Influence to dosimetry of patient by set-up errors / 医疗卫生装备

Objective To investigate the influence to dosimetry of the patient with rectum cancer by setup errors.Methods First an intensity modulated radiation treatment planning for a rectum cancer patient was designed,then the isocenter was moved 5 mm respectively to the left side,right side,abdomen side,back side,head side and foot side;and the isocenter was moved 5 mm to head side,back side and left side at the same time;and the isocenter was moved 5 mm to foot side,abdomen side and right side at the same time;and the isocenter was moved according to the largest set-up error for the first five Cone Beam CT scanning,thus nine new plans and a confirmed plan were got,the influence to dosimetry for targets and fermur head,bladder and intestine for these ten plans was analyzed.Results The influence to the dosimetry gained the maximum value in the planning target volume (PTV) with the isocenter moving 5 mm to three directions and normal organs.All the plans had little influence on clinical target volume (CTV),which posed few effects on small intestine and bladder while big influence to femoral head incase of high dose D2 to 2％ target volume and mean dose.Conclusion The set-up error may influence dosimetry of PTV,and the reduction of low dose D98 to 98％ target volume may affect treatment effect.For patients whose set-up errors are large,times of cone beam CT scanning have to be increased in order to ensure the precise implementation of the treatment plans.

Influence to dosimetry of patient by set-up errors / 医疗卫生装备

Objective To investigate the influence to dosimetry of the patient with rectum cancer by setup errors.Methods First an intensity modulated radiation treatment planning for a rectum cancer patient was designed,then the isocenter was moved 5 mm respectively to the left side,right side,abdomen side,back side,head side and foot side;and the isocenter was moved 5 mm to head side,back side and left side at the same time;and the isocenter was moved 5 mm to foot side,abdomen side and right side at the same time;and the isocenter was moved according to the largest set-up error for the first five Cone Beam CT scanning,thus nine new plans and a confirmed plan were got,the influence to dosimetry for targets and fermur head,bladder and intestine for these ten plans was analyzed.Results The influence to the dosimetry gained the maximum value in the planning target volume (PTV) with the isocenter moving 5 mm to three directions and normal organs.All the plans had little influence on clinical target volume (CTV),which posed few effects on small intestine and bladder while big influence to femoral head incase of high dose D2 to 2％ target volume and mean dose.Conclusion The set-up error may influence dosimetry of PTV,and the reduction of low dose D98 to 98％ target volume may affect treatment effect.For patients whose set-up errors are large,times of cone beam CT scanning have to be increased in order to ensure the precise implementation of the treatment plans.

Measurement and analysis of the lung large tumor respiratory movements of large lung tumors / 肿瘤研究与临床

Objective To measure intrapulmonary tumor motion due to breathing and analyze the impact factors and characteristics of the respiratory movement of large lung tumors.Methods CT sean was conducted in 30 patients with pulmonary cancer,in the calm inspiratory breath-holding and calm breath after breath-holding state.The tumor GTV in the two phases was recorded.The motion range in the left-right and antero-postefior directions in the GTV center level during the respiratory cyele was measured.The motion range of uppermost and lowermost layer of the tumor from top to bottom was also recorded.The clinical variables and anatomical factors assoeiated with the degree of motion were analyzed.Results The position of large lung tumor was relatively fixed,and the motion range was 3-5 mm,but 2 patients movement was found more than 5 mm.The two tumors were located in the lower part and the rear of the chest with low adhesion coefficient and smaller vertical direction of movement.95 ％ of motion range of the intrapulmonary tumors were under 3.8 mm in the vertical direction,under 5.8 mm in the front-rear direction,and under 1.1 mm in the left-right direction.Conclusion The movement of lung tumors caused by respiratory are influenced by tumor location,volume,and other factors such as the degree of adhesion,but the motion ranges are lower.The motion of lower rear tumors mainly occur in the vertical direction with the maximum range.

Application of electronic beam irradiation technology of L shape field in the traditional radiotherapy of nasopharyngeal carcinoma / 肿瘤研究与临床

Objective To introduce a new way to solve the problem of field-field junction in the traditional radiotherapy of the nasopharyngeal carcinoma better.Methods Using the 3-dimentional planning system,the dose distribution of traditional radiotherapy and the electronic beam irradiation technology of L shape field for nasopharyngeal carcinoma in 2D-or 3D-CRT could be gotten.Results The dose coverage of V95 of the gross tumor volume(GTV)satisfied the clinical requirements.The highest dose in the electronic beam irradiation of L shape field was 7200 cGy,while it was 8900 cGy in the traditional way.The volume of dose that over 6500 cGy of throat was 19.64 ％ in the former,the latter was 31.95 ％.Conclusion The electronic beam irradiation technology of L shape field is better than the traditional radiotherapy in field-field junction and in dose distribution.Since that,the electronic beam irradiation technology of L shape field is worth of application for the treatment of nasopharyngeal carcinoma.

Scheduled Interval Trans-Catheter Arterial Chemoembolization Followed by Radiation Therapy in Patients with Unresectable Hepatocellular Carcinoma

Combination treatment of trans-catheter arterial chemoembolization (TACE) and conformal radiation therapy (RT) reported promising results in patients with hepatocellular carcinoma (HCC), but, optimal interval was not determined. We hypothesized that a two-week interval between TACE and RT would be optimal. Therefore, we designed this study to evaluate the safety and efficacy of scheduled interval TACE followed by RT. HCC patients who were not eligible for standard therapies were enrolled for scheduled interval TACE followed by RT (START). Patients received TACE on the first day of treatment, and then RT was delivered after 14 days. The entire course of treatment took between four and five weeks. In 81 patients (96.4%), START was completed in the planned treatment period. RT was delayed in the remaining three patients because of decreased liver function or poor performance status after TACE. Of the 81 patients, objective response was observed in 57 patients (70.4%). One unexpected death occurred after START due to hepatic failure. Other toxicities were manageable. The median survival was 14.7 months. There was a significant difference in overall survival according to the response to START (P < 0.001). In conclusion, START is safe and feasible.

Ansiedad y depresión en mujeres con cáncer de mama en radioterapia: Prevalencia y factores asociados / Anxiety and Depression in Women with Breast Cancer Undergoing Radiation Therapy: Prevalence and Associated Factors

Someterse a radioterapia y padecer los efectos secundarios son situaciones que generan ansiedad y depresión en las mujeres con cáncer de mama. El objetivo fue evaluar la prevalencia de ansiedad y depresión que presentan las mujeres con cáncer de mama en radioterapia y analizar los efectos y las diferencias de variables clínicas y sociodemográficas sobre su malestar psicológico. Participaron 203 mujeres mexicanas con cáncer de mama en estadios 0-III. Para evaluar ansiedad y depresión se utilizó la versión adaptada de la escala The Hospital Anxiety and Depression Scale (HADS) y los datos sociodemográficos se recolectaron mediante una entrevista estructurada. La prevalencia de ansiedad y depresión fue 27 y 28% respectivamente. Escolaridad F (6,203) = 2.39, p =.009 y ocupación F (3,203) = 1.32, p =.009 tuvieron un efecto significativo sobre depresión; mientras que "vive con" resultó significativa F (6,203) = 2.69, p = .016 únicamente con ansiedad. Significativamente las pacientes deprimidas (M = 3.73) presentaron más efectos secundarios que las no deprimidas (M = 2.84). Resequedad en la boca, irritación en la piel y dolor en la zona radiada fueron los síntomas más reportados. La prevalencia de ansiedad y depresión encontrada, indica la importancia de proporcionar apoyo psicológico a las pacientes.

Enduring the symptoms of breast cancer and the effects of radiation therapy frequently lead to depressive and anxious symptoms in patients. The purpose of the present study was to examine the prevalence of anxious and depressive symptomatology in these patients and to explore the effects of clinical and socio-demographic variables on psychological distress. A total of 203 women with breast cancer, in stages 0 - III from a large public medical center in Mexico City participated. Anxious and depressive symptomatology was assessed through the Hospital Anxiety and Depression Scale (HADS) and Socio-demographic data were obtained through a structured interview. Prevalence of anxious and depressive symptomatologies were 27% and 28% respectively. One-way ANOVA on socio-demographic variables with symptomatology revealed that schooling F (6.203) = 2.39, p = .009 and occupation F (3.203) = 1.32, p = .009 were significant for depressive symptomatology. Living with specific persons was significant F (6.203) = 2.69, p = .016 for anxious symptomatology. The clinical variables "radiotherapy week" and specific features of the diagnostic, as well as marital status and age groups showed small differences related to either anxious or depressive symptomatology. More radiation side effects were reported by women with (M = 3.73) than those without (M = 2.84) depressive symptoms. The most frequent side effects were dry mouth, skin irritation and pain in the radiated area. The high levels of distress and the extreme physical discomfort produced by radiotherapy make the present findings useful for developing interventions aimed at helping breast cancer patients under radiation therapy.

Meningiomas en pediatría / Meningiomas in childhood

Objetivo. Estudiar los signos clínicos, epidemiología, tratamiento, seguimiento y pronóstico de los meningiomas intracraneales en la infancia, y compararlos con la misma patología en la población adulta. Material y método. En nuestro Hospital se trataron 25 pacientes menores de 16 años con meningiomas, durante los últimos 20 años (1989-2009). En el estudio se contemplaron la edad y distribución por sexo, signos clínicos, neuroimágenes, localización de las lesiones, asociación con NF (neurofibromatosis), seguimiento, resección quirúrgica, subtipos histológicos, morbimortalidad y recidiva. Resultados. La relación hombre-mujer fué 1,1:1 (13:12) con una edad media de 10 años (11meses – 15,6 años). Las crisis convulsivas fueron el síntoma más común (36%), seguido por la hipertensión endicraneana (HTE) (28%). Localización de la lesión: 15 supratentoriales, 6 en fosa posterior, 2 extracraneales y 1 espinal. Siete pacientes tenían asociada NF 1 ó 2. Todos los pacientes fueron operados. La mortalidad perioperatoria fué de 1 paciente y la mortalidad global de 3 pacientes, 2 de las cuales por eventos no relacionados al tumor (hemorragia digestiva – síndrome de Steven Johnson) y 1 por progresión tumoral. Se logró la resección total (100%) en 16 pacientes, subtotal (60-99%) en 7 y parcial en 2 pacientes. En 14 pacientes mejorarron los síntomaspreoperatorios, en 6 no se modificaron, 4 empeoraron y 1 falleció. La recidiva fué 1/16 en resecciones totales, 6/7 en resecciones subtotales y 2/2 en resecciones parciales. Once pacientes necesitaron más de una cirugía. El meningioma meningoteliomatoso fue el subtipo más frecuente. Conclusión. Los meningiomas en pediatría son infrecuentes. No hay predominio de sexo como en la población adulta. La neurofibromatosis y radioterapia previa son los factores de riesgo más importantes. La resescción total es el factor pronóstico mas importante.

Objective. To study clinical signs, epidemiology, follow up, treatment and prognosis of intracranial meningiomas in childhood and correlates them with the same pathology in the adultpopulation. Material and method. 25 patients under 16 years with meningiomas were treated in our Hospital in the last 20 years (1989-2009). The study included their age and sex distribution, clinical signs, neuroimages, localization of the lesion, NF association, follow up, surgical removal, pathological subtypes of meningiomas, morbimortality and recurrence. Results. The male-to-female ratio was 1,1:1 (13:12) and themean age was 10 years ranging from 11 months to 15.6 years. Seizure was the most common symptom (36%) followed by intracranial hypertension (28%). Lesion localization: 15 supratentorial, 6 in the posterior fossa, 2 extracraneal and 2 spinal. Seven patient had NF 1/2 association. All patients were treated with surgery. Perioperative mortality was of 1 patient and the global mortality was of 3 patients, two caused by non-tumorrelated events (gastrointestinal hemorrhage – Steven Johnson syndrome) and in the other case by tumor progression. Totalremoval (100%) was achieved in 16 patients, subtotal removal (60 to 99%) in 7 and partial in 2 patients. Preoperative symptoms improved in 14 patients, 6 remained unchanged, 4 had further deficit, and 1 died. The recurrence was 1/16 in total removal, 6/7 in subtotal removal and 2/2 in partial removal. Eleven patients required more than one surgery. Meningotheliomatous meningioma was the most frequent subtype. Conclusion. Meningiomas in childhood are infrequent. There is no gender predominance as in adults. The Neurofibromatosis and previous radiation treatment are the most important risk factors. Total removal is the most important prognostic factor.

Factors influencing target volume motion in tangential whole breast irradiation for breast cancer / 中华放射肿瘤学杂志

Objective To evaluate the impact of breathing motion on target volume and the factors influencing the set-up errors during tangential whole breast irradiation.Methods From Jan 2003 to Dec 2003,patients with early-stage breast cancer after breast conserving surgery,were selected to be eligible for the study.All patients were immobilized in treatment position by breast beard of Med-Tec 250.The motion of the breast treatment volume was observed on a fluoroscope in different directions under free breathing in 16 patients.The set-up errors in different dimensions during irradiation were measured by weekly portal films (PF) in comparison with digital reconstructed radiographs (DRR) in 11 patients.Results The central lung distance (CLD) variation during free breathing was (2.1?1.2) mm which is greater than the motion to- wards the other directions.By comparing the PF and DRR,the systemic error,random error and overall er- ror in the outer,inner and cranio-caudal directions was 1.9,1.6,2.5 and 2.4,1.7,3.1 and 2.6,2.3, 3.5 mm,respectively.In addition,the discrepancy of the treatment position in cranio-caudal direction and breast volume was most obvious at the beginning 2 weeks with the peak of breast volume at the second week. It decreased gradually during the following 3 weeks.Conclusions This study suggests that the mean value of the motion of the breast target volume during one breathing cycle is less than 2 mm.The set-up errors dur- ing irradiation is the greatest in cranio-caudal direction,suggesting that the fixing precision of the breast board should be further improved.The set-up error during irradiation are most obvious at the beginning two weeks,with the peak of the breast volume in the second week.

The Effect of Hormone Replacement Therapy on Osteoporosis Following Irradiation of Gynecologic Cancer Patients / 부인종양

OBJECTIVE: This article is based on gynecologic cancer patients who were treated with radiation-therapy. The postmenopausal symptoms and osteporotic change and it's deterioration before and after these treatments were investigated. We represent the effect of appropriate medication for these patients. METHODS: Patients who were diagnosed as cervical cancer, endometrial cancer and ovarian cancer and hospitalized for their treatment in department of gynecology in Ajou Medical Center were selected. Before the treatment, Kupperman's index and bone mineral density of lumbar spine were checked. After the treatment, we divided the patients into 2 groups; a group of patients who were medicated with premarin, tibolone and raloxifen and a control group who were non-medicated. And these groups were reexamined Kupperman's index and bone mineral density of lumbar spine. And then effect on radiation-therapy and result of hormone therapy were analyzed. RESULTS: This study was based on total 63 patients; 47 (74.6%) patients were medicated and 16 (25.4%) patients were not medicated, for hormone therapy used. The average age of patients was 49.6 years old for medicated and 51.2 years old for non-medicated showing no significant differences. The mean period of medication of was 6-30 months. Comparing one group who's treated with radiation-therapy to the other group who's not treated with radiaton-therapy, decrease in BMD and T-score was noted, but statistically not significant (p=0.309, p=0.107). Comparing hormone treated group to control group, the BMD after medication was from 0.89 g/cm2 to 0.91 g/cm2, that of T-score was -1.48 from -1.68, and for the control group, BMD was from 0.91 g/cm2 to 0.96 g/cm2 and that of T-score was from -1.16 to -1.53. This indicates that osteoporotic change was turning in favor in hormone treated group. Especially, for the menopausal women who were treated with radiation-therapy, hormone replacement therapy was proved to be effective. In addition, medicated and non-medicated group showed significant difference in Kupperman's index which account for change in postmenopausal symptom. DISCUSSION: Gynecologic cancer generally occurs in 40-50 years at times when postmenopausal symptom and osteoporotic change begin to appear. In case of patients who're treated with radiation-therapy, this phenomenon is likely to happen much faster. Nowadays, as the average life expectancy becomes longer owing to development of cancer therapy, we suggest a method which improves quality of life, that is taking osteoporosis exam at regular interval and appropriate hormone therapy when needed after radiation-therapy.

Clinical design and research on 3DCRT and IMRT of gamma radiation / 医疗卫生装备

A special method of clinical tumor radiation therapy,namely 3DCRT& IMRT,is described in this paper,including its design and clinical application.

Endobronchial Brachytherapy for MalignantAirway Obstruction: Low Dose Rate Versus High Dose Rate / 대한치료방사선과학회지

PURPOSE: This is a retrospective study to compare the palliation rates, survival rates and complications of low dose rate and high dose rate endobronchial brachytherapy in the management of malignant airway obstruction. METHODS AND MATERIALS: Forty three consecutive patients with malignant airway compromise from primary or metastatic lung tumors were treated with low dose rate(LDR) endobronchial Iridium-192 insertion (21 patients) between October 1988 and June 1992, and high dose rate(HDR) endobronchial brachytherapy(22 patients) between August 1992 and April 1994 with palliative aim. Flexible fiberoptic bronchoscopy under fluoroscopic control was utilized in all 91 provedures. Twenty seven LDR provedures delivereda dose of 5-7.5 Gy to a 1.0 cm radius respectively. RESULTS: Subjective and objective responses to treatments were evaluated on follow-up examinations by clinical examination, chest x-rays and CT scan of the chest had been demonstrated on 8 LDR patients and 10 HDR patients. CONCLUSION: The technique of LDR and HDR endobronchial brachytherapy is simple and well tolerated procedure with minimal morbidity. It provides excellent palliation by keeping airway patent in these short life-spanned patients.