人工智能放疗平台结合5G技术实现远程放疗

目的:评估人工智能放疗平台（AiContour）与5G技术结合的可行性，以及通过该结合实现跨区域远程放疗的可行性。方法:选取中国移动作为5G技术服务商，北京连心医疗作为人工智能放疗平台服务商，内江肿瘤医院作为远程放疗服务接收方，构建基于5G技术的人工智能放疗平台远程放疗架构。结果:人工智能放疗平台能够与5G技术结合，放疗医师能通过5G终端随时随地进行肿瘤患者靶区勾画，提升工作效率。同时，跨区域远程放疗模式能够降低市县级肿瘤患者放疗成本，提升肿瘤放疗应用范围。结论:通过5G终端实现肿瘤患者靶区自动勾画可节省放疗医师大量的时间；通过人工智能放疗平台可实现省级优势放疗技术向市县级的扩展，符合国家分级诊疗的要求。     

上颌窦癌63例临床诊治分析

目的探讨上颌窦癌的临床诊治经验。方法回顾性分析1995～2001年间经病理证实的上颌窦癌63例,鳞癌36例,腺癌17例,其他类型10例。分别采用术前放疗 手术、手术 术后放疗以及单纯放疗的治疗方法。结果早期误诊23例。术前放疗 手术组、手术 术后放疗组、单纯放疗组的5年生存率分别为50%、55.6%、37.5%。结论为避免上颌窦癌的早期误诊,应熟悉上颌窦癌早期症状,提高队该病的认识。手术和放疗相结合的综合治疗5年存率高于单纯的放射治疗,应根据病情尽量采用综合治疗手段。     

联合疗法与放疗的比较

放疗作为一种传统的治疗癌症的手段 ,在肿瘤的治疗中起了重要的作用。目前采用的放疗和热疗相结合的治疗方法 ,具有比单纯放疗更好的治疗效果。本文通过对结合疗法和放疗的对比 ,说明了结合疗法具有放疗所不可比拟的优越性 ,并从缓解率、局部控制的持续时间以及生存率等方面来说明这一问题     

Combination of pentoxifylline and α-galactosylceramide with radiotherapy promotes necro-apoptosis and leukocyte infiltration and reduces the mitosis rate in murine melanoma

Despite the success for the treatment of melanoma such as targeted molecular therapy, the use of such treatments are expensive For this reason, this study was carried out to explore the anti-cancer properties of available drugs that are able to modify the melanoma prognosis. The study was conducted in two phases: Evaluation of pharmacological effects of pentoxifylline (PTX) administered above (60 mg/kg) which is the therapeutic dose that is aimed at reducing the side-effect of radiotherapy, and of α- galactosylceramide (GalCer) administered at 100 μg/kg, as well as their combination using a murine model (BDF1 mice) of melanoma cell line (B16-F1, ATCC). For the radiotherapy phase, 9 Gy was applied in the tumor area, before (3 days), during (30 min) and after (3 days) the PTX + GalCer treatment. In both study phases, the mitosis rate, leukocyte infiltration and necro-apoptosis were assessed using histological and immunohistochemical approach and tumor volume evaluation as biomarkers. All treatments showed good prognosis results estimated as reduction of mitosis rate (PTX + GalCer after radiotherapy and GalCer), increased leukocyte infiltrate (PTX + GalCer after radiotherapy and GalCer) and necro-apoptosis augmentation (PTX + GalCer after radiotherapy and radiotherapy control). Nevertheless, a lower development of tumor volume was found in GalCer treatment. In this way, it is possible to suggest that the integrated treatment with immuno-stimulators such as GalCer, plus drug used for peripheral vascular disease (PTX) after radiotherapy is probably an alternative for controlling aggressive melanoma in murine model.     

Short-term preoperative radiotherapy interferes with the determination of pathological parameters in rectal cancer

Short-term preoperative radiotherapy in combination with surgery has been shown to decrease the rate of local recurrence in rectal cancer patients. The effects of this type of radiotherapy on the histopathology of rectal carcinoma has been hitherto unknown. Since various histopathological factors are associated with prognosis, the study of alterations induced by irradiation is an important issue. This paper examines the histopathology of resection specimens from 1306 patients who were treated in a randomized trial that evaluated the benefits of preoperative radiotherapy. In this trial, patients were treated with short-term radiotherapy (5 x 5 Gy) and operated on within 5 days after radiation. Histopathological parameters were determined by the Pathology Review Committee of the trial and we compared tumours of patients with and without preoperative radiotherapy. Tumours of patients who were treated with preoperative radiotherapy were smaller, more often mucinous carcinomas (13% versus 7%, p < 0.001) and more often poorly differentiated (35% versus 24%, p<0.001). After radiotherapy, there was less inflammatory reaction around the tumour (extensive in 7% versus 18%, p<0.001), which was mainly caused by a decrease in T lymphocytes and neutrophil granulocytes. The fibroblastic reaction was more pronounced in the radiotherapy group (extensive in 22% versus 10%, p <0.001). Remarkable histological alterations occurred within a week after 5 days of irradiation of rectal carcinomas. The prognostic value of these factors therefore needs to be re-evaluated for irradiated patients.     

The use of intraoperative radiotherapy and external beam therapy in the management of desmoid tumors

Desmoid tumors are rare nonencapsulated benign lesions that invade the musculoaponeurotic tissues of the body. Such tumors infiltrate insidiously, and attempts to remove them frequently fail, usually leaving residual tumor. The use of adjuvant radiotherapy to decrease the recurrence rate in partially resected extra-abdominal desmoids has been reported by several authors. The role of irradiation in the management of desmoid tumors is illustrated in a case that combined surgery, intraoperative radiotherapy, and postoperative external beam radiotherapy in the management of this lesion.     

头颈部腺样囊性癌放射治疗的研究进展

头颈部腺样囊性癌发病率较低,目前主要治疗手段为手术联合术后放射治疗,但对于术后放射治疗的必要性及选取何种放射治疗手段可以使患者获益最大的问题目前仍有广泛争议。本文综合各方面因素,考虑目前头颈部腺样囊性癌的术后放疗主要以常规光子放疗为主,中子放疗虽能提高局部控制率,但晚期毒性反应不可忽视,质子、碳离子放疗虽有其物理特点上的优势,但因病例数少,且其放疗机器价格昂贵等客观障碍,尚未收集足够数据证明其优势。     

Differences in radiosensitivity between brain, small and large arteriovenous malformations

Intriguing differences in the results of brain arteriovenous malformation (AVM) therapy with ionizing radiation are reported in the literature, i.e. AVMs obliterate at different time intervals from the initiation of radiotherapy although presenting with similar nidus volumes that are treated with the same radiation dose. The purpose of this paper is to present a new concept that explains the variety of results after radiotherapy. To account for an individual AVM's responsiveness to radiotherapy, four variables have been identified from the literature. The variables are factors that are generally accepted to influence the biological effect of radiation. Combined, they can visualize a variety of AVM tissues as well as surrounding normal brain. These hypothesized variations in the type of tissues are then matched with the incongruent results of radiotherapy in order to clarify the issue. Future clinical research programs and possible therapeutical implications of this concept are proposed and discussed.     

肿瘤放射治疗摆位技术质量控制的探讨

目的：探讨肿瘤放射治疗过程中,在不同放射治疗手段（调强适形放疗、高能X线和电子线治疗）上提高摆位精确度的方法。方法：通过对不同放射治疗手段的操作过程分析研究,探讨放疗摆位实施过程中摆位误差的影响因素和相应的质量控制措施,总结提高放射治疗摆位精确性的方法。结果：放疗技师通过对放疗摆位的质量控制,包括体位固定、放疗靶区等中心位置的验证、放疗摆位的要点与方法等,保证了治疗的重复性,明显提高了放射治疗的准确性及疗效,大大提高了肿瘤局部控制率,减少了放疗反应和后遗症。患者很好地完成治疗。达到了放疗目的。结论：放射治疗的精确性是疗效的关键,质量控制是肿瘤放射治疗精度极重要的措施,只有严格执行质量控制措施。才能取得精确的治疗和满意的疗效。     

三维适形放疗计划轮照对肺癌剂量分布影响的研究

介绍了肺癌的常规放疗.分析了肺癌三维适形放疗的CT定位和靶区确定、计划的设计、计划的优化、计划的评价,计划的轮照对肺癌正常组织等影响.提出了减少正常组织损伤的方法.     

应用胞质分裂阻滞微核试验定量放疗所致辐射损伤

目的应用胞质分裂阻滞微核试验定量检测由放疗所致的辐射损伤。方法用胞质分裂阻滞微核试验（CBMNT）,检测接受放疗的鼻咽癌（NPC）患者的双核淋巴细胞微核率（fMNBNLs）,并建立fMNBNLs与辐射剂量的剂量效应曲线。结果放疗后,fMNBNLs迅速显著增高,所得曲线拟合的最佳回归方程为Y=12．3458＋10．6107X-0．3095X^2＋0．0030X^3,呈现良好的剂量．效应关系。结论fMNBNLs可以较好地反映放疗所致的辐射损伤。     

表观扩散系数在胰腺癌放疗疗效定量评价中的应用

目的探讨MRI检查中表观扩散系数(ADC)在胰腺癌放疗后疗效评价中的作用。方法26例接受放射治疗的胰腺癌患者,分别于放射治疗前、放疗后1、3和6个月行磁共振成像(MRI)检查,对弥散加权成像(DWI)序列的ADC值进行测量。同时测量肿瘤最大径,根据肿瘤最大径放疗前后的变化率将病例分为缓解组和未缓解组,运用SPSS17.0软件统计分析表观扩散系数在放疗前后的变化及其与肿瘤最大径变化率之间的关系。结果全部26例胰腺癌患者的放疗后ADC值均明显升高(P<0.001);缓解组放疗前ADC值明显低于未缓解组(P<0.05);26例患者的放疗前ADC值与肿瘤最大径缩小率呈负相关(P<0.01)。结论胰腺癌放疗前后ADC值的变化对胰腺癌放疗后(特别是病灶体积未发生明显变化时)的疗效评价有重要价值,对预测肿瘤放疗后体积缩小的程度、判断肿瘤放疗治疗的效果也有一定价值。     

基于PET/CT形变配准技术对放疗前后靶区变化的评估

PET图像提供的新陈代谢信息可用于判断放疗后肿瘤的复发区域,对于制订精确的放疗计划具有重要的临床意义。研究采用多分辨率形变配准的方法提取放疗前后CT图像的形变域,并将其作用于放疗前PET图像,与放疗后的PET图像相比较,通过设定图像中SUV 的阈值,判断勾画轮廓之间的重叠率,以获得图像中的高摄取区域,回顾性指导精确放疗。研究针对22例肺癌病例,实验结果显示放疗后残留的高代谢区域和放疗前GTV重叠较好:当阈值设定为SUV_max的70%、80%和90%时,对应的重叠率分别为(95.2±0.6)%、(96.6±3.4)%和100%;当阈值设定为SUV2.5和SUV5.0时,对应的重叠率为(86.0±6.6)%和(97.0±3.0)%。对氟代脱氧葡萄糖(FDG)高摄取区域的高重叠率表明病变区域在放疗前后的位置相对稳定,放疗后的残余肿瘤基本上位于放疗前靶区对FDG的摄取区域。初步实验结果证明,研究可用于判断靶区区域对放疗的反应,回顾性指导在放疗计划中,针对放疗后残余的靶区加大照射剂量,保护危及器官和组织,精确放疗。     

Small animal radiotherapy research platforms

Advances in conformal radiation therapy and advancements in pre-clinical radiotherapy research have recently stimulated the development of precise micro-irradiators for small animals such as mice and rats. These devices are often kilovolt x-ray radiation sources combined with high-resolution CT imaging equipment for image guidance, as the latter allows precise and accurate beam positioning. This is similar to modern human radiotherapy practice. These devices are considered a major step forward compared to the current standard of animal experimentation in cancer radiobiology research. The availability of this novel equipment enables a wide variety of pre-clinical experiments on the synergy of radiation with other therapies, complex radiation schemes, sub-target boost studies, hypofractionated radiotherapy, contrast-enhanced radiotherapy and studies of relative biological effectiveness, to name just a few examples. In this review we discuss the required irradiation and imaging capabilities of small animal radiation research platforms. We describe the need for improved small animal radiotherapy research and highlight pioneering efforts, some of which led recently to commercially available prototypes. From this, it will be clear that much further development is still needed, on both the irradiation side and imaging side. We discuss at length the need for improved treatment planning tools for small animal platforms, and the current lack of a standard therein. Finally, we mention some recent experimental work using the early animal radiation research platforms, and the potential they offer for advancing radiobiology research.     

Challenge and Hope in Radiotherapy of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most critical global health issues. With frequent association of viral liver disease, HCC is highly complex, harboring both cancer and chronic liver disease. The tumor stage and underlying liver function are both major determinants of the treatment selection as well as prognosis in HCC patients, thus allowing no more than a 20% chance for potentially curative therapies. Radiotherapy technology has been evolved remarkably during the past decade, and radiation can be precisely delivered, thereby permitting higher doses to the tumour and reduced doses to surrounding normal tissues. There has been increasing interest in the merits of radiotherapy in HCC over the past few years, as indicated by a Pub Med search. Radiotherapy has been used as the definitive therapy with curative intent in early stage tumours. It has been used also in combination with TACE for intermediate stage tumours. In locally advanced tumours, radiotherapy has been combined with systemic agents. Despite its efficacy, radiotherapy has not yet been incorporated into the standard management guidelines of HCC. The lack of high evidence level data, especially randomized controlled trials, has posed an obstacle in including radiotherapy into the routine treatment schema of HCC. Therefore, well-designed prospective studies are strongly recommended using developing technology for radiotherapy alone or combination therapies. Also, many issues such as the optimal dose-fractionation, intra- or extrahepatic metastasis after radiotherapy, and radiation-induced hepatic dysfunction remain to be solved. In this review, current status of radiotherapy for HCC will be discussed with regard to technical consideration and combination strategy. The limitation and future perspectives will also be discussed.     

A DICOM-RT-based toolbox for the evaluation and verification of radiotherapy plans

The verification of radiotherapy plans is an essential step in the treatment planning process. This is especially important for highly conformal and IMRT plans which produce non-intuitive fluence maps and complex 3D dose distributions. In this work we present a DICOM (Digital Imaging and Communication in Medicine) based toolbox, developed for the evaluation and the verification of radiotherapy treatment plans. The toolbox offers the possibility of importing treatment plans generated with different calculation algorithms and/or different optimization engines and evaluating dose distributions on an independent platform. Furthermore the radiotherapy set-up can be exported to the BEAM Monte Carlo code system for dose verification. This can be done by simulating the irradiation of the patient CT dataset or the irradiation of a software-generated water phantom. We show the application of some of the functions implemented in this toolbox for the evaluation and verification of an IMRT treatment of the head and neck region.     

Combination of anthracyclines with radiotherapy. Value and problems

Association between radiotherapy and anthracyclines (especially adriamycin) early showed major toxicity on critical normal tissues so that its antitumor activity was concealed. This toxicity proved to be acute toxicity, recall phenomenon and cardiac toxicity. Clinical and experimental studies showed synergistic effect when drug and radiation are administered concomitantly and additive effect in sequential administration. So concomitant association must be rejected. The main point is the time interval between adriamycin injection and radiotherapy (at least seven days). These conditions are respected when alternating treatment schedule is applied: radiation split courses are integrated between two chemotherapy cycles including adriamycin. At this time new anthracycline analogs were not associated to radiotherapy.     

Comparative histological studies of germinative tissue after chemotherapy or radiation therapy in patients with malignant testicular tumors

Described in this paper are morphological and morphometric alterations that occurred to the remaining testicles in patients who had undergone chemotherapy or radiotherapy for malignant testicular tumours, with findings, on average, being recorded 4.5 years after treatment. Qualitative histological investigations of testicular tissue exhibited differentiated characteristics, with radiotherapy resulting in significantly stronger phenomena. Epithelial height was clearly reduced in conjunction with increase in wall thickness, especially after radiotherapy. Tubular lumens, in the wake of radiotherapy, were more often filled with hyalin than after chemotherapy. Unambiguous evidence was produced to impairment of fertility in response to both chemotherapy and radiotherapy.     

An x-ray detector system and modified simulator providing CT images for radiotherapy dosimetry planning

A high count rate position-sensitive detector was developed in order to obtain CT information using a modified radiotherapy simulator. The detector is attached to one arm of the simulator gantry and acquires projection data from a fan beam of X-rays derived from the simulator X-ray tube. The scanner is designed principally for planning the dosimetry of breast cancer radiotherapy. During the collection of transmission projection data, suitable for the digital reconstruction of patient cross sections, the simulator gantry rotates continuously through about 360 degrees. A film cassette holder can be positioned above the detector to provide conventional simulator check films. Cross sections through patients receiving post-operative radiotherapy for breast cancer were reconstructed from projections acquired with the patient lying in the treatment position. These scans are an average over the breathing cycle. The outlines of internal anatomy and the patient external contour were used to produce treatment plans which include tissue inhomogeneity corrections. The data produced by this wide aperture CT scanner are suitable for planning those conditions in which radiotherapy is delivered to an organ such as the breast or the whole body, rather than to a localised lesion.     

Apoptosis in cervical squamous carcinoma: predictive value for survival following radiotherapy

BACKGROUND: Apoptosis, or programmed cell death, can be induced by radiotherapy. The extent of apoptosis in a tumour before treatment may have important implications for response to radiotherapy and long term survival. AIM: To examine the extent of apoptosis in tumour tissue from patients with squamous carcinoma of the cervix before radiotherapy, and to correlate this with response to treatment and prognosis. METHODS: The percentage of apoptotic cells was assessed in 146 carcinomas of the cervix from patients scheduled to receive radiotherapy. The CAS 200 static image analysis system was used to count the number of tumour nuclei per high power field, while the numbers of apoptotic cells in the same field were visualised simultaneously on the image analyser and recorded manually. RESULTS: The median apoptotic level was 0.73%. Patients were divided into two groups around the median. There was no statistically significant difference in outcome between the two groups as determined by long term survival following radiotherapy. CONCLUSIONS: The CAS 200 static image analyser system can be used to assist in the rapid semiautomated assessment of apoptosis in conventionally prepared tissue. The results suggest that the apoptotic state of a tumour before treatment is of no value in predicting response to radiotherapy and subsequent prognosis. Tumour stage, size, and BrdU labelling index, as a measure of proliferation rate, remain the most important prognostic factors in terms of predicting local tumour control.