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Intensity Modulated Proton Therapy for Re-Irradiation of Bulky Loco-Regional Recurrent Breast Cancer: A Case Report

International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2021年第1期10卷 1-11页

作者： Bosco giap Thorsten Ostrander Angie Waldinger Fantine giap huan giap University of Texas Health Science Center College Station TX USA Scripps Clinic La Jolla CA USA University of Florida Gainesville FL USA University of Miami Sylvester Cancer Center Miami FL USA

Patients with recurrent breast cancer to chest wall, who had previous irradiation, are difficult to manage and have limited options. Several reports described the use of photon therapy, hyperthermia, and brachytherapy. This is a case report of a 72-year-old female with Stage IIIA (pT3N1M0) invasive ductal carcinoma of the right breast status post modified radical mastectomy. The patient developed recurrence to the chest wall and one internal mammary lymph node one year later. She received 3-D conformal photon radiation therapy for this recurrence. Two years later, she had progression of the recurrence at the right chest wall and axillary and internal mammary lymph nodes. She was treated with intensity modulated proton therapy (IMPT) for a total of 6600 cGy in 33 fractions. However, four months later, she was found to have biopsy-proven isolated metastatic disease at her right bicep, which was again treated with IMPT for a dose of 6000 cGy in 20 fractions. Proton beam therapy was used in this case to spare dose to the brachial plexus, heart and lung while optimally irradiating the recurrent tumors. At last follow up, the patient is alive and has been disease free for 39 months. This report describes the technique and dosimetry for this unique case, which also reviewed recent series of re-irradiation using proton beam.

关键词： Proton Therapy Breast Cancer Re-Irradiation Intensity Modulated Proton Therapy

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Stereotactic ablative radiotherapy for hepatocellular carcinoma

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Hepatoma Research 2019年第1期5卷 36-48页

作者： Benjamin Spieler Eric A.Mellon Patricia D.Jones huan giap Lynn Feun Shree Venkat LorrainePortelance Department of Radiation Oncology Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFL 33136USA Department of Medicine Division of HepatologyUniversity of MiamiMiamiFL 33136USA Department of Medical Oncology Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFL 33136USA Department of Radiation Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFL 33136USA

Patients with hepatocellular carcinoma(HCC)often present with underlying liver disease and significant comorbidities,limiting treatment *** the development of improved toxicity models and highly conformal radiation delivery systems,external beam radiotherapy has become a valuable treatment option for liver *** cutting edge technology,stereotactic ablative radiotherapy(SABR)allows for the delivery of ablative doses in few fractions while sparing uninvolved liver *** approach permits dose escalation and precise tumor targeting with minimal risk of radiation induced liver *** review clarifies SABR's role alongside liver-directed treatments such as radiofrequency ablation,transarterial radioembolization,and transarterial chemoembolization in the management of *** also examines the promising potential of SABR combined with immunotherapy to treat advanced HCC.

关键词： Hepatocellular carcinoma stereotactic ablative body radiation therapy image guided radiation therapy adaptive radiation therapy radiation toxicity multidisciplinary cancer treatment

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早期乳腺癌保乳术后部分乳腺高剂量率后装加速照射的毒性反应及美容效果

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中华放射肿瘤学杂志 2007年第1期16卷 25-29页

作者：修霞 Tripuraneni Prabhakar giap huan Lin Ray Chu Colin 北京医院放疗科 100730 Tripuraneni Prabhakar Giap HuanLin RayChu Colin

目的介绍早期乳腺癌保乳术后单独行局部高剂量率组织间插植加速照射的方法、副作用及美容效果。方法46例Ⅰ、Ⅱ期乳腺癌的47个乳腺在肿瘤局部扩大切除后使用了高剂量率^192Ir组织间插植瘤床区加速照射（APBI）。符合条件的患者包括年龄... 详细信息

目的介绍早期乳腺癌保乳术后单独行局部高剂量率组织间插植加速照射的方法、副作用及美容效果。方法46例Ⅰ、Ⅱ期乳腺癌的47个乳腺在肿瘤局部扩大切除后使用了高剂量率^192Ir组织间插植瘤床区加速照射（APBI）。符合条件的患者包括年龄＞40岁、T1～T2N0～N1（≤3阳性淋巴结），手术切缘＞1～2mm，小叶癌和炎性乳腺癌除外。术后接受高剂量率近距离放疗，2次／d，间隔至少6h，总量34Gy分10次5d完成。治疗后1、6、12个月及以上观察毒性反应及美容效果。结果全组患者随访18～46个月（中位随访34个月），治疗期间急性反应包括红斑、水肿、乳腺触痛和感染共21例（46％），均为1～2级，无3～4级发生。晚期毒性包括皮肤纤维化、乳腺触痛、脂肪坏死及毛细血管扩张1＋2级加例（43％），3级2例（4％），其中1例疗后接受6个周期系统化疗。美容效果达到极好和良好的在6、12个月分别为95％、98％，无一局部复发。结论早期乳腺癌保乳术后APBI后装组织间插植技术具有良好美容功效，急性和晚期毒性作用小，局部控制率有待于长期随访观察。

关键词：乳腺肿瘤/放射疗法近距离疗法毒性反应美容效果

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Hepatic intra-arterial infusion of yttrium-90 microspheres in the treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report

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World Journal of Gastroenterology 2006年第35期12卷 5729-5732页

作者： Louis Rivera huan giap William Miller Jonathan Fisher Donald J Hillebrand Christopher Marsh Randolph L Schaffer Naval Medical Center San Diego San Diego CA 92134 United States Department of Radiation Oncology Scripps Clinic/ Green Hospital La Jolla CA 92037 United States Department of Hematology/Oncology Scripps Clinic/Green Hospital La Jolla CA 92037 United States Scripps Center for Organ and Cell Transplantation Scripps Clinic/Green Hospital La Jolla CA 92037 United States

Hepatocellular carcinoma (HCC) recurs with a reported frequency of 12%-18% after liver transplantation. Recurrence is associated with a mortality rate exceeding 75%. Approximately one-third of recurrences develop in the transplanted liver and are therefore amenable to local therapy. A variety of treatment modalities have been reported including resection, transarterial chemo- embolization (TACE), radiofrequency ablation (RFA), ethanol ablation, cryoablation, and external beam irradiation. Goals of treatment are tumor control and the minimization of toxic effect to functional parenchyma. Efficacy of treatment is mitigated by the need for ongoing immunosuppression. Yttrium-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results. Twenty-two months after liver transplantation for hepatitis C cirrhosis complicated by HCC, a 42-year old man developed recurrence of HCC in his transplant allograft. Treatment of multiple right lobe lesions with anatomic resection and adjuvant chemotherapy was unsuccessful. Multifocal recurrence in the remaining liver allograft was treated with hepatic intra-arterial infusion of yttrium-90 microspheres (SIR-Spheres, Sirtex Medica Inc., Lake Forest, IL, USA). Efficacy was demonstrated by tumor necrosis on imaging and a decrease in alpha-fetoprotein (AFP) level. There were no adverse consequences of initial treatment.

关键词：肝疾病钇-90 肝细胞癌肝移植

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