Workflow and error analyses of patient setup based on open-face mask immobilization combined with AlignRT for head tumor radiotherapy / 中华放射医学与防护杂志

Objective:To propose a markless patient setup workflow based on the optical surface monitoring system (AlignRT) and open-face mask immobilization for whole-course head tumor radiotherapy, assess the setup time and repositioning frequency of the proposed workflow, and conduct a comparative analysis of the differences, correlation, and consistency of the setup errors of the AlignRT and cone beam CT (CBCT) systems.Methods:A retrospective analysis was conducted for the data on the errors of 132 fractionated setup based on open-face mask immobilization of 33 head tumor patients. AlignRT-guided markless patient setup workflow was applied throughout the radiotherapy. Meanwhile, the body structures automatically generated by the treatment planning system were used as body references. The 6-degree-of-freedom (6DoF) setup errors (lateral, vertical, longitudinal, rotation, pitch, roll, and yaw directions), setup time, and repositioning frequency of the AlignRT and CBCT systems were recorded and analyzed. The Wilcoxon and Spearman analyses were used to statistically assess the differences and correlation of the setup errors of the two systems. Moreover, the Bland-Altman analysis was employed to evaluate the consistency of the two systems.Results:The 6DoF setup errors of CBCT were within the clinical tolerance (linear motions: -0.30 to 0.30 cm; rotational motions: -2.0° to 2.0°). The setup time and repositioning frequency of CBCT were (98 ± 31) s and 1.51% (2/132), respectively. There was no significant difference in setup errors between the two systems except those in x-axis ( Z = -3.11, P= 0.002), y-axis ( Z = -7.40, P<0.001), and Pitch ( Z= -4.48, P<0.001). There was a significant positive correlation between the setup errors along lateral ( rs = 0.47, P<0.001) and vertical ( rs = 0.29, P = 0.001) directions, rotation (Rtn; rs = 0.47, P<0.001), pitch (Pitch; rs = 0.28, P = 0.001) and roll (Roll; rs = 0.45, P<0.001) of the two systems. The 95% limits of agreement (95% LoA) of 6DoF setup errors were -0.12 to 0.09 cm, -0.07 to 0.17 cm, -0.19 to 0.20 cm, -1.0° to 0.9 °, -1.0° to 1.5°, and -0.9° to 1.0°, respectively. The 95% confidence interval (95% CI) of 95% LoA was -0.14 to 0.11 cm, -0.09 to 0.19 cm, -0.23 to 0.23 cm, -1.2° to 1.1°, -1.2° to 1.7°, and-1.0° to 1.1°, respectively, all of which were within the permissible error ranges. The 6DoF setup error difference of 3.41% (27/792< 5%) was beyond the 95% LoA. The maximum absolute differences of 6DoF setup errors within the 95% LoA were 0.12, 0.16, 0.19 cm, 0.9°, 1.5°, and 1.0°, respectively. Conclusions:The proposed markless setup workflow based on AlignRT combined with open-face mask immobilization for whole-course head tumor radiotherapy exhibits reasonable agreement and consistency with the patient setup using CBCT, with acceptable clinical efficiency. It can be applied to the first radiotherapy and the real-time monitoring of therapy to improve the safety and thus is of value in clinical applications.

A Giant Cranial Sebaceous Adenocarcinoma Which Responded to Multi-modal Therapy Including Palliative Radiotherapy

Introduction: We report a case in which multidisciplinary treatment including palliative radiotherapy reduced the size, exudate production and symptoms of a sebaceous carcinoma that had been neglected and allowed to form into a large destructive lesion. Case: A 48-year-old unemployed man who lived alone, was estranged from his family and socially isolated presented with a cranial tumor which had been present for three years. He did seek medical attention on one occasion. But a definitive diagnosis was not made, and he neglected to seek further treatment. The tumor became very large, painful and began to ooze exudate, and the patient became unwell with difficulty mobilizing. He was transported to the hospital by ambulance. The tumor was centered on the vertex of the scalp and had a maximum diameter of 30 cm. It was diagnosed pathologically as a sebaceous carcinoma and was inoperable. The tumor was treated with palliative radiotherapy, a total dose of 27 Gy　　/　　9 Fr, causing it to shrink by approximately 30% and markedly reduced the rate of exudate production. His condition improved markedly and he was able to go out on leave. Discussion: This case highlights the management and clinical course of an uncommon and large cranial sebaceous carcinoma.

Alpha-hederin induces the apoptosis of oral cancer SCC-25 cells by regulating PI3K/Akt/mTOR signaling pathway

BACKGROUND: Oral cancer is one of the common malignant tumors of the head and neck. However, current treatments have numerous side effects, and drugs from natural sources may have better therapeutic potential. This research investigated the induction of apoptosis by α-hederin (α-HN), a constituent of Pulsatilla chinensis (Bunge) Regel, in the oral cancer cell line SCC-25 and its underlying mechanism. RESULTS: SCC-25 cells were treated with 50, 100, and 200 µmol/L α-HN. Cell proliferation; extent of apoptosis; activities of caspases-3, 8, and 9; and the expression of Bcl-2, Bax, phosphorylated (p)-phosphoinositide 3-kinase (PI3K), p-Akt, and p-mammalian target of rapamycin (mTOR) proteins were determined using the 3-(4,5)-2-thiazole-(2,5)-diphenyl tetrazolium bromide, flow cytometry, caspase activity detection kits, and western blot assays, respectively. The results showed that the proliferation of SCC-25 cells in the α-HN-treated groups decreased significantly, and the inhibitory effect was time and concentration dependent. Compared with cells in the control group, the extent of apoptosis increased significantly, caspase-3 and -9 activities were significantly enhanced, and the Bcl-2 level was lowered and the Bax level was elevated significantly in SCC-25 cells treated with α-HN for 48 h (P b 0.05). The expression of p-PI3K, p-Akt, and p-mTOR was also significantly lower in SCC-25 cells treated with α-HN than that in the control group (P b 0.05). CONCLUSION: These results indicate that α-HN can inhibit proliferation and induce apoptosis of SCC-25 cells and may exert these effects by inhibiting the PI3K/Akt/mTOR signaling pathway.

Caracterización clinicoepidemiológica de los tumores de cabeza y cuello en niños y adolescentes desde 2000 hasta 2016 / Clinical epidemiological characterization of head and neck tumors in children and adolescents from 2000 to 2016

Se realizó un estudio descriptivo, transversal y retrospectivo de 23 pacientes con tumores de cabeza y cuello, atendidos en el Servicio de Oncología Pediátrica del Hospital Infantil Sur Docente Dr Antonio María Béguez César de Santiago de Cuba durante el período 2000-2016. En la casuística predominaron el grupo etario de 10-14 años (39,1 por ciento), el sexo masculino, la localización nasofaríngea (39,1 por ciento), el linfoma no Hodking y el carcinoma papilar como variedades histológicas, el estadio clínico III y el mayor número de pacientes diagnosticados en 2013 y 2014

A descriptive, cross-sectional and retrospective study of 23 patients with head and neck tumors, assisted in the Oncology Pediatric Service of Dr Antonio María Béguez César Southern Teaching Children Hospital was carried out in Santiago de Cuba during 2000-2016. In the case material there was a prevalence of the 10-14 age group (39.1 percent), male sex, nasopharingeal localization (39.1 percen), non Hodking lymphoma and papillary carcinoma as histological varieties, phase III clinical stage and the highest number of patients diagnosed in 2013 and 2014

Study on the value of ultrasound in the diagnosis of the tumors of pancrea head

From April 1998 to June 2001, ultrasound had diagnosed the tumors at the pancrea head in 80 patients and they were operated at Viet Duc Hospital. Among these subjects, there were 43 tumors of pancrea head, 14 tumors of inferior part of common bile duct, 18 tumors ooffvater ampulla, 2 tumors of duodenal, 2 chronical pancreatitis and 1 unspecific fibroma of liver external bile duct. Among 77 patients of tumor of pancrea head definitely diagnosed, there are 3 falsely positive cases and 3 negative cases by ultrasound. In 48 patients invasive structures in vessal bundle of superior mesenteriolum were diagnosed by surgery. Thus detecting pancrea head tumors, ultrasonic technique is a convenient and simple method with a sensibility of 96.1%