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As a non-invasive image analysis method, radiomics can deeply explore the clinical information hidden behind medical images, and has been widely used in medicine in recent years. Consolidation immunotherapy after concurrent chemoradiotherapy has become the standard treatment for locally advanced non-small cell lung cancer. The prediction and identification of treatment-associated adverse events radiation pneumonitis (RP) and immune checkpoint inhibitor-related pneumonitis (CIP) are of vital importance for the formulation of treatment plan and the selection of subsequent treatment. CT-based radiomics analysis shows great potential in predicting and identifying RP and CIP.
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Objective:To establish an in vivo model of acute radiation esophagitis in Wistar rats based on a small animal precision radiotherapy platform (SARRP). Methods:Thirty-six Wistar rats were randomly divided into control group, 40, 60 and 75 Gy groups. Based on MRI images, the esophageal target area of rats was outlined and the radiotherapy plan was formulated. The rats were respectively irradiated with 0, 8, 12 and 15 Gy per day for 5 consecutive days. The changes of body weight, food intake, esophageal pathology and magnetic resonance imaging were observed.Results:The body weight of rats in 75 Gy group decreased significantly on the 6th day after irradiation (IR) ( P<0.05). The esophageal tissue of rats in each IR group was thicker than that in control ( F = 14.20, P < 0.05). HE staining showed that the formation rate of radiation-induced esophagitis in 40 Gy and 60 Gy groups were 4/5 and 5/5, respectively, mainly mild. In 75 Gy group, the incidence of radiation-induced esophagitis approached to 5/5, of which 3/5 was severe at 9 d post-IR. The pathological injury scores [ M( Q1, Q3)] of rats in each group were 0, 1.0 (0.5, 2.5), 1.0 (1.0, 2.5) and 4.0 (1.5, 6.0) on the 9th day after IR. There was significant difference between the 75 Gy group and the control group ( H=12.69, P<0.05). After dynamic monitoring of neck MRI images, it was found that the esophageal signal of rats in each IR group increased and widened at 9 d post-irradiation. Conclusions:The animal model of acute radiation-induced esophagitis in rats was successfully established based on a small animal precision radiotherapy platform combined with MRI. 75 Gy was the best irradiation dose and the 9th day was the best observation time point.
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Objective To investigate the effects of multimedia information technologies on precision radiotherapy of head and neck malignant tumors (HNT). Methods A total of 96 patients with HNT recruited from 2016 to 2019 were randomly assignedto group A and group B with the same planning methodand therapists/technicians. Conventional and multimedia information technologies were respectively used in group A and group B for medical science popularization, individualized education, and doctor-patient communication before radiotherapy planning and positioning. Medical compliance, radiotherapy responses, setup errors, and machine occupancy time were investigated. Results Medical compliance was significantly higher (P < 0.05) in group A (96.5%) than in group B (73.8%). Skin acute radiation reaction was significantly lower (P < 0.05) in group A than in group B. Three-dimensional absolute setup errors were 0.69 ± 0.29 mm, 0.97 ± 0.69 mm, and 0.79 ± 0.47 mm in group A, which were significantly lower than 1.39 ± 0.81 mm, 1.87 ± 1.19 mm, and 2.50 ± 0.99 mm in group B(P < 0.05). Traditional three-dimensional setup errors were 0.73 ± 0.39 mm, 0.51 ± 0.69 mm, and 0.74 ± 0.17 mm in group A, which were significantly lower than 1.32 ± 0.76 mm, 1.89 ± 1.21 mm, and 1.37 ± 0.57 mm in group B (P < 0.05). Planning time was 145.15 ± 28.45 sin group A, which was significantly lower than 240.38 ± 50.45 sin group B (P < 0.05). Positioning time was 115.15 ± 18.45 s in group A, which was significantly lower than 173.38 ± 24.45 sin group B (P < 0.05). Conclusion The application of multimedia information technologies inmedical science popularization, individualized education, and doctor-patient communication forpatients who received precision radiotherapy for HNT can significantly increase patient compliance, alleviate acute radiation reactions, reduce setup errors, and shorten the machine occupancy time of planning and positioning.
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Objective To clarify the advantages and disadvantages of domestic precision radiotherapy equipment by comparing the clinical efficacies of domestic and imported precision radiotherapy equipments in the treatment of lymphoma. Methods We investigated the treatments of lymphoma in hospitals of different levels using domestic and imported medical linear accelerators and divided them into domestic and imported groups. The data of patients in the two groups were retrospectively analyzed, and the radiotherapy equipment brand, short-term efficacy, acute toxicity, dosimetric parameters of organs at risk and the costs of radiation therapy were compared between the two groups. Results A total of 101 cases receiving radiation therapy for lymphoma in 10 hospitals were collected, including 77 cases in the imported group and 24 cases in the domestic group. The overall response rates were high in both groups, being 88.3% (68/77) in the imported group and 87.5% (21/24) in the domestic group, with no significant difference (P=1.00). The incidences of hematological toxicity (>grade 2) were low in both groups, being 1.3% (1/77) vs 8.3% (2/24), with no significant difference (P=0.14). Subgroup analysis was performed on the dosimetric parameters of organs at risk and acute toxicity of the two groups for extranodal nasal type NK/T cell lymphoma, and there were no significant differences in the maximal dose (Dmax) of the lens, Dmaxof the optic nerve, or mean dose (Dmean) of the parotid gland between the two groups (all P>0.05). However, there was an increasing trend in the domestic group compared with the imported group for Dmeanof bilateral parotid gland (left: [2 306.53±1 119.66] cGy vs[ 1 279.44±1 026.95] cGy, P=0.16; right:[ 2 328.35±1 009.76] cGy vs[ 1 303.79±1 116.79] cGy, P=0.17). The incidence of grade 2 xerostomia in the domestic group was higher than that in the imported group, but the difference was not statistically significant (50.0%[ 2/4] vs 14.3%[ 1/7], P>0.05). The domestic group had significantly lower radiotherapy cost [( 26 743.9±8 061.2] yuan vs[ 42 428.7±14 744.7] yuan) and total hospitalization cost [( 36 702.1± 12 225.8] yuan vs[ 50 192.7±15 494.4] yuan) than the imported group (both P<0.01). Conclusion There is no significant difference in the short-term efficacy of lymphoma treatment between the domestic radiotherapy equipment and the imported radiotherapy equipment, while the treatment cost of the domestic radiotherapy equipment is relatively low. However, the dosimetric parameters of organs at risk of imported radiotherapy equipment is lower and the acute toxicity is less..
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How to realize the real-time monitoring of the position and dose of the superficial tumor target area in the process of radiotherapy and ensure the target area to receive sufficient radiation dose, so as to improve the local control rate of patients is both the key problem to be solved urgently in radiotherapy and an important way for the accurate and safe implementation of quality control and quality assurance. The ideal radiotherapy monitoring technology should have the advantages of being non-radiation and non-invasive, and three-dimensional dynamic real-time imaging. This paper will briefly review the existing location and dose monitoring technologies in the process of precise radiotherapy.
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Radiotherapy is one of the main means of tumor treatment. With the progress of tumor radiotherapy technology and the rapid development of computer technology, radiophysics, radiobiology, imaging and functional imaging, revolutionary progress has been made in tumor radiotherapy. Precision radiotherapy requires accurate radiotherapy positioning, planning and design, and dose calculation. It involves 3D image processing technology, high-precision dose calculation algorithm and cutting-edge linear accelerator series technology. Recent years has witnessed remarkable progress of precision radiotherapy in the comprehensive treatment of tumors. This paper reviews the value of precision radiotherapy in the comprehensive treatment of tumors and predicts its application prospect.
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With the development of modern computing technology and medical physics,radiotherapy has made great progress.The theoretical basis of radiobiology seems to lag behind the clinical application of radiotherapy,which hampers the further improvement of treatment efficacy and the optimization of treatment modality.In this paper,some emerging challenges of precision radiotherapy technology to the traditional theory of radiobiology,such as radiosensitivity,dose-response curve and survival curve,linear-quadratic model,4Rs theory,as well as the interaction between cancer and microenvironment,radiation-induced second primary cancers (RISPC),will be discussed.The interplay between precision radiotherapy and traditional radiobiology theories will be addressed with the aim to potentially solve some of the challenging problems.
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Dose verification, as part of the radiotherapy QA chain, is a significant method to ensure the patients' safety and efficacy of treatment. The increasing application of precision radiotherapy techniques in clinic has advanced the need of three-dimensional ( 3D) dose verification. Gel dosimeters, prevailing for its intrinsic 3D high-resolution measurement and good tissue equivalence, can serve as effective supplement to the clinical radiotherapy dosimetric system. This paper reviews the method ology, dose response mechanism, characterizations of the state-of-the-art gel dosimeters. Gel dosimeters, outstanding for 3D dose measurement, have a great potential to explore both for clinical application and academic research.
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New developments in radiomics and bio-omics, blockchain, digital twins, cloud-to-edge computing, big data, and artificial intelligence are revolutionizing cancer radiotherapy, with breakthroughs in treatment accuracy and efficacy. Smart omics-guided radio-therapy will eventually resolve the problem of radiotherapy. In the radiotherapy decision-making, the whole genetic information and biological characteristics of tumors and individuals can be obtained through the methods of omics technology. For the determination of radiotherapy targets, through the image technique it provides the full genetics and microenvironmental information of the cancer lesion. For treatment response evaluation and follow-up, it can timely optimize the radiotherapy plan and monitor the tumor by real-time dynamic observation of changes in various histological information throughout the treatment process. The advantages of the treatment model are reflected in accurate decision-making, avoiding "blind people's touch" and partial errors. Holographic target iden-tification avoids the uncertainty caused by manual delineation of targets, and full and dynamic histological evaluation can promote the early detection of tumor recurrence.
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Radiomics is a new area of research, which converts imaging data into high?resolution quantitative imaging features by applying the automatic high?throughput imaging?feature?extraction algorithm. With the development of data science, more and more attention has been paid to the non?invasive and quantitative method in precision radiotherapy all over the world. This paper will briefly introduce the concept of radiomics and its application in precision radiotherapy.
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Objective:It is more difficult to conduct precision radiotherapy for organs of the human body with the respiratory movement. It is necessary to compensate a certain degree of deviation which is produced by many thoracic and abdominal organs with breathing exercises. To develop a new breathing control system of tumor target for precision radiotherapy is the practical demand in hospital.Methods: According to the current active breathing control system, there are gasbag, control box, handle switch for the patients, computer, automatic gasbag controller, respiratory sensor and communication tools. The Pneumotach PowerCube pulmonary function respiratory sensor and C++ high level programming language were selected to program the breathing control system.Results: The system could make patients conduct respiratory control better, reduce the deviation of pulmonary tumor caused by respiratory movement and improve the accuracy of treatment.Conclusion: The system had a lot of functions, such as dispersion, oscillation, ventilation and so on. It is refitted on the current instruments and successful to clinical application.
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Technological advances that have been achieved over the last two decades in the area of treatment planning and sophisticated and complicated hardware capabilities, such as computer-controlled treatments, multileaf collimators, and incorporating imaging devices into treatment machines, enable clinical implementation of high-precision radiotherapy in field of radiation oncology. High-precision radiotherapy allows the delivery of increased tumor doses with relative sparing of normal tissues compared to 3 -dimensional radiotherapy and conventional techniques. Preliminary clinical experiences of high precision radiation therapy have been encouraging by high rates of local control and decrease of toxicity. This article provides an overview of high precision radiotherapy such as intensity-modulated radiotherapy, stereotactic radiation therapy, image-guided radiotherapy, and charged particle therapy.
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Terapia de Protones , Oncología por Radiación , Radioterapia Guiada por Imagen , Radioterapia de Intensidad ModuladaRESUMEN
The precision radiotherapy adopts the accurate fixation,immobilization,spacial orientation and 3-dimensional calculation & display methods.On three-dimensional direction,stereotactic conformal or intensity modulated radiation therapy with conventional or non-conventional segmentation method is used.So the high dose area is identical with the target on three-dimensional and the dose intensity modulated in the target.It aims to decrease or not increase the radiation dose in the normal organs and tissues around the target when increasing the radiation dose in the tumor target.The technology can improve the partial control rate and the living quality of the patients.