Evaluation of the accuracy of optical surface imaging system in non-coplanar radiotherapy using orthogonal kV/MV images / 中华放射肿瘤学杂志

Objective:To evaluate the accuracy of the optical surface imaging system (OSI) using stereotactic radiosurgery (SRS) algorithm in single-center non-coplanar treatment of multiple brain metastases.Methods:Data of phantom and 15 patients with multiple brain metastases who underwent single-center non-coplanar radiotherapy in West China Hospital of Sichuan University from February to April 2022 were retrospectively analyzed. kV/MV and OSI imaging were used for imaging of the patients and phantoms under the same non-coplanar couch angle, respectively. The accuracy of OSI imaging of the phantoms and patients was evaluated using kV/MV imaging as reference image. The difference between the OSI and kV/MV systems is defined as accuracy, and the percentage of the absolute difference ≤1.00 mm in the translational direction or ≤0.50° in the rotational direction is defined as the threshold pass rate. Origin software was used to draw radar maps and Bland-Altman plots for statistical analysis.Results:When OSI images were used for the phantom imaging, the average differences in six-dimensional directions of lateral, long, vertical, rotational, roll and pitch were 0.03 mm, -0.09 mm, -0.27 mm, 0.04°, 0.17° and -0.19°, respectively. The maximum values were -2.20 mm, -2.30 mm, -1.20 mm, 0.60°, -1.00°, and -1.00°, respectively. When OSI system was utilized for the imaging of 15 patients, the average differences in six-dimensional directions were 0.44 mm, 0.16 mm, -0.20 mm, -0.11°, 0.10°, and -0.12°, respectively. The maximum values were -1.80 mm, 2.00 mm, 0.90 mm, -0.90°, -0.70°, and 0.80°, respectively. The translational errors mainly occurred in the lateral and long directions. The qualified rates of the threshold values of the phantoms and patients were 77% and 75% in the lateral direction, 82% and 89% in the long direction, respectively. In addition, 57% and 56% of patients met the threshold conditions of ±1.00 mm and ±0.50° in the six-dimensional directions, respectively.Conclusions:The OSI system using new SRS algorithm cannot meet the high accuracy requirements of single-center non-coplanar radiotherapy for multiple brain metastasis, especially in the lateral and long directions. It is not recommended for non-coplanar image guidance.

Value of early radiotherapy for EGFR mutation-positive non-small cell lung cancer with brain metastasis in the era of third-generation targeted drugs: a single center retrospective study of 85 cases / 中华放射肿瘤学杂志

Objective:To explore the reasonable timing of radiotherapy for epidermal growth factor receptor ( EGFR) mutation-positive non-small cell lung cancer patients with brain metastasis in the era of third-generation targeted drugs. Methods:Clinical data of EGFR mutation-positive non-small cell lung cancer patients with brain metastasis who received first-line treatment with third-generation targeted drugs and stereotactic radiotherapy at Shanghai Armed Police Corps Hospital from September 2019 to May 2022 were retrospectively analyzed. According to the timing of radiotherapy before / after targeted drug resistance, all patients were divided into the early and salvage radiotherapy groups. The proportion of brain metastasis, physical fitness, complete response rate, objective response rate, delaying the progression of brain metastasis and overall survival (OS) were compared between two groups. Kaplan-Meier method was used for survival analysis, log-rank test was used for univariate prognostic analysis, and factors with P <0.1 were included in Cox multivariate analysis. Results:A total of 85 patients were included, including 51 (60%) cases receiving early radiotherapy. Patients who participated in early radiotherapy had a higher proportion of symptomatic brain metastasis (82% vs. 56%, P=0.013) and poorer physical fitness (Kanofsky performance score <70: 61% vs. 26%, P=0.002) compared to patients who underwent salvage radiotherapy. Early radiotherapy significantly improved the complete response rate of intracranial lesions (35% vs. 12%, P=0.015) and objective response rate (88% vs. 71%, P=0.041), delayed the progression of brain metastasis (median intracranial progression free survival: 23.0 months vs. 16.0 months, P=0.005; median intracranial secondary progression free survival: 31.0 months vs. 22.0 months, P=0.021), and improved OS (median OS: 44.0 months vs. 35.0 months, P=0.046). In multivariate analysis, diagnosis-specific graded prognostic assessment score <2.5, mutation of EGFR exon 21, and salvage brain radiotherapy were adverse prognostic factors for OS. Conclusion:In the era of third-generation targeted drugs therapy, early involvement of stereotactic radiotherapy in non-small cell lung cancer patients with brain metastasis can bring greater clinical benefits.

Application of precision radiotherapy in the treatment of hepatocellular carcinoma / 中华放射肿瘤学杂志

With the development of radiotherapy technology, the role of radiotherapy in the treatment of primary liver cancer has been gradually recognized. In recent years, precision radiotherapy for hepatocellular carcinoma has become a research hotspot. A number of clinical trials have shown that precision radiotherapy can significantly improve clinical prognosis of patients with hepatocellular carcinoma. In this article, the research progress and existing problems of radiotherapy in the treatment of hepatocellular carcinoma were reviewed, aiming to provide literature support for the application of radiotherapy in the treatment of hepatocellular carcinoma.

Efficacy and safety of cyberknife in the treatment of elderly patients with early stage non-small cell lung cancer / 中国现代医生

@#Objective To investigate the efficacy and safety of Cyberknife in the treatment of elderly patients(aged≥75 years)with early stage non-small cell lung cancer(NSCLC),and to compare the results with those of patients aged<75 years.Methods We retrospectively analyzed 75 patients with early(T1-2N0M0)NSCLC admitted to the 960th Hospital of Jinan People's Liberation Army from January 2013 to October 2019.There were 32(42.7%)patients aged<75 years,and 43(57.3%)patients aged≥75 years.All patients were treated with 45-66Gy/3-8F,60%-85%isodose line as the prescription dose to cover planning target volume(PTV),and irradiation once a day and five times a week.The clinical efficacy,survival status and radiotherapy toxicity of the two groups were compared,and the factors affecting the efficacy of elderly patients were analyzed.Results The disease control rates of patients aged<75 and≥75 years were 96.9%and 93.0%,respectively(P>0.05).The 5-year local control rate(LC),progression-free survival(PFS)and cancer-specific survival(CSS)were 70.9%and 85.4%,58.5%and 54.4%,and 70.4%and 64.5%,respectively(P>0.05).However,the overall survival(OS)of patients aged≥75 years was significantly lower than that of patients aged<75 years,and the 5-year OS was 49.2%and 68.2%,respectively(P<0.05).There was no significant difference in the treatment complications between the two groups(P>0.05).Multivariate analysis showed that biologic effective dose(BED)was an independent factor affecting OS in patients aged≥75 years.Conclusion Stereotactic body radiotherapy with cyberknife is a safe and effective treatment for elderly patients with early stage NSCLC who are not suitable for surgery.

Application of MRI-based image navigation and target selection in transcranial magnetic stimulation treatment / 中国组织工程研究

BACKGROUND:In clinical application,the therapeutic effect of transcranial magnetic stimulation depends on the ability to accurately target the areas of the brain that need to be stimulated.In recent years,with the development of neuronavigation systems,mobile augmented reality technology,and the new methods of processing magnetic resonance imaging(MRI)data,the accuracy of stimulus target localization and the optimization of target selection are expected to improve further. OBJECTIVE:To review the principle of MRI-based image navigation and its application in transcranial magnetic stimulation and summarize the roles of different modal MRI data analyses in guiding the selection of target areas for transcranial magnetic stimulation. METHODS:An online computer search for relevant literature was performed in PubMed,CNKI database and WanFang database,with the keywords"transcranial magnetic stimulation,coil positioning,neuronavigation,augmented reality,magnetic resonance,theory."Finally,63 documents were included for review. RESULTS AND CONCLUSION:Among the traditional methods of positioning transcranial magnetic stimulation coils,the"5 cm rule"and the international electroencephalogram 10-20 positioning method are the most commonly used.These methods have the advantages of simplicity and economy,but they rely too much on the operator's experience and there were technical differences between operators.The neuronavigation system,which is based on stereotactic technology,is the guiding method for positioning transcranial magnetic stimulation coils with the highest visual degree and accuracy.It achieves visual positioning through MRI data acquisition,3D brain reconstruction,head model registration and stereogeometric positioning.It has high application value in clinical treatment and scientific research,but it cannot be promoted in medical institutions due to its high cost.For various medical institutions,mobile augmented reality is a cost-effective and efficient alternative to the neuronavigation system,which achieves visual positioning of brain tissue under the scalp through MRI data acquisition,2D/3D image construction,virtual image and real brain image superposition.It has the advantages of directly visualization and low cost,and is expected to be popularized and applied in primary medical units.Although the superiority of clinical efficacy of visual coil positioning over the electroencephalogram 10-20 localization strategy has not yet been fully demonstrated,with the progress of brain MRI data analysis,visual positioning is expected to further optimize the target selection strategy of transcranial magnetic stimulation therapy and to improve the response rate and individuation degree of transcranial magnetic stimulation treatment.This is a promising and challenging research direction in the future.

A Case of New Rapidly Progressing Ground-glass Nodule Lung Adenocarcinoma Near Primary Lesion after Stereotactic Body Radiation Therapy / 中国肺癌杂志

Ground-glass nodule (GGN) lung cancer often progresses slowly in clinical and there are few clinical studies on long-term follow-up of patients with operable GGN lung cancer treated with stereotactic body radiation therapy (SBRT). We present a successful case of GGN lung cancer treated with SBRT, but a new GGN was found in the lung adjacent to the SBRT target during follow-up. The nodule progressed rapidly and was confirmed as lung adenocarcinoma by surgical resection. No significant risk factors and related driving genes were found in molecular pathological findings and genetic tests. It deserves further study whether new GGN is related to the SBRT. This case suggests that the follow-up after SBRT should be vigilant against the occurrence of new rapidly progressive lung cancer in the target area and adjacent lung tissue.
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Usos y aplicaciones actuales de la radioterapia corporal estereotáctica / Current uses and applications of stereotactic body radiation therapy

Resumen La radioterapia corporal estereotáctica es una modalidad que con alta precisión administra dosis alta de radiación a un objetivo tumoral bien definido, en una o en pocas fracciones, y reduce significativamente la dosis que reciben los tejidos sanos circundantes. Está indicada en cáncer primario de pulmón de células no pequeñas en estadios tempranos (T1 y T2) no operable, metástasis pulmonares con un tumor primario controlado, tumores prostáticos y enfermedad oligometastásica. A pesar de la falta de estudios a largo plazo o fase III, los resultados de su eficacia en el control local es superior a 90 %, con toxicidad similar a la reportada con fraccionamientos convencionales de radioterapia. Este artículo describe la tecnología y la técnica de radioterapia corporal estereotáctica, con las aplicaciones clínicas, indicaciones y limitaciones de esta modalidad terapéutica.

Abstract Stereotactic body radiation therapy (SBRT) is a modality that delivers high doses of radiation to a well-defined tumor target in a single or a few fractions and with high precision, which significantly reduces the dose received by surrounding normal tissues. SBRT is indicated for inoperable, early stage (T1 and T2) primary non-small cell lung cancer, lung metastases with a controlled primary tumor, prostate tumors and oligometastatic disease. Despite the lack of long-term or phase III studies, efficacy results in local control are higher than 90%, with similar toxicity to that reported with conventional fractionated radiotherapy. This article describes SBRT technology and technique, along with clinical applications, indications and limitations of this therapeutic modality.

Prognosis Analysis of Early-stage Non-small Cell Lung Cancer Patients Treated with Stereotactic Body Radiotherapy / 中国肺癌杂志

BACKGROUND@#With the aging of the population and the increased importance of lung cancer screening, the number of early-stage lung cancer patients has been on the rise in recent years, which can be classified into operable early-stage lung cancer and inoperable early-stage lung cancer. The most common pathological type is non-small cell lung cancer (NSCLC). Stereotactic body radiation therapy (SBRT) is the optimal treatment for inoperable early-stage NSCLC. The aim of this study was to investigate the prognosis of early-stage NSCLC patients treated with SBRT and its influencing factors in order to reduce the side effects of radiotherapy and improve the survival and quality of life.@*METHODS@#Clinical data and follow-up outcomes of early-stage NSCLC patients treated with SBRT in our hospital from August 2010 to August 2020 were collected. Kaplan-Meier method was used to assess the prognosis, and the Cox proportional risk model was used for multivariate prognostic analysis.@*RESULTS@#A total of 165 patients were included with a median follow-up time of 43.2 (range: 4.8-132.1) mon. The local control (LC) rates at 1-yr, 2-yr and 5-yr were 98.1%, 94.8% and 86.5% respectively. Karnofsky performance status (KPS) score greater than 80 was an independent prognostic factor for LC (P=0.02). The overall survival (OS) rates at 1-yr, 2-yr and 5-yr were 97.6%, 93.0% and 68.9% respectively. A biological equivalent dose when α/β=10 (BED10) greater than 132 Gy was an independent prognostic factor for OS (P=0.04). Progression-free survival (PFS) rates at 1-yr, 2-yr and 5-yr were 93.3%, 79.5% and 55.3% respectively. The distance metastasis free survival (DMFS) rates at 1-yr, 2-yr and 5-yr were 94.5%, 83.2% and 58.4% respectively. BED10 greater than 150 Gy was an independent prognostic factor for DMFS (P=0.02). The regional control (RC) rates at 1-yr, 2-yr and 5-yr were 98.8%, 95.4% and 87.9% respectively.@*CONCLUSIONS@#SBRT is effective in treating early-stage NSCLC. KPS greater than 80 is an independent prognostic factor for LC; BED10 greater than 132 Gy is an independent prognostic factor for OS; BED10 greater than 150 Gy is an independent prognostic factor for DMFS.

The application value of a cervical collar combined with a vacuum pad in the positioning of Cyberknife radiosurgery for cervical spine metastases / 中华放射医学与防护杂志

Objective:To explore the clinical application value of personalized positioning using a cervical collar combined with a vacuum pad in the Cyberknife radiosurgery for cervical spine metastases.Methods:This study enrolled 68 patients with cervical spine metastases to be treated with Cyberknife stereotactic radiotherapy for cervical spines. These patients consisted of 41 males and 27 females, aged from 43 to 78 years (average: 51.5 years). They were divided into groups A, B, and C using the random number table method. The patient positioning in these groups was achieved using a cervical collar combined with a vacuum pad (personalized positioning), a vacuum pad, and a small head mold, respectively. After the first treatment, the comfort levels of the positioning molds during treatment were investigated. After radiotherapy, the average deviations in translational and rotational directions, the minimum tolerance distance (dxAB), the minimum rotational deviation angle (drAB), the proportion of false nodes, and the comfort level of the three positioning method were acquired for analysis.Results:The three groups showed statistically significant differences in the inf-sup, left-right, ant-post, pitch, roll, and yaw directions during the first treatment ( F = 7.13, 2.56, 3.41, 4.21, 2.71, 8.14, P < 0.05). Compared with groups B and C, Group A had significantly lower dxAB, drAB, and the proportion of false nodes, showing statistically significant differences ( F = 5.06, 4.31, 3.30, P < 0.05). Furthermore, patients in groups A and B felt more comfortable with the positioning molds than those in Group C ( χ2 = 12.46, P < 0.05), with no statistically significant differences between groups A and B ( P > 0.05). Conclusions:For patients with cervical spine metastases undergoing Cyberknife radiosurgery for cervical spines, the personalized positioning using a cervical collar combined with a vacuum pad can improve the accuracy and safety of Cyberknife spinal tracking while remaining the comfort level.

Strategy and progress of stereotactic body radiotherapy for renal cell carcinoma / 中华放射医学与防护杂志

Renal cell carcinoma (RCC) is one of the most aggressive malignancies in the genitourinary system with a poor prognosis, especially in patients with RCC who have metastases. RCC is conventionally considered not sensitive to radiotherapy. Compared with conventional radiotherapy, stereotactic body radiotherapy (SBRT) has the characteristics of higher precision, higher irradiation dose, and less damage to the surrounding tissue. In recent years, SBRT has shown definite efficacy in the treatment of primary and advanced metastatic RCC. SBRT combined with targeted therapy and immunotherapy can improve the local tumor control rate and cause fewer adverse reactions in patients with primary and advanced metastatic RCC. This article reviews the literature on the strategy and progress of SBRT in combination with targeted therapy and immunotherapy.

Dosimetric comparison of Zap-X and CyberKnife stereotactic radiosurgery for single brain metastasis / 中华放射肿瘤学杂志

Objective:To evaluate the dosimetric characteristics of Zap-X system and CyberKnife (CK) G4 system of stereotactic radiosurgery (SRS) for single brain metastasis.Methods:Twelve patients with single brain metastasis had been treated with CK were selected retrospectively. The prescribed dose of planning target volume (PTV) was 18-24 Gy for 1-3 fractions. The PTV was ranged from 0.44 to 11.52 cm 3. The 12 patients were re-planned in the Zap-X planning system using the same prescription dose and organs at risk constraints, and the prescription dose of PTV was normalized to 70% for both Zap-X and CK. The planning parameters and dosimetric parameters of PTV and organs at risk were compared and evaluated between two plans. All data were read at MIM Maestro. A paired Wilcoxon' signed-rank test was adopted for statistical analysis. A P value of less than 0.05 was considered as statistical significance. Results:For the target coverage, CK was significantly higher than Zap-X (99.14±0.57% vs. 97.55±1.34%, P<0.01), but Zap-X showed a higher conformity index (0.81±0.05 vs. 0.77±0.07, P<0.05), a lower Paddick gradient index (2.98±0.24 vs. 3.15±0.38), and a higher gradient score index (GSI) than CK. The total monitor unit (MU) of Zap-X was significantly lower than that of CK (11 627.63 ±5 039.53 vs. 23 522.16 ±4 542.12, P<0.01) and the treatment time was shorter than that of CK [(25.08 ±6.52) vs. (38.08 ±4.74) min, P<0.01]. Zap-X had lower dose volumes than CK for the dose of brain ( P<0.05). Zap-X had a lower D mean and D max of brainstem (both P<0.05), but a higher value of eyes and lens. For optic nerves and optic chiasm, there were no significant differences between two groups. In addition, for the protection of skin (V 22.5 Gy), Zap-X seemed better than CK [(4.15±4.48) vs. (4.37±4.50) cm 3, P<0.05]. Conclusions:For SRS treating single brain metastasis, Zap-X could provide a high quality plan equivalent to or even better than CK, especially reducing the treatment time. With continuous improvement and upgrading of Zap-X system, it may become a new SRS platform for the treatment of brain metastasis.

Research progress in preoperative stereotactic radiosurgery for resectable brain metastases / 中华放射肿瘤学杂志

Surgery combined with postoperative stereotactic radiosurgery (SRS) can improve the overall survival and becomes one of main treatments for resectable brain metastases. Compared with postoperative SRS, preoperative SRS (Pre-SRS) has theoretical advantages of reducing the dissemination of active tumor cells into the treatment cavity during surgery, reducing radiation dose, reducing radiation to surrounding normal brain tissue, and ensuring successful implementation of perioperative treatment, etc. Recent clinical studies have confirmed that Pre-SRS can reduce local recurrence rate and the incidence of radiation necrosis (RN) and leptomeningeal metastasis (LMM). Moreover, the indications, dose fractionation, and combined therapy remain to be confirmed by more prospective studies. In this article, research progress in Pre-SRS for resectable brain metastases was reviewed.

When radiation meets the heart:Future of stereotactic body radiation therapy for hypertrophic obstructive cardiomyopathy / 中南大学学报(医学版)

Hypertrophic obstructive cardiomyopathy(HOCM)is a hereditary cardiac disorder characterized primarily by septal hypertrophy and left ventricular outflow tract obstruction.Traditional therapeutic modalities,such as medications and surgeries,do not yield satisfactory outcomes in a subset of patients.The advancements have been made in novel treatments,including new drugs and percutaneous intramyocardial septal radiofrequency ablation(PIMSRA),still need further observation to obtain long-term efficacy and safety.In recent years,stereotactic body radiation therapy(SBRT)has emerged as an innovative non-invasive approach for treating HOCM.Studies indicate that SBRT allows for precise targeting of the hypertrophied septal region,causing both direct and indirect damage to targeted myocardial cells.This can alleviate left ventricular outflow tract obstruction and myocardial ischemia,fulfilling the therapeutic objective.For those with HOCM who neither respond well to medications nor are surgical candidates,SBRT offers a potential new therapeutic alternative.However,the latent risks of radiation therapy persist,such as the onset of radiation-induced heart disease(RIHD).The preliminary investigations guarantee the safety and feasibility of SBRT in HOCM management,an increased volume of clinical studies and prolonged follow-up data are essential to evaluate its real efficacy and potential hazards.In addition,research regarding the therapeutic mechanisms of SBRT for HOCM,optimal dosages and treatment durations,indications and contraindications,prevention of complications,and enhancing the precision of radiation therapy,still needs to be further exploration,to determine the best therapeutic strategies.

Efficacy and safety of stereotactic body radiotherapy combined with karelizumab and apatinib in treatment of advanced hepatocellular carcinoma / 解放军医学杂志

Objective To investigate the efficacy and safety of stereotactic body radiotherapy(SBRT)combined with camrelizumab and apatinib in treatment of advanced hepatocellular carcinoma(HCC).Methods The clinical data were retrospectively analyzed of 85 patients with advanced HCC treated in the Fifth Affiliated Hospital of Zhengzhou University and People's Hospital of Zhengzhou from January 2019 to September 2021.They were divided into observation group(n=31,SBRT combined with camrelizumab and apatinib)and control group(n=54,treated with camrelizumab and apatinib)according to whether they received SBRT.The propensity score matching(PSM)was used to balance the influence of confounding factors.The objective remission rate(ORR)and disease control rate(DCR)were compared between the two groups.The 6-month overall survival rate,1-year overall survival rate and progression-free survival(PFS)were compared between the two groups by Kaplan-Meier method.The safety of the two groups was evaluated by Common Terminology Criteria for Adverse Events(CTCAE)version 5.0.Results Before PSM,there were significant differences in age(P=0.043),number of extrahepatic metastasis(P=0.028),and previous surgical treatment(P=0.038)between the two groups.After PSM,there was no significant difference in baseline characteristics between the two groups(P>0.05).After PSM,27 cases were included in each groups,and three months after treatment,the ORR in observation group and control group were 66.7%and 29.6%,respectively,showed difference with statistically significant(P=0.006);and the DCR in the both groups were 96.3%and 85.2%respectively,showed no statistically significant difference(P=0.175).There were statistical differences in 6-month overall survival rate(96.3%vs.80.9%,P=0.001),1-year overall survival rate(75.0%vs.61.4%,P=0.034)and median PFS(8 months vs.5 months,P=0.003)between the observation group and control group.Multi-factor Cox regression analysis showed that baseline alpha-fetoprotein(AFP)≥400 ng/ml was an independent risk factor for affecting the survival of patients with advanced HCC(HR>1,P<0.05),while the triple therapy and previous targeted drugs therapy were the protective factors for the survival of patients with advanced HCC(HR<1,P<0.05).In the observation group,4 patients had grade 3 adverse reactions,and the common adverse reactions were dyspepsia(14.8%).One case of grade 3 adverse reactions occurred in control group,and there was no statistically significant difference in the incidence of adverse reactions between the two groups(P=0.639).Conclusion SBRT combined with camrelizumab and apatinib is a safe and effective treatment for advanced HCC with significant clinical effect and controllable adverse reactions.

Stereotactic body radiotherapy versus radiofrequency ablation for hepatocellular carcinoma:a meta-analysis / 介入放射学杂志

Objective Stereotactic body radiotherapy(SBRT)and radiofrequency ablation(RFA)are primary treatments for hepatocellular carcinoma(HCC)at present.However,the effect of these treatments in clinical trails are rather controversial.The purpose of this paper is to conduct a meta-analysis on the clinical effect and related complications of SBRT and RFA for HCC.Methods A computerized retrieval of academic papers concerning the treatment effect of SBRT and RFA for HCC from the databases of PubMed,Embase,Cochrane Library,Scopus,Web of Science,CBM,CNKI,Wanfang database,VIP was conducted.The retrieval time period was from the establishment of the database to June 2022.Stata14.0 software was used to make meta-analysis.Results A total of 14 retrospective studies including 6 806 patients were included in this analysis.The results of combined hazard ratio(HR)based on overall survival(OS)showed that the OS rate of SBRT was lower than that of RFA(HR=1.25,95％CI=1.10-1.43,12=0％,P=0.000 9),while the results of combined HR of local control(LC)rate indicated that SBRT had a better therapeutic effect(HR=0.61,95％CI=0.47-0.78,I2=0％,P=0.000 1).Subgroup analysis revealed that the combined HR of LC rate favored the performance of SBRT for patients with tumor diameter larger than 2 cm(HR=2.64,95％CI=1.56-4.48,I=0％,P=0.000 3).No statistically significant difference in the incidence of late serious adverse reactions existed between SBRTgroup and RFA group(OR=1.01,95％CI=0.59-1.73,I2=30％,P=0.97).Conclusion SBRT is superior to RFA in controlling local HCC lesions,especially in patients whose tumor diameter is larger than 2 cm,although it does not show certain advantages in the survival benefit.(J Intervent Radiol,2023,32:1233-1241)

Clinical,electrophysiological and imaging features of frontal opercular epilepsy / 临床神经病学杂志

Objective To summarize the clinical,electrophysiological and imaging features of frontal opercular epilepsy.Methods A retrospective analysis was conducted on 5 cases with frontal opercular epilepsy,who were treated at the Department of Functional Neurology,Shenzhen Second People's Hospital from December 2020 to December 2022.Among these cases,4 cases were underwent stereotactic-EEG(SEEG)guided radiofrequency thermocoagulation.The clinical,electrophysiological,and imaging characteristics of these 5 cases were summarized.Results The 5 cases had an onset age ranging from 2 to 17 years and a disease duration ranging from 1 to 20 years.All of them experienced daily seizures,especially at night.The seizure duration was less than 30 seconds,and consciousness recovered rapidly.Among the cases,3 exhibited hypermotor seizures of typeⅠorⅡ,characterized by body turning along the horizontal body axis.Two of them experienced laughter during the seizures,while 1 showed a fearful expression.The remaining 2 cases presented with symmetric tonic seizures,involving the facial muscles.One case reported indescribable aura,and 2 cases had autonomic symptoms.During the interictal period,all 5 cases showed epileptic discharges predominantly in the frontal region on EEG,with lateralization value present in only 2 cases.During the ictal period,4 cases demonstrated general low volatility and fast activity(LVFA),while 1 case showed low-frequency rhythmic sharp and slow waves originating from the lesioned side.Four cases underwent SEEG,which revealed seizure starting from the frontal operculum and adjacent electrodes with LVFA,rapidly spreading to the insula,insular opercular,and medial frontal lobe.Positive changes were observed in the MRI of 4 cases,including 2 cases with possible cortical dysplasia,1 case with tuberous sclerosis,and 1 case with encephalomalacia foci.All 4 cases underwent SEEG guided radiofrequency thermocoagulation,resulting in seizure frequency reduction.Conclusions Frontal opercular epilepsy is mainly characterized by hypermotor seizure with body turning along the horizontal body axis or symmetric tonic seizure.These seizure may be accompanied by emotional symptom or facial muscle tonic,but aura and autonomic symptom are less common.The lateralization value of EEG is limited in frontal opercular epilepsy.SEEG indicates early involvement of the insula,insular opercular,and medial frontal lobe.

Research advances in immune response of stereotactic body radiotherapy / 中华放射肿瘤学杂志

The mechanisms of radiotherapy (RT) in cancer treatment are both by immunity and non-immunity pathways. According to different absorbed doses, the immune modulating effect of RT comprises of tumor microenvironment modulating effect, immune-modulatory effect as well as immune-ablative effect. RT could improve the therapeutic efficacy of immunotherapy, while immunotherapy could enlarge the immunity activating effect induced by RT in turn. Therefore, RT is emerging as a valuable partner of cancer immunotherapy. RT regimens have a vital impact on immunity within tumor microenvironment. Stereotactic body RT (SBRT) has obvious advantages regarding interferon production and abscopal effect. At present, potentially sub-ablative RT regimen of 8 Gy plus 3 fractionations is the most widely used SBRT. Several novel RT regimens, such as hybrid fractionation, singular site irradiation and multisite irradiation, have been designed to maximize the immune induction effect and improve the combination efficacy with immunotherapy in metastatic malignancies. In this review, the latest advances in the immune effect of RT were discussed and novel SBRT regimens were proposed, aiming to provide reference for enhancing the efficacy of radio-immunotherapy or immuno-radiotherapy in clinical practice.

Evaluation of technical performance of stereotactic radiosurgery algorithm in optical surface imaging system in non-coplanar radiotherapy / 中华放射肿瘤学杂志

Objective:To evaluate the accuracy and stability of stereotactic radiosurgery (SRS) algorithm in optical surface imaging (OSI) system in non-coplanar radiotherapy.Methods:Three OSI imaging systems were used to measure the phantom repeatedly at different couch rotation angles to analyze the accuracy and stability of OSI system. Seven patients with multiple brain metastases who underwent single-center non-coplanar radiotherapy were randomly selected, and the accuracy and stability of OSI for patient imaging were analyzed. Stability is defined as the difference between the two OSI measurements when the couch is turned from 0° to a non 0° angle, and then back to 0°, using the 0° cone beam CT (CBCT) as the "gold standard". Accuracy is defined as the difference between OSI and CBCT (at 0° couch angle) measurement data. The measurement data with normal distribution were described as Mean ± SD. The data with non-normal distribution were expressed as M (Q). The difference of the former data was compared by one-way ANOVA, and the difference of the latter data was assessed by Kruskal-Wallis H nonparametric test. Results:For non-coplanarity, the translation accuracy of the phantom and the patient was ≤ 1.30 mm and ≤ 1.00 mm, and the rotation accuracy was ≤ 0.50° and ≤ 0.60°, respectively. The translation errors mainly occurred in the left-right and head-foot directions. In terms of stability, the maximum standard deviation of phantom coplanar translation and rotation was 0.06 mm and 0.06°. The maximum standard deviation of patient translation and rotation was 0.17 mm and 0.19°.Conclusions:Although the new SRS algorithm improves the non-coplanar accuracy, it still cannot meet the precise requirements of non-coplanar single isocenter radiotherapy for multiple brain metastases, especially in the left-right and head-foot directions. When the couch rotation angle is large, OSI is not recommended for image-guided radiotherapy. However, its high stability can be used to monitor the intrafractional motion of patients.

Clinical application and prospect of SBRT in treatment of oligo-metastatic NSCLC / 中华放射肿瘤学杂志

The rapid progress on immunotherapy and targeted therapy has brought long-term survival benefits for locally advanced non-small cell lung cancer (NSCLC). The oncology community has also paid more attention to the local treatment for advanced NSCLC, especially for patients with limited metastatic lesions, also known as oligo-metastasis. Many studies have reported that oligo-metastatic NSCLC patients could benefit from the combination of local and systematic treatment, and even to be cured. In recent years, with the advances in radiation technology, stereotactic body radiation therapy (SBRT) has achieved precise high-dose radiotherapy for small target tumors. Currently, SBRT has been widely applied in the treatment of inoperable early lung cancer, and its application value and safety in patients with advanced lung cancer are also being actively explored. In this article, the research status, progress and future development direction of SBRT in the treatment of oligo-metastatic NSCLC were discussed.

Analysis of failure patterns and survival after SBRT for 147 cases of T 1-2N 0M 0 stage non-small cell lung cancer / 中华放射肿瘤学杂志

Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.