74%. Furthermore, the end-inspiratory delay has greater effects on the planned dose than the end-expiratory delay( Z = -2.67, P< 0.01). However, there was no significant correlation between the dose and the delay duration ( P > 0.05), and no significant difference in the rate of the planned dose of the three plans affected by respiratory waveform change ( P > 0.05). Irregular breathing had greater effects on the dose. Specifically, the dose from six repeated measurements of 3D-CR, IMRT, VMAT was (709.68±180.00), (751.40±127.16), and (750.00±185.60) cGy, respectively, all less than the prescribed dose with a poor consistency. Conclusions:The changes in the patients′ respiratory status will reduce the dose, especially when the baseline shift exceeds the setup error threshold or large respiratory waveform variation corresponding to irregular breathing occurs. Moreover, there is no correlation between the decrease in the dose and the radiotherapy technology.
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Objective:To establish a novel clinical application process of the optical surface monitoring system (OSMS) in the cranial frameless stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), and to assess the accuracy and effectiveness of the OSMS in the intra-fraction motion monitoring of both cranial phantoms and cranial SRT patients fixed using the Q-Fix encompass immobilization system.Methods:The deviations of OSMS in the real-time motion monitoring were assessed by determining the deviations between the displacement of the cranial SRS phantoms detected by the OSMS and the predefined displacement of the Varian Edge six degrees of freedom (6DoF) couch. The ability of the OSMS to conduct real-time monitoring of the head movement was also analyzed when one camera was blocked by the rotary gantry of the accelerator and when the couch was at non-zero angles. Moreover, ten patients who received 50 fractions of cranial frameless SRT were enrolled in this study. All the patients were fixed using the Q-Fix Encompass system, and their intra-fraction motion was monitored using the OSMS. The intra-fraction errors of OSMS real-time monitoring throughout the treatment were obtained from the OSMS logs. The patients received cone-beam computed tomography (CBCT) after the beam delivery, and the six-dimensional errors were obtained as intra-fraction motion errors of the CBCT.Results:For the cranial phantoms, there was a close correlation between the OSMS monitoring deviations and the predefined displacement in six dimensions. The OSMS-detected 3D vector deviations in the translational and rotational directions were (0.28±0.10) mm and (0.15±0.09)°, respectively when the angel both the gantry and couch was 0° and were (0.35±0.13) mm and(0.17±0.09)°, respectively, when one camera was blocked. The OSMS monitoring deviations with the couch at a non-zero degree were greater than those at zero degree. The maximum deviations occurred when the couch was at 270° and were (0.69±0.19) mm and (0.32±0.12)°, respectively, in the translational and rotational directions. For the cranial SRT patients fixed using the Q-Fix Encompass system, the OSMS and CBCT showed comparable intra-fractional motion deviations, which were (0.40±0.26) and (0.29±0.10) mm, respectively in the translational direction and were (0.33±0.20)°and (0.26±0.08)° in the rotational direction.Conclusions:The OSMS is an effective tool for optically guided radiotherapy, which allows for intra-fraction real-time motion monitoring with sub-millimeter accuracy. Therefore, to ensure the accurate preformation of cranial SRS/SRT, it is necessary to conduct the intra-fractional position monitoring using OSMS.
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@#<b>Objective</b> To investigate the dosimetric differences between volumetric modulated arc therapy (VMAT) with a flattening filter (FF) and flattening filter-free (FFF) VMAT in fractionated stereotactic radiotherapy for brain metastases. <b>Methods</b> Seventeen patients with brain metastases were divided into FF-VMAT group (VMAT plans with the FF mode) and FFF-VMAT group (VMAT plans with the FFF mode). The two groups were compared in terms of target volume dose parameters (<i>D</i><sub>98%</sub>, <i>D</i><sub>2%</sub> and <i>D</i><sub>mean</sub>), the conformal index (<i>CI</i>), the gradient index (<i>GI</i>), the gradient, normal brain tissue dose parameters (<i>V</i><sub>5Gy</sub>, <i>V</i><sub>10Gy</sub>, <i>V</i><sub>12Gy</sub> and <i>D</i><sub>mean</sub>), monitor units, and beam-on time. <b>Results</b> Compared with the FF-VMAT group, the FFF-VMAT group had significantly lower <i>GI</i> (3.33 ± 0.37 <i>vs</i> 3.27 ± 0.35, <i>P</i> = 0.001), a significantly lower gradient [(0.85 ± 0.20) cm <i>vs</i> (0.84 ± 0.19) cm, <i>P</i> = 0.002], a significantly shorter beam-on time [(177.05 ± 62.68) s <i>vs</i> (142.71 ± 34.59) s, <i>P</i> = 0.001], and significantly higher <i>D</i><sub>2%</sub> [(65.69 ± 2.15) Gy <i>vs</i> (66.99 ± 2.03) Gy, <i>P</i> = 0.001] and <i>D</i><sub>mean</sub> [(58.77 ± 1.60) Gy <i>vs</i> (59.95 ± 1.43) Gy, <i>P</i> <0.001]. There were no significant differences in the <i>CI</i>, the<i> D</i><sub>98% </sub>of the target volume, the <i>V</i><sub>5Gy</sub>, <i>V</i><sub>10Gy</sub>, <i>V</i><sub>12Gy</sub> and <i>D</i><sub>mean</sub> of the normal brain tissue, and monitor units between FFF-VMAT and FF-VMAT. <b>Conclusion</b> FFF-VMAT can better protect the normal tissue around the target volume, reduce the beam-on time, and improve treatment efficiency.
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The effect of radiotherapy on anti-tumor immunity is bidirectional, immunotherapy, especially the combination of immune checkpoint inhibitors (ICIs) and radiotherapy, can produce synergistic effects on anti-tumor immunity. Compared with conventional radiotherapy, stereotactic ablative body radiotherapy (SABR) can achieve high-precision and high-dose irradiation on target lesions, and has stronger anti-tumor immune activation effect. At the same time, due to the steep dose gradient, SABR can better protect the surrounding normal tissues, which is an effective means for the rapid control of local lesions in advanced non-small cell lung cancer (NSCLC). ICIs are an important component of standard treatment for advanced NSCLC. There is growing evidence that SABR in combination with ICIs can benefit patients with advanced NSCLC. This article reviews the biological basis and clinical research progress on the combination of these two therapies, aiming to provide reference for the domestic counterparts to better use this new treatment model.
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Objective:To compare the efficacy and side effects of multi-fraction stereotactic radiotherapy (SRT) and single-fraction stereotactic radiosurgery (SRS) in the treatment of brain metastases from colorectal cancer.Methods:A total of 98 patients with brain metastases from colorectal cancer searched from the database of Professional Committee of Brain Metastasis of Shanghai Anticancer Association were recruited in this study. Among them, 46 patients weretreated with SRT and 52 patients with SRS. Clinical characteristics of all patients were analyzed between two groups and the local tumor control rate, median survival time and the incidence of radiation-induced brain injury were compared between two groups.Results:The objective remission rates (ORR) in the SRT and SRS groups were 76.1% and 67.3%, respectively. The 12-month local tumor control rates were 88.3% and 83.9% between two groups, with no statistical difference ( P=0.689). The median overall survival time of all patients was 11.6 months, 10.8 months in the SRT group and 12.7 months in the SRS group. There was no statistical difference between two groups ( P=0.129). Multivariate analysis showed that the main factors leading to poor prognosis included the number of tumors of >3( P=0.026), low GPA score ( P=0.035), and lack of systematic treatment mode and bevacizumab ( P=0.001). There was no statistical difference in the incidence of acute and late radiation-induced brain injury between two groups. Conclusions:Both SRT and SRS are effective therapies for brain metastases from colorectal cancer. The synergistic application of systematic treatment mode may be one of the main reasons affecting the survival time of the patients.
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Liver transplantation is one of the main treatments of early hepatocellular carcinoma (HCC). The recurrence of HCC after liver transplantation severely affects the long-term survival rate of the recipients. Targeted therapy and immunotherapy play a critical role in HCC downstaging, preventing disease progression, reducing recurrence rate, prolonging the survival and improving the quality of life. However, no consensus has been reached on the application of targeted therapy and immunotherapy in recipients undergoing liver transplantation for HCC, including indications, timing and dosage. In this article, clinical research progresses on the indications and timing of targeted therapy and immunotherapy before and after liver transplantation for HCC were reviewed, aiming to provide reference for prolonging the survival of recipients after liver transplantation for HCC.
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Objective To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016,lung adenocarcinoma and analyze the related factors.Methods In this multi-center retrospective analysis,clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122).The clinical characteristics of patients in two groups were analyzed.The local tumor control rate,median survival time and radiation brain injury were statistically compared between two groups.Results At the end of follow-up,the objective response rates (ORR) were 70.9％ and 71.3％ in the SRT and SRS groups (P=0.772).The local tumor control rates at 12 months were 89％ and 86％ in the SRT and SRS groups (P=0.383).The median overall survival time of all patients was 14.3 months,15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349).Multivariate analysis showed that large target volume (P＜0.001),low GPA score (P=0.012) and no insensitive gene mutation (P＜ 0.001) were the main factors of poor prognosis.The incidence of late radiation brain injury was 5.8％ and 14.8％ in two groups (P=0.043).Conclusions SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma.SRT may have a lower incidence of late radiation brain injury than SRS.
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Objective@#To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016, lung adenocarcinoma and analyze the related factors.@*Methods@#In this multi-center retrospective analysis, clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122). The clinical characteristics of patients in two groups were analyzed. The local tumor control rate, median survival time and radiation brain injury were statistically compared between two groups.@*Results@#At the end of follow-up, the objective response rates (ORR) were 70.9% and 71.3% in the SRT and SRS groups (P=0.772). The local tumor control rates at 12 months were 89% and 86% in the SRT and SRS groups (P=0.383). The median overall survival time of all patients was 14.3 months, 15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349). Multivariate analysis showed that large target volume (P<0.001), low GPA score (P=0.012) and no insensitive gene mutation (P<0.001) were the main factors of poor prognosis. The incidence of late radiation brain injury was 5.8% and 14.8% in two groups (P=0.043).@*Conclusions@#SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma. SRT may have a lower incidence of late radiation brain injury than SRS.
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Surgery,radiotherapy and chemotherapy are three traditional treatments for malignant tumors.With the development of medicine,immunotherapy has been gradually adopted as an emerging therapy of malignancies.Recent clinical studies have demonstrated that the combination of radiotherapy and immunotherapy can induce the abscopal effect and improve the prognosis of patients.Compared with the conventional radiotherapy,stereotactic radiotherapy has a larger single dose and higher accuracy,which is more likely to induce the bystander effect and anti-tumor response.The combination of stereotactic radiotherapy and immunotherapy has been proven to be a more promising therapy in certain clinical trials.However,not all types of tumors can benefit from such combined therapy in clinical practice.The optimal dose,fraction pattern and lesion of radiotherapy,immune enhancement and safety remain to be further clarified.In this article,the research progress,related controversies and future research direction of stereotactic radiotherapy combined with immunotherapy for malignancies were reviewed.
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Objective To evaluate the necessity of arc by arc setup verification in patients with brain metastases receiving stereotactic radiotherapy (SRT) by analyzing the inter-and intra-fraction setup errors and residual errors collected from the ExacTrac X-ray portal image.Methods Clinical data of brain metastases patients treated with SRT in the previous two years were retrospectively analyzed.The ExacTrac X-ray setup images were collected after the normal setup procedure.Setup errors were calculated by registering the cranial bony structures of the ExacTrac X-ray setup images to that of the digitally reconstructed setup images.The inter-and intra-fraction setup errors and residual errors were statistically analyzed.Results Seventy-five patients from 116 lesions received 337 cycles of SRT of the head.The inter-and intra-fraction translational setup errors in the x,y and z directions were (0.93±0.86) mm and (0.15±0.59) mm;(1.83± 1.27) mm and (0.25±0.73) mm;(0.96±0.80) mm and (0.14±0.56) mm,respectively.The inter-and intra-fraction rotational setup errors in the x,y,z directions were (0.65°± 0.62°) and (0.19°± 0.40°);(0.97°±0.94°) and (0.13°± 0.25°);(0.92°± 0.71°) and (0.10°± 0.29°),respectively.The residual translational setup errors in the x,y,z directions were (0.06±0.23) mm,(0.08±0.24) mm and (0.08±0.22)mm,and (0.12°± 0.27°),(0.09°± 0.18°) and (0.06°± 0.19°) for the residual rotational setup errors,respectively.For a reference setup error threshold of 0.7 mm/0.7°,99.1％ of the SRT exceeded the threshold and required setup correction.For 1 006 non-coplanar arcs,rotating the treatment couch from 0° to the treatment angle made 66.4％ of arcs exceed the threshold and require at least once setup correction.Conclusions During SRT for brain metastasis,the inter-and intra-fraction setup errors should be emphasized.It is necessary to perform arc by arc setup error verification.
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Objective To investigate the short-term clinical efficacy and adverse reactions of stereotactic radiotherapy (SRT) in the treatment of locally recurrent non-small cell lung cancer (NSCLC).Methods Clinical data of 120 cases of recurrent NSCLC after radiotherapy admitted to our hospital from October 2009 to October 2015 were retrospectively analyzed.SRT was adopted for further radiotherapy.The prescription dose was 50％ dose curve surrounding the target area.The total dose was 40-50 Gy,with a single dose of 4-5 Gy for 8-12 times.The chest CT was re-examined every 2 months after radiotherapy.The short-term clinical efficacy and adverse reactions were evaluated.The changes of Karnofsky performance score (KPS) and quality of life (QOL) were recorded before and after radiotherapy.Results One patient terminated the radiotherapy due to grade 3 acute radiation-induced pneumonia,25 patients (21.0％) obtained complete remission (CR),61 cases (51.3％) of partial remission (PR),19 cases (16.0％) of stable disease (SD),14 cases (11.8％) of progress disease (PD),86 cases (72.3％) of objective remission rate (CR+PR),and 105 cases (88.2％) of disease control (CR+PR+SD),respectively.Thirty-one patients experienced radiation-induced pneumonia,23 cases of radiation-induced myelosuppression and 1 case of acute radiation-induced heart injury.All these adverse reactions were mitigated after symptomatic treatment.The KPS was significantly increased from 68.16±15.22 before SRT to 78.39± 11.50 after SRT (P＜0.05).The QOL was considerably elevated from 27.58±5.37 prior to SRT to 38.16±8.39 following SRT (P＜0.01).Conclusion SRT is an efficacious and safe treatment of locally recurrent NSCLC,which yields controllable and tolerable adverse reactions and enhances the QOL of patients.
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Objective To evaluate the efficacy and safety of CyberKnife stereotactic body radiation therapy (SBRT) in the treatment of hepatic hilar cancer.Methods A retrospective study was performed on the clinical data of 36 patients with hepatic hilar cancer who were admitted to our hospital and treated with CyberKnife SBRT from 2009 to 2015.In the 36 patients,37 lesions were found with tumor diameters ranging from 1.5 to 5.5 mm (median diameter 3 cm).The Synchrony respiratory tracking system was used for 21 lesions in 20 patients,while the XSight spinal tracking system was used for 16 lesions in 16 patients.Local progression was evaluated based on contrast-enhanced computed tomography and/or magnetic resonance imaging.The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates,and the log-rank test was used for survival comparison and univariate prognostic analysis.Results The median follow-up time was 12.7 months.The 1-and 2-year postoperative LC rates were 90％ and 76％,respectively.The 1-year OS and progression-free survival (PFS) rates were 63％ and 39％,respectively.The median OS and PFS times were 15.2 and 10 months,respectively.The incidence of grade 3 adverse reactions was 11％.Conclusions The CyberKnife SBRT is a safe and effective way to treat hepatic hilar cancer.
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Objective To investigate the utilization rate of gold fiducial markers and reasons for abandonment of gold fiducial markers in the CyberKnife VSI System, and to provide reference data for implantation of gold fiducial markers and radiotherapy planning. Methods From March to August,2017,a total of 47 patients had gold fiducial markers implanted or pasted. In those patients, 42 patients had gold fiducial markers implanted,including 32 receiving computed tomography(CT)-guided 3D-printing coplanar template assisted implantation, 1 receiving CT-guided 3D-printing non-coplanar template assisted implantation,1 receiving CT-guided implantation,and 8 receiving ultrasound-guided implantation. A total of 44 patients received the CyberKnife treatment, including 2 patients who failed to use gold fiducial markers and were treated with spine tracking instead and 3 patients missing the treatment for other reasons. The numbers of utilized and abandoned gold fiducial markers were recorded for calculation of the utilization and abandonment rates. The reasons for abandonment of gold fiducial markers were analyzed and classified. Results A total of 134 gold fiducial markers were implanted into or pasted to the 44 patients.In all the gold fiducial markers, 111 were utilized and 23 abandoned, yielding a utilization rate of 82.8% and an abandonment rate of 17.2%.The reasons for abandonment of gold fiducial markers included large rigidity error(26.1%), unqualified implanted fold fiducial markers(17.4%), displacement of gold fiducial markers(26.1%), and others(30.4%). Conclusions Compared with the CT-guided or ultrasound-guided implantation of gold fiducial markers, the CT-guided 3D-printing coplanar or non-coplanar template assisted implantation of gold fiducial markers requires only two puncture needles for each implantation and implants two gold fiducial markers by a single needle,which reduces the number of puncture needles,risk of puncture-induced injury,and incidence of complications after implantation. Not all the gold fiducial markers implanted by a variety of ways will be utilized. Some gold fiducial markers will be abandoned for different reasons,which should be taken into account during implantation of gold fiducial markers.