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Objective:To compare and analyze the differences in the setup accuracy of different immobilization method in breast cancer radiotherapy after breast-conserving surgery.Methods:A retrospective study was conducted on 60 patients who received radiotherapy after breast-conserving surgery from January to August, 2021. These patients were divided into two groups. One group consisted of 30 cases who were immobilized using a modified body thermoplastic membrane combined with a multifunction body board during the breast cancer radiotherapy and was called the modified body thermoplastic membrane group. The other group comprised 30 cases immobilized using a vacuum cushion during breast cancer radiotherapy and was referred to as the vacuum cushion group. The setup errors, 3D vector errors, the proportion of errors of > 5 mm, and the dosimetric differences in the planning target volume (PTV) and the clinical target volume (CTV) before and after simulated treatment bed moving (including the PTV_ V100, PTV_ V95, and CTV_ V95 before simulated treatment bed moving and the PTV_ V100 S, PTV_ V95 S, and CTV_ V95 S after simulated treatment bed moving) were compared between two groups. Moreover, for the modified body thermoplastic membrane group, the changes in the average setup errors at different radiotherapy stages were also analyzed. Results:A total of 369 cone-beam CT scans were conducted for 60 patients, including 195 CT scans for the modified body thermoplastic membrane group and 174 CT scans for the vacuum cushion group. The setup errors in the x, y, and z directions (right-left, anterior-posterior, and superior-inferior, respectively) of the modified body thermoplastic membrane group were (2.59±1.98) mm, (2.38±2.04) mm, and (1.45±1.16) mm, respectively, while those of the other group were (2.24±1.63) mm, (2.78±2.17) mm, and (2.70±1.88) mm, respectively. The 3D vector errors of both groups were (4.32±2.28) mm and (5.13±2.14) mm, respectively. Therefore, the setup error in direction z and the 3D vector error of the modified body thermoplastic membrane group were less than those of the vacuum cushion group ( t = -7.77, -3.41, P<0.05). Moreover, the proportion of setup errors of > 5 mm in the x direction of the vacuum cushion group was lower than that of the modified body thermoplastic membrane group ( χ2 = 7.13, P<0.05), while such proportion in the z direction of the modified body thermoplastic membrane group was lower than that of the vacuum cushion group ( χ2= 5.90, P<0.05). After the simulated treatment bed moving, the PTV_ V100 S of the modified body thermoplastic membrane group was better than that of the vacuum cushion group ( t = 2.47, P < 0.05). Furthermore, for the modified body thermoplastic membrane group, the setup errors in the x direction in the first week were higher than those in the 2-3 weeks and 4-5 weeks ( P<0.05). Conclusions:The modified body thermoplastic membrane combined with a multifunction body board yield better immobilization effects than a vacuum cushion. However, it produces high setup errors in the x direction in the first week of the radiotherapy, to which special attention should be paid.
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Objective To evaluate the clinical efficacy and toxicity of intensity-modulated radiation therapy (IMRT) following prostatectomy for elderly patients with prostate cancer.Methods Ninety-eight prostate cancer patients receiving IMRT after prostatectomy were included in this study.The median age was 68 years old.The number of patients with low-,middle-and high-risk prostate cancer was 10,21 and 67,respectively.Two patients had oligometastases (pelvic bone metastases).Sixty-four patients were treated with IMRT combined with endocrine therapy.Among them,43 cases received adjuvant volumetric modulated arc therapy (VMAT),and 55 patients received salvage IMRT.The median radiotherapy dose was 72 Gy for the tumor bed.Twenty-nine patients received radiotherapy of the pelvic node region with a median dose of 50 Gy.Results The median follow-up time was 40 months.The 5-year overall survival (OS),biochemical recurrence-free survival (BRFS) and local control (LC) were 90％,76％ and 100％,respectively.The OS (88.8％ vs.90.8％,P=0.94),BRFS (75.9％ vs.71％,P=0.79) or LC (100％ vs.100％,P=0.32) did not significantly differ between the adjuvant and salvage radiotherapy groups,respectively.The incidence of grade Ⅰ-Ⅱ late rectal toxicities was 24.1％,and no ≥ grade 3 late toxicity was observed.The incidence of grade 1-2 late bladder toxicities was 29.9％,and 3.4％ for grade 3.Conclusion IMRT following prostatectomy yields high clinical efficacy and slight late toxicities in elderly patients with prostate cancer.
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Objective To retrospectively analyze the safety of anti-radiation injury drug of Andorin using real-world big data.Methods A total of 87 053 hospitalized cancer patients receiving radiotherapy from 2015 to 2017 were analyzed.Ten medical institutions with the largest number of patients treated with Andorin capsules were screened.Patients with 5 types of cancer including lung cancer,cervical cancer,nasopharyngeal carcinoma,breast cancer and colorectal cancer with/without use of Andorin capsule were subject to propensity score matching (PSM).The safety of Andorin capsule as an adjuvant drug in the radiotherapy for cancer patients was evaluated by the results of blood biochemical detection and liver and kidney function test.Results In the relevant indexes of liver function,the AST and TBIL levels in the lung cancer patients with use of Andorin capsule were significantly lower than those in their counterparts without use of Andorin capsule (22.1 U/L vs.24.7 U/L,P =0.04 and 9.8 mmol/L vs.11.4 μmol/L,P =0.01),but all the results were within the normal range.In patients with cervical cancer,the ALT level in patients treated with Andorin capsule was considerably higher than that in those without use of Andorin capsule (24.7 U/L vs.21.1 U/L,P=0.01) and both the results were within the normal range.In terms of the renal function-related indexes,CRE and UREA were similar between patients with and without use of Andorin capsule in 5 types of tumors (P=0.09-0.86).In patients with cervical and colorectal cancer,the LDH in patients with Andorin capsule was significantly lower compared with that in those without use of Andorin capsule (P=0.04,0.00),but both the resuhs were within the normal range.Regarding the nutrition-related indexes,the TB level in breast cancer patients with use of Andorin capsule was significantly higher than that in those without use of Andorin capsule (69.4 g/L vs.67.1 g/L,P=0.030),but both the results were within the normal range.Conclusion As the first anti-radiation traditional Chinese medicine in China,Andorin capsule is utilized as an adjuvant drug for radiotherapy,which yields no significant liver and kidney toxicity and possesses high safety.
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Objective To compare the therapeutic effects between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in patients with stage Ⅱ/Ⅲ esophageal cancer and investigate the prognostic factors.Methods Medical record of 2 132 patients with stage Ⅱ/Ⅲ esophageal cancer who underwent definitive radiotherapy with/without chemotherapy in 10 hospitals from January 2002 to December 2016 from were retrospectively analyzed.Among these patients,37.9％ of them were aged ≥ 70 years,33.9％ with neck and upper esophageal tumors and 66.1％ with middle and lower esophageal and borderline tumors.The median gross tumor volume (GTV) and lymph node gross tumor volume (GTVnd) was 41.6 cm3.Among them,32％ were stage Ⅱ] and 68％ were stage Ⅲ.A total of 723 patients received 3DCRT and 1 409 cases received IMRT.Patients received an equivalent dose in 2 Gy (EQD2) ≥ 60 Gy accounted for 86.1％,and 41.1％ of them received concurrent chemoradiotherapy.Results The median follow-up time was 60.8 months.The 1-,3-and 5-year overall survival (OS) of all patients was 73.9％,41.7％ and 32.6％,and the 1-,3-and 5-year progression-free survival (PFS) was 62.2％,37.3％ and 32％,respectively.Multivariate analysis demonstrated that age,primary tumor location,clinical stage,tumor target volume,EQD2 and concurrent chemoradiotherapy were the independent prognostic factors for OS.Age,primary tumor location,clinical stage,tumor target volume and EQD2 were the independent prognostic factors for PFS.The OS and PFS did not significantly differ among the low-risk,low-/moderate-risk,moderate-/high-risk and high-risk groups according to age≥70 years,tumor diameter＞5 cm,tumor volume ≥41.6 cm3 and stage Ⅲ (P＜0.001).After the propensity score matching (PSM) method,neither 3DCRT nor IMRT yielded significant advantages in OS or PFS (P=0.971;P=0.658).However,IMRT tended to yield survival benefits in low-risk patients (P=0.125).Conclusions Both 3DCRT and IMRT yield relatively high OS rate in patients with stage Ⅱ/Ⅲ esophageal cancer.The prognosis model established in this investigation can properly predict the survival of patients.Low-risk patients tend to obtain survival benefits from IMRT.
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Objective To evaluate the clinical efficacy and adverse events of intensity-modulated radiotherapy ( IMRT ) in the treatment of intermediate risk localized prostate cancer, and analyze the significance of prostate-specific antigen ( PSA) level changes. Methods Clinical data of 66 patients with intermediate risk localized prostate cancer admitted to our hospital between 2007 and 2018 were retrospectively analyzed. Sixty patients were treated with endocrine therapy before radiotherapy. The radiation field covered the pelvic lymph node drainage area in 6 cases. Forty-seven patients received image-guided radiotherapy ( IGRT) . The median dose in the prostate and seminal vesicle was 78 Gy and 48 Gy in the pelvic lymph node drainage area. The survival rate was calculated using the Kaplan-Meier method. Results The median age was 77 years. The median follow-up time was 71. 3 months. The 5-year sample size was 47. The 3-and 5-year overall survival (OS) was 98％ and 90％.The 3-and 5-year cancer-specific survival (CSS) was 100％ and 93％.The 3-and 5-year biochemical relapse-free survival was 97％ and 86％. The mean time of PSA declining to the nadir was 5. 83 months. The median level of PSA nadir was 0. 06 ng/ml after IMRT. The incidence of grade I andⅡearly adverse events in the urinary system was 38％ and 6％. The incidence of grade I andⅡearly adverse events in the gastrointestinal system was 21％ and 3％. The incidence of grade I andⅡadvanced-stage adverse events in the urinary system was 9％ and 2％. The incidence of grade I advanced-stage adverse events in the gastrointestinal system was 5％. Conclusions IMRT yields high clinical efficacy in the treatment of intermediate risk localized prostate cancer with a low risk of adverse events in the early and advanced stage. The monitoring of PSA after IMRT contributes to the assessment of clinical prognosis.
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Objective To assess the dosimetric benefit,prognosis and toxicity of intensitymodulated radiation therapy (IMRT) for stage Ⅲ esophageal squamous cell cancer.Methods This was a retrospective analysis of 28 patients,aged between 45 and 83 years,with stage Ⅲ esophageal squamous cell cancer who had received radical IMRT.Of these patients,six received concurrent chemotherapy and eight received targeted therapy.The median radiotherapy dose was 67.1 Gy.Dosimetric parameters for the target volume and critical normal structures were evaluated by dose volume histogram.The Kaplan-Meier method was used to calculate overall survival (OS),progress free survival (PFS) and locoregional control (LRC).Results The mean conformity index (CI) and homogeneity index (HI) scores of the planning target volume (PTV) were 0.82 and 0.92,respectively,indicating very good coverage of the target volume.Three-year OS,PFS,and LRC were 48.0 ％,31.2％,and 62.0％,respectively.Acute toxicities were mild,only two patients developed acute esophagitis (grade ≥3),and three had acute pneumonitis (grade ≥2).Conclusions IMRT can provide excellent dose conformity and achieve favorable LRC and survival with only mild toxicities in patients with stage Ⅲ esophageal squamous cancer.
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Objective To assess the dosimetric benefit,prognosis and toxicity of intensitymodulated radiation therapy (IMRT) for stage Ⅲ esophageal squamous cell cancer.Methods This was a retrospective analysis of 28 patients,aged between 45 and 83 years,with stage Ⅲ esophageal squamous cell cancer who had received radical IMRT.Of these patients,six received concurrent chemotherapy and eight received targeted therapy.The median radiotherapy dose was 67.1 Gy.Dosimetric parameters for the target volume and critical normal structures were evaluated by dose volume histogram.The Kaplan-Meier method was used to calculate overall survival (OS),progress free survival (PFS) and locoregional control (LRC).Results The mean conformity index (CI) and homogeneity index (HI) scores of the planning target volume (PTV) were 0.82 and 0.92,respectively,indicating very good coverage of the target volume.Three-year OS,PFS,and LRC were 48.0 ％,31.2％,and 62.0％,respectively.Acute toxicities were mild,only two patients developed acute esophagitis (grade ≥3),and three had acute pneumonitis (grade ≥2).Conclusions IMRT can provide excellent dose conformity and achieve favorable LRC and survival with only mild toxicities in patients with stage Ⅲ esophageal squamous cancer.
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Objective To investigate the efficacy and safety of Bushen Huoxue Decoction in the treatment of carotid atherosclerotic plaque. Methods Totally 50 patients of carotid atherosclerotic plaque were collected to conduct health education. At the same time, they were given Bushen Huoxue Decoction, one dosage a day, twice a day, decoction, for 12 weeks. The correlation indexes of carotid artery before and after treatment were observed, and TCM syndrome integrals were evaluated before and after 4, 8 and 12 weeks treatment. FBG, TC, LDL-C, CRP HCY, IL-6, IGF-1, and OPG were detected before and after treatment. Hematuria routine, liver and renal function were monitored. Results After treatment, the Crouse score and the plaque grade score of carotid atherosclerotic plaque showed a tendency to decrease, without statistical significance (P=0.060, P=0.336). Carotid maximal plaque area and modified total score of carotid atherosclerotic plaque were significantly reduced compared with that before treatment (P<0.05). TCM syndrome integrals were significantly reduced compared with that before treatment (P<0.05), and the scores decreased significantly with the prolongation of treatment time. TCM syndrome integrals after 4, 8, and 12 weeks were significantly reduced compared with that before treatment (F=160.352, P<0.001). Total effective rate of treatment in the efficacy of TCM syndrome was 85.11％ (40/47). Serum levels of FBG and TC decreased significantly after the treatment compared with that before the treatment, with statistical significance (P<0.05). Serum levels of LDL-C, HCY, CRP, IL-6, IGF-1, and OPG all showed a tendency to decrease, without statistical significance (P>0.05). No abnormality in hematuria routine, liver and renal function examinations were found during the research. Conclusion Bushen Huoxue Decoction has obvious clinical efficacy for carotid atherosclerotic plaque, which can improve clinical symptoms of patients, it also could stabilize and reduce plaque with high safety.
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Aim To examine weather fructo-oligosaccharides(FOS) and silybin(Sil) could exhibit synergetic effect on treating obesity-associated non-alcoholic fatty liver disease(NAFLD).Methods Seventy mice were randomly divided into two groups:control group (NCD,fed with normal chow diet),the other sixty mice were fed with high-fat diet (HFD) to establish NAFLD model.Seventy days after the establishment of experimental model,the latter group was then randomly subdivided into six groups:model (HFD),Sil (30mg· kg-1),FOS (2 000 mg · kg-1),Sil (30 mg ·kg-1) combined with FOS of high,medium and low dose respectively.The NCD and HFD group were given 0.5％ CMC,and the other groups were fed with high-fat diet and given 10 mL · kg-1 by gavage daily,then body weight and food intake were recorded.Fasting blood glucose,insulin,homeostasis model of assessment for insulin resistence index (HOMA-IR) and oral glucose tolerance tests(OGTT) were measured after 120 days.All mice were sacrificed after 130 days,and blood and liver were collected.Levels of TC,TG,ALT,AST in serum were detected,and liver index and pathology were also examined.Results FOS (2 000 mg · kg-1) showed obvious synergism for Sil-mediated attenuation of levels of TC,TG,ALT,AST in serum,fasting blood glucose,insulin,HOMA-IR,OGTI curve,liver index and pathology,but FOS (4 000 mg · kg-1) could not bring superiority with a double dose,except for its improvement in body weight of mice with NAFLD.Conclusions In the treatment of NAFLD,FOS exhibits synergetic effect with Sil.This agent might be a potent candidate for obesity and NAFLD prevention,through modulating the composition of gut microbiota.
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Objective To analyze the clinical application of high?throughput gene sequencing technolo?gy and STR in chromosome karyotype analysis of the villus tissues of spontaneous abortion. Methods In 27 ca?ses of spontaneous abortion after pregnancy,classic cell of villus tissues culture and chromosomal karyotype anal?ysis,and high ?throughput gene sequencing technology and STR were performed,and then compared the analysis results of two methods. Results ( 1) The successful rate of cell of villus tissues culture and chromosomal karyo?type analysis was 85%( 23/27) ,of high?throughput gene sequencing technology and STR was 96%( 26/27) ,and the difference was not significant( P>0. 05) ( 2) In the 4 cases that failed in karyotype analysis,there were 3 ca?ses showed abnormal chromosomal number variation( CNV) in high?throughput gene sequencing technology and STR. ( 3) Of the 23 cases,chorionic villus was successfully cultured in 10 cases,abnormal karyotypes were iden?tified in 13 cases,the positive rate was 57%. Of the 26 cases,high?throughput gene sequencing technology and STR was successfully checked in 3 cases,abnormal CNV were identified in 23 cases,the positive rate was 85%, the difference was significant(χ2=6.387,P<0.05). (4)The rates of chromosomal number abnormality were 52%( 12/23) and 50% ( 13/26) of karyotype analysis and chromosome aberration detection,respectively. In 10 cases of normal cell culture karyotype,there were 7 cases in the presence of micro deletion / micro repetition de?tected by high?throughput gene sequencing technology and STR. Conclusion The method of massively parallel sequencing in chromosome analysis,compared with the method of cell of villus tissues culture and chromosome a?nalysis,can be accurate and quick,and has high successful rate in detecting the chromosome of non aneuploid and deletion/duplication abnormality,which can be a good complementary and alternative method of the classic cell of villus tissues culture and chromosome karyotype analysis.
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Objective To analyze the data from intensity-modulated radiotherapy ( IMRT) for prostate cancer guided by kilovoltage cone-beam computed tomography (CBCT), and to provide a clinical basis for selecting the optimal image registration method and reasonable target volume margins.Methods A total of 16 patients with prostate cancer who received radical IMRT were enrolled, and CBCT for online position verification was performed 214 times.The images were obtained after conventional skin marking and laser alignment, and automatic registration, bone registration, soft tissue registration, and manual registration were performed for CBCT images and planned CT images.The differences between these four registration methods were evaluated, and the margins for extending clinical target volume into planning target volume (PTV) were calculated.Results The setup errors in left-right, anterior-posterior, and cranial-caudal directions for automatic registration, bone registration, soft tissue registration, and manual registration were-0.6±2.8 mm/-0.6±4.5 mm/-0.6±3.8 mm,-0.7±2.7 mm/-0.9±4.5 mm/-0.8±4.1 mm,-0.8± 2.6 mm/-0.3±4.4 mm/-1.1±4.0 mm, and-0.6±2.9 mm/-0.7±5.1 mm/-0.9±3.9 mm, respectively. There were no significant differences between the four registration methods.The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions were calculated as 4.7 mm, 5.2 mm, and 6.5 mm, respectively.Conclusions With a comprehensive consideration of various factors, a default setting of automatic registration and manual fine adjustment is appropriate for CBCT-guided radiotherapy for prostate cancer.The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions are 4.7 mm, 5.2 mm, and 6.5 mm, respectively.
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Objective To investigate the significance of thyroid function screening in high-risk pregnant women with gestational diabetes (GDM) in early pregnancy.Methods A total of 194 cases with GDM were selected as our subjects.The patients were divided into group A(three normal items,a total of 109 cases),group B (one abnormal item,a total of 57 cases) and group C (two abnormal items,a total of 28 cases).The levels of serum anti-thyroglobulin antibody (TGAb),anti-thyroid peroxidase antibody (TPOAb),serum three triiodothyronine(TT3),thyroxine (TT4),free three triiodothyronine (FT3),free thyroxine (FT4) and thyroidstimulating hormone (TSH) were screened.Results TSH levels in group A was (1.45 ± 0.43) mU/L,significantly lower than in group B and group C((1.77±0.53),(1.89±0.74) mU/L).FT4 levels in group A was (11.62±0.98) nmol/L,significantly higher in group B and group C((10.23±0.75),(9.87±0.88) nmol/L)).Proportion of TPOAb,TGAb positive in group A were 9.17％(10/109) and 21.05％(12/57),significantly lower than that of group B and group C((28.57％(8/28) and 3.67％(4/109),7.02％(5/57) and 17.86％(5/28)).And the differences were significant (P＜ 0.05).And TPOAb + TGAb in group A was 0.92％(1/109),significantly lower than that of group B and group C(7.02％ (4/57),17.86％ (5/28);P ＜0.05).Conclusion The importance of screening thyroid function in early pregnancy in women at high risk for gestational diabetes is worthy of clinical promotion.
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Objective To observe the motions of the rectum and bladder by image?guided radiotherapy ( IGRT) and to analyze their impact on treatment. Methods Eighteen patients with prostate cancer undergoing intensity?modulated radiotherapy ( IMRT) were enrolled in the study and 247 cone?beam computed tomography ( CBCT) images were obtained from this study. The clinical target volume, bladder, and rectum were contoured on all simulated CT and CBCT to examine their volume and position changes. The dose distributions were recalculated based on the data of the x?, y?, and z?axis setup errors. The doses to planning target volume ( PTV) and organs at risk were calculated in the replanning, and their impact on treatment was analyzed. Comparison of the planning and replanning results was made by paired t?test. The effects of displacements and volumes of the bladder and rectum on target doses were analyzed by Pearson correlation method. Results Great changes in the volumes of the bladder and rectum were observed during the treatment. For the planning and replanning results, PTVD95% was 7777. 37 cGy vs. 7628. 56 cGy ( P=0. 027), PTV Dmin was 87. 91 cGy vs. 83. 35 cGy (P=0. 000), and RVP was 5. 89% vs. 8. 31%(P=0. 000). There were correlations between PTVD95% and the motions of the bladder and rectum, with correlation coefficients of 0. 296 and 0. 177, respectively. The correlation coefficient between rectal volume and PTVD95% was 0. 115, indicating a certain correlation. There is a certain correlation between and PTV Dmin and bladder volume, with a correlation coefficient of?0. 128. Conclusions The recovery of the state during localization for the bladder and rectum, especially the latter, has great significance to ensure the target dose and reduce exposure of the rectum in the IMRT for prostate cancer.
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Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer.Methods From June 2007 to June 2013,51 untreated patients with histopathologically proven rectal cancer (T3/T4 or N (+))were included in this study.Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0-50.4 Gy/25-28 fractions.Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy.Surgery was performed at 4-8 weeks after chemoradiotherapy.Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis.Results Fortynine patients completed the preoperative chemoradiotherapy and surgery.The median follow-up was 2.9 years.The overall sphincter preservation rate was 65％;the overall downstaging rate was 59％.Ten (20.4％) of all patients achieved a pathologic complete response (pCR).Grade ≥3 toxicities occurred in 25％ of all patients,and the overall postoperative complication rate was 31％.The 3-and 5-year sample sizes were 24,12,respectively.The 3-and 5-year overall survival rates were 81％ and 69％,respectively;the 3-and 5-year disease-free survival (DFS) rates were 76％ and 60％,respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78％ and 70％,respectively;the distant metastasis-free survival rates were 82％ and 74％,respectively.The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS.Conclusions For locally advanced middle-low rectal cancer,preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate,pCR rate,and sphincter preservation rate.Patients with tumor downstaging may have a better survival advantage.
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Objective To explore a method of using a computer system for multi-media cases study in radiation oncology clinical work,in order to replace the traditional use of film images and paper.Methods We use a dedicated networked computer's Windows XP's Remote Desktop feature to remote access an Eclipse TPS and the radiation therapy information management system.Then we can online read the patient' s information of CT images,target volumes,treatment plans,plan application forms and electronic medical records,and use a projector to project it on the screen.Results There has been half a year since we successfully set up a radiation therapy case study multi-media system in the department.It's convenient and effective to achieve the department conducted a collective case discussion.Conclusions The equipment required is simple,and it's a safe and reliable technology,greatly improving the clinical efficiency and quality of medical care.
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Objective To compare the errors of final isocenter marking method and reference point marking method for CT simulation positioning in intensity-modulated radiotherapy (IMRT).Methods From 2009 to 2012,327 patients with head and neck cancer for IMRT underwent CT simulation positioning using the Philips Brilliance CT Big Bore scanner and Philips Tumor LOC workstation and were divided into final isocenter marking group (n =208) and reference point marking group (n =119) according to positioning methods.Target volume delineation and treatment plan design were performed on the Varian Eclipse treatment planning system (TPS).Before treatment,kilovoltage cone-beam CT scans and registration were performed with the Varian EX on-board imager system to obtain beam position errors in the right-left (RL),superior-inferior (SI),and anterior-posterior (AP) directions,and then comparisons of errors between the two groups were made by independent-samples t test.Finally,the TPS was used to measure the changes in the doses to the organs at risk after moving isocenters in the RL,SI,and AP directions among 5 patients with nasopharyngeal carcinoma.Results The mean beam position errors in the three directions were less in the final isocenter marking group than in the reference point marking group (P =0.02,0.01,0.03).After moving isocenters in the three directions,the target dose was reduced and the dose to the normal tissue around the target tumor was increased significantly.The error in the AP direction had the maximum influence on the spinal cord and brainstem.Conclusions Final isocenter marking method leads to less beam position error than reference point marking method in CT simulation positioning.Small isocenter motion can cause large changes in the doses to the organs at risk.
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Objective To analyze the influence of tumor volume change on intensity modulated radiotherapy(IMRT)for nasopharyngeal carcinoma by analyzing the repeated CT simulation.Methods Twenty nasopharyngeal carcinoma patients undergoing IMRT from July 2011 to November 2012 were selected in the study.The first CT simulation was conducted prior to radiotherapy,and the repeated CT simulation was finished after radiotherapy of 30 Gy.The first and the repeated CT images were fused in treatment planning system and GTV volume shrink rate was calculated.The original plan was used to recalculate the dose distribution on repeated CT.The dose volume histogram was used to calculate the dose difference of organs at risk including the brain stem and spinal cord.Results Compared with the first CT,GTV volume shrink rate of the repeated CT simulation was 28.7％,the maximum dose,1 cm3 volume and the average dose percentage of the brain stem and spinal cord were increased(t=0.83-3.17,P＜0.05).Conclusions GTV volume shrinked significantly after radiotherapy of 30 Gy in IMRT for nasopharyngeal carcinoma.The dose of the organs at risk increased accordingly.
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Objective:To discuss application of large aperture 16 row spiral CT in radiotherapy simulation positioning. Methods: To apply CT simulation positioning with large aperture 16 row spiral CT for the breast tangential field by early breast cancer after breast conserving surgery and radical radiotherapy. Compare CT-simulation and X-ray conventional positioning technique and Compare large aperture 16 row spiral CT and single row spiral CT image. Results: The application of large aperture 16 row spiral CT avoided the error because of body limited. Large aperture 16 row spiral CT simulation position validation error is superior to X-ray positioning. Its image quality is better than that of single row spiral CT. Conclusion:The application of large aperture 16 row spiral CT make simulation positioning more accurate, planned and treatment more accurate, it can provide guarantee of accurate simulation positioning for accurate plan and treatment.
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<p><b>OBJECTIVE</b>To evaluate the curative effect and safety of Bushen Qiangji Decoction (BQD) and Qingre Qiangji Decoction (QQD) in treating ankylosing spondylitis (AS) patients, and to verify the clinical utility of AS syndrome differentiation and treatment scheme [Shen-deficiency induced stasis obstruction syndrome (SDISOS) and dampness-heat obstruction syndrome (DHOS) being two basic syndrome types, Shen invigorating blood activating method (SIBAM) and heat clearing dampness resolving method (HCDRM) being two basic treatment methods].</p><p><b>METHODS</b>Totally 354 AS patients of SDISOS and DHOS were randomly assigned to the treatment group and the control group using a multi-center randomized, positive drug parallel-controlled clinical trail. Patients in treatment group were treated by BQD or QQD according to syndrome typing, while those in the control group took Sulfasalazine enteric-coated tablet (SECT), 24 weeks as one therapeutic course. After treatment, the clinical efficacy was evaluated by using ASAS20 standard (set by Asessment in Ankylosing Spondylitis working group), Chinese medical efficacy evaluation standards, and BASDAI, BASFI, BASMI, night-pain index, spinal pain index, PGA, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).</p><p><b>RESULTS</b>After 24 weeks of treatment by BQD or QQD, ASAS20 standard rate was 86.75% in the treatment group, and the total effective rate of Chinese medical syndrome was 85.47%. They could significantly reduce patients' integrals of Chinese medical syndrome, BASDAI, BASFI, BASMI, night-pain index, spinal pain index, and PGA (all P < 0.01).</p><p><b>CONCLUSIONS</b>QQD and BQD got confirmable clinical effects in treating AS, providing strong evidence of evidence-based medicine for syndrome differentiation and treatment of AS.</p>
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Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Medicamentos de Ervas Chinesas , Usos Terapêuticos , Medicina Tradicional Chinesa , Fitoterapia , Métodos , Espondilite Anquilosante , Tratamento Farmacológico , Resultado do TratamentoRESUMO
Objective To investigate the correction of manual monitor unit calculation for asymmetric fields using the Varian enhanced dynamic wedge.Methods Monitor unit (MU) was calculated when the field sizes ranged from 6 cm × 6 cm to 20 cm × 20 cm at a depth of 5 cm using Varian Eclipse and both 6 MV and 10 MV X-rays data from Varian Clinac 23EX for all seven available EDW angles,including 10°15°,20°,25°,30°,45°and 60° The field size was kept fixed,and the distance between geometry center of field and isocenter was increased in increments of 1 cm,ranging from -9 cm to 4 cm.When the field size was the same,the correction factor was defined as the ratio of MU calculated for asymmetric field to monitor unit calculated for symmetric field.To ensure the correction factors obtained above could be used in routine manual calculation for EDW fields,measurements were made at a depth of 5 cm for 30°and 45°EDW with field size of 10 cm × 10 cm using 6 MV X-rays.Results The correction factor was independent of field dimensions,so the average value was adopted to make practical calculation.Without correction,the maximum error was 18% for 30°,and 30% for 45.After the results of monitor unit calculation were corrected,the largest error was - 1.8% and - 1.7% for 30° and 45°EDW,respectively.The magnitude of errors was within the clinical tolerance limits.Conclusions For asymmetric EDW fields,there is very large difference between the prescribed dose by manual calculation using EDW factors measured for symmetric fields and that delivered during treatment in order to obtain correct dose to reference point.The errors are decreased to be acceptable after correction.The method of correction is simple and independent of machine specific beam parameters.