Study on improving accuracy of setup errors of supraclavicular field in radiotherapy for breast cancer by breast bracket and moisture-cured resin cushion / 中华放射医学与防护杂志

Objective To explore the effects of improvements on setup error ( SE ) and clinical target ( CTV ) margin of supraclavicular field ( SCF ) by using moisture-cured resin cushion and breast bracket for lower neck fixation in breast cancer patients who underwent post-mastectomy radiotherapy. Methods Totally 13 patients with breast cancer who underwent post-mastectomy radiotherapy were enrolled. All patients were immobilized by breast bracket and moisture-cured resin cushion. Firstly, each patient′s lower neck and head was fixed well by moisture-cured resin cushion, filling the gap between the neck and breast bracket. Secondly,each patient underwent the cone-beam CT ( CBCT) at the first, tenth and twentieth treatment after positioning. Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational directions, and SCF CTV margins by the systematic and random errors were evaluated. Results The setup errors in x (left-right), y (superior-inferior), z (anterior-posterior) translational directions were (2. 16 ± 1. 25), (1. 50 ± 1. 28), (1. 94 ± 1. 12) mm and (1. 76 ±1. 87)°, (1. 82 ±1. 12)°, (0. 99 ±0. 58)°, respectively in θ (pitch degree),Ф(roll degree),ψ( yaw degree) rotational directions. Non-parametric rank test ( Mann-Whitney U test) was performed with previous data, the differences of the setup error in y, z,θ directions were statistically significant ( Z =4. 152, 3. 415, 2. 053, P<0. 05). The margins from CTV were 4. 07, 4. 03 and 3. 73 mm in x, y and z directions, respectively. Compared with the previous study on SCF, CTV margin required 8, 8 and 6 mm in x, y and z axis directions, the volume of CTV to PTV were decreased by 32. 73% on average. Conclusions Compared with plastic circular pillow alone, moisture-cured resin cushion with breast bracket locating method could reduce setup errors in SCF target region. The margins from CTV to PTV weredecreased to 4. 07, 4. 03 and 3. 73 mm in x, y and z axis directions at least.

Sensitivity prediction of preoperative chemoradiotherapy in patients with rectal cancer and the clinical application / 国际肿瘤学杂志

Some of the patients with rectal cancer are less sensitive to preoperative concurrent chemoradiotherapy (CCRT).Patients who are resistant to CCRT have a poor local tumor control and CCRT may also increase adverse reactions.The sensitivity of rectal cancer patients to CCRT can be predicted by magnetic resonance imaging (MRI),positron emission tomography,serum carcinoembryonic antigen,molecular biomarkers and gene expression profiling before treatment.According to the predicted results,the clinicians are instructed to choose individualized treatment for the patients so that the therapeutic effects of rectal cancer are further improved.

Study on improving accuracy of setup errors of supraclavicular field in radiotherapy for breast cancer by breast bracket and moisture-cured resin cushion / 中华放射医学与防护杂志

Objective To explore the effects of improvements on setup error ( SE ) and clinical target ( CTV ) margin of supraclavicular field ( SCF ) by using moisture-cured resin cushion and breast bracket for lower neck fixation in breast cancer patients who underwent post-mastectomy radiotherapy. Methods Totally 13 patients with breast cancer who underwent post-mastectomy radiotherapy were enrolled. All patients were immobilized by breast bracket and moisture-cured resin cushion. Firstly, each patient′s lower neck and head was fixed well by moisture-cured resin cushion, filling the gap between the neck and breast bracket. Secondly,each patient underwent the cone-beam CT ( CBCT) at the first, tenth and twentieth treatment after positioning. Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational directions, and SCF CTV margins by the systematic and random errors were evaluated. Results The setup errors in x (left-right), y (superior-inferior), z (anterior-posterior) translational directions were (2. 16 ± 1. 25), (1. 50 ± 1. 28), (1. 94 ± 1. 12) mm and (1. 76 ±1. 87)°, (1. 82 ±1. 12)°, (0. 99 ±0. 58)°, respectively in θ (pitch degree),Ф(roll degree),ψ( yaw degree) rotational directions. Non-parametric rank test ( Mann-Whitney U test) was performed with previous data, the differences of the setup error in y, z,θ directions were statistically significant ( Z =4. 152, 3. 415, 2. 053, P<0. 05). The margins from CTV were 4. 07, 4. 03 and 3. 73 mm in x, y and z directions, respectively. Compared with the previous study on SCF, CTV margin required 8, 8 and 6 mm in x, y and z axis directions, the volume of CTV to PTV were decreased by 32. 73% on average. Conclusions Compared with plastic circular pillow alone, moisture-cured resin cushion with breast bracket locating method could reduce setup errors in SCF target region. The margins from CTV to PTV weredecreased to 4. 07, 4. 03 and 3. 73 mm in x, y and z axis directions at least.

Expression and clinical significance of macrophage inflammatory protein -1α,interferon gamma inducible protein 10 and angiopoietin-1 in primary acute myelogenous leukemia / 中国基层医药

Objective To study the expression of macrophage inflammatory protein-1α(MIP-1α),inter-feron gamma inducible protein 10(IP -10)and angiopoietin -1 (Ang -1)in primary acute myelogenous leukemia (AML),and clarify their clinical significance.Methods ELISA was used to detect the expressions of MIP -1α,IP-10 and Ang -1 in serum samples from 54 AML patients(observation group),and twenty volunteers(normal control group).Results The expression levels of MIP -1α,IP -10 and Ang -1 in the observation group[(198.813 ± 53.923)pg/mL,(2.332 ±0.745)ng/mL,(1.593 ±0.447)ng/mL]were significantly higher than the normal control group[(153.309 ±44.475)pg/mL,(1.569 ±0.485)ng/mL,(0.838 ±0.333)ng/mL](t =3.369,5.133,6.856, all P 0.05).There were remarkable correlation between the serum expression levels of MIP -1αand Ang -1 (r =0.324,P <0.05).Conclusion There are differences of serum MIP -1α, IP -10 and Ang -1 in the different NCCN prognosis groups,which reflect they may have certain guiding significance in the choice of clinical treatment and the prognosis for newly diagnosed AML.

Analysis of lower neck setup errors and planning target margin by CBCT for breast cancer radiation with breast bracket immobilized / 中华放射医学与防护杂志

Objective To evaluate the setup errors for lower neck with cone beam CT (CBCT) in breast cancer patients immobilized by breast bracket,and to probe the margins from supraclavicular clinical target volume (CTV) in 3 directions.Methods A total of 14 breast cancer patients with supraclavicular lymph node radiation were enrolled.All patients were immobilized by breast bracket,and each patient would undergo CBCT at the first,tenth and twentieth treatment after positioning,respectively.Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational direction,and evaluated correlation between them.At last,CTV margins were calculated from the systenatic and random errors.Results The setup errors on x (left-ring),y (superior-inferior),z (anterior-posterior) translational directions were (2.89 ±.2.52),(3.96 ±2.97),(4.21 ±2.24) mm and on θ (pitch degree),φ (roll degree),Ψ (yaw degree) rotational direction were (2.38 ± 1.97)°,(1.60±1.63) °,(1.91 ±1.54)°,respectively.The margins from CTV were 8.08,8.13,6.30mminx,y and z direction.On y and z directions translational errors were correlated significantly with φ and Ψ degree rotational errors(Pearson =-0.515,-0.509,P ＜ 0.05).In inter-fraction only on z direction the setup changes were considered as correlative with Ψ degree (Pearson =-0.583,P ＜ 0.05).Conclusions For supraclavicular region irradiation breast cancer patients immobilized with breast bracket,the margins from CTV were recommended as not less than 8.08,8.13,6.30 mm in x,y,z directions,respectively.The position immobilized method and the positioning workflow should be further improved in order to reduce the influence of the neck rotational on setup errors.

Effects of jaw tracking technique on the absorb dose of PTV and OARs in intensity-modulated radiation therapy for nasopharyngeal carcinoma / 国际生物医学工程杂志

Objective To study the effects of using jaw tracking technique with Smart LMC algorithm on the absorbing dose of planning target volume (PTV) and organs at risk (OARs) in dynamic intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods Field fluencies of 10 cases of NPC patients were optimized using DVO algorithm on Eclipse TPS (11.0),and according to the same optimal fluence,MLC operation files were calculated using jaw tracking technique and jaw fixing technique respectively,dose distribution was calculated with AAA algorithm and jaw tracking IMRT plan (JT-IMRT) and jaw fixing IMRT plan (JF-IMRT) were generated respectively.Collimators' position at the plan implementation was observed,and the total number of plans' monitor units (MU),the dose of PTV,the absorb dose of OARs,and the actual fluence verification pass rate were compared.Results The collimators' opening gap distances in 166 control points of the JT-IMRT reduced in both X and Y directions in the field,compared to that of the JF-IMRT.Total number of the JT-IMRT's MU increased by 3.59％-11.63％.There was no statistical significant difference between the doses of the PTV.Statistical significance was found in the differences between maximum dose (Dmax) of brainstem,spinal cord,crystal,optic nerve,the mean dose (Dmean) and D50％ of parotid and their decreased values after therapy (t=5.70-8.66,P＜0.05).The actual fluence verification pass rate of the JT-IMRT was higher than that of the JF-IMRT.There was a significant difference between the results (t=5.18,P＜0.05).Conclusions The JT-IMRT plan of the smart LMC algorithm is more tolerant to the radiation leakage between inter-and intra-leaf.The dose of OARs is lower,while the dose calculation precision and the verification pass rate are higher,the actual radiation dose is more accurate and reliable.Therefore it is more suitable for clinical applications.

Comparative study of coplanar and non-coplanar intensity-modulated radiotherapy in advanced lung cancer / 中华放射肿瘤学杂志

Objective To study the dosimetry and safety of the non-coplanar IMRT plan for advanced lung cancer.Methods The two groups IMRT plans were designed with coplanar (5,7F) and non-coplanar field (5,7F-n) for patients.To compare the dosimetry of two groups and perform 4 patients F7-n IMRT plan.Results With the increase of the fields in each group PTV's CI were improved (all P =0.000),especially the 7F-n plan PTV's Dmean,Dmax,V95％ and HI also were improved (P=0.001,0.001,0.009,0.000) ; in the coplanar group each lung' s V5 increased (P =0.000,0.002,0.000) and whole lung's Dmean increased (P =0.000),but non-coplanar group whole lung's and contralateral lung's V5 reduce (P =0.001,0.005).Between the groups,7F-n plan PTV's indicators were all improved to compared with 5F plan (all P =0.000),and each lung's V20 reduced (all P =0.000),and whole lung's Dmean,V30,contralateral lung' s V5 reduced (P =0.000,0.001,0.000),and spinal cord' s Dmax also reduced (P =0.033),but ipsilateral lung's V5 and heart's Dmean increased (P =0.000,0.003);with compared to 7F plan,the 7F-n's ipsilateral lung's V5 and heart's Dmean also increased (P =0.000,0.048),but whole lung' s and contralateral lung's V5 decreased (all P =0.000).Four patients were performed successfully non-coplanar IMRT treatment,no collision occurred.Conclusions 7 fields non-coplanar IMRT plan not only improve the dose distribution of PTV,but also effectively control the volume of low dose lung increase,lung V20 and Dmean reduce too.Thus recommended to use this design in patients with advanced lung cancer for radiotherapy

DNA polymerase iota and cancer / 国际肿瘤学杂志

DNA polymerase iota (Polt),as well as Revl,Polκ and Polη,are all Y family DNA polymerases,which are able to replicate damaged DNA via translesion synthesis pathway.However,Pol(t) has the lowest fidelity among all DNA polymerases in both correct and inaccurate DNA templates.Also Pol(t) can bypass certain DNA damages and accumulate mutations.Recent studies show that the aberrant expression of Pol(t) is observed in human uveal melanoma,breast cancer,bladder cancer,lung cancer and esophageal cancer,which may contribute to the tumorigenesis and progression of tumor.The special role of Pol(t) in replicating damaged DNA may contribute to the resistance in oncotherapy.

Probabilistic safety assessment method in the application of external beam radiotherapy process control management study / 中华放射肿瘤学杂志

Objective To study the probability safety assessment to analyze and evaluate radiation error risk in the external beam radiotherapy,so as to establish and strengthen the control and management of the radiotherapy process,continuous improvement of quality control and quality management.Methods To build the whole of radiotherapy flow chart and process tree,using the decision tree model to determine critical control points in the whole process,making risk assessment chart and analyzing 4 patients with potential safety hazards error.Results The whole process is divided into 22 missions in 3 functional areas,the entire cover 15 branches and 59 key and 11 key control point.The enumeration of error as risks and critical control points has certain correlation.Conclusions Probabilistic safety assessment method have strengthened manage,analyze and control to risk,and all these provide the basis for developing and improving radiotherapy process control management.Radiotherapy quality management for future multidisciplinary and high-level management personnel who take up provides a prospective study.

Effect of heme oxygenase-1 on radiation-induced skin injury / 中华放射医学与防护杂志

Objective To investigate the effect of heme oxygenase-1 ( HO-1 ) on the acute radiation-induced skin injury by gene transfer.Methods Thirty-three male SD rats were randomly divided into three groups as PBS-injected group,Ad-EGFP-injeeted group and Ad-HO-1-injected group ( n =11 ).In each group,three rats were used for determining the expression of target gene and the other rats were irradiated on the buttock skin with 40 Gy electron beam generated by a linear accelerator.Immediately after irradiation,rats were administered with a subcutaneous injection of PBS,Ad-EGFP or Ad-HO-1,respectively.Subsequently,the skin reactions were measured twice a week using the semi-quantitative skin injury scale.Results The strong positive expression of HO-1 was observed in subcutaneous dermal tissue after injection of Ad-HO-1.Compared to the PBS-injected group or the Ad-EGFP-injected group,a significant mitigation of skin injury was observed in Ad-HO-1-injected mice 14 d after irradiation (q =0.000-0.030,P ＜ 0.05 ).Conclusions HO-1 could significantly mitigate radiation-induced acute skin injury and Ad-HO-1 could be used to treat radiation-induced skin injury.

The dosimetric comparison of different treatment planning for postoperative radiaotherapy of parotid cancer / 中国癌症杂志

Background and purpose:Now 3-dimensional conformal radiotherapy(3DCRT)and intensitymodulated radiotherapy(IMRT)are widely used in the treatment of head and neck tumor.For the parotid,this target area is located on the side of the head and the tumor has a concave shape.What kind of radiation method can be used more eriectively to achieve dose uniformity and protection organs at risk is the topic of much discussion.The postoperative irradiation of parotid tumor is varied in the techniques used.In this study,3-dimensional conformal radiotherapy (3DCRT),intensity-modulated radiotherapy(IMRT)and simplified forward planned multi-segment radiotherapy (MSRT)were compared to conventional planning techniques in order to investigate the potential advantages of these new treatments.Methods:The conventional planning included the large opposed lateral fields with 2 or 3 weight ratio at the target lateral(2F-2D)and the unilateral field with mixture of 6 MV photon and electron beams(X+E).The 3D techniques included 3DCRT,MSRT and IMRT.Their dose distributions were calculated and compared for 8 patients treated in our center.Different beam arrangements were used for 3D techniques.In each case.the dose of PTV was prescribed to 60 Gy.All plans were compared using dose-volume histogram data.The conformity index(CI)and heterogeneity index(HI)of dose were used to evaluate the dose coverage of the target volume.Dose sparing of brain stem.spinal cord and the contra lateral parotid was also compared.To compare IMRT and MS RT,the timing ofplanning and radiation delivery was recorded.Results:Compared to conventional planning,the 3DCRT,MSRT and IMRT plans produced adequate target coverage,and the CI showed 3DCRT plans(0.78)produced poorer target coverage than MSRT(0.81)and IMRT(0.85).MRST and IMRT plans showed a significant reduction in maximum dose to the spinal cord,brainstem and the contra lateral parotid,compared to the conventional plans,while the 3DCRT plan did not show significant sparing of these structures.MSRT and IMRT plans produced better dose coverage among all the techniques.The efficacy of beam delivery comparing between two modulated planning showed MSRT was better.Conclusion:For postoperative irradiation of parotid cancer,3D planning techniques generated better target dose-coverage,without compromising the dose-sparing advantages of important structures.A satisfactory dose distribution can be obtained using MSRT and such a simple technique may be suitable for replacing IMRT.

Clinical study of methylene blue staining technique for conventional aponeurotic cyst′s resection in wrist / 中国医师进修杂志

Objective To explore the technical point of methylene blue staining for aponeurotic cyst′s resection in wrist for decrease the recurrence. Methods Fifty-six patients with aponeurotic cysts in wrist were divided into two groups, the control group: 33 patients accepted conventional aponeurotic cyst′s resection, the experimental group: 23 patients accepted the same operation along with methylene blue staining technique. Results In control group, 28 cases of aponeurotic cysts were ruptured in operation, rupture rate was 84.8%, recurrence was seen in 6 cases, recurrent rate was 18.2%. In experimental group, 17 cases of blue-stained aponeurotic cysts were ruptured in the operation, rupture rate was 73.9%. No recurrence was seen in this group. Recurrent rate in experimental group was significantly lower than that of control group (P0.05). Conclusions Methylene blue staining technique in the operation of aponeurotic cyst′s resection is helpful in confirming the base of cysts, completely removing cysts and reducing the recurrent rate.This method is both operable and feasible.

Laparoscopic Extraperitoneal Inguinal Hernia Repair with Low-pressure Pneumoperitoneum without Using Stapling Devices: Report of 38 Cases / 中国微创外科杂志

Objective To investigate the feasibility and effectiveness of laparoscopic extraperitoneal inguinal hernia repair with low-pressure pneumoperitoneum without using stapling devices.Methods A total of 38 patients with reducible inguinal hernia underwent laparoscopic extraperitoneal inguinal hernia repair in our hospital from January 2006 to February 2007.Three abdominal trocars were introduced into the extraperitoneal cavity.An 11-mm trocar was placed at the lower border of the umbilicus,and the other two sized 5.5 mm were at the upper and lower 1/3 of the line between the umbilicus and the pubic symphysis,respectively.Then,low-pressure(6-8 mm Hg) CO2 was insufflated into the extraperitoneal cavity.Non-traumatic forceps was used to create an operative space from the hilum to the pubic symphysis and the diseased inguinal area.The hernia sac and the fabrics around it were disconnected.For big hernia sacs,the sac was ligated,cut at the cervix,and then left at its original site.While for small hernia sacs,it was dissociated and put back into the abdominal cavity.Afterwards,a patch sized 12 cm ? 15 cm was placed into the cavity,stretched,and attached to the abdominal wall,covering the annulus inguinalis profundus,Hesselbach triangle,and the femoral ring,without using stapling devices.After the operation,the patients received sandbag compression at the operative area and were kept in bed with urethral catheter for 24 hours. Results The operation was successfully accomplished in all the 38 cases without conversion to open surgery.The operation time was 45-85 min(mean,56 min).The intraoperative blood loss was 5-10 ml.After the operation,seroma occurred in 4 cases,and perforation in 2.No subcutaneous emphysema,hypercapnia,intestinal injury,neuralgia,or hemorrhage was found.The patients were followed up for 6 to 19 months(mean,10.5 months),and no recurrence occurred.Conclusions It is feasible to use laparoscopic extraperitoneal inguinal hernia repair with low-pressure pneumoperitoneum without using stapling devices.The method is associated with few complications and confirmed efficacy.

Combination of Percutaneous Nephrolithotomy with Fibrous Sheath and Swiss LithoClast Master(EMS Ⅲ) through T-Tube Tract for Retained Choledocholithiasis:Report of 32 Cases / 中国微创外科杂志

Objective To study the feasibility,superiority and curative effect of percutaneous nephrolithotomy with fibrous sheath and Swiss LithoClast Master (EMS Ⅲ) through T-tube tract for retained choledocholithiasis. Methods This study involved 32 patients with hepatolithiasis who were treated in our hospital from August 2004 to August 2007. By combining percutaneous nephrolithotomy (with a fibrous sheath on) and Swiss LithoClast Master (EMS Ⅲ) through a T-tube tract,retained choledocholithiasis was removed. Results The 32 patients totally underwent 36 operations. The mean operation time was 43 minutes (ranged from 33 to 78 minutes). In 28 of the cases,the stones were extracted completely by one session; and 2 were cured by two operations. The final stone-free rate was 94% (30/32). Follow-up was carried out in all the patients for 26 to 48 months (mean,29 months),during which no patients developed abdominal pain,jaundice or fever,no recurrence was detected by B-ultrasonography. Two patients showed residual stones after the treatment,one of them received Roux-en-Y hepatocholangioenterostomy because of extensive multiple biliary stones in the liver,which could no be removed completely after three sessions of nephrolithotomy; another patient who was a 70-year old man refused the secondary operation and thus retained a few stones in the right inferior lobe of the liver. In this series of 32 cases,no bile duct tear,massive hemorrhage,biliary leakage,cholangitis or abdominal distension occurred. Conclusions It is a safe,convenient,and simple method to combine percutaneous nephrolithotomy with Swiss LithoClast Master via T-Tube tract for retained choledocholithiasis. The procedure results in less pain in patients,and reduced equipment spoilage,while the cost is low. As the surgery is easy to perform,it is worth being widely used.

Single photon emission CT perfusion imaging of cerebral blood flow of early syphilis patients / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To injvestigate the cerebral blood flow of patients with early syphilis.</p><p><b>METHODS</b>(99)Tc(m)-ECD as brain perfusion imaging agent was used in single photon emission computed tomography (SPECT) for 32 patients with early syphilis and 15 controls. Visual analyses were made on every BSPECT image.</p><p><b>RESULTS</b>The 32 patients with early syphilis had general, patchy hypoperfusion of cerebral blood flow. Fourteen of the 32 patients had 48 episodes of marked patchy hypoperfusion of rCBF. The responsible areas of hypoperfusion in a patchy distribution involved the left frontal lobe (6 episodes), right frontal lobe (3), left parietal lobe (7), right parietal lobe (6), left temporal lobe (11), right temporal lobe (5), left occipital lobe (3), left basal ganglia (3), cerebellum (1), and nerve nuceus (1). No abnormality was found in the control group.</p><p><b>CONCLUSIONS</b>Cerebral blood flow abnormalities exist in patients with early syphilis. General patchy hypoperfusion on SPECT imaging is common.</p>

99mTc-TRODAT-1 SPECT imaging of dopamine transporter in early diagnosis of Parkinsons disease / 中国神经精神疾病杂志

Objective 　To evaluate the value of 99m　Tc-TRODAT-1 SPECT DAT imaging in the early diagnosing of Parkinsons disease (PD).Methods　 Eleven patients (9 PD and 2 possible PD) and eighteen healthy subjects matched by sex and age were studied with 99m　Tc-TRODAT-1 SPECT DAT imaging. Striatum specific uptake of 99mTc-TRODAT-1 was calculated according to the ratio of DAT uptake in striatum (ST) and cerebellum (CB). Results　In the hemi-Parkinsons disease group, the DAT specific uptake of 99mTc-TRODAT-1 was significantly lower (P＜0.01) in contralateral than in ipsilateral striatum to the clinically symptomatic side. There was significant decrease (p＜0.01) of striatum DAT uptake in patients with hemi-PD compared to the controls.Conclusions　99mTc-TRODAT-1 SPECT DAT imaging may help to confirm the diagnosis of PD at the early stage.