Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20190929-00007
Binbing Wang, Guang Zheng, Xiang Zhang, Ji-ping Liu
Objective To introduce the workflow of individualized 3D-printed intracavitary/interstitial vaginal template design. Dosimetric parameters and operation safety were investigated to evaluate the performance of 3D-printed template and freehand implantation. Methods Forty patients previously treated with intracavitary/interstitial Ir-192 HDR brachytherapy were enrolled in this study. All patients were randomly divided into the treatment (n=20) and control groups (n=20). In the treatment group, twenty patients were treated with individualized 3D-printed template. CT-based preplan was carried out to determine the needle implantation cannels. Template with customized shape and implantation cannels was then produced by a 3D printer. Finally, the template was inserted under CT guidance. In the control group, twenty patients received freehand implantation. Needle insertion was decided empirically without the preplan process. Results The difference of D90 for high risk CTV was found to be minor, while the D2cm3 in the rectum, bladder and sigmoid was significantly improved in the treatment group. Meanwhile, the high dose region and conformal index were also improved in the treatment group. A total of 273 needles were inserted and one (0.3%) not-used needle was found. No normal tissues were penetrated during needle insertion in the treatment group. In the control group, a total of 203 needles were inserted and 4(2.0%) not-used needles were observed, and normal tissue penetration occurred in 3(1.5%) needle insertion. Conclusions The individualized 3D-printed template implantation approach has advantages in terms of dosimetry and safety compared with freehand implantation. The actual treatment can achieve the dosimetric design requirements of the preplan. Key words: 3D printing; Cervical neoplamsm/brachytherapy; Dosimetry
{"title":"Application value of individualized 3D-printed vaginal template for cervical cancer brachytherapy","authors":"Binbing Wang, Guang Zheng, Xiang Zhang, Ji-ping Liu","doi":"10.3760/CMA.J.CN113030-20190929-00007","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20190929-00007","url":null,"abstract":"Objective \u0000To introduce the workflow of individualized 3D-printed intracavitary/interstitial vaginal template design. Dosimetric parameters and operation safety were investigated to evaluate the performance of 3D-printed template and freehand implantation. \u0000 \u0000 \u0000Methods \u0000Forty patients previously treated with intracavitary/interstitial Ir-192 HDR brachytherapy were enrolled in this study. All patients were randomly divided into the treatment (n=20) and control groups (n=20). In the treatment group, twenty patients were treated with individualized 3D-printed template. CT-based preplan was carried out to determine the needle implantation cannels. Template with customized shape and implantation cannels was then produced by a 3D printer. Finally, the template was inserted under CT guidance. In the control group, twenty patients received freehand implantation. Needle insertion was decided empirically without the preplan process. \u0000 \u0000 \u0000Results \u0000The difference of D90 for high risk CTV was found to be minor, while the D2cm3 in the rectum, bladder and sigmoid was significantly improved in the treatment group. Meanwhile, the high dose region and conformal index were also improved in the treatment group. A total of 273 needles were inserted and one (0.3%) not-used needle was found. No normal tissues were penetrated during needle insertion in the treatment group. In the control group, a total of 203 needles were inserted and 4(2.0%) not-used needles were observed, and normal tissue penetration occurred in 3(1.5%) needle insertion. \u0000 \u0000 \u0000Conclusions \u0000The individualized 3D-printed template implantation approach has advantages in terms of dosimetry and safety compared with freehand implantation. The actual treatment can achieve the dosimetric design requirements of the preplan. \u0000 \u0000 \u0000Key words: \u00003D printing; Cervical neoplamsm/brachytherapy; Dosimetry","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"283-288"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44981013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20190304-00002
Chenxue Jiang, Tingting Xu, Cuihong Wang, G. Sun, Qifeng Wang, Chunying Shen, Chaosu Hu, Xueguan Lu
Objective To evaluate the diagnostic value of HPV detection in squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site. Methods Clinical data of 6 patients who were initially diagnosed with squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site and eventually diagnosed with HPV-related oropharyngeal squamous cell carcinoma were collected, and the process of diagnosis was analyzed. Results Upon the initial admission, all patients were diagnosed with squamous cell carcinoma of the cervical lymph node metastasis with positive p16 expression, positive HPV-16 subtype and negative EBER expression. No obvious primary lesion was found after comprehensive examination. Subsequently, four of them underwent ipsilateral tonsollar blind biopsy (n=2) and ipsilateral tonsillectomy (n=2). All these four patients were pathologically diagnosed with tonsillar squamous cell carcinoma. For the other two cases, MRI detected the thickening complicated with enhancement of ipsilateral wall of oropharynx and tongue root after follow-up for D149 and D545 , respectively. Biopsy confirmed the diagnosis of squamous cell carcinoma of the tonsil and tongue root, respectively. Conclusion For patients with HPV-positive squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site, the possibility that the primary lesion originates from the oropharyngeal site, especially the tonsil and tongue root, should be highly suspected. Key words: Neoplasm, cervical lymph node metastasis; Human papillomavirus; p16; Oropharyngeal carcinoma
{"title":"The diagnostic value of HPV detection in squamous cell carcinoma of cervical lymph node metastasis from an unknown primary site (with report of 6 cases)","authors":"Chenxue Jiang, Tingting Xu, Cuihong Wang, G. Sun, Qifeng Wang, Chunying Shen, Chaosu Hu, Xueguan Lu","doi":"10.3760/CMA.J.CN113030-20190304-00002","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20190304-00002","url":null,"abstract":"Objective \u0000To evaluate the diagnostic value of HPV detection in squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site. \u0000 \u0000 \u0000Methods \u0000Clinical data of 6 patients who were initially diagnosed with squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site and eventually diagnosed with HPV-related oropharyngeal squamous cell carcinoma were collected, and the process of diagnosis was analyzed. \u0000 \u0000 \u0000Results \u0000Upon the initial admission, all patients were diagnosed with squamous cell carcinoma of the cervical lymph node metastasis with positive p16 expression, positive HPV-16 subtype and negative EBER expression. No obvious primary lesion was found after comprehensive examination. Subsequently, four of them underwent ipsilateral tonsollar blind biopsy (n=2) and ipsilateral tonsillectomy (n=2). All these four patients were pathologically diagnosed with tonsillar squamous cell carcinoma. For the other two cases, MRI detected the thickening complicated with enhancement of ipsilateral wall of oropharynx and tongue root after follow-up for D149 and D545 , respectively. Biopsy confirmed the diagnosis of squamous cell carcinoma of the tonsil and tongue root, respectively. \u0000 \u0000 \u0000Conclusion \u0000For patients with HPV-positive squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site, the possibility that the primary lesion originates from the oropharyngeal site, especially the tonsil and tongue root, should be highly suspected. \u0000 \u0000 \u0000Key words: \u0000Neoplasm, cervical lymph node metastasis; Human papillomavirus; p16; Oropharyngeal carcinoma","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"259-261"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41868168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20190614-00004
M. Qi, Yongbao Li, A. Wu, F. Guo, Q. Jia, T. Song, Linghong Zhou
Objective To establish a correlation model between MRI and CT images to generate synthetic-CT (sCT) of head and neck cancer during MRI-guided radiotherapy by using generative adversarial networks (GAN). Methods Images and IMRT plans of 45 patients with nasopharyngeal carcinoma were collected before treatment. Firstly, the MRI (T1) and CT images were preprocessed, including rigid registration, clipping, background removal and data enhancement, etc. Secondly, the cases were trained by GAN, of which 30 cases were randomly selected and put into the network as training set images for modeling and learning, and the other 15 cases were used for testing. The image quality of predicted sCT and real CT were statistically compared, and the dose distribution recalculated upon predicted sCT was statistically compared with that of real planned dose distribution. Results The mean absolute error of the predicted sCT of the testing set was (79.15±11.37) HU, and the SSIM value was 0.83±0.03. The MAE values of dose distribution difference at different regional levels were less than 1% compared to the prescription dose. The gamma passing rate of the sCT dose distribution was higher than 92% and 98% under the 2mm/2% and 3mm/3% criteria. Conclusions We have successfully proposed and realized the generation of sCT for head and neck cancer using GAN, which lays a foundation for the implementation of MRI-guided radiotherapy. The comparison of image quality and dosimetry shows the feasibility and accuracy of this method. Key words: Nasopharyngeal neoplasm/magnetic resonance-image guided radiotherapy; Generative adversarial networks; Synthetic-CT generation
{"title":"Generative Adversarial Networks based synthetic-CT generation for patients with nasopharyngeal carcinoma","authors":"M. Qi, Yongbao Li, A. Wu, F. Guo, Q. Jia, T. Song, Linghong Zhou","doi":"10.3760/CMA.J.CN113030-20190614-00004","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20190614-00004","url":null,"abstract":"Objective \u0000To establish a correlation model between MRI and CT images to generate synthetic-CT (sCT) of head and neck cancer during MRI-guided radiotherapy by using generative adversarial networks (GAN). \u0000 \u0000 \u0000Methods \u0000Images and IMRT plans of 45 patients with nasopharyngeal carcinoma were collected before treatment. Firstly, the MRI (T1) and CT images were preprocessed, including rigid registration, clipping, background removal and data enhancement, etc. Secondly, the cases were trained by GAN, of which 30 cases were randomly selected and put into the network as training set images for modeling and learning, and the other 15 cases were used for testing. The image quality of predicted sCT and real CT were statistically compared, and the dose distribution recalculated upon predicted sCT was statistically compared with that of real planned dose distribution. \u0000 \u0000 \u0000Results \u0000The mean absolute error of the predicted sCT of the testing set was (79.15±11.37) HU, and the SSIM value was 0.83±0.03. The MAE values of dose distribution difference at different regional levels were less than 1% compared to the prescription dose. The gamma passing rate of the sCT dose distribution was higher than 92% and 98% under the 2mm/2% and 3mm/3% criteria. \u0000 \u0000 \u0000Conclusions \u0000We have successfully proposed and realized the generation of sCT for head and neck cancer using GAN, which lays a foundation for the implementation of MRI-guided radiotherapy. The comparison of image quality and dosimetry shows the feasibility and accuracy of this method. \u0000 \u0000 \u0000Key words: \u0000Nasopharyngeal neoplasm/magnetic resonance-image guided radiotherapy; Generative adversarial networks; Synthetic-CT generation","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"267-272"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44629435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20191108-00013
T. Zhao, Yongqiang Yang, S. Cai, Ye Tian
Acute radiation-induced intestinal injury is the common complication in patients following abdominal and pelvic radiotherapy. However, no effective clinical prevention and treatment interventions are available. As the probiotics and symbiotic bacteria, many species of the genus Lactobacillus are normally present in the gastrointestinal tract and beneficial for the intestinal health. Preclinical studies have reported that the genus Lactobacillus can prevent and treat acute radiation-induced intestinal injury by protecting crypt stem cells, maintaining intestinal barrier and exerting the antioxidant effect, etc. Clinical trials have prompted that oral administration of adequate complex probiotics containing Lactobacillus spp.at one week before radiotherapy contributes to preventing radiation-induced diarrhea. In addition, oral intake of the genus Lactobacillus has the tendency to treat radiation-induced diarrhea and mitigate acute radiation proctitis. At present, no relevant adverse events have been reported. Key words: Genus Lactobacillus; Aacute radiation-induced intestinal injury; Research progress
{"title":"Research progress on the prevention and treatment of radiation-induced intestinal injury by the genus Lactobacillus","authors":"T. Zhao, Yongqiang Yang, S. Cai, Ye Tian","doi":"10.3760/CMA.J.CN113030-20191108-00013","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20191108-00013","url":null,"abstract":"Acute radiation-induced intestinal injury is the common complication in patients following abdominal and pelvic radiotherapy. However, no effective clinical prevention and treatment interventions are available. As the probiotics and symbiotic bacteria, many species of the genus Lactobacillus are normally present in the gastrointestinal tract and beneficial for the intestinal health. Preclinical studies have reported that the genus Lactobacillus can prevent and treat acute radiation-induced intestinal injury by protecting crypt stem cells, maintaining intestinal barrier and exerting the antioxidant effect, etc. Clinical trials have prompted that oral administration of adequate complex probiotics containing Lactobacillus spp.at one week before radiotherapy contributes to preventing radiation-induced diarrhea. In addition, oral intake of the genus Lactobacillus has the tendency to treat radiation-induced diarrhea and mitigate acute radiation proctitis. At present, no relevant adverse events have been reported. \u0000 \u0000Key words: \u0000Genus Lactobacillus; Aacute radiation-induced intestinal injury; Research progress","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"313-316"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45819095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20190423-00006
Tantan Li, Jiang-hu Zhang, Yong-wen Song, Yu Tang, S. Qi, Feng-ying Lu, Wei Zhang, Zengzhou Wang, Xin-zhi Feng, S. Qin, Bin Cheng, Bofei Liu, Gui-shan Fu, Shulian Wang, J. Dai
Objective To establish the basic procedures of the application of optical surface monitoring system (OSMS) in the deep inspiration breath hold (DIBH) radiotherapy for patients with left sided breast cancer and compare the performance of OSMS and cone-beam CT (CBCT) in the determination of the set-up errors of DIBH radiotherapy for patients with left sided breast cancer. Methods Twenty patients with left sided breast cancer received DIBH radiotherapy. Through the registration of CBCT images with the planning CT images, and the registration of OSMS radiography images with the outer contour of the body surface, translational set-up errors and rotational errors were determined along the lateral-medial (Rx), superior-inferior (Ry) and anterior-posterior (Rz) directions. Pearson correlation analysis was performed to evaluate the correlation of the set-up errors determined by two methods, and Bland-Altman plot analysis was used to assess the coincidence of these two methods. Results Two methods were positively correlated. The Rz volume was 0.84, 0.74 and 0.84 in the x, y and z directions, and 0.65, 0.41 and 0.54 in the Rx, Ry and Rz directions, respectively (all P<0.01). The 95%CI of agreement were within preset 5 mm tolerance (-0.37-0.42cm, -0.39-0.41cm, -0.29-0.49cm ) in x, y and z directions for two methods. The 95%CI of agreement were within preset 3 ° tolerance -2.9°-1.4°, -2.6°-1.4°, -2.4°-2.5°in Rx, Ry and Rz directions for two methods. The system errors of 20 patients with left sided breast cancer receiving DIBH radiotherapy were <0.18cm and the random errors were <0.24cm. Conclusions OSMS is equivalent to CBCT in the determination and stimulation of set-up errors for patients with left sided breast cancer receiving DIBH radiotherapy. The combination of CBCT and OSMS is a safe and reliable method. Key words: Optical surface monitoring system; Deep inspiration breath hold; Image registration
{"title":"Comparison of the performance of two methods to determine set-up errors for DIBH patients with left sided breast cancer in radiotherapy","authors":"Tantan Li, Jiang-hu Zhang, Yong-wen Song, Yu Tang, S. Qi, Feng-ying Lu, Wei Zhang, Zengzhou Wang, Xin-zhi Feng, S. Qin, Bin Cheng, Bofei Liu, Gui-shan Fu, Shulian Wang, J. Dai","doi":"10.3760/CMA.J.CN113030-20190423-00006","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20190423-00006","url":null,"abstract":"Objective \u0000To establish the basic procedures of the application of optical surface monitoring system (OSMS) in the deep inspiration breath hold (DIBH) radiotherapy for patients with left sided breast cancer and compare the performance of OSMS and cone-beam CT (CBCT) in the determination of the set-up errors of DIBH radiotherapy for patients with left sided breast cancer. \u0000 \u0000 \u0000Methods \u0000Twenty patients with left sided breast cancer received DIBH radiotherapy. Through the registration of CBCT images with the planning CT images, and the registration of OSMS radiography images with the outer contour of the body surface, translational set-up errors and rotational errors were determined along the lateral-medial (Rx), superior-inferior (Ry) and anterior-posterior (Rz) directions. Pearson correlation analysis was performed to evaluate the correlation of the set-up errors determined by two methods, and Bland-Altman plot analysis was used to assess the coincidence of these two methods. \u0000 \u0000 \u0000Results \u0000Two methods were positively correlated. The Rz volume was 0.84, 0.74 and 0.84 in the x, y and z directions, and 0.65, 0.41 and 0.54 in the Rx, Ry and Rz directions, respectively (all P<0.01). The 95%CI of agreement were within preset 5 mm tolerance (-0.37-0.42cm, -0.39-0.41cm, -0.29-0.49cm ) in x, y and z directions for two methods. The 95%CI of agreement were within preset 3 ° tolerance -2.9°-1.4°, -2.6°-1.4°, -2.4°-2.5°in Rx, Ry and Rz directions for two methods. The system errors of 20 patients with left sided breast cancer receiving DIBH radiotherapy were <0.18cm and the random errors were <0.24cm. \u0000 \u0000 \u0000Conclusions \u0000OSMS is equivalent to CBCT in the determination and stimulation of set-up errors for patients with left sided breast cancer receiving DIBH radiotherapy. The combination of CBCT and OSMS is a safe and reliable method. \u0000 \u0000 \u0000Key words: \u0000Optical surface monitoring system; Deep inspiration breath hold; Image registration","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"278-282"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47537009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN.113030-20190805-00003
P. Xing, Yongqiang Yang, J. Qian, Ye Tian
Objective According to the SIOPE (2018) guidelines, the whole brain target of patients undergoing craniospinal irradiation was delineated and the underdose of sub-structures which were not delineated in original plan was verified, aiming to provide evidence for the risk of whole brain recurrence of craniospinal irradiation and accumulate experience for the clinical application of SIOPE guidelines. Methods Twelve children who underwent craniospinal irradiation were selected. As per the SIOPE guidelines in 2018, the CTVsub (including the superior orbital fissure, foramen rotundum, foramen ovale, jugular foramen, hypoglossal canal, internal auditory meatus and optic nerve) were delineated based on the original CTVold (whole brain plus sieve plate) to form PTVnew. A rough PTV (PTVrough) was formed by giving a margin of 15 mm forward-downward (skull base) and 3 mm in the other directions. CRTold and IMRTold plans were designed based on PTVold. CRTnew and IMRTnew plans were designed based on PTVnew. CRTrough plan was designed based on PTVrough. The omission of sub-structures based on CTVold and the underdose of CTVsub in each plan were evaluated. Results A total of 78.6% of superior orbital fissure, 71.99% of foramen rotundum, 96.76% of foramen ovale, 88.5% of jugular foramen, 97.71% of hypoglossal canal, 99.48% of internal auditory meatus and 100% of optic nerve volume were missed based on CTVold. The target dose coverage of CTVsub based on CRTold and IMRTold was only 91.70% and 89.83%, respectively. The underdose was observed in 16.66%, 3.57%, 20.83%, 1.78% and 1.19% of sub-structures in CRTold, CRTnew, IMRTold, IMRTnew and CRTrough plans, respectively. Of the underdose of all sub-structures, 38.36% and 46.58% occurred in CRTold and IMRTold plans, respectively. Among them, the least and the most significant underdose occurred in foramen rotundum (0%) and foramen ovale (36.66%), respectively. Conclusions As per the SIOPE guidelines, traditional brain tissue delineation (including sieve plate) is likely to omit part of the target during the cranial target definition of craniospinal irradiation. The most significant underdose occurs in foramen ovale, and more obvious in the IMRT plan. The plan based on the delineation of sub-structures can significantly improve the underdose. When AP-PA irradiation is adopted, a rough PTV is recommended to obtain approximate target dose coverage and organ of risk sparing, whereas it requires further clinical verification. Key words: SIOPE guideline; Craniospinal irradiation; Target definition; Sub-structures
{"title":"Clinical application of SIOPE guidelines in target definition for craniospinal irradiation in children","authors":"P. Xing, Yongqiang Yang, J. Qian, Ye Tian","doi":"10.3760/CMA.J.CN.113030-20190805-00003","DOIUrl":"https://doi.org/10.3760/CMA.J.CN.113030-20190805-00003","url":null,"abstract":"Objective \u0000According to the SIOPE (2018) guidelines, the whole brain target of patients undergoing craniospinal irradiation was delineated and the underdose of sub-structures which were not delineated in original plan was verified, aiming to provide evidence for the risk of whole brain recurrence of craniospinal irradiation and accumulate experience for the clinical application of SIOPE guidelines. \u0000 \u0000 \u0000Methods \u0000Twelve children who underwent craniospinal irradiation were selected. As per the SIOPE guidelines in 2018, the CTVsub (including the superior orbital fissure, foramen rotundum, foramen ovale, jugular foramen, hypoglossal canal, internal auditory meatus and optic nerve) were delineated based on the original CTVold (whole brain plus sieve plate) to form PTVnew. A rough PTV (PTVrough) was formed by giving a margin of 15 mm forward-downward (skull base) and 3 mm in the other directions. CRTold and IMRTold plans were designed based on PTVold. CRTnew and IMRTnew plans were designed based on PTVnew. CRTrough plan was designed based on PTVrough. The omission of sub-structures based on CTVold and the underdose of CTVsub in each plan were evaluated. \u0000 \u0000 \u0000Results \u0000A total of 78.6% of superior orbital fissure, 71.99% of foramen rotundum, 96.76% of foramen ovale, 88.5% of jugular foramen, 97.71% of hypoglossal canal, 99.48% of internal auditory meatus and 100% of optic nerve volume were missed based on CTVold. The target dose coverage of CTVsub based on CRTold and IMRTold was only 91.70% and 89.83%, respectively. The underdose was observed in 16.66%, 3.57%, 20.83%, 1.78% and 1.19% of sub-structures in CRTold, CRTnew, IMRTold, IMRTnew and CRTrough plans, respectively. Of the underdose of all sub-structures, 38.36% and 46.58% occurred in CRTold and IMRTold plans, respectively. Among them, the least and the most significant underdose occurred in foramen rotundum (0%) and foramen ovale (36.66%), respectively. \u0000 \u0000 \u0000Conclusions \u0000As per the SIOPE guidelines, traditional brain tissue delineation (including sieve plate) is likely to omit part of the target during the cranial target definition of craniospinal irradiation. The most significant underdose occurs in foramen ovale, and more obvious in the IMRT plan. The plan based on the delineation of sub-structures can significantly improve the underdose. When AP-PA irradiation is adopted, a rough PTV is recommended to obtain approximate target dose coverage and organ of risk sparing, whereas it requires further clinical verification. \u0000 \u0000 \u0000Key words: \u0000SIOPE guideline; Craniospinal irradiation; Target definition; Sub-structures","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"262-266"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45580546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20181221-00005
Zhenli Wang, A. Zheng, Jian Zhu, H. Du, Xiaodong Sun, Dong Wang, Huitao Wang, Yaowen Zhang, Qingshan Zhu, Z. Cui
Objective To explore the application of ArcCheck system in the validation of Helical and Direct tomotherapy plans for esophageal cancer and summarize relevant experience. Methods The Helical and Direct tomotherapy verification plans were established for 32 patients with esophageal cancer at different positions according to the doctor′s instructions, which were verified by the ArcCHECK system to compare the passing rate of the results.The correlation between the volume of the target area and the passing rate of the planned verification was analyzed. The therapeutic verification plan with a small target volume was made. The target area was placed at the center of ArcCHECK phantom and the area of detectors to statistically compare the verification passing rates. Results Helical plan showed a significantly higher passing rate than the Direct plan (P 0.05). Conclusions The passing rate of the Helical plan is generally higher than that of the Direct plan, which may be related to the angular response of the ArcCHECK detector and the fact that more reference points are not included for calculation due to low-dose radiation. In addition, it may also be related to the higher requirements of Direct plan for tomotherapy dose control system. In the Helical verification plan, when the 3%/3mm criterion is adopted, the larger the target volume, the higher the possibility of lower passing rate, whereas the correlation coefficient between them is relatively low. The high-dose area can be verified by the plans at the center of the phantom or the detection point. With the comprehensive consideration, we suggest putting it at the center of the phantom. Key words: Esophageal neoplasm/helical tomotherapy; ArcCHECK system; Plan verification; Quality assurance
{"title":"Application of ArcCHECK system in the verification of tomotherapy plan for esophageal cancer","authors":"Zhenli Wang, A. Zheng, Jian Zhu, H. Du, Xiaodong Sun, Dong Wang, Huitao Wang, Yaowen Zhang, Qingshan Zhu, Z. Cui","doi":"10.3760/CMA.J.CN113030-20181221-00005","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20181221-00005","url":null,"abstract":"Objective \u0000To explore the application of ArcCheck system in the validation of Helical and Direct tomotherapy plans for esophageal cancer and summarize relevant experience. \u0000 \u0000 \u0000Methods \u0000The Helical and Direct tomotherapy verification plans were established for 32 patients with esophageal cancer at different positions according to the doctor′s instructions, which were verified by the ArcCHECK system to compare the passing rate of the results.The correlation between the volume of the target area and the passing rate of the planned verification was analyzed. The therapeutic verification plan with a small target volume was made. The target area was placed at the center of ArcCHECK phantom and the area of detectors to statistically compare the verification passing rates. \u0000 \u0000 \u0000Results \u0000Helical plan showed a significantly higher passing rate than the Direct plan (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000The passing rate of the Helical plan is generally higher than that of the Direct plan, which may be related to the angular response of the ArcCHECK detector and the fact that more reference points are not included for calculation due to low-dose radiation. In addition, it may also be related to the higher requirements of Direct plan for tomotherapy dose control system. In the Helical verification plan, when the 3%/3mm criterion is adopted, the larger the target volume, the higher the possibility of lower passing rate, whereas the correlation coefficient between them is relatively low. The high-dose area can be verified by the plans at the center of the phantom or the detection point. With the comprehensive consideration, we suggest putting it at the center of the phantom. \u0000 \u0000 \u0000Key words: \u0000Esophageal neoplasm/helical tomotherapy; ArcCHECK system; Plan verification; Quality assurance","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"273-277"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42397213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20181008-00010
Shuirong Yang, Xiao-qiu Ye, Xiao-bo Li, Benhua Xu, Li-Yu Tang, Zhixiong Lin
Objective To design and implement a network-based quality management system for tumor radiotherapy. Methods The system consists of B/S framework-based three-layer structures including the application layer, system service layer and data layer. It utilizes Nutz as the development framework to develop web applications, MySQL as the system database, Java programming language for system development, Tomcat as a system application server for project release and IE, Google and other mainstream browsers to achieve client access server functions. Results The system can support integrated information management and service of quality control institutions at the provincial, municipal and county levels. The functions include procedure management, case management, quality control management, notification announcement, data management and system management, etc. The system has been set up and tested in the cooperation units, and the operation and function are in good condition. Conclusion The system can support the assessment of online quality control, which is conducive to information analysis and sharing, promotes the standardization and normalization of quality control and improves work efficiency. Case management function can monitor the diagnosis and treatment processes of patients, establish continuous electronic record, deliver rational treatment and rehabilitation guidance plan, which play a pivotal role in the evaluation of tumor radiotherapy. Key words: Case follow-up; Web application; Quality control
{"title":"Design and implementation of quality management system for tumor radiotherapy","authors":"Shuirong Yang, Xiao-qiu Ye, Xiao-bo Li, Benhua Xu, Li-Yu Tang, Zhixiong Lin","doi":"10.3760/CMA.J.CN113030-20181008-00010","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20181008-00010","url":null,"abstract":"Objective \u0000To design and implement a network-based quality management system for tumor radiotherapy. \u0000 \u0000 \u0000Methods \u0000The system consists of B/S framework-based three-layer structures including the application layer, system service layer and data layer. It utilizes Nutz as the development framework to develop web applications, MySQL as the system database, Java programming language for system development, Tomcat as a system application server for project release and IE, Google and other mainstream browsers to achieve client access server functions. \u0000 \u0000 \u0000Results \u0000The system can support integrated information management and service of quality control institutions at the provincial, municipal and county levels. The functions include procedure management, case management, quality control management, notification announcement, data management and system management, etc. The system has been set up and tested in the cooperation units, and the operation and function are in good condition. \u0000 \u0000 \u0000Conclusion \u0000The system can support the assessment of online quality control, which is conducive to information analysis and sharing, promotes the standardization and normalization of quality control and improves work efficiency. Case management function can monitor the diagnosis and treatment processes of patients, establish continuous electronic record, deliver rational treatment and rehabilitation guidance plan, which play a pivotal role in the evaluation of tumor radiotherapy. \u0000 \u0000 \u0000Key words: \u0000Case follow-up; Web application; Quality control","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"300-303"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47047213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20190715-00011
Xiaoyang Liu, Xuewen Liu, Hui Wang
Treatment approaches for buccal mucosa carcinoma include surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy and various combinations of these modalities, whereas the clinical efficacy is not satisfactory. In this article, literature review was conducted to summarize the current situation of the diagnosis, lymph node metastasis, treatments of buccal mucosa carcinoma, aiming to provide reference for clinical practice. Key words: Buccal mucosa squamous cell carcinoma/chemoradiotherapy; Buccal mucosa squamous cell carcinoma/immunotherapy; Lymph node metastasis; Current situation
{"title":"Current situation of clinical research of buccal mucosa squamous cell carcinoma","authors":"Xiaoyang Liu, Xuewen Liu, Hui Wang","doi":"10.3760/CMA.J.CN113030-20190715-00011","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20190715-00011","url":null,"abstract":"Treatment approaches for buccal mucosa carcinoma include surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy and various combinations of these modalities, whereas the clinical efficacy is not satisfactory. In this article, literature review was conducted to summarize the current situation of the diagnosis, lymph node metastasis, treatments of buccal mucosa carcinoma, aiming to provide reference for clinical practice. \u0000 \u0000Key words: \u0000Buccal mucosa squamous cell carcinoma/chemoradiotherapy; Buccal mucosa squamous cell carcinoma/immunotherapy; Lymph node metastasis; Current situation","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"304-307"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42741893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-15DOI: 10.3760/CMA.J.CN113030-20190911-00009
Yanfang Wan, W. Ouyang, S. Su, Jun Zhang, Shi-Lin Xu, Zhu Ma, Qingsong Li, Y. Geng, B. Lu
Objective The experimental animal model was established to unravel the mechanism of radiation-induced myocardial fibrosis and validate the role of recombinant human endostatin in aggravating the process of radiation-induced myocardial fibrosis via the TGF-β 1, Smad2 and Smad3 signaling pathways. Methods Sixty male adult Sprague-Dawley rats were randomly divided into the following groups: radiotherapy (RT)25 Gy, recombinant human endostatin (RE) 6 mg/kg, RE 12 mg/kg, RT 25 Gy+ RE 6 mg/kg, RT 25 Gy+ RE 12 mg/kg and blank control groups. Five rats were sacrificed in each group at 1 and 3 months after interventions. The myocardial tissues were collected. The pathological changes were observed by Hematoxylin and eosin staining. The degree of fibrosis was assessed by Masson trichrome staining. The expression levels of TGF-β1, Smad2, Smad3 and Collagen-I mRNA and protein were quantitatively measured by real-time PCR and Western blotting. Results At 3 months after intervention, Masson trichrome staining revealed that the collagen deposition in the RT 25Gy and RT 25Gy+ RE (6 and 12 mg/kg) groups was more significant than that in the control group. In addition, The expression levels of TGF-β1, Smad2, Smad3 and Collagen-I mRNA and protein in these groups were significantly up-regulated compared with those in the control group. Conclusions Radiation with a total physical dose of 25 Gy can induce myocardial fibrosis in the SD rat models. TGF-β 1 and Smad2 signaling pathways are the common signaling pathways of myocardial fibrosis induced by radiation combined with recombinant human endostatin. Key words: Radiation-induced heart disease; Recombinant human endostatin; TGF-β1 gene; Smad2 gene; Smad3 gene; Collagen-I gene
{"title":"Mechanism of radiation combined with recombinant human endostatin in inducing myocardial fibrosis","authors":"Yanfang Wan, W. Ouyang, S. Su, Jun Zhang, Shi-Lin Xu, Zhu Ma, Qingsong Li, Y. Geng, B. Lu","doi":"10.3760/CMA.J.CN113030-20190911-00009","DOIUrl":"https://doi.org/10.3760/CMA.J.CN113030-20190911-00009","url":null,"abstract":"Objective \u0000The experimental animal model was established to unravel the mechanism of radiation-induced myocardial fibrosis and validate the role of recombinant human endostatin in aggravating the process of radiation-induced myocardial fibrosis via the TGF-β 1, Smad2 and Smad3 signaling pathways. \u0000 \u0000 \u0000Methods \u0000Sixty male adult Sprague-Dawley rats were randomly divided into the following groups: radiotherapy (RT)25 Gy, recombinant human endostatin (RE) 6 mg/kg, RE 12 mg/kg, RT 25 Gy+ RE 6 mg/kg, RT 25 Gy+ RE 12 mg/kg and blank control groups. Five rats were sacrificed in each group at 1 and 3 months after interventions. The myocardial tissues were collected. The pathological changes were observed by Hematoxylin and eosin staining. The degree of fibrosis was assessed by Masson trichrome staining. The expression levels of TGF-β1, Smad2, Smad3 and Collagen-I mRNA and protein were quantitatively measured by real-time PCR and Western blotting. \u0000 \u0000 \u0000Results \u0000At 3 months after intervention, Masson trichrome staining revealed that the collagen deposition in the RT 25Gy and RT 25Gy+ RE (6 and 12 mg/kg) groups was more significant than that in the control group. In addition, The expression levels of TGF-β1, Smad2, Smad3 and Collagen-I mRNA and protein in these groups were significantly up-regulated compared with those in the control group. \u0000 \u0000 \u0000Conclusions \u0000Radiation with a total physical dose of 25 Gy can induce myocardial fibrosis in the SD rat models. TGF-β 1 and Smad2 signaling pathways are the common signaling pathways of myocardial fibrosis induced by radiation combined with recombinant human endostatin. \u0000 \u0000 \u0000Key words: \u0000Radiation-induced heart disease; Recombinant human endostatin; TGF-β1 gene; Smad2 gene; Smad3 gene; Collagen-I gene","PeriodicalId":10288,"journal":{"name":"Chinese Journal of Radiation Oncology","volume":"29 1","pages":"294-299"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41524314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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