三种固定野调强计划在鼻腔及鼻旁窦肿瘤放疗中的对比研究

目的 对比3种鼻腔及鼻旁窦肿瘤的固定野调强放射治疗计划,包括基于常规C型臂加速器(Trilogy)的共面调强放疗(IMRT)(C-IMRT)、非共面IMRT (NC-IMRT)和基于O型环加速器(Halcyon)的共面IMRT (H-IMRT)计划。方法 选择2018年12月至2021年12月在宁波市第一医院的10例鼻腔及鼻旁窦肿瘤术后放疗患者的资料,以相同处方剂量和目标条件重新设计3种计划,比较靶区和危及器官剂量、验证通过率以及执行时间的差异。统计方法采用Friedman检验,结果有差异时进一步多重比较。结果 3种计划关于计划靶区(PTV)和PTV_boost适形指数CI的差异有统计学意义(χ²=7.51、9.69,P < 0.05);多重比较显示H-IMRT高于NC-IMRT (Z=2.53、2.68,P < 0.05),其他靶区参数差异均无统计学意义(P>0.05)。H-IMRT较C-IMRT计划降低了双侧眼晶状体、双侧角膜、患侧视神经和患侧眼球的D_max(Z=2.80、2.80、2.80、2.80、2.81、2.09,P < 0.05)。NC-IMRT与C-IMRT计划相比降低了双侧眼晶状体、角膜、眼球和对侧视神经的D_max(Z=2.80、2.66、2.80、2.70、2.29、2.29、2.65,P < 0.05),同时减小了双侧眼球的D_mean(Z=2.80、2.80,P < 0.05)。H-IMRT较NC-IMRT计划的患侧眼晶状体和角膜D_max有所下降(Z=2.50、2.08,P < 0.05),但对侧视神经D_max和双侧眼球的D_mean更高(Z=2.80、2.80、2.80,P < 0.05)。3种计划的验证通过率均满足机构标准,差异无统计学意义(P>0.05)。此外,H-IMRT执行计划的中位用时最短(172.00 s),C-IMRT次之(337.50 s),NC-IMRT最长(388.00 s)。结论 所有计划的验证通过率均可满足治疗实施要求;3种计划的靶区剂量学差异相近,但H-IMRT和NC-IMRT对正常组织尤其是眼部各器官的保护更好,有利于降低放疗不良反应,亦为肿瘤局部加量或复发的再程放疗提供剂量空间;执行效率方面,H-IMRT > C-IMRT > NC-IMRT。建议根据实际情况选择合适的放疗设备和技术。     

Toxicity and outcome of pelvic IMRT for node-positive prostate cancer

Background and purpose

This study reports on the treatment techniques, toxicity, and outcome of pelvic intensity-modulated radiotherapy (IMRT) for lymph node-positive prostate cancer (LNPPC, T1-4, c/pN1 cM0).

Patients and methods

Pelvic IMRT to 45–50.4?Gy was applied in 39?cases either after previous surgery of involved lymph nodes (n?=?18) or with a radiation boost to suspicious nodes (n?=?21) with doses of 60–70?Gy, usually combined with androgen deprivation (n?=?37). The prostate and seminal vesicles received 70–74?Gy. In cases of previous prostatectomy, prostatic fossa and remnants of seminal vesicles were given 66–70?Gy. Treatment-related acute and late toxicity was graded according to the RTOG criteria.

Results

Acute radiation-related toxicity higher than ?grade?2 occurred in 2?patients (with the need for urinary catheter/subileus related to adhesions after surgery). Late toxicity was mild (grade 1–2) after a median follow-up of 70?months. Over 50% of the patients reported no late morbidity (grade 0). PSA control and cancer-specific survival reached 67% and 97% at over ?5?years.

Conclusion

Pelvic IMRT after the removal of affected nodes or with a radiation boost to clinically positive nodes led to an acceptable late toxicity (no grade 3/4 events), thus justifying further evaluation of this approach in a larger cohort.     

Tumor control and cosmetic outcome of weekly iridium-192 high-dose-rate brachytherapy for nonmelanoma skin cancers in the elderly

PurposeRadiotherapy with high-dose-rate (HDR) brachytherapy is used to treat nonmelanoma skin cancers. We retrospectively analyzed a hypofractionated regimen to assess its safety and efficacy in elderly patients ≥70 years.Methods and MaterialsForty-eight patients with 67 lesions treated since 2016 with catheter-based iridium-192 HDR brachytherapy using a custom mold or three-dimensional–printed applicator met inclusion criteria. Treatment was 36 Gy in six weekly fractions. Local and locoregional control were assessed with Kaplan–Meier curves. Acute and late toxicity were graded as per Common Terminology Criteria for Adverse Events, version 5. Cosmesis was defined as “excellent” (indistinguishable from untreated skin), “good” (minimal changes), or “poor” (extensive changes). Univariate analyses were performed.ResultsMedian age was 85.7 years, and 21 were female. Durable local control occurred in 63 lesions (94.0%), giving estimated local control of 100% at 6 months, 95.1% at 1 year, and 88.8% at 2 years. No factors were predictive of local control on univariate analysis. All experienced acute toxicity that ultimately resolved: 28.4% Grade 2 and 4.5% Grade 3. Larger treatment volume receiving ≥36 Gy was associated with increased Grade ≥2 acute toxicity. Patients experienced late Grade 2 and late Grade 4 toxicity after 6.5% treatments each. Younger age was associated with increased Grade ≥2 late toxicity. “Good” or better cosmesis occurred in 93.2%, and “poor” cosmesis was associated with lower extremities and larger lesions.ConclusionsHypofractionated HDR brachytherapy using 36 Gy in six weekly fractions is associated with satisfactory locoregional control and cosmesis with minimal risk of severe acute or late toxicities.     

Local effect of hyperthermia for superficial and shallow-seated tumors

In approximately seven years, 134 patients with 161 tumors were treated by hyperthermia combined with radiation or chemotherapy at our department. The primary tumors were breast cancer, head and neck cancer, and soft tissue tumors in most patients. Adenocarcinoma was the most frequent, followed by squamous cell carcinoma and soft tissue sarcoma. The local response rates for primary inoperable advanced, metastatic, and local recurrence of breast cancer were 88% (7/8), 50% (10/15), and 86% (18/21), respectively. The local response rate of 39 tumors of neck lymph nodes was 49% (19/39). A total of 26 tumors of bone and soft tissue were treated. Five tumors showed CR and six PR, for a total response rate of 42%. Among 20 patients with malignant melanoma, CR and PR were 25% (5/20) and 30% (6/20), respectively. The local response rate for all patients with superficial and shallow-seated tumors was 58% (94/161). In some tumors classified as showing NR, complete disappearance of tumor cells was demonstrated by a post-treatment histological examination. The efficacy of hyperthermia, when evaluated solely on the basis of tumor size, is likely to be underestimated.     

Arteritis following intra-arterial chemotherapy for liver tumors

Primary and metastatic tumors of the liver can be treated successfully with transcatheter chemoembolization (TACE) during selective arterial catheterism. Arteritis is a possible referred side effect which can lead to tortuosity of the arteries, stenosis and occlusion of vessels. In our hospitals 117 consecutive patients were treated with TACE from January 1990 to December 1992; 61 patients were affected by hepatocellular carcinoma (HCC) and 56 were affected by metastases from colorectal carcinoma. Each patient received from 1 to 4 treatments at monthly intervals using epirubicin/Lipiodol ultrafluid (E/LUF) or a mixture of epirubicin and mitomicin C (MC)/LUF and followed by gelatine sponge injection in the hepatic artery. Selective angiography performed 30–62 days after the first chemoembolization showed artery stenosis in 7 patients and thrombosis in 2 cases related to toxic arteritis due to chemoembolization. Reports about arteritis during TACE treatments are discussed. Received 6 April 1995; Revision received 4 August 1995; Accepted 9 July 1996     

IMRT fluence map editing to control hot and cold spots

Manually editing intensity-modulated radiation therapy (IMRT) fluence maps effectively controls hot and cold spots that the IMRT optimization cannot control. Many times, re-optimizing does not reduce the hot spots or increase the cold spots. In fact, re-optimizing only places the hot and cold spots in different locations. Fluence-map editing provides manual control of dose delivery and provides the best treatment plan possible. Several IMRT treatments were planned using the Varian Eclipse planning system. We compare the effects on dose distributions between fluence-map editing and re-optimization, discuss techniques for fluence-map editing, and analyze differences between fluence editing on one beam vs. multiple beams. When editing a beam’s fluence map, it is essential to choose a beam that least affects dose to the tumor and critical structures. Editing fluence maps gives an advantage in treatment planning and provides controlled delivery of IMRT dose.     

IMRT fluence map editing to control hot and cold spots

Manually editing intensity-modulated radiation therapy (IMRT) fluence maps effectively controls hot and cold spots that the IMRT optimization cannot control. Many times, re-optimizing does not reduce the hot spots or increase the cold spots. In fact, re-optimizing only places the hot and cold spots in different locations. Fluence-map editing provides manual control of dose delivery and provides the best treatment plan possible. Several IMRT treatments were planned using the Varian Eclipse planning system. We compare the effects on dose distributions between fluence-map editing and re-optimization, discuss techniques for fluence-map editing, and analyze differences between fluence editing on one beam vs. multiple beams. When editing a beam’s fluence map, it is essential to choose a beam that least affects dose to the tumor and critical structures. Editing fluence maps gives an advantage in treatment planning and provides controlled delivery of IMRT dose.     

编辑通量图控制调强治疗计划的剂量冷热点

目的 研究手动编辑通量图控制调强治疗计划靶区内外剂量冷热点的优势。方法选择5例头颈肿瘤患者，回顾性比较二次优化和编辑通量图两种方法对控制靶区内外冷热点剂量分布的差别。结果与第1次优化得到的凋强治疗计划相比，第2次优化使靶区内外冷热点剂量分别增加0．5％、减少1．1％，而编辑通量图使靶区内外冷热点剂量分别增加1．0％、减少4．2％。结论 编辑通量图，特别是二次优化后剂量改善不明显的计划．对改善靶区内外冷热点剂量分布很有效．     

左侧乳腺癌患者根治术后常规调强计划与电子束适形联合调强计划的剂量比较

目的比较左侧乳腺癌患者根治术后常规调强放射治疗计划(intensity modulated radiotherapy, IMRT)与电子束适形放疗(electron beam conformal radiotherapy, EBCRT)联合调强放疗计划的剂量学差异。方法选择2018年6月至2021年10月于宁波市第一医院放化疗中心收治的20例左侧乳腺癌根治术后患者资料, 计划靶区(plan target volume, PTV)包括锁骨上下淋巴结引流区域计划靶区(PTVsc)和患侧胸壁计划靶区(PTVcw), 处方剂量均为50 Gy/25次。所有患者均采用美国Varian Eclipse治疗计划系统(treatment planning system, TPS)设计两种放疗计划, 然后对比两种放疗计划的剂量学参数差异。结果所有20例患者的IMRT计划全部满足临床要求, 与此同时EBCRT联合IMRT计划中有2例患者因患侧肺剂量参数超出本单位的剂量限定标准而不被临床接受, 两例失败计划的胸壁最大深度分别为3.7和4.4 cm, 使用的电子束能量分别为12和15 MeV。其余18例患者的胸...     

Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia

Objective

Sacrectomy and ilio-lumbar reconstruction is an uncommonly performed complex surgical procedure for the treatment of sacral neoplasia. There are many challenges in the post-operative period including the potential for tumor recurrence, infection, and construct failure. We present our experience of this patient cohort and describe the complications and imaging appearances that can be encountered during the follow-up period.

Materials and methods

Retrospective review of our Orthopaedic Oncology database was undertaken which has been collected over a 30-year period to identify patients that had undergone sacrectomy and ilio-lumbar reconstruction. Pre and post-operative imaging including radiographs, CT, and MRI was reviewed. These were viewed by two experienced musculoskeletal radiologists with consensus opinion if there was disagreement over the imaging findings. Data regarding patient demographics, tumor type, and dimensions was collected. Serial review of radiographs, CT, and MRI was performed to assess implant position and integrity, strut graft position and union, and for the presence of recurrence within the surgical bed.

Results

Five male and two female patients (mean age 36 years, age range 15–54 years) were treated with this procedure. Histological diagnoses included chordoma, chondrosarcoma, osteosarcoma, and spindle cell sarcoma. Mean maximal tumor size on pre-operative imaging was 10.7 cm (range, 6–16 cm). Post-operative follow-up ranged from 10–46 months. A total of 76 imaging studies were reviewed. Commonly identified complications included vertical rod and cross-connector fracture and screw loosening. Fibula strut graft non-union and fracture was also evident on imaging review. Two patients demonstrated disease recurrence during the follow-up period.

Conclusions

This study demonstrates the spectrum and frequency of complications that can occur following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia.     

Commissioning and quality assurance for MLC-based IMRT.

The commissioning and quality assurance (QA) associated with the implementation of linear accelerator multileaf collimator (MLC)-based intensity-modulated radiation therapy (IMRT) at the University of Nebraska Medical Center are described. Our MLC-based IMRT is implemented using the PRIMUS linear accelerator interface through the IMPAC record and verification system to the CORVUS treatment planning system. The "step-and-shoot" technique is used for this MLC-based IMRT. Commissioning process requires the verification of predefined parameters available on the CORVUS and the collection of some machine data. The machine data required are output factor in air and output factor in phantom, and percent depth dose for a number of field sizes. In addition, inplane and crossplane dose profiles of 4 x 4 cm and 20 x 20 cm field sizes and diagonal dose profiles of a large field size have to be measured. Validation of connectivity and dose model includes the use of uniform intensity bar strips, triangular-shaped nonuniform intensity bar strip, and N-shaped target. QA procedure follows the recommendation of the AAPM Task Group No. 40 report. In addition, the leaf position accuracy and reproducibility of the MLC should be checked at regular intervals. The dose validation is implemented through the hybrid plan where the patient beam parameters are applied to a flat phantom. Independent dose calculation method is used to confirm the dose delivery plan and data input to the CORVUS.     

鼻腔、副鼻窦几种良性肿瘤的CT表现

目的：探讨鼻空、副鼻窦几种良性肿瘤的CT诊断和鉴别。方法：对经手术和病理证实的49例（纤维瘤5例，神经纤维瘤6例，纤维血管瘤20例，骨化纤维瘤6例及内翻乳头状瘤12例）病人的临床，病理及CT表现进行分析对照。CT扫描采用轴位，层厚及层距5mm，部分病例用静脉闭注强后扫描，测量增强前后肿瘤的平均CT值。结果：各种肿瘤各自不同的病理改变决定了不同的CT特征，它们在发部位，病理变大小，形态，钙化，增强等方面均有不同，结论：根据CT表现可提示诊断，但需要与该部位的其它良性肿瘤及一些早期恶性肿瘤相鉴别。     

Fractionated stereotactic radiotherapy of glomus jugulare tumors. Local control, toxicity, symptomatology, and quality of life.

BACKGROUND AND PURPOSE: For glomus jugulare tumors, the goal of treatment is microsurgical excision. To minimize postoperative neurologic deficits, stereotactic radiosurgery (SRS) was performed as an alternative treatment option. Stereotactic fractionated radiotherapy (SRT) could be a further alternative. This study aims at the assessment of local control, side effects, and quality of life (QoL). PATIENTS AND METHODS: Between 1999-2005, 17 patients were treated with SRT. 11/17 underwent previous operations. 6/17 received primary SRT. Treatment was delivered by a linear accelerator with 6-MV photons. Median cumulative dose was 57.0 Gy. Local control, radiologic regression, toxicity, and symptomatology were evaluated half-yearly by clinical examination and MRI scans. QoL was assessed by Short Form-36 (SF-36). RESULTS: Median follow-up was 40 months. Freedom from progression and overall survival for 5 years were 100% and 93.8%. Radiologic regression was seen in 5/16 cases, 11/16 patients were stable. Median tumor shrinkage was 17.9% (p=0.14). Severe acute toxicity (grade 3-4) or any late toxicity was never seen. Main symptoms improved in 9/16 patients, 7/16 were stable. QoL was not affected in patients receiving primary SRT. CONCLUSION: SRT offers an additional treatment option of high efficacy with less side effects, especially in cases of large tumors, morbidity, or recurrences after incomplete resections.     

Australian prostate-specific antigen outcome and toxicity following radiation therapy for localized prostate cancer

The objective of the present study was to examine prostate-specific antigen relapse free survival (PSA-RFS) and morbidity following 'conventional' radical radiation therapy for prostate cancer in two Australian regional treatment services. Four hundred and eighty men with clinically localized prostate cancer were treated between 1993 and 1997 at Liverpool and Westmead Hospitals using a standardized 4-field, CT-planned radiotherapy technique. Principal endpoints were PSA-RFS (American Society for Therapeutic Radiology and Oncology guidelines definition) and late rectal and urinary morbidity (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria). The median follow up of patients from the end of RT was 55 months. Prospectively, they were divided into three prognostic categories: (i) high risk T3 or 4 and/or PSA > 20 ng/mL and/or Gleason score 8-10 (40% of cohort); (ii) intermediate risk T1 or 2 and PSA 10-20 ng/mL and/or Gleason score 7 (33% of cohort); and (iii) low risk T1 or 2 and PSA < 10 ng/mL and Gleason score < 6 (27% of cohort). The 5-year actuarial PSA-RFS was 53% for the whole patient group. The 4-year rates were 32, 56 and 75% for high, intermediate and low risk groups, respectively. On multivariate analysis, T-stage, Gleason score, pre-RT-PSA were strong independent predictors of PSA-defined outcome. Late (grade 2) rectal and urinary morbidity occurred at some point in time in the post-RT period in 8.0 and 5.8% of patients, respectively. These results confirm that low Gleason score, low T stage, presenting PSA < 10 ng/mL and nadir < 1 ng/mL remain the strongest predictors of a good outcome. Long-term toxicity was very acceptable. However, further improvement in outcome is desirable, and with the adoption of new technology allowing escalation of radiotherapy doses such an expectation might be achieved.     

Malignant tumors of the nasal cavity and paranasal sinuses (author's transl)]

Therapeutic results from 134 cases with malignant tumors of the nasal cavity and paranasal sinuses are reported. Retrospective classification based on clinical and roentgenological findings was possible in 121 cases. 49 patients underwent primary radiation treatment by 60Co-teletherapy, 46 were exposed to postoperative irradiation. The mean 2-year survival rate considering all stages and all kinds of malignant tumors amounts to 52%, the 5-year survival rate to ca. 32%. The 5-year survival rate obtained by means of curative tumor doses was 59%. Recurrences of the tumor appeared in 58 cases (43%), most of them in the course of a year. The therapeutic control of local tumor disease and the possibilities of an early detection of recurrences, improved with the help of new diagnostic methods, must therefore be regarded as the essential problems. No generally approved clinical classification of tumors of the nasal cavity and paranasal sinuses is available as yet, and the comparison of therapeutic results from different authors thus is difficult.