Liposome-based multifunctional nanoplatform as effective therapeutics for the treatment of retinoblastoma

Photothermal therapy has the characteristics of minimal invasiveness, controllability, high efficiency, and strong specificity, which can effectively make up for the toxic side effects and tumor resistance caused by traditional drug treatment. However, due to the limited tissue penetration of infrared light, it is difficult to promote and apply in clinical practice. The eye is the only transparent tissue in human, and infrared light can easily penetrate the eye tissue, so it is expected that photothermal therapy can be used to treat fundus diseases. Here in, a new nano-platform assembled by liposome and indocyanine green (ICG) was used to treat retinoblastoma. ICG was assembled in liposomes to overcome some problems of ICG itself. For example, ICG is easily quenched, self-aggregating and instability. Moreover, liposomes can prevent free ICG from being cleared through the systemic circulation. The construction of the nano-platform not only ensured the stability of ICG in vivo, but also realized imaging-guide photothermal therapy, which created a new strategy for the treatment of retinoblastoma.

Dosimetry test of domestically-made accelerator intensity-modulated radiation therapy and volumetric-modulated arc therapy / 中华放射肿瘤学杂志

Objective:To create AAPM TG 119 test plans for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in order to evaluate the accuracy of the United Imaging Healthcare′s URT treatment planning system (URT-TPS). The plans were delivered to the phantom using the United Imaging Healthcare′s URT-Linac 506C.Methods:The overall accuracy of IMRT and VMAT planning, measurement, and analysis were evaluated for four test geometries provided by American Association of Physicists in Medicine (AAPM) Task Group Report 119(TG-119) on multi-target, prostate, head and neck and C-shape (easy). The dose distributions were measured in the coronal plane. The point measurements were measured by a Farmer type ion chamber and fluence measurements were completed with film and Delta4 phantom, respectively. Measured planar dose distributions were analyzed using gamma index with criteria 3%/3 mm.Results:For IMRT and VMAT plans, the planning results matched the TG-119 planning results. Measured point doses of IMRT and VMAT were within 2.62% and 3.90% of the planned doses, respectively. Measured film dosimetry gamma values of IMRT and VMAT were> 97.50% and> 93.27%, respectively.Conclusion:Based on these analyses which were performed in line with the TG119 recommendations, it is evident that the URT treatment planning system and URT-Linac 506C have commissioned IMRT and VMAT techniques with adequate accuracy.

Impact of accelerator operating errors on γ passing rate during dose verification of volumetric modulated arc therapy for pelvic tumors / 中华放射肿瘤学杂志

Objective:To investigate the impacts of gantry rotation angle errors, monitor unit (MU) errors, collimator and multi-leaf collimator (MLC) position errors upon the γ passing rate of dose verification in volumetric modulated arc therapy (VMAT).Methods:Ten patients with rectal cancer and 10 patients with uterine tumors were selected. The operating errors of accelerator parameters were introduced during the VMAT execution. By comparing the γ passing rates during dose verification between the simulating and original plans, the impact and sensitivity of the operating errors of each accelerator parameter on γ passing rate were analyzed.Results:When the γ criteria were set as 3%/3 mm, 3%/2 mm and 2%/2 mm, the γ passing rate decreasing gradient was less than 7.0% after the introduction of gantry rotation angle, MU and collimator position errors, respectively. However, after the reverse, opposite, and co-directional motion errors of the MLC blades on both sides were introduced, the γ passing rate decreasing was less than 19.13 %, 18.53%, 0.19 %; 19.87%, 20.01%, 0.42 % and 23.11%, 23.45%, 0.65 % for absolute dose verification, respectively.Conclusion:During VMAT, the reverse and opposite motion errors of MLC blades exert more significant effect on the γ passing rate compared with the gantry rotation angle errors, MU errors, collimator position errors and co-directional motion errors of the MLC blades. When the γ criteria of 3%/3 mm, 3%/2 mm and 2%/2 mm are adopted, the impact of accelerator operating errors upon the γ passing rate is strengthened in sequence. Therefore, when performing dose verification for a specific patient, appropriate γ criteria should be chosen and absolute dose verification should be taken as the reference index to evaluate the consistency between the calculated and measured dose distribution.

Study of clinical application of a novel immobilization system in total marrow irradiation / 中华放射肿瘤学杂志

Objective To evaluate the clinical application value of a novel immobilization system in total marrow irradiation ( TMI) with MVCT image. Methods From 2016 to 2017, a retrospective analysis of the setup errors of 22 patients receiving TMI in two groups ( twelve patients were immobilized with the novel immobilization system in group 1, ten patients were immobilized with the combinatorial immobilization devices in group 2) was performed in this study on Zhongnan Hospital of Wuhan University. Two-sample t-test was used to analyze the differences of setup errors and the consistency of setup between two groups. Results In group 1, the setup errors on left-right, superior-inferior, anterior-posterior and rotation directions were ( 1.06±0.79) , ( 1.34±0.66) , ( 2.45±1.48) mm and ( 0.63°±0.65°) for the head and neck position, ( 1.58±1.13) , ( 2.38±1.99) , ( 2.05± 1.68) mm and ( 0.31°± 0.32°) for the chest position, ( 1.67± 1.24) , ( 3.88±2.20) , ( 1.96± 1.32) mm and ( 0.48°± 0.53°) for the pelvis position, and ( 0.95± 0.73) , ( 1.99± 1.35) , ( 3.66±2.13) mm and ( 0.24°±0.31°) for the lower limb, respectively. In group 2, the setup errors were ( 2.59±2.58) , ( 3.28±1.85) , ( 3.71±2.43) mm and ( 1.15°±1.18°) for the head and neck position, ( 4.38±3.69) , ( 5.64±3.78) , ( 2.72± 1.91) mm and ( 1.55°± 0.86°) for the chest position, ( 4.14± 2.97) , ( 6.97±3.68) , ( 2.21±2.26) mm and ( 1.23°±0.74°) for the pelvis position, ( 2.28± 1.15) , ( 5.97± 3.00) , ( 3.44±1.93) mm and ( 1.09°±0.94°) for the lower limb, respectively. The setup errors significantly differed between two groups on the left-right, superior-inferior and rotation directions for all positions ( all P<0.05) . The setup consistency significantly differed between two groups on the left-right, superior-inferior and rotation directions for the chest and pelvis positions ( all P<0.05) . Conclusion The novel immobilization system can significantly improve the setup accuracy and setup consistency, and enhance the precision of treatment for patients.

The dosimetric impacts of accelerator operation error on the volumetric modulated arc therapy for cervical cancer / 中华放射医学与防护杂志

Objective To investigate the dosimetric effect of accelerator gantry rotation angle errors, collimator and multileaf collimator ( MLC) leaf position errors on volumetric-modulated arc therapy ( VMAT) for cervical cancer. Methods A total of 10 patients with cervical cancer were selected. The plan. Trail file of each clinical plan was extracted from the Pinnacle3 V9. 2 planning system of USA Philips, then the operating parameters of tach control point were read and modified by Matlab programs, and thus the operating error of the accelerator was simulated. Results In this paper, it was discovered that systematic accelerator gantry rotation angle errors, systematic collimator position errors and systematic MLC shift errors which led to the maximum changes of the PTV dose limit were 0. 16％, 0. 46％ and 0. 57％, respectively, and the maximum changes of the dose limit of organs at risk ( OAR) were 0. 38％, -1. 32％ and -0. 44％, respectively. When the systematic MLC gap width errors were ± 0. 5, ± 1 and ± 2 mm, respectively, the maximum changes of PTV dose were 2. 11％, 3. 04％ and 6. 03％, respectively, while the maximum changes of the OAR average dose were 2. 17％, 3. 92％ and 7. 97％, respectively. Furthermore, the dose limits of PTV and OAR showed a strong linear correlation with MLC open or close errors(t=21. 201～90. 562,P<0. 05). If actual errors of each parameter of accelerator were introduced, the maximum changes of PTV and OAR dose limits were 0. 16％ and 1. 30％, respectively, and conformity index (CI) and homogeneity index (HI) were barely changed. Conclusions No significant effect was found for systematic accelerator gantry rotation angle errors, systematic collimator position errors and systematic MLC shift errors for cervical cancer VMAT patients. However, there is a high sensitivity to dose distribution for MLC open or close errors. Therefore, it is necessary to pay more attention on the quality control of the accelerator running in particular MLC position errors to ensure the therapeutic accuracy.

Quantitative analysis of setup errors in lung SBRT with R 624-SCF immobilization equipment / 中华放射肿瘤学杂志

Objective KV-CBCT was utilized to evaluate the setup errors in lung SBRT with R624-SCF immobilization equipment,quantitatively analyze the percentage of all types of errors in the cumulative errors and unravel the main sources of setup errors.Methods The CBCT data weekly and QA data monthly from 32 patients diagnosed with lung neoplasms were collected to quantitatively analyze the setup errors.The cumulative errors were calculated by statistical model.The proportion and source of each type of setup error was analyzed.Results All 32 patients received a total of 420 times of CBCT.The setup errors of immobilization equipment in the lateral,supine-inferior,anterior-posterior directions were (0.03±0.72) mm,(0.73± 1.16) mm and (0.21±0.95) mm,respectively.The errors of tumor motion in three directions were (0.71±2.61) mm,(-0.80±2.60) mm and (0.075± 1.77) mm,respectively.According to the calculation formula proposed by Vance Keeling,the proportion of the cumulative error was 54.55％,9.21％ for immobilization equipment,12.97％ for tumor motion,2.55％ for couch sagging,5.70％ for Gantry radiation isocenter,4.73％ for Collimator radiation isocenter,4.61％ for couch radiation isocenter and 5.70％ for Xray field isocenter,respectively.Conclusions The main factors of setup errors during SBRT treatment for lung cancer are setup random,tumor motion,immobilization equipment,couch sagging and machine isocenter.During radiotherapy,targeted control of tumor motion is of significance for minimizing the cumulative errors.

Evaluation of the feasibility of log file-based three-dimensional independent dose verification system in quality assurance of intensity-modulated radiation therapy / 中华放射肿瘤学杂志

Objective To assess the feasibility of the log file-based three-dimensional independent dose verification system for the quality assurance of clinical radiotherapy.Methods The statistical values of the percentage depth dose,off-axis curves and output factor calculated by the Mobius system were statistically compared with the measured data by three-dimensional water tank.The three-dimensional independent dose verification in clinical radiotherapy plan and the acceleratr log file-based three-dimensional dose verification during the treatment were performed in 17 patients with nasopharyngeal cancer.The accuracy of dose calculation and reconstruction of Mobius system was assessed.A statistical analysis was performed on the intra-fractionalγpass rate (3％/3 mm) for each patient to evaluate the stability of intra-fractional radiotherapy.Results The percentage depth dose,off-axis curve and output factor statistically calculated by the Mobius system matched well with the data measured by three-dimensional water tank.The dose-volume histogram (DVH) parameters between the target area and organ at risk during clinical radiotherapy plan were statistically compared in 17 patients with nasopharyngeal cancer.The maximum deviation was-2.16％ for the three-dimensional independent dose verification in the clinical radiotherapy plan,and 0.18 Gy for the accelerator log file-based three-dimensional dose verification.The averageγpass rate for 17 nasopharyngeal cancer patients was 99.26％,and the maximum deviation of intra-fractional radiotherapy was below 0.5％.Conclusions The function of dose reconstruction and independent calculation of the Mobius system yeilds the same accuracy with the treatment planning system,which can quickly perform three-dimensional independent dose verification in the clinical radiotherapy plan and accelerator log file-based three-dimensional dose verification throughout the treatment,thereby guarantting and providing the safe and reliable technical support for clinical treatment.

The impact of electronic portal imaging device position error on 3D dose verification of volumetric modulated arc therapy / 中华放射医学与防护杂志

Objective To analyze the impact of electronic portal imagingdevice (EPID) position error on three-dimensional dose verification of volumetric modulated arc therapy (VMAT).Metbods Five Suremark SL-20 lead points were fixed on Elekta tray,and EPID images were collected in 0-360° rotation,one image per 5°.The position error relative to the accelerator was analyzed via Matlab.Then the images position error was corrected according to the analysis,and the 3D dose was reconstructed with the corrected images.The dose distributions of double arcs,clockwise arc(arc 1),and counterclockwise arc (arc 2) of 16 nasopharyngeal carcinoma patients' VMAT plan were evaluated by γ analysis,and the results of before and after position error correction were compared.Results Compared to 0° gantry angle,the error of source to the image distance (SID) was maximum (1.20 cm) when the gantry angle was 180°.On account of the SID change,the maximum error along the up-down (y) direction in the iso-center planar was 2.28 mm and the left-right (x) direction error was within ± O.5 mm.The 3D γ analyses of 16 nasopharyngeal carcinoma in VMAT plans were obviously increased after the position error along y was corrected.The double arcs,arc1 and arc 2 were increased by (4.12 ±1.67) ％ (t =-9.86,P＜ 0.05),(3.47±1.64) ％ (t=-8.46,P＜ 0.05) and (5.08±1.30) ％ (t=-15.63,P＜ 0.05) in 5％/3 mm standard,respectively.However,in 3％/3 mm standard,γ value of the double arcs,arc 1 and arc2 were increased by (7.63 ±2.24) ％ (t =-13.63,P＜ 0.05),(6.03 ±2.07) ％ (t =-11.66,P＜ 0.05),(9.17 ±2.23) ％ (t =-16.41,P＜ 0.05),respectively.Since the EPID position error along x was corrected after y,the 3D γ analysis of reconstruction dose indicated that the average of the 5％/3 mm and 3％/3 mm γ value were increased by 0.23％ and 0.24％,respectively.Conclusions EPID motion error along the gantry to table direction of the accelerator can't be ignored.When reconstruct dose based on EPID,a modification should be made for rebuilding more accurate patients' 3D dose distribution.

Clinical efficacy and prognostic factors of stereotactic body radiotherapy for pulmonary oligometastases / 中华放射肿瘤学杂志

Objective To evaluate the clinical efficacy and prognostic factors of stereotactic body radiotherapy(SBRT)for pulmonary oligometastases,and to further explore the patients most suitable for SBRT. Methods From 2012 to 2105,51 patients with 76 oligometastatic lung tumors were treated with SBRT.In those patients,27 had primary lung tumors and the others had extrapulmonary tumors. Seven patients had squamous cell carcinoma,thirty-five had adenocarcinoma, and the rest had other types of cancer. The patients received radiotherapy at a dose of 50 Gy in five fractions or 60 Gy in three fractions. Survival analysis was made by the Kaplan-Meier method. A multivariate analysis was made by the Cox model. Results The 1-and 2-year local control rates were 86%(65/76)and 80%(61/76),respectively. The 1-and 2-year overall survival(OS)rates were 80%(41/51)and 55%(28/51),respectively. The median survival time was 30(2-57)months,while the median progression-free survival time was 8(1-32)months. Twenty-one patients had grade 1 radiation pneumonitis(RP),while one patient had grade 2 RP. The multivariate analysis revealed that no more than 2 oligometastatic lung tumors,progression-free interval(PFI), and a performance score(PS)no higher than 1 were independent factors for OS(all P<0.05). Conclusions SBRT is effective and safe for treating pulmonary oligometastases. The number of oligometastatic lung tumors,PFI,and PS are independent prognostic factors for OS. Suitable patients and the appropriate timing of treatment are key to the efficacy of SBRT.

Application of active breathing control (ABC) and four dimensional CT technology in stereotactic radiotherapy of lung tumor / 中华放射医学与防护杂志

Objective To investigate the difference of lung and target volume and dosimetry characteristics features of deep inhalation breathing holding-active breathing control (ABC) and the four dimensional CT (4D-CT) free breathing in stereotactic body radiation therapy (SBRT) technology for patients with lung cancer.Methods 10 patients with pulmonary malignant tumor who were proposed SBRT treatment were selected,and received CT under free breath (FB-CT),4D-CT scan under quiet respiration (4D-CT) and active breathing control CT scan (ABC-CT),respectively.With SBRT technology under the same condition designed four corresponding plans,FB-CT,ABC-CT,4D-CT and 4D-CT0 which was the end inspiratory phase of 4D-CT respectively.The lung volume(V),PTV,V5,V20,mean lung dose(MLD) and normal tissue complication probability(NTCP) of four treatment programs were counted and compared.Results Compared with FB-CT,V,PTV,V5,V20,MLD and NTCP of ABC-CT were 51.48％,-65.34％,-42.64％,-56.62％,-40.22％ and-98.53％ (t=-7.14 to6.16,P＜0.05);PTV,V5,V20,MLD and NTCP of 4D-CT were-40.14％,-16.90％,-37.16％,-17.85％ and-90.96％ (t =0.54 to 3.22,P＜0.05);PTV,V5,V20,MLD and NTCP of 4D-CT0 were-68.98％,-30.21％,-48.49％,-37.45％ and-95.82％ (t=1.32 to 5.46,P＜0.05),respectively.Compared with FB-CT,the lung volume of 4D-CT and 4D-CT0 had no statistical difference (P ＞ 0.05).Conclusions ABC-CT methods have ideal clinical characteristics,with larger double lung volume,smaller artifacts of image,and higher target matching precision.ABC-CT methods reduce the dose of normal lung tissues significantly.

Effect of Fitting Rigid Gas Permeable Lenses Correcting Ametropia on Keratoconus / 中国康复理论与实践

@# Objective To observe the effect of fitting rigid gas permeable lenses(RGP) correcting ametropia of keratoconus.Methods 25 patients(43 eyes) with keratoconus fitted RGP,and patinets' visual acuity(VA),cornea condition,degree of comfort and complications were observed.Results All of 43 eyes were successfully to fit RGP at the first time with mean diopter-8.99±-5.55 DS,corrected vision of RGP was significantly better than(or equal to) spherical-cylindrical lens,and get better corrected vision and fewer and more mild complications.Conclusion RGP can get a better correcting vision to keratoconus than spherical-cylindrical lens,and is the good nonoperative treatment to correct ametropia of keratoconus.