18F-FDG and11C-methionine PET for evaluation of treatment response of lung cancer after stereotactic radiotherapy

This study was performed to investigate the feasibility of FDG- and L-[methyl-11C]methionine (Met)-PET for the follow up of lung cancer after stereotactic radiotherapy (SRT). Nine patients (pt) with solitary lung cancer underwent SRT. Met- and FDG-PET studies were performed one week before SRT and from one week to 8 months after SRT. Responses to SRT were complete in 2 pt and partial in 7 pt. Met- and FDG-PET scan showed high tracer uptake in all tumors before SRT. After SRT, standardized uptake values (SUV) of FDG and Met changed concordantly. Both decreased with time in 5 pt but did not decrease steadily in 4 pt, where 2 pt showed an increase at 1 to 2 weeks after SRT and 2 pt showed an increase at more than 3 months after SRT. The former appears to reflect the acute reaction to SRT and the latter radiation-induced pneumonitis. Although the addition of Met-PET did not provide additional information over FDG-PET, FDG- and Met-PET could be used to evaluate the treatment effect of SRT.     

Ultrasound demonstration of clip migration to Skin within 6 weeks of 11-gauge vacuum-assisted stereotactic breast biopsy

A 39-year-old woman underwent 11-gauge vacuum-assisted stereotactic biopsy of a cluster of calcifications at the 5 o'clock location in the left breast. Initial clip placement was confirmed by mammograms to be at the biopsy site. The patient experienced episodic minimal bleeding at the skin entry site when she went home. The patient presented 6 weeks later with a history of progressive discomfort and lump at the stereotactic breast biopsy scar site. Ultrasound confirmed clip migration to the skin incision site. The clip was removed percutaneously by the radiologist, relieving the patient of her symptoms.     

Treatment of isolated sphenoid sinus inflammatory disease by endoscopic sphenoidotomy without ethmoidectomy

OBJECTIVES/HYPOTHESIS: Isolated chronic sphenoid sinusitis is a rare entity. The study was conducted to determine the efficacy of endoscopic sinus surgery with partial middle turbinectomy and without ethmoidectomy in treating isolated sphenoid opacification from inflammatory and infectious disease. STUDY DESIGN: Case series of 20 patients generated by retrospective review of 307 consecutive patients who underwent surgical treatment for chronic rhinosinusitis. METHODS: The medical records were reviewed for pertinent demographic, symptom, radiographic, and endoscopic data preoperatively, interoperatively, and postoperatively. All patients in the series underwent computed tomographic image-guided endoscopic sphenoid sinus surgery with partial middle turbinectomy. RESULTS: The study population consisted of 12 male and 8 female patients between 28 and 75 years of age. Headache (15 patients) and/or postnasal drip (14 patients) were the presenting symptoms in 17 of the patients. Three patients were asymptomatic. Surgical findings included inspissated secretions (15 patients), fungal debris (2 patients), and mucopyoceles (3 patients). The 17 patients with preoperative symptoms were symptom free by 12 weeks postoperatively and have remained so with follow-up ranging from 12 months to 3.25 years (mean follow-up, 23.1 mo). There were no operative complications in the series. CONCLUSIONS: Endoscopic sphenoid sinus surgery without ethmoidectomy is effective for treating isolated sphenoid sinus opacification associated with inflammatory or infectious sinus disease. Partial middle turbinectomy at the time of surgery facilitates the approach, as well as postoperative cleaning and surveillance.     

立体定向适形多靶点置管引流术治疗脑出血的临床研究

根据高血压脑出血血肿的三维重建图像的形式和血肿量的大小设置靶点,通过立体定向技术,将硅胶管关至预定的靶点,根据血肿量由导管注尿激酶（ＵＫ）２００００Ｕ～４００００Ｕ。夹闭２ｈ后开放引流,１～３天后９０％～９５％的血肿可被排除。应用此术式共治疗高血压脑出血９６例,死亡率为３．９５％（后期）,近期优良率为６２％,远期优良率为８５．２％．此方法较单纯立体定向血肿抽吸术血肿排出彻底,尤其适用于不规则形血肿     

我国实验用豚鼠面神经核的立体定位坐标值

目的：确定我国实验用豚鼠面神经核（ＦＮ）中心的立体定位坐标值．方法：Ｎｉｓｓｌ染色、ＨＲＰ逆行追踪方法及立体定位仪确定ＦＮ立体定位坐标值;利用Ｎｉｓｓｌ染色在连续切片上确定豚鼠面神经核的外径．结果：体重３００ｇ～６５０ｇ豚鼠的ＦＮ中心坐标值为Ｐ：（２．４±０．１）ｍｍ,ＬＬ／ＲＬ：（２．０±０．０７）ｍｍ,Ｈ：（－１．９±０．０８）ｍｍ;ＦＮ的前后径：（１．５±０．０９）ｍｍ,左右径：（１．３±０．０７）ｍｍ,上下径：（１．４±０．０６）ｍｍ结论：确定了我国实验用豚鼠ＦＮ的立体定位坐标值,为面神经的研究提供了便利条件．     

3089例全身肿瘤的立体定向放射（伽玛刀/X刀）治疗效果

目的：回顾性分析恶性肿瘤的立体定向放射治疗（γ刀/X刀）和疗效。方法：2001年6月-2006年8月,应用γ刀/X刀治疗全身肿瘤4030例。随访了2005年8月前满1年的3089例,治疗前随机分组,γ刀组1935例,肿瘤病灶2903个,剂量分割采用36-45Gy/6-12f;X刀组1154例,肿瘤病灶1616个,剂量分割为36-45Gy/8-15f。结果：总的1年局部控制率（CR＋PR）达91.7%;临床获益率（CBR）90.9%;γ刀组和X刀组之间局控率和CBR无显著差异。两组患者各部位肿瘤在放疗期间均出现不同程度的白细胞、血小板下降;头颈、胸部肿瘤部分出现咳嗽、咽痛、进食不适;部分腹部肿瘤出现轻度恶心、呕吐,无严重肝功能损伤;放射性肺炎8.1%（132/1639）、放射性食道炎1.2%（19/1639）、放射性肠炎5.0%（39/782）,两组放疗反应无明显差异,经过对症支持治疗大多数患者均能完成放射治疗。结论：全身γ刀和X刀治疗恶性肿瘤,局控率高,复发率低,并发症和不良反应少,两组之间疗效无显著差异。对早期肿瘤能达到根治,对中、晚期恶性肿瘤可减轻痛苦,延长生命。     

Implantation Metastasis along the Stereotactic Biopsy Tract in Anaplastic Astrocytoma: A Case Report

Objective and importance: Stereotactic biopsy for brain lesion is usually a safe procedure and the reported rate of complication is minimal. Moreover, local seeding along the trajectory of the stereotactic biopsy is a rare complication. The authors report a case of metastatic implantation along the trajectory of the stereotactic biopsy in anaplastic astrocytoma. Clinical presentation: A 64-Year-old man who presented with a one-month history of speech and memory disturbance underwent magnetic resonance (MR) imaging that disclosed a large mass in the left basal ganglia and medial temporal region. Intervention: Under the impression of high-grade glioma, computed tomography guided stereotactic biopsy was performed using the Riechert–Mundinger system. The histologic diagnosis was anaplastic astrocytoma. MR images after two cycles of chemotherapy showed a small enhancing portion in the middle of the biopsy tract, which was considered a surgical artifact and not included in the field of the following conventional fractionated radiation therapy. MR images three months after the completion of radiation therapy revealed that the enhancing portion had become a larger mass irrespective of good control of the primary tumor. Conclusion: Our findings suggest that tumor seeding along the stereotactic biopsy trajectory must be considered if an enhancing lesion appears in the MR image following the stereotactic biopsy. The cause and the prevention of implantation metastasis along the stereotactic biopsy tract are also discussed.     

26例术后复发性胆管细胞癌射波刀SBRT疗效分析

目的 评价射波刀SBRT在复发性胆管细胞癌治疗中的效果及安全性。方法 回顾分析2010-2015年26例术后复发的胆管癌射波刀SBRT的患者,中位术后复发时间10个月,中位肿瘤直径为2.8 cm。中位处方剂量45 Gy,中位分割次数5次。基于增强CT或MRI评估肿瘤进展。采用Kaplan-Meier法计算OS、PFS及LC。使用CTCAE4.0版评估不良反应。结果 中位随访29.3个月,其中位OS和PFS分别为13.5个月和6.5个月,1、2年OS和PFS率分别为52%、21%和28%、15%。4例患者出现肿瘤原位进展。3例患者发生3级不良反应,包括1例胃肠道反应、1例肝功能减退、1例胆道感染;仅1例患者在晚期出现了≥4级消化道出血。结论 射波刀SBRT术后复发性胆管癌可获得较好的疗效且不良反应可耐受。     

六维配准技术在肺癌立体定向放射治疗中的必要性

目的:研究肺癌立体定向放射治疗患者在CBCT扫描后进行六维方向的配准相对于传统四维方向配准在位移误差纠正方面的必要性及其临床意义.方法:选取2018年3月～2019年7月在本院接受立体定向放射治疗的肺癌患者25例,使用VARIAN的edge直线加速器先进行CBCT扫描,再分别在四维方向和六维方向与计划中的定位CT图像进...