A newly developed patient fixation system using a dedicated mouthpiece and dental impression materials for head and neck radiotherapy: a preliminary study

We evaluated the basic characteristics and efficacy of our newly developed patient fixation system for head and neck radiotherapy that uses a dedicated mouthpiece and dental impression materials. The present investigation demonstrated that with this system, the changes in the absorbed dose to water depending on the material of the mouthpiece were small, with a maximum of 0.32% for a 10-MV photon beam. For the dental impression material, we selected a silicone material with the lowest Hounsfield unit (HU) value that had little effect on the generation of artifacts and the quality of the X-ray beam. Multiphase magnetic resonance imaging (MRI) revealed that the head-up and -down motions in the thermoplastic shell without the mouthpiece were 5.76 ± 1.54 mm, whereas the motion with the mouthpiece decreased significantly to 1.72 ± 0.92 mm (P = 0.006). Similarly, the head-left and -right motion displacement decreased from 6.32 ± 1.86 mm without the mouthpiece to 1.80 ± 0.42 mm with the mouthpiece (P = 0.003). Regarding the tongue depressor function of the mouthpiece, the median distance from the hard palate to the surface of the tongue was 28.42 mm. The present results indicate that the new immobilization device developed herein that uses a mouthpiece and a thermoplastic shell is useful for suppressing patients’ head motions and tongue positions.     

口腔金属材料磁共振成像伪影的实验研究

研究3种口腔常用金属材料在l3种不同头颈部扫描序列中的伪影。测量伪影大小，并进行统计学分析。得出3种金属在相同序列成像中，纯钛伪影最小，硬质钴铬合金伪影最大；相同金属材料，6种自旋回波及快速自旋回波序列产生伪影最小，3种梯度回波序列产生伪影较大，4种平面回波序列伪影最大且使图像变形。口腔金属材料产生伪影与材料类型及成像技术密切相关，通过合理选择金属材料及成像技术得到最佳MR成像。     

JX-300型头颈部立体定向适形放射治疗系统的研制与应用

对于头颈部肿瘤立体定向放射治疗,精确的定位和摆位是保证治疗效果、减轻周围组织损伤的关键环节之一。介绍了一种新型头颈部适形放射治疗系统的组成和结构,成功解决了现有头颈部肿瘤立体定向放射治疗中的不足,值得临床推广。     

头颈部肿瘤立体定向放射治疗中的质量保证

本文介绍了头颈部肿瘤立体定向放射治疗时各环节中的质量保证     

头颈部肿瘤立体定向放射治疗中的质量保证

目的：介绍头颈肿瘤立体定向放射治疗实施过程中各环节质量保证措施.方法：从我科实施立体定向放射治疗的患者中随机抽取30例,将患者按拓能固定装置进行体位固定,用面罩固定头颈部,并在面罩上开窗,标记复位标志,用GE螺旋CT定位,拓能计划系统设计治疗计划,治疗计划经过验证合格后治疗,记录摆位前后的参数,对摆位误差进行分析.结果：30例头颈肿瘤患者测试结果显示摆位误差为≤2mm.结论：QA是保证立体定向放射治疗精度极重要的措施,只有严格执行QA措施,才能取得精确而满意的疗效.     

Audit of nutritional guidelines for head and neck cancer patients undergoing radiotherapy

BACKGROUND: Head and neck cancer patients being treated with radiotherapy are at an increased risk of malnutrition due to the severe side-effects, e.g. mucositis, odynophagia and xerostomia, impacting on the ability to eat and drink. Effective dietetic management involves identifying those patients malnourished or at risk of becoming so and incorporating nutritional intervention into their treatment plan. The use of gastrostomy tubes in this patient group has been shown to be acceptable. By placing them prophylactically, the aim is to prevent a disruption to treatment and avoid an unnecessary admission for feeding. This audit was carried out to determine whether the implementation of locally produced nutritional guidelines improved the dietetic management of this patient group. METHOD: A prospective audit tool was used to collect data on 32 head and neck cancer patients undergoing radiotherapy. Data was collected weekly during the course of treatment and compared with data from previous audits. Weight change was the nutritional outcome measured. RESULTS: More patients underwent combined treatment (radiotherapy postoperatively or with concurrent weekly chemotherapy) when compared with previous audits. However, implementation of the guidelines appeared to contribute to an improvement in dietetic management, as fewer patients lost weight over the course of radiotherapy and there were no admissions for feeding. The presence of a dietitian at the multidisciplinary head and neck clinic improved access and communication and this is also likely to have contributed to the improved management. CONCLUSIONS: Implementation of the guidelines led to an improvement in the nutritional management of this patient group. Implementation may be more likely if a dietitian is present at the combined head and neck clinic.     

Initial experience of radiotherapy plus cetuximab for Japanese head and neck cancer patients

In Japan, cetuximab with concurrent bioradiotherapy (BRT) for squamous cell carcinoma of head and neck (SCCHN) was approved in December 2012. We herein report our initial experience of BRT, with special emphasis on acute toxicities of this combination therapy. Thirty-one non-metastatic SCCHN patients who underwent BRT using cetuximab between July 2013 and June 2014 were retrospectively evaluated. All patients received cetuximab with a loading dose of 400 mg/m² one week before the start of radiotherapy, followed by 250 mg/m² per week during radiotherapy. The median cycle of cetuximab was seven cycles and the median dose of radiotherapy was 70 Gy. Twenty-five patients (80.6%) accomplished planned radiotherapy and six cycles or more cetuximab administration. Six patients (19.4%) discontinued cetuximab. Grade 3 dermatitis, mucositis and infusion reaction occurred in 19.4%, 48.3% and 3.2%, respectively. One patient experienced Grade 3 gastrointestinal bleeding caused by diverticular hemorrhage during BRT. Grade 3 drug-induced pneumonitis occurred in two patients. The response rate was 74%, including 55% with a complete response. BRT using cetuximab for Japanese patients with SCCHN was feasible as an alternative for cisplatin-based concurrent chemoradiation, although longer follow-up is necessary to evaluate late toxicities.     

头颈部肿瘤影像学诊断进展

头颈部肿瘤是一种常见的肿瘤,其发病率逐年呈增长趋势,早期临床诊断尤为重要。影像学检查是诊断评价头颈部肿瘤的重要手段,其中CT/MRI灌注检查、PET分子成像等影像学技术是目前研究热点,但各种影像学检查均有其优缺点,多种检查手段的联合应用可以提高头颈部肿瘤诊断的准确度、敏感度和特异度,为临床治疗和预后评估提供重要依据。     

Visual analogue scales: a screening tool for assessing nutritional need in head and neck radiotherapy patients

Background: It has been estimated that more than 80% of head and neck cancer patients have significant weight loss during multimodal treatment, leading to poor wound healing, impaired immune function and a decreased tolerance to therapy. This study assesses the use of visual analogue scales (VAS) as a clinical screening tool to identify the nutritional needs of head and neck cancer patients during radical radiotherapy. Methods: Twenty patients with squamous cell carcinoma (10 larynx, 10 pharynx) were assessed four times during their radiotherapy. They completed a VAS, subjectively assessing their appetite, ability to take solids and liquids and sense of taste on a 5-point scale, with very poor and very good as the anchor points. Three-day food diaries, weight, anthropometry and basal metabolic rate were also recorded. Results: The results indicate that although there were no significant differences between the larynx and pharynx groups at the start of radiotherapy, significant differences were apparent by the end of treatment. The VAS showed a significant correlation with energy intake from normal food. This correlation was stronger for solids and appetite than for liquids and taste. Conclusion: The VAS can quickly identify when radiotherapy patients require nutritional intervention and support.     

Early-onset dropped head syndrome after radiotherapy for head and neck cancer: dose constraints for neck extensor muscles

Dropped head syndrome (DHS) is a famous but unusual late complication of multimodality treatment for head and neck carcinoma. We reported this early-onset complication and analyzed the dose to the neck extensor muscles. We examined the records of three patients with DHS after radiotherapy. The doses to the neck extensor muscles were compared between three patients with DHS and nine patients without DHS. The mean dose to the neck extensor muscles of the three patients with DHS were 58.5 Gy, 42.3 Gy and 60.9 Gy, while the dose was <50 Gy in all nine patients in the control group. The onset of this syndrome was 5 months, 6 months and 15 months. The early-onset DHS may have something to do with dose to the neck extensor muscles. The proposed dose to the neck extensor muscles might be <46 Gy (or at least <50 Gy).     

Temporal assessment of quality of life of head and neck cancer patients receiving radical radiotherapy

The study was undertaken to evaluate physical, psychological and functional aspects in quality of life (QoL) assessment prospectively in biopsy-proven head and neck cancer patients receiving radical radiotherapy. Fifty male patients were assessed using Karnofsky's Performance Status (KPS), Beck's Depression Inventory (BDI) and the Functional Living Index – Cancer (FLIC). Patient questionnaires were completed before radiotherapy, during 3–4 weeks of radiotherapy and 3 months after radiotherapy. Before the start of radiotherapy, KPS was 91±10.26, FLIC was 129.98±33.41 and BDI was 7.10±4.57. This indicated good performance and functional status with lower depression. In weeks 3–4 of radiotherapy, KPS (71.00±20.12) and FLIC (81.34±45.23) decreased, while BDI(16.56 ±9.01) increased, indicating impairment in QoL. Three months after radiotherapy, KPS (78.37±23.0), FLIC (119.51± 43.62) and BDI(9.02±7.81) improved but were not restored to pre-treatment levels. When patients were scheduled for radical radiotherapy, maximum deterioration in QoL was seen in weeks 3–4. This is the time when maximum supportive care and psychologic counselling is required.     

A slice classification model-facilitated 3D encoder–decoder network for segmenting organs at risk in head and neck cancer

For deep learning networks used to segment organs at risk (OARs) in head and neck (H&N) cancers, the class-imbalance problem between small volume OARs and whole computed tomography (CT) images results in delineation with serious false-positives on irrelevant slices and unnecessary time-consuming calculations. To alleviate this problem, a slice classification model-facilitated 3D encoder–decoder network was developed and validated. In the developed two-step segmentation model, a slice classification model was firstly utilized to classify CT slices into six categories in the craniocaudal direction. Then the target categories for different OARs were pushed to the different 3D encoder–decoder segmentation networks, respectively. All the patients were divided into training (n = 120), validation (n = 30) and testing (n = 20) datasets. The average accuracy of the slice classification model was 95.99%. The Dice similarity coefficient and 95% Hausdorff distance, respectively, for each OAR were as follows: right eye (0.88 ± 0.03 and 1.57 ± 0.92 mm), left eye (0.89 ± 0.03 and 1.35 ± 0.43 mm), right optic nerve (0.72 ± 0.09 and 1.79 ± 1.01 mm), left optic nerve (0.73 ± 0.09 and 1.60 ± 0.71 mm), brainstem (0.87 ± 0.04 and 2.28 ± 0.99 mm), right temporal lobe (0.81 ± 0.12 and 3.28 ± 2.27 mm), left temporal lobe (0.82 ± 0.09 and 3.73 ± 2.08 mm), right temporomandibular joint (0.70 ± 0.13 and 1.79 ± 0.79 mm), left temporomandibular joint (0.70 ± 0.16 and 1.98 ± 1.48 mm), mandible (0.89 ± 0.02 and 1.66 ± 0.51 mm), right parotid (0.77 ± 0.07 and 7.30 ± 4.19 mm) and left parotid (0.71 ± 0.12 and 8.41 ± 4.84 mm). The total segmentation time was 40.13 s. The 3D encoder–decoder network facilitated by the slice classification model demonstrated superior performance in accuracy and efficiency in segmenting OARs in H&N CT images. This may significantly reduce the workload for radiation oncologists.     

Phase I study of oral S-1 and concurrent radiotherapy in patients with head and neck cancer

This study investigated the maximum tolerated dose (MTD) of S-1 with concurrent radiotherapy in patients with head and neck cancer, based on the frequency of dose-limiting toxicities (DLT). S-1 was administered orally at escalating doses from 40 mg/m² b.i.d. on the days of delivering radiotherapy, which was given at a total dose of 64–70 Gy in 32–35 fractions over 6–7 weeks. A total of 12 patients (3 patients at 40 mg/m², 6 patients at 60 mg/m², and 3 patients at 80 mg/m²) were enrolled in this trial. At the dose of 80 mg/m², two of the three patients developed DLT (Grade 3 anorexia and rhabdomyolysis) due to S-1, so the MTD was determined to be 80 mg/m². Among the 12 enrolled patients, 9 (75%) showed a complete response and 3 (25%) showed a partial response. The overall response rate was 100%. The recommended dose of S-1 with concurrent radiotherapy is 60 mg/m².     

Randomized phase III trial of concurrent chemoradiotherapy vs accelerated hyperfractionation radiotherapy in locally advanced head and neck cancer

The aim of this study was to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) vs accelerated hyperfractionation with concomitant boost (CCB) as a primary treatment for patients with Stage III–IV squamous cell carcinoma of head and neck (SCCHN). A total of 85 non-metastatic advanced SCCHN patients were accrued from January 2003 to December 2007. Of these, 48 and 37 patients received CCRT and CCB, respectively. The patients were randomized to receive either three cycles of carboplatin and 5-fluorouracil plus conventional radiotherapy (CCRT, 66 Gy in 6.5 weeks) or hybrid accelerated radiotherapy (CCB, 70 Gy in 6 weeks). The primary endpoint was determined by locoregional control rate. The secondary endpoints were overall survival and toxicity. With a median follow-up of 43 months (range, 3–102), the 5-year locoregional control rate was 69.6% in the CCRT arm vs 55.0% in the CCB arm (P = 0.184). The 5-year overall survival rate was marginally significantly different (P = 0.05): 76.1% in the CCRT arm vs 63.5% in the CCB arm. Radiotherapy treatment interruptions of more than three days were 60.4% and 40.5% in the CCRT arm and CCB arm, respectively. The median total treatment time was 55.5 days in the CCRT arm and 49 days in the CCB arm. The rate of Grade 3–4 acute mucositis was significantly higher in the CCB arm (67.6% vs 41.7%, P = 0.01), but no high grade hematologic toxicities were found in the CCB arm (27.2% vs 0%). CCRT has shown a trend of improving outcome over CCB irradiation in locoregionally advanced head and neck cancer.     

Dosimetric and geometric evaluation of the use of deformable image registration in adaptive intensity-modulated radiotherapy for head-and-neck cancer

The aim of this study was to carry out geometric and dosimetric evaluation of the usefulness of a deformable image registration algorithm utilized for adaptive head-and-neck intensity-modulated radiotherapy. Data consisted of seven patients, each with a planning CT (pCT), a rescanning CT (ReCT) and a cone beam CT (CBCT). The CBCT was acquired on the same day (±1 d) as the ReCT (i.e. at Fraction 17, 18, 23, 24 or 29). The ReCT served as ground truth. A deformed CT (dCT) with structures was created by deforming the pCT to the CBCT. The geometrical comparison was based on the volumes of the deformed, and the manually delineated structures on the ReCT. Likewise, the center of mass shift (CMS) and the Dice similarity coefficient were determined. The dosimetric comparison was performed by recalculating the initial treatment plan on the dCT and the ReCT. Dose–volume histogram (DVH) points and a range of conformity measures were used for the evaluation. We found a significant difference in the median volume of the dCT relative to that of the ReCT. Median CMS values were ∼2–5 mm, except for the spinal cord, where the median CMS was 8 mm. Dosimetric evaluation of target structures revealed small differences, while larger differences were observed for organs at risk. The deformed structures cannot fully replace manually delineated structures. Based on both geometrical and dosimetrical measures, there is a tendency for the dCT to overestimate the need for replanning, compared with the ReCT.     

头颈恶性肿瘤放射性口腔黏膜炎危险因素meta分析

目的 系统评价头颈恶性肿瘤放疗后放射性口腔黏膜炎的危险因素,为在临床工作中预防头颈恶性肿瘤患者放射性口腔黏膜炎的发生提供循证证据。 方法 通过计算机检索数据库PubMed、Embase、MEDLINE、Ovid、Web of Science、Cochrane Library、中国知网、维普、万方中公开发表的与头颈恶性肿瘤患者放疗过程中引起放射性口腔黏膜炎的危险因素有关的文献,检索各数据库从建库起至2020年6月的相关文献,由两位研究人员独立完成文献筛选、资料提取、质量评价,运用Rev Man 5.3软件和Stata 12.0软件进行分析。 结果 共计纳入14篇文献(英文5篇,中文9篇),结果显示,联合化疗(OR=2.24,95％CI:1.66～3.02)、吸烟(OR=2.12,95％CI:1.45～3.10)、饮酒(OR=1.58,95％CI:1.09～2.29)、糖尿病(OR=1.99,95％CI:1.46～2.70)、口腔pH≤7(OR=3.11,95％CI:2.13～4.55)、口腔卫生差(OR=4.38,95％CI:2.19～8.73)、未使用抗生素(OR=5.92,95％CI:2.91～12.04)、未使用黏膜保护剂(OR=5.39,95％CI:2.89～10.04)是头颈恶性肿瘤放射性口腔黏膜炎的危险因素,差异均有统计学意义(P＜0.05)。 结论 联合化疗、吸烟、饮酒、糖尿病、口腔pH≤7、口腔卫生差、未使用抗生素、未使用黏膜保护剂是头颈恶性肿瘤放射性口腔黏膜炎的危险因素,医务人员在临床工作中可采取相应预防措施降低放射性口腔黏膜炎的发生率及严重程度。     

The threshold of hypothyroidism after radiation therapy for head and neck cancer: a retrospective analysis of 116 cases

The purpose of the present study was to determine the risk factors for developing thyroid disorders based on a dose–volume histograms (DVHs) analysis. Data from a total of 116 consecutive patients undergoing 3D conformal radiation therapy for head and neck cancers was retrospectively evaluated. Radiation therapy was performed between April 2007 and December 2010. There were 108 males and 8 females included in the study. The median follow-up term was 24 months (range, 1–62 months). The thyroid function was evaluated by measuring thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels. The mean thyroid dose, and the volume of thyroid gland spared from doses ≥10, 20, 30 and 40 Gy (VS10, VS20, VS30 and VS40) were calculated for all patients. The thyroid dose and volume were calculated by the radiotherapy planning system (RTPS). The cumulative incidences of hypothyroidism were 21.1% and 36.4% at one year and two years, respectively, after the end of radiation therapy. In the DVH analyses, the patients who received a mean thyroid dose <30 Gy had a significantly lower incidence of hypothyroidism. The univariate analyses showed that the VS10, VS20, VS30 and VS40 were associated with the risk of hypothyroidism. Hypothyroidism was a relatively common type of late radiation-induced toxicity. A mean thyroid dose of 30 Gy may be a useful threshold for predicting the development of hypothyroidism after radiation therapy for head and neck cancers.     

A digital model individual template and CT-guided 125I seed implants for malignant tumors of the head and neck

To enhance the accuracy of radioactive seed implants in the head and neck, a digital model individual template, containing information simultaneously on needle pathway and facial features, was designed to guide implantation with CT imaging. Thirty-one patients with recurrent and local advanced malignant tumors of head and neck after prior surgery and radiotherapy were involved in this study. Before ¹²⁵I implants, patients received CT scans based on 0.75mm thickness. And the brachytherapy treatment planning system (BTPS) software was used to make the implantation plan based on the CT images. Mimics software and Geomagic software were used to read the data containing CT images and implantation plan, and to design the individual template. Then the individual template containing the information of needle pathway and face features simultaneously was made through rapid prototyping (RP) technique. All patients received ¹²⁵I seeds interstitial implantation under the guide of the individual template and CT. The individual templates were positioned easily and accurately, and were stable. After implants, treatment quality evaluation was made by CT and TPS. The seeds and dosages distribution (D₉₀,V₁₀₀,V₁₅₀) were well meet the treatment requirement. Clinical practice confirms that this approach can facilitate easier and more accurate implantation.