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Background: Currently, recommended heart dose constraints are difficult to meet in whole?breast irradiation (WBI) for left?sided breast cancer patients, who cannot be treated with the deep inspiration breath hold. We performed a radiotherapy planning study to establish if the use of intensity?modulated radiation therapy (IMRT) or volumetric?modulated arc therapy (VMAT) allows for better sparing of the heart and its subvolumes than the three?dimensional conformal radiation therapy (3D?CRT), and how these attempts affect the dose delivered to the other organs. Methods: A total of 17 left?sided and 10 right?sided consecutive patients treated with free?breathing WBI were retrospectively included. The 3D?CRT, IMRT, and VMAT plans were generated. Several dose杤olume parameters and plan quality indices were compared, separately for the left? and right?sided plans. Results: All the techniques fulfilled the planning objectives. In the left?sided plans, there was no heart or left ventricle dose reduction with IMRT, nor with VMAT; the maximum dose in the left anterior descending coronary artery was reduced with VMAT (P = 0.005); V5 for the contralateral breast, contralateral lung, and total?body increased markedly in VMAT, and for the ipsilateral lung (V5IL) also in IMRT, compared with 3D?CRT (P < 0.001). In the right?sided plans, the V5 values, except for V5IL, did not differ between the three techniques. Conclusions: IMRT and VMAT had a limited heart?sparing benefit in the left?sided free?breathing WBI, at the cost of increased low?dose volumes, measured by V5. The low?dose volumes are not increased by IMRT or VMAT in the right?sided WBI, where heart sparing is not a problem, but the attempts to reduce cardiac doses in the left?sided WBI increase them.
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Non-coplanar radiotherapy is a kind of radiotherapy technology which employs multiple non-coplanar fixed fields or non-coplanar arcs. The non-coplanar field can be defined that the central axis of each field is not on the same plane, while the non-coplanar arc can be described that the trajectory formed by each arc is not on the same plane. Compared with coplanar radiotherapy, non-coplanar radiotherapy can achieve multi-angle or multi-radian irradiation, which effectively improves the focusing level of ray and is beneficial to enlarge the radiation dose of the target area between the surrounding normal tissues. Its dosimetric advantages have been proven in multiple types of tumors, such as intracranial tumors, liver cancer and lung cancer, etc. Multiple approaches can be employed to realize non-coplanar radiotherapy, which can be divided into the non-coplanar conic radiotherapy, non-coplanar conformal radiotherapy, non-coplanar intensity-modulated radiotherapy and non-coplanar volumetric modulated arc therapy according to the established sequence. In this review, the development process and principal characteristics of these implementations were summarized.
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Objective:To investigate the dosimetric differences between conventional IMRT and electron beam conformal radiotherapy (EBCRT) combined with IMRT for post-mastectomy left-sided breast cancer patients.Methods:A total of 20 post-mastectomy left-sided breast cancer patients who were treated in the Ningbo First Hospital from June 2018 to October 2021 were retrospectively studied. The planning target volume (PTV) included the supra-and infra-clavicular regions(PTV sc)and the ipsilateral chest wall (PTV cw), and the prescribed dose was 50 Gy/25 f. All radiotherapy plans were designed using the Varian Eclipse treatment planning system (TPS). After that, the dose distribution of the target volume and the dose exposure of organs at risk (OARs) were compared and analyzed. Results:All the IMRT plans met the clinical requirements, yet 2/20 of the EBCRT combined with IMRT plans were not clinically accepted. For these two patients, the maximum chest wall thickness was 3.7 cm and 4.4 cm each, and the designed electron beam energy was 12 MeV and 15 MeV, respectively. The dose to the ipsilateral lung of these two patients exceeded the institution-specific dose limit standard. For the remaining 18 patients whose chest wall thickness was 3 cm or less, the designed electron beams were 9 MeV or less. All the EBCRT combined with IMRT plans were clinically accepted. The target dose distribution of the conventional IMRT was better than that of the EBCRT combined with IMRT (uniformity index (HI): PTV sc: t = -10.20, P<0.05; PTV cw: t = -9.24, P<0.05; conformal index (CI): PTV all: t = 10.39, P <0.05). For OARs, the V5 Gy, V20 Gy, and Dmean of the ipsilateral lung of EBCRT combined with IMRT were lower than those of IMRT ( t = 5.98, 6.30, 11.30, P <0.05). Specifically, the V25 Gy and Dmean of heart decreased by 8.3% and 4.79 Gy, respectively ( t = 15.23, 15.76, P<0.05), the Dmean of the left anterior descending coronary artery (LADCA) decreased by 44.03% ( t = 11.69, P <0.05), and the V5 Gy and Dmean of the contralateral breast decreased by 7.9% and 0.8 Gy, respectively ( t = 3.66, 4.93, P<0.05). The dosimetric differences of other OARs were not statistically significant ( P > 0.05). Conclusions:For post-mastectomy left-sided breast cancer patients with a chest wall thickness of less than 3 cm, EBCRT combined IMRT can significantly reduce the exposure dose to the heart, the ipsilateral lung, and the contralateral breast, which is beneficial to reducing the potential risk of long-term complications after radiotherapy and can further improve the long-term overall survival rate of patients. For patients with thick chest wall, IMRT plans are more technologically ideal.
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Objective To analyze the correlation between ≥grade 2 radiation pneumonitis (RP) and dose volume parameters of elderly patients with esophageal cancer after three-dimensional conformal radiotherapy. Methods We collected the data of 250 elderly patients with esophageal cancer who received three-dimensional conformal radiotherapy from different medical centers. The clinical features of patients were analyzed by Chi-square test while dose volume parameters were analyzed by Logistic univariate and multivariate analyses. ROC curve was used to determine the best cut-off value. Results After three-dimensional conformal radiotherapy, 20% of patients developed ≥grade 2 RP. Univariate analysis showed that bilateral pulmonary V5, V10, V20, V30 and mean lung dose were associated with ≥grade 2 RP but multivariate analysis revealed that only V5 and V20 were independent relevant factors of RP. ROC curve indicated that the best cut-off value was V5 < 52.9% and V20 < 23.2%. Conclusion Bilateral pulmonary V5 and V20 are independently related to ≥grade 2 RP in elderly patients with esophageal cancer after 3-D conformal radiotherapy.
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Objective:To investigate the effects of CT simulation positioning and three-dimensional conformal radiotherapy combined with regimen of paclitaxel and cisplatin (TP) on serum squamous cell carcinoma antigen (SCC) level and prognosis in patients with advanced esophageal cancer.Methods:A total of 80 cases of advanced esophageal cancer patients in People′s Hospital of Xinjiang Uygur Autonomous Region from June 2016 to October 2017 were selected and randomly divided into treatment group and control group, with 40 cases in each group. The control group was treated with CT simulation positioning three-dimensional combined cisplatin and Docetaxel, and the treatment group was treated with CT simulation positioning three-dimensional combined TP regimen. The clinical efficacy, tumor marker levels [serum SCC, carcinoembryonic antigen (CEA), carbohydrate antigen-199 (CA-199), human cytokeratin 21-1 fragment (CYFRA21-1)], Karnofsky functional status (KPS) score, Quality of Life(QOL) score, progression free survival period and incidence of adverse reactions were compared between the two groups.Results:After treatment, the total effective rate in the treatment group was 70.00%, which was significantly higher than 55.00% in the control group ( P<0.05); the levels of serum SCC, CEA, CA-199 and CYFRA21-1 in the two groups after treatment were significantly lower than those before treatment ( P<0.05), and those in the treatment group were significantly lower than those in the control group ( P<0.05); after treatment, the QOL and KPS scores in the two groups were significantly higher than those before treatment ( P<0.05), and the scores in the treatment group were significantly higher than those in the control group ( P<0.05); The progression free survival time in the treatment group was significantly longer than that in the control group ( P<0.05); The incidence of adverse reactions in the treatment group was 15.00%, which had no significant difference compared with 25.00% in the control group ( P>0.05). Conclusions:CT simulation positioning three-dimensional combined with TP regimen in the treatment of advanced esophageal cancer has obvious effect, can effectively reduce the level of tumor markers, improve the patient′s physical function and quality of life, improve prognosis , and does not increase the survival rate of adverse reactions, which is safe and effective.
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Background:Palliative radiotherapy offers significant relief in the huge physical distress of patients with bony metastasis. The enormous potential of conformal techniques has not been tested in palliative settings. However,the increasing life span of patients with metastatic disease demands to optimize the radiotherapy techniques to provide maximal durable symptomatic relief. Despitean increase in the utilization of the 3DCRT technique for palliative bony metastasis, the optimal beam arrangement remains unknown. Materials and Methods:Ten patients of vertebral bony metastasis were retrospectively selected and four virtual 3DCRT plans were generated for each patient. The field approaches were a single field, two fields, three fields and five field approaches. For PTV, D90, D50, Dmean, Conformity index (CI) were evaluated.Dmean was evaluated for the esophagus, bowel, kidneys, and combined lungs. Dose-volume histograms were computed for the various treatment plans and compared. Statistical analysis was done by ANOVA test. Results:A total of forty radiotherapy plans were generated. PTV parameters were significantly better with two field plans over one field plans in terms of D90 (p= 0.002), D50 (p= 0.02), Dmean(p=0.0009). Dmeanwassignificantly better with three field approach compared to two field approach (p=0.0006). The Dmeanwas significantly increased for organs at risk in two fields and three field plans.Five field approach did not showan advantage in terms of dosimetry of PTV but there was a significant rise in the dose to Organs at risk (OAR’s). Conclusion:The three field plans showed better dose distribution to the PTV with an acceptable increase in the dose to OAR’s.
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Radiation skin injury is a common and severe adverse event of radiotherapy in patients with head and neck cancer or nasopharyngeal carcinoma, which not only limits the radiation dose of the tumor, but also seriously affects the follow-up treatment and quality of life of the patients. It has become a bottleneck to improve the curative effect of tumor. The occurrence of radiation skin injury is a complex process of the interaction of many factors, which is closely related to the patient's own factors, radiotherapy technology, radiotherapy dose segmentation scheme and the combined regimens of radiotherapy and chemotherapy. Different regimens of radiotherapy and chemotherapy with drugs have effects on the occurrence and development of acute skin injury. There is still a lack of effective prevention and treatment of radiation-induced skin injury. Therefore, it is of great significance to explore its mechanism and radiation skin damage caused by different radiotherapy and chemotherapy regimens. This paper mainly reviews the combined application of concurrent chemoradiotherapy, induction and adjuvant chemotherapy to aggravate skin injury and its related mechanisms.
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Objective@#To evaluate the prognostic factors of T1-2N0M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy.@*Methods@#The clinical data of 196 patients with T1-2N0M0 ESCC who were treated with definitive radiotherapy in 10 hospitals were retrospectively analyzed. All sites were members of Jing-Jin-Ji Esophageal and Esophagogastric Cancer Radiotherapy Oncology Group (3JECROG). Radiochemotherapy were applied to 78 patients, while the other 118 patients received radiotherapy only. 96 patients were treated with three-dimensional conformal radiotherapy (3DCRT) and 100 treated with intensity-modulated radiotherapy (IMRT). The median dose of plan target volume(PTV) and gross target volume(GTV) were both 60 Gy. The median follow-up time was 59.2 months. Log rank test and Cox regression analysis were used for univariat and multivariate analysis, respectively.@*Results@#The percentage of normal lung receiving at least 20 Gy (V20) was (18.65±7.20)%, with average dose of (10.81±42.05) Gy. The percentage of normal heart receiving at least 30 Gy (V30) was (14.21±12.28)%. The maximum dose of exposure in spinal cord was (39.65±8.13) Gy. The incidence of radiation pneumonia and radiation esophagitis were 14.80%(29/196) and 65.82%(129/196), respectively. The adverse events were mostly grade 1-2, without grade 4 toxicity. Median overall survival (OS) and progression-free survival (PFS) were 70.1 months and 62.3 months, respectively. The 1-, 3- and 5-year OS rates of all patients were 75.1%、57.4% and 53.2%, respectively. The 1-, 3- and 5-year PFS rates were 75.1%、57.4% and 53.2%, respectively. Multivariate analysis demonstrated that patients′age (HR=1.023, P=0.038) and tumor diameter (HR=1.243, P=0.028)were the independent prognostic factors for OS, while tumor volume were the independent prognostic factor for PFS.@*Conclusions@#Definitive radiotherapy is a promising therapeutic method in patients with T1-2N0M0 ESCC. Patients′ age, tumor diameter and tumor volume may impact patients′ prognosis.
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Introduction: With sectional imaging, wide variations are reported in pelvic anatomy of individual patients raising concerns over adequate coverage of target volume with conventional radiotherapy based on standard bony landmarks. Three-dimensional conformal radiotherapy (3DCRT) is reported to decrease normal tissue toxicity, along with decrease in chances of geographic miss. Present study is done for dosimetric comparison of Planning Target Volume (PTV) and Organs at Risk (OAR) in cancer cervix patients treated with conventional and conformal radiotherapy along with clinical correlation in terms of side effects and tumor response. Materials and Methods: Fifty patients of cancer cervix underwent planning contrast enhanced CT scan. Target volumes & OAR were contoured. Patients were randomized into conventional & conformal arms. Conventional fields were planned using standard bony landmarks. CT based radiotherapy planning was done for 3DCRT arm. Field sizes &dose volume histogram (DVH) were recorded & compared for target coverage & OAR sparing in both arms. All patients received concurrent chemotherapy followed by brachytherapy. Results: Field sizes used for the 3DCRT plans were significantly larger than those used for the conventional plans (p= 0.000). Optimal PTV coverage was significantly improved using 3DCRT as compared to conventional radiotherapy (p= 0.0001). Dose homogeneity in both arms were almost similar (p= 0.292), while conformity index was better in 3DCRT which was statistically significant between the groups (p= 0.000). Mean dose to the Planning Target Volume was increased significantly in the CT based plan when compared with the standard four field plan (p= 0.0001).Difference in doses to the organs at risk (urinary bladder, and small bowel)and their side effects were statistically significant across both groups. There was no difference in tumor response. Conclusion: The present study showed significantly better target volume coverage & dose homogeneity with 3DCRT which may translate into better local control & survival but longer follow up is required to validate it.
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Background: Conformal Radiotherapy techniques adapting to the ballistics of delineated volumes allowed significant reduction in excess radiation induced mortality however the increasing number of long-term survivors and expanding use of cardiotoxic drug highlight the persistent need for maximal cardiac possible sparing. The low dose volume of left ventricle are better predictor of acute coronary events than mean heart dose. Materials and Methods: 38 post-MRM patients were randomized to treatment by 3Dimensional Conformal Radiotherapy (3D CRT) and Intensity Modulated Radiotherapy (IMRT) technique. Two tangential beams were used in 3D CRT technique while five to seven (mostly tangential beams) were used in inversely planned IMRT technique. The dose volume parameters of planning target volume, heart and left ventricle were compared. Results: The dosimetry of Planning target volume showed significantly better coverage in IMRT technique (D90, D95) however the D50 was comparable in both the techniques. In dosimetry of heart, the high dose volumes (V30, V40) were nearly comparable in both the techniques. The other dose volume parameters (V5, V10, V20, V25, D33, D67, D100) and the mean dose were significantly lesser in 3D CRT technique along with significantly better sparing of left ventricle (Dmean and V5). Conclusion: The dosimetry of target volume was better with IMRT technique, but this was accompanied by a huge increase in dose to whole heart and specifically the left ventricle which has strong potential to translate into an increased cardiotoxicity. A better distribution of the target region may be obtained by multiple segmentation of the two tangential fields in 3D CRT plans with further reduction in dose to heart and left ventricle.
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Background: Postmastectomy radiation (PMRT) to the chest wall using electron beam treatment with uniform bolus was practiced at our institution. The planning target volume (PTV) included the chest wall and the internal mammary nodes (IMN) along with supraclavicular nodal regions. The varying thickness of the postmastectomy chest wall and the varying position of the IMN resulted in dose inhomogeneity in the PTV. In addition, there was the risk of increased lung and cardiac doses. In this prospective study, we report the making of a custom-made bolus using dental wax called “step bolus.” Materials and Methods: From March 2010 to January 2011, 167 patients received PMRT. As conformal photon plans were not acceptable in 48 patients, they were treated with single energy electrons and custom-made bolus. Results: Addition of the step bolus improved dose distribution to the PTV reduced the mean lung dose %, the mean heart dose % and lung dose (D10, D20, D30, D50, and D70). Forty-seven patients had Grade 2, and one patient had Grade 3 skin toxicity. Acute symptomatic radiation pneumonitis was observed in one patient. At 5 years, 29 patients were alive with a median follow-up of 32 months and no local recurrences were observed. One patient died of myocardial infarction unrelated to treatment, one patient did not come for follow-up, 22 patients had systemic metastases, and 24 patients were disease free. Conclusion: A custom-made step bolus using dental wax can be used for tissue compensation in electron beam therapy with resulting good local disease control and acceptable toxicity.
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Introduction: Since 1980s, computerization has made improvements in radiation therapy delivery from conventional two-dimensional to three-dimensional conformal radiotherapy (2DCRT to 3DCRT) to intensity-modulated radiotherapy (IMRT) and its newer versions. This small study is aimed to compare the existing techniques for planning target volume (PTV) and organ at risk (OAR) dose distribution parameters in postoperative buccal mucosa cases. Materials and Methods: Ten post operative cases of early stage carcinoma buccal mucosa in whom only post operative bed irradiation was indicated was enrolled and was planned with conventional, 3DCRT and IMRT techniques to get 95% PTV coverage and dose received by organs at risk were recorded and evaluated. Results: Mean and standard deviation values for PTV 95% for IMRT, 3DCRT, and conventional plans were 96.4 ± 1.8, 95.1 ± 1.9, and 91 ± 2.7, respectively. Dose received by OARs was high in conventional technique when compared to the other two. Maximum dose received by 1 cc of brain (46.2 ± 7.9 and 60.8 ± 3.8) (priority was given for PTV coverage) and mean dose received by the same eye (13.6 ± 1.4 and 22 ± 2.4) were less in IMRT when compared to 3DCRT. However, maximum dose received by 1 cc of brainstem (29.7 ± 7.6 and 14.1 ± 9.5), optic chiasma (29.2 ± 4.2 and 12 ± 2.1), spinal cord (31.8 ± 3 and 20.9 ± 4.2), and the same-side optic nerve (22 ± 6.9 and 11.7 ± 9.4) and mean dose received by opposite-side parotid (8.7 ± 1.1 and 1.7 ± 0.4) and submandibular gland (18.6 ± 1.7 and 3.2 ± 0.9) were more with IMRT when compared to 3DCRT. Conclusion: In postoperative cases of early-stage carcinoma buccal mucosa, it is good enough to treat with 3DCRT technique. Here, the target area will be well lateralized, and 3DCRT technique can give good target coverage and less dose to OARs, especially the only remaining major salivary glands.
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Objective To investigate the effect of three-dimensional conformal radiotherapy (3D-CRT)combined with PC chemotherapy (paclitaxel + carboplatin)on non-small cell lung cancer (NSCLC) patients and the serum levels of CA125,tissue inhibitor of metalloproteinase-1 (TIMP-1),serum amyloid A (SAA)and T-lymphocyte subsets. Methods A total of 100 patients with NSCLC treated in Affiliated Hospital of Guangdong Medical University from May 2015 to December 2017 were selected as the study subjects. They were divided into control group and observation group according to random number table method,with 50 cases in each group. The observation group was treated with 3D-CRT combined with PC chemotherapy,while the con-trol group was treated with PC chemotherapy. The two groups were treated for 4 cycles. The therapeutic effect, serum CA125,TIMP-1,SAA,T-lymphocyte subsets and adverse reactions were compared between the two groups. Results Four cases were lost to follow-up both in the two groups. The overall response rate in the observation group (43. 48％,20 / 46)was higher than that in the control group (23. 91％,11 / 46;χ2 = 3. 941, P = 0. 047). The serum levels of CA125,TIMP-1 and SAA of the two groups had no significant difference be-fore treatment,and the levels of these indexes decreased after treatment. The serum levels of CA125,TIMP-1 and SAA in the observation group after treatment were (12. 31 ± 1. 13)U/ ml,(275. 31 ± 13. 69)pg/ ml and (47. 21 ± 7. 21)mg/ L,which were lower than those in the control group [(30. 36 ± 1. 98)U/ ml,(320. 36 ± 17. 23)pg/ ml,(65. 92 ± 8. 36)mg/ L],with significant differences (t = 53. 699,P < 0. 001;t = 13. 884, P < 0. 001;t = 11. 495,P < 0. 001). The levels of CD3 +,CD4 +,CD8 + and CD4 + / CD8 + of the two groups had no significant difference before treatment,and the levels of these indexes decreased after treatment. The levels of CD3 +,CD4 +,CD8 + and CD4 + / CD8 + in the observation group were (35. 27 ± 10. 31 )％, (20. 27 ± 6. 72)％,(15. 89 ± 3. 37)％ and 0. 91 ± 0. 37,which were higher than those in the control group [(30. 77 ± 9. 27)％,(15. 27 ± 5. 73)％,(12. 02 ± 2. 69)％ and 0. 75 ± 0. 39],with significant differences (t = 2. 201,P = 0. 030;t = 3. 840,P < 0. 001;t = 6. 087,P < 0. 001;t = 2. 019,P = 0. 047). There were no significant differences in the adverse reactions such as nausea and vomiting [63. 04％ (29 / 46)vs. 43. 48％(20 / 46);χ2 = 3. 537,P = 0. 060],phlebitis [6. 52％ (3 / 46)vs. 4. 35％ (2 / 46);χ2 = 0. 000,P >0. 999],abnormal liver function [6. 52％ (3 / 46)vs. 2. 17％ (1 / 46);χ2 = 0. 261,P = 0. 609]and myelo-suppression [8. 70％ (4 / 46)vs. 6. 52％ (3 / 46);χ2 = 0. 000,P > 0. 999]between the observation group and the control group. Conclusion For patients with NSCLC,3D-CRT combined with PC chemotherapy can im-prove the overall response rate,decrease the levels of serum CA125,TIMP-1 and SAA,and improve the im-mune function of patients. The therapeutic effect is remarkable and the safety is good. The therapeutic scheme is suitable for the treatment of NSCLC.
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Objective@#To investigate the effect of three-dimensional conformal radiotherapy (3D-CRT) combined with PC chemotherapy (paclitaxel + carboplatin) on non-small cell lung cancer (NSCLC) patients and the serum levels of CA125, tissue inhibitor of metalloproteinase-1 (TIMP-1), serum amyloid A (SAA) and T-lymphocyte subsets.@*Methods@#A total of 100 patients with NSCLC treated in Affiliated Hospital of Guangdong Medical University from May 2015 to December 2017 were selected as the study subjects. They were divided into control group and observation group according to random number table method, with 50 cases in each group. The observation group was treated with 3D-CRT combined with PC chemotherapy, while the control group was treated with PC chemotherapy. The two groups were treated for 4 cycles. The therapeutic effect, serum CA125, TIMP-1, SAA, T-lymphocyte subsets and adverse reactions were compared between the two groups.@*Results@#Four cases were lost to follow-up both in the two groups. The overall response rate in the observation group (43.48%, 20/46) was higher than that in the control group (23.91%, 11/46; χ2=3.941, P=0.047). The serum levels of CA125, TIMP-1 and SAA of the two groups had no significant difference before treatment, and the levels of these indexes decreased after treatment. The serum levels of CA125, TIMP-1 and SAA in the observation group after treatment were (12.31±1.13) U/ml, (275.31±13.69) pg/ml and (47.21±7.21) mg/L, which were lower than those in the control group [(30.36±1.98) U/ml, (320.36±17.23) pg/ml, (65.92±8.36) mg/L], with significant differences (t=53.699, P<0.001; t=13.884, P<0.001; t=11.495, P<0.001). The levels of CD3+ , CD4+ , CD8+ and CD4+ /CD8+ of the two groups had no significant difference before treatment, and the levels of these indexes decreased after treatment. The levels of CD3+ , CD4+ , CD8+ and CD4+ /CD8+ in the observation group were (35.27±10.31)%, (20.27±6.72)%, (15.89±3.37)% and 0.91±0.37, which were higher than those in the control group [(30.77±9.27)%, (15.27±5.73)%, (12.02±2.69)% and 0.75±0.39], with significant differences (t=2.201, P=0.030; t=3.840, P<0.001; t=6.087, P<0.001; t=2.019, P=0.047). There were no significant differences in the adverse reactions such as nausea and vomiting [63.04% (29/46) vs. 43.48% (20/46); χ2=3.537, P=0.060], phlebitis [6.52% (3/46) vs. 4.35% (2/46); χ2=0.000, P>0.999], abnormal liver function [6.52% (3/46) vs. 2.17% (1/46); χ2=0.261, P=0.609] and myelosuppression [8.70% (4/46) vs. 6.52% (3/46); χ2=0.000, P>0.999] between the observation group and the control group.@*Conclusion@#For patients with NSCLC, 3D-CRT combined with PC chemotherapy can improve the overall response rate, decrease the levels of serum CA125, TIMP-1 and SAA, and improve the immune function of patients. The therapeutic effect is remarkable and the safety is good. The therapeutic scheme is suitable for the treatment of NSCLC.
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Objective The aim of this study was to search for a better individualized clinical radiotherapy scheme for breast cancer patients after modified radical mastectomy by comparing the dosimetric data on the radiotherapeutic techniques of three-dimensional conformal radiation therapy (3D-CRT) and volumetric modulated arc therapy (VMAT). Methods This retrospective study included 77 cases of breast cancer treated by modified radical mastectomy followed by radiotherapy in Hebei General Hospital from November 2015 to February 2019. According to the radiotherapeutic techniques used, we divided the patients into a 3D-CRT (n = 54) and a VMAT group (n = 23), Using the dose-volume histogram, we evaluated the dose parameters of the clinical target volume (CTV) and the organs at risk (OAR). Results Compared with the patients in the 3D-CRT group, those in the VMAT group showed significantly decreased V110% ([12.14 ± 14.03]% vs [7.18 ± 6.36]%, P < 0.05), increased conformity index (0.62 ± 0.11 vs 0.66 ± 0.09, P < 0.05), reduced ipsilateral lung dose ([1308.42 ± 276.49] vs [1114.34 ± 233.71] cGy, P < 0.05), V5 (P < 0.05) and V10 (P < 0.05), and elevated contralateral breast dose (P < 0.05) and V5 in those with left breast cancer ([63.49 ± 17.49]% vs [76.97 ± 11.81]%, P = 0.028). Conclusion VMAT can effectively reduce the average dose and the dose in the low-dose area of the ipsilateral lung of the breast cancer patient after modified radical mastectomy. VMAT and 3D-CRT each have its own advantages for specific patients.
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Objective To evaluate the clinical efficacy and safety of the hypofractionated three-dimensional conformal radiotherapy in the treatment of recurrent nasopharyngeal carcinoma.Methods Clinical data of 153 patients with recurrent nasopharyngeal carcinoma admitted to our hospital from 2008 to 2013 undergoing hypofractionated three-dimensional conformal radiotherapy (3 Gy for each time,5 times a week,a total dose of 51-60 Gy,17-20 times/4 weeks) were retrospectively analyzed.The short-and long-term radiation-induced injury,Karnofsky performance score (KPS),short-and long-term clinical efficacy were evaluated.Results For the short-term radiation-induced injury,the incidence of oral mucosa and fatigue significantly differed before and after treatment (both P＜0.05).Regarding the long-term radiation-induced injury,the incidence of dry mouth (95.4％) and deafness (51.0％),difficulty in opening mouth (79.1％),maxillofacial fibrosis (33.3％) and radiation-induced encephalopathy (15.0％) significantly differed before and following treatment (all P＜ 0.05).The actual long-term radiation-induced injury included dry mouth (91.5％),deafness (50.9％),difficulty in opening mouth (76.5％),maxillofacial fibrosis (32.0％) and radiation-induced encephalopathy (14.4％).The number of patients with changes in the KPS scores significantly differed between the end of treatment and 3 months after treatment (P＜0.05).The local control rates were 29.4％,68.6％,79.1％,83.7％ and 86.9％ at 1-,3-,6-,9-and 12-month after corresponding treatment,respectively.The local control rate significantly differed between 1 and 3 months,and between 3 and 6 months after treatment (both P＜0.05).The 1-,2-,3-,4-and 5-year survival rates were calculated as 96.1％,80.4％,68.5％,57.9％ and 51.1％,respectively.Conclusions Hypofractionated three-dimensional conformal radiotherapy is an efficacious and safe treatment of recurrent nasopharyngeal nasopharyngeal carcinoma,which yields relatively high short-and long-term clinical efficacy,high local control rate and well tolerance by the patients.
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Objective To 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 investigate the efficacy and adverse reaction of three-dimensional conforml radiotherapy (3DCRT) combined with thalidomide and GEMOX regimen (gemcitabine + oxaliplatin) in patients with advanced intrahepatic cholangiocarcinoma.Methods A total of 100 patients with advanced intrahepatic cholangiocarcinoma in 901 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from March 2015 to June 2018 were divided into chemotherapy group (n =50) and combination group (n =50) by random number table method.The chemotherapy group was treated with thalidomide and GEMOX regimen,and the combined group was treated with 3DCRT on the basis of the chemotherapy regimen.The levels of serum tumor markers,clinical efficacy and adverse reactions of patients in the two groups were compared before and after treatment.Results The levels of serum carcinoembryonic antigen (CEA),carbohydrate antigen 125 (CA125) and carhohydrate antigen 19-9 (CA19-9) in the combined group were (8.76 ± 2.69) μg/L,(76.17 ± 10.12) × 103 U/L and (169.85 ± 78.97) × 103 U/L respectively,which were significantly lower than those of (12.46 ± 3.47) μg/L,(104.56 ± 14.38) × 103 U/L,(312.45 ± 71.36) × 103 U/L in the chemotherapy group,with statistically significant differences (t =5.959,P ＜ 0.001;t =11.416,P ＜ 0.001;t =9.474,P ＜ 0.001).The clinical benefit rate and the total effective rate of the combined group were respectively 64.0％ (32/50) and 88.0％ (44/50),which were higher than those of 42.0％ (21/50) and 72.0％ (36/50) in the chemotherapy group,with statistically significant differences (x2 =4.857,P =0.028;x2 =4.000,P =0.046).The incidences of leukopenia,nausea and vomiting,constipation and alopecia of patients in the combined group were 20.0％ (10/50),24.0％ (12/50),30.0％ (15/50) and 12.0％ (6/50) respectively,which were 14.0％ (7/50),16.0％ (8/50),24.0％ (12/50) and 8.0％ (4/50) respectively in the chemotherapy group,with no statistically significant differences (x2 =0.638,P =0.424;x2 =1.000,P =0.317;x2 =0.457,P =0.499;x2 =0.444,P =0.505).Conclusion 3DCRT combined with thalidomide and GEMOX regimen can significantly reduce the levels of serum tumor markers in patients with advanced intrahepatic cholangiocarcinoma,enhance the short-term efficacy without significantly increasing and aggravating adverse reactions.
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PURPOSE: The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). RESULTS: At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). CONCLUSION: A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
Assuntos
Humanos , Estudos de Coortes , Intervalo Livre de Doença , Educação , Seguimentos , Neoplasias Nasofaríngeas , Radioterapia , Radioterapia de Intensidade Modulada , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Objective@#To explore the efficacy, toxicity and prognosis of three-dimensional conformal radiotherapy combined with concurrent chemotherapy for locally advanced cervical cancer.@*Methods@#From January 2014 to January 2015, 96 patients with locally advanced cervical cancer in Yuncheng Central Hospital were selected and randomly divided into radiotherapy group and concurrent chemoradiotherapy group according to the digital table, with 48 cases in each group.The radiotherapy group received CT based three-dimensional conformal radiotherapy and three-dimensional 192Ir after loading irradiation technology, the concurrent chemotherapy group received docetaxel plus cisplatin chemotherapy synchronous three-dimensional conformal radiotherapy and three-dimensional 192Ir after loading irradiation technology.The clinical effect, 2-year survival rate, liver function injury, leukopenia and incidence of side effects, survival of patients and Karnofsky score before and after treatment were compared between the two groups.@*Results@#The effective rate of chemoradiotherapy of the concurrent chemoradiotherapy group was 75.00%, which was higher than 50.00% of the radiotherapy group (χ2=4.181, P<0.05). The 2-year survival rates of the two groups were 75.00%, 95.83%, respectively, which of the concurrent chemoradiotherapy group was higher than that of the radiotherapy group.In the radiotherapy group, 12 cases of liver function injury, white cells reduced in 10 cases, 36 cases of gastrointestinal reaction, 13 cases of nervous system reaction, 1 case of renal injury.In the concurrent chemoradiotherapy group, liver function injury in 11 cases, 14 cases with leukopenia, 30 cases of gastrointestinal reaction, 13 cases of nervous system reaction, 1 case of renal injury, and there were no statistically significant differences between the two groups(all P>0.05). Before treatment, the living conditions and Karnofsky score had no statistically significant differences between the two groups (all P>0.05). After treatment, the survival and Karnofsky score improved more significantly in the concurrent chemoradiotherapy group, the differences were statistically significant(all P<0.05).@*Conclusion@#The curative effect of three dimensional conformal radiotherapy combined with concurrent chemotherapy on locally advanced cervical cancer is definite, and it can improve the prognosis of patients with high safety.As to liver function damage, leukocyte depletion and other toxic side effects, there are no statistically significant differences between two groups, so it is worthy of popularizing.