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Postoperative radiotherapy increase the overall survival rate offor breast cancer improves overall survivalpatients, but. Nevertheless, the heart is at risk of radioactive heart damageradiation-induced cardiac injury due to its anatomical location, which is inevitably exposed to radiation during radiotherapy. The heart is considered a "high-risk organ" sensitive to radiation, and its radiation dose should be as low as possible. Previous studies have evaluated the effect of overall heart radiation dose on long-term cardiovascular events, but the. However, new study has found that the average heart dose does not accurately reflect the degree of heart radiation exposure. In recent years, more and morewidespread attention has been paid to subclinical cardiac injury after radiotherapy, aiming at early identification of latent cardiac injury. In addition, the relationship between specific cardiac substructural doses and arrhythmias is unclear. This paper focuses onIn this article, the limitations of average cardiac dose in predicting radioactive heart injuryradiation- induced cardiac injury, the indicators of early identification of the indicators for cardiac injury and the influencing factors of radiation-induced cardiac injury in breast cancer radioactive heart injurywere illustrated, and focuses on the relationship between radiation damage of different cardiac substructures and arrhythmia was evaluated, so asaiming to achieve fine cardiac risk management in breast cancer patients and reduce the non-cancer mortality in breast cancer patients.
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Objective:To investigate the feasibility of surface-guided hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization.Methods:Nineteen patients treated with hypo- fractionated radiotherapy for intracranial metastasis in our hospital were included. Before the start of treatment, each patient underwent simulation with open face mask immobilization. During the treatment, cone-beam CT(CBCT)images were collected for verification each time. Laser-guided positioning was used for the first time in the treatment, and surface images were captured after six-dimensional position correction as the reference images for subsequent treatment. Subsequent treatment was randomly divided into laser-guided positioning group(LG, 85/F)and optical surface-guided positioning group(SG, 101/F). The six-dimensional error data of patients with two positioning methods were compared and expressed as mean ± standard deviation. Meanwhile, the correlation and consistency between the optical surface error data and the gold standard CBCT error data were compared in the laser-guided fraction. GraphPad Prism 6.0 software was used for data processing and mapping, and SPSS 21.software was used for mean analysis and normality test. Pearson correlation analysis was used to analyze the correlation, and Bland-Altman plot analysis was used to test the coincidence between two methods.Results:Compared with the laser-guided positioning, the 3D error of optical surface-guided positioning was reduced from(0.35±0.16)cm to(0.14±0.07)cm. The Pearson coefficient of correlation along all three directions was less than 0.01,R 2 was 0.91,0.70 and 0.78 on Lat, Lng and Vrt, and R 2 was 0.75,0.85 and 0.77 on Pitch, Roll and Rtn(all P<0.01), respectively. The measurement results of two methods were positively correlated. The Bland-Altman plot analysis showed that the 95% limits of agreement were within preset 3 mm tolerance([-0.29 cm, 0.19 cm], [-0.25 cm, 0.25 cm], [-0.27 cm, 0.19 cm]), and the 95% limits of agreement were within preset 3° tolerance(Pitch[-1.76°,1.76°], Roll[-1.54°,1.60°], ROT[-2.18°,1.69°]), indicating agreement between two methods. Conclusions:The optical surface-guided positioning can reduce the setup errors in the hypo-fractionated radiotherapy for intracranial metastasis with open face mask immobilization. The optical surface error and CBCT error have good correlation and agreement.
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Objective To evaluate the clinical efficacy and safety of the hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma.Methods Clinical data of 153 patients with recurrent nasopharyngeal carcinoma admitted to our hospital from 2008 to 2013 undergoing hypofractionated three-dimensional conformal radiotherapy (3 Gy for each time,5 times a week,a total dose of 51-60 Gy,17-20 times/4 weeks) were retrospectively analyzed.The short-and long-term radiation-induced injury,Karnofsky performance score (KPS),short-and long-term clinical efficacy were evaluated.Results For the short-term radiation-induced injury,the incidence of oral mucosa and fatigue significantly differed before and after treatment (both P＜0.05).Regarding the long-term radiation-induced injury,the incidence of dry mouth (95.4％) and deafness (51.0％),difficulty in opening mouth (79.1％),maxillofacial fibrosis (33.3％) and radiation-induced encephalopathy (15.0％) significantly differed before and following treatment (all P＜ 0.05).The actual long-term radiation-induced injury included dry mouth (91.5％),deafness (50.9％),difficulty in opening mouth (76.5％),maxillofacial fibrosis (32.0％) and radiation-induced encephalopathy (14.4％).The number of patients with changes in the KPS scores significantly differed between the end of treatment and 3 months after treatment (P＜0.05).The local control rates were 29.4％,68.6％,79.1％,83.7％ and 86.9％ at 1-,3-,6-,9-and 12-month after corresponding treatment,respectively.The local control rate significantly differed between 1 and 3 months,and between 3 and 6 months after treatment (both P＜0.05).The 1-,2-,3-,4-and 5-year survival rates were calculated as 96.1％,80.4％,68.5％,57.9％ and 51.1％,respectively.Conclusions Hypofractionated three-dimensional conformal radiotherapy is an efficacious and safe treatment of recurrent nasopharyngeal nasopharyngeal carcinoma,which yields relatively high short-and long-term clinical efficacy,high local control rate and well tolerance by the patients.
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Objective To analyze the efficacy and safety of hypofractionated stereotactic radiotherapy ( FSRT ) combined with temozolomide ( TMZ ) for large brain metastases ( BMs ) in a prospective phaseⅡclinical trial.Methods From 2010 to 2015, a total of 33 patients were enrolled as subjects.The median Karnofsky Performance Status scores before and after treatment were 70 and 80, respectively.The major primary tumor was non-small cell lung cancer (57.6%).The brain metastasis had a diameter of≥3 cm or a volume of ≥6 cm3 .The radiation dose was 52 Gy in 13 fractions or 52.2 Gy in 15 fractions.Patients received TMZ at a dose of 75 mg/m2 per day concurrently.The radiotherapy was followed by 6 cycles of adjuvant treatment with TMZ (150 mg/m2, days 1-5, 28 days per cycle).Patients were reexamined by magnetic resonance imaging ( MRI) during the treatment.The radiation field would be shrunk if the gross target volume ( GTV) was reduced by≥20%.The treatment outcomes were evaluated by MRI at 2-3 months after treatment.Results The total numbers of tumors and GTVs were 95 and 38, respectively. Twenty-four (63%) out of the 38 GTVs had a volume larger than 10 cm3 and the median GTV was 15.3 cm3 (5.7-142.8 cm3).Twenty-two (67%) out of the 33 patients achieved field shrinking during the treatment, and the median reduction rate of GTV was 44%( 21%-88%) .The median total dose was 59.5 Gy, and 100%and 21.2%of patients completed the concurrent and adjuvant treatment with TMZ, respectively.In all patients, the overall response rate was 97.0%;the 1-year local control, intracranial progression-free survival, and overall survival rates were 97%, 70%, and 62%, respectively;the median survival time was 15.3 months.The main adverse reactions were grade 1-2 nausea and vomiting.One patient got grade 3 liver function impairment.Conclusions FSRT combined with TMZ is a safe and effective approach for treating large BMs.More than 50%of patients can achieve field shrinking to shorten treatment duration and reduce toxicity.Clinical Trial Registry ClinicalTrials.gov,registration number:NCT02654106.
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Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly significantly associat-ed with grade ≥1 acute GI toxicity. Grade 1,2 and 3 acute genitourinary (GU) toxicity occurred in 68%, 0% and 3% of the patients, respectively. The bladder V50> 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5%, respectively. The rectal V65> 10% was highly significantly associated with grade ≥1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49%, 11% and 3%, respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.