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Treatment for paraganglioma with stereotactic radiotherapy

World Journal of Clinical Cases 2024年第16期12卷 2729-2737页

作者： Antonio Pontoriero Paola Critelli Marco Zeppieri Filippo Flavio Angileri Tamara Ius Radiation Oncology Unit Department of BiomedicalDental Science and Morphological and Functional ImagesUniversity of MessinaMessina 98125Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy Neurosurgery Unit Department of BiomedicalDental Science and Morphological and Functional ImagesUniversity of MessinaMessina 98125Italy Neurosurgery Unit Head-Neck and NeuroScience DepartmentUniversity Hospital of UdineUdine 33100Italy

BACKGROUND Paragangliomas(PG)are rare neoplasms of neuroendocrine origin that tend to be highly vascularized,slow-growing,and usually sporadic.To date,common treatment options are surgical resection(SR),with or without radiation therapy(RT),and a watch-and-wait approach.AIM To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT(FSRT)treatment in unresectable PG(uPG).METHODS We retrospectively evaluated patients with uPG(medically inoperable or refused SR)treated with FSRT with a cyberknife System(Accuray Incorporated,Sunnyvale,California).Toxicity and initial efficacy were evaluated.RESULTS From May 2009 to January 2023,6 patients with a median age of 68(range 20-84)were treated with FSRT.The median delivered dose was 21 Gy(range 20-30 Gy)at a median isodose line of 75.5%(range 70%-76%)in 4 fractions(range 3-5 fractions).The median volume was 13.6 mL(range 12.4-65.24 mL).The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively.Site of origin involved were the timpa-nojugular glomus(4/6),temporal bone,and cervical spine.In 1 of the 6 patients,the follow-up was insufficient;5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%.We observed negligible toxicities during and after RT.The majority of patients showed stable symptoms during follow-up.Only 1 patient developed spine metastases.CONCLUSION Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.

关键词： Unresectable paraganglioma Fractionated stereotactic radiation therapy cyberknife Neurosurgery Metastasis

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Comprehensive Treatment Uncertainty Analysis and PTV Margin Estimation for Fiducial Tracking in Robotic Liver Stereotactic Body Radiation Therapy

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当代医学科学(英文) 2023年第3期43卷 572-578页

作者： Zhi-wen LIANG Meng-lan ZHAI Biao TU Xin NIE Xiao-hui ZHU Jun-ping CHENG Guo-quan LI Dan-dan YU Tao ZHANG Sheng ZHANG Cancer Center Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China

Objective This study aims to quantify the uncertainties of cyberknife Synchrony fiducial tracking for liver stereotactic body radiation therapy(SBRT)cases,and evaluate the required planning target volume(PTV)margins.Methods A total of 11 liver tumor patients with a total of 57 fractions,who underwent SBRT with synchronous fiducial tracking,were enrolled for the present study.The correlation/prediction model error,geometric error,and beam targeting error were quantified to determine the patient-level and fraction-level individual composite treatment uncertainties.The composite uncertainties and multiple margin recipes were compared for scenarios with and without rotation correction during treatment.Results The correlation model error-related uncertainty was 4.3±1.8,1.4±0.5 and 1.8±0.7 mm in the superior-inferior(SI),left-right,and anterior-posterior directions,respectively.These were the primary contributors among all uncertainty sources.The geometric error significantly increased for treatments without rotation correction.The fraction-level composite uncertainties had a long tail distribution.Furthermore,the generally used 5-mm isotropic margin covered all uncertainties in the left-right and anterior-posterior directions,and only 75%of uncertainties in the SI direction.In order to cover 90%of uncertainties in the SI direction,an 8-mm margin would be needed.For scenarios without rotation correction,additional safety margins should be added,especially in the superior-inferior and anterior-posterior directions.Conclusion The present study revealed that the correlation model error contributes to most of the uncertainties in the results.Most patients/fractions can be covered by a 5-mm margin.Patients with large treatment uncertainties might need a patient-specific margin.

关键词： cyberknife fiducial tracking liver cancer stereotactic body radiation therapy margin expansion

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Brain metastasis treated with cyberknife

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Chinese Medical Journal 2009年第16期122卷 1847-1850页

作者： WANG Zhi-zhen YUAN Zhi-yong ZHANG Wen-cheng YOU Jin-qiang WANG Ping Key Laboratory of Cancer Prevention and Therapy and Department of Radiation Therapy Tianjin Cancer Hospital of Tianjin Medical University Tianjin 300060 China

Background cyberknife can greatly raise the fractional dose of stereotactic radiosurgery, thus improving its clinical efficacy. We retrospectively analyzed clinical outcomes of brain metastasis treated with cyberknife. Methods We analyzed 40 cases of brain metastases treated with cyberknife in the Tianjin Cancer Hospital from August 1, 2006 to August 1, 2007, for a total of 68 lesions with maximal diameter of 0.4-7.5 cm （average 1.88 cm）. Total hypofractional radiated dosage was 18-36 Gy （5-25 Gy/F, 1-5 F） by cyberknife. We evaluated the remission rate of clinical symptoms, correlation factors to new foci, 3-month local control rates, and 3-month and 1-year survival rates. All patients were followed up for more than 14 months. Results After 1 week, clinical remission was 90.0% （36/40）. After 3 months, the local control rate and therapeutic effective rate were 77.9% （53/68） and 94.1% （64/68）, respectively, as observed by cranium augmentation CT or MRI. The three-month, six-month and 1-year survival rates were 97.5% （39/40）, 82.5% （33/40） and 67.5% （27/40）, respectively. Fourteen patients had neopathy outside the original lesion after 3 months. Neopathy was not correlated with age, whole-brain radiotherapy, number of original lesions, maximum diameter of the original lesion, therapeutic dose per fraction, therapeutic frequency or total therapeutic dose. Conclusions cyberknife got perfect clinical outcomes by higher dosage per fraction. It is an appropriate and valid treatment shortcut for brain metastasis.

关键词： cyberknife brain tumor metastasis clinical practice whole brain radiotherapy

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cyberknife放射治疗肿瘤的临床研究

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中国肿瘤临床 2007年第5期34卷 297-300页

作者：韩俊庆毕迎惠盛巍刘奇山东省立医院肿瘤研究治疗中心济南市250021 山东大学医学院

cyberknife是一种影像引导下的无框架立体定向放射治疗肿瘤的国际前沿性新技术。它可使其放射线到达传统立体定向放射外科治疗技术无法接近的病变部位;在放射治疗前和放疗的过程中,其先进的影像导航系统可对病灶进行准确的实时监控和跟... 详细信息

cyberknife是一种影像引导下的无框架立体定向放射治疗肿瘤的国际前沿性新技术。它可使其放射线到达传统立体定向放射外科治疗技术无法接近的病变部位;在放射治疗前和放疗的过程中,其先进的影像导航系统可对病灶进行准确的实时监控和跟踪;目标如有移动,会补偿性的自动修正治疗床的位置或射束的方向;非等中心照射特征可使放射线的剂量分布在病变部位达到最大程度的均匀性和适形度,消除以往传统立体定向放射外科治疗技术在靶区剂量分布方面存在的冷点和热点问题;既可以实施单次治疗,也可以进行分次照射,是真正意义上的全新概念的肿瘤立体定向放射外科治疗系统。

关键词： cyberknife 放射治疗临床研究

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Hepatic Resection Versus Stereotactic Body Radiation Therapy Plus Transhepatic Arterial Chemoembolization for Large Hepatocellular Carcinoma:A Propensity Score Analysis

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Journal of Clinical and Translational Hepatology 2021年第5期9卷 672-681页

作者： Jing Sun Wen-Gang Li Quan Wang Wei-Ping He Hong-Bo Wang Ping Han Tao Zhang Ai-Min Zhang Yu-Ze Fan Ying-Zhe Sun Xue-Zhang Duan Radiation Oncology Department Fifth Medical Center of Chinese PLA General HospitalBeijingChina Department of Hepatic Surgery Fifth Medical Center of Chinese PLA General HospitalBeijingChina

Background and Aims:There are no comparative studies on the efficacy of hepatic resection(HR)and cyberknife stereotactic body radiation therapy(CK-SBRT)plus transhepatic arterial chemotherapy embolization(TACE)in the treatment of large hepatocellular carcinoma(HCC).Therefore,this study aimed to compare the efficacy of HR and CKSBRT+TACE in large HCC.Methods:A total of one hundred and sixteen patients were selected from November 2011 to December 2016.Among them,50 were allocated to the CKSBRT+TACE group and 66 were allocated to the HR group.The Kaplan-Meier method was applied to calculate overall survival(OS)and progression-free survival(PFS)rates.Propensity score matching was performed to control for baseline differences between the groups.Results:Thirtysix paired patients were selected from the CK-SBRT+TACE and HR groups.After propensity score matching,the 1-,2-and 3-year OS rates were 83.3%,77.8%and 66.7%in the HR group and 80.6%,72.2%and 52.8%in the CKSBRT+TACE group,respectively.The 1-,2-and 3-year PFS rates were 71.6%,57.3%and 42.3%in the HR group and 66.1%,45.8%and 39.3%in the CK-SBRT+TACE group,respectively(OS:p=0.143;PFS:p=0.445).Both a high platelet count and low alpha-fetoprotein value were revealed as influencing factors in improving OS and PFS.Conclusions:CK-SBRT+TACE brought local effects that were similar to those of HR in HCC patients with a large and single lesion.Moreover,the liver injury occurrence rate was acceptable in both groups.

关键词： cyberknife Radiation-induced liver disease Survival rates Large hepatocellular carcinoma

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Influence of Cy berKnife Prescription Isodose Line on the Discrepancy of Dose Results Calculated by the Ray Tracing and Monte Carlo Algorithms for Head and Lung Plans: A Phantom Study

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Current Medical Science 2020年第2期40卷 301-306页

作者： Jing YANG Gang LIU Hong-yuan LIU Xin NIE Zhi-yong YANG Jun HAN Sheng ZHANG Zhi-wen LIANG Cancer Center Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430023China

Incorporation of the Monte Carlo(MC)algorithm in optimizing cyberknife(CK)plans is cumbersome,and early models unconfigured MC calculations,therefore,this study investigated algorithm-based dose calculation discrepancies by selecting different prescription isodose lines(PIDLs)in head and lung CK plans.CK plans were based on anthropomorphic phantoms.Four shells were set at 2-60 mm from the target,and the constraint doses were adjusted according to the design stratcgy.After optimization,30%-90%PIDL plans were generated by ray tracing(RT).In the evaluation module,CK plans were recalculated using the MC algorithm.Therefore,the dosimetric parameters of different PIDL plans based on the RT and MC algorithms were obtained and analyzed.The discrepancies(mean+SD)were 3.72%+0.31%,3.40%+0.11%,3.47%+0.32%,0.17%+0.11%,0.64%+3.60%,7.73%+1.60%,14.62%+3.21%and 10.10%+1.57%for Djs,Dmeam),Dys,and coverage of the PTV,DGI,V,,V;and V,in the head plans and-6.32%+1.15%,-13.46%+0.98%,-20.63%+2.25%,-34.78%+25.03%,12248%+175.60%,-12.92%+5.41%,3.19%+4.67%and 7.13%+1.56%in the lung plans,respectively.The following parameters were significantly correlated with PIDL:dp98%at the 0.05 level and dpal,dys and dv3 at the 0.01 level for the head plans;dp98e%at the 0.05 level and do1e%,dpmeam,Ccoweange,dool,dvs and dv;at the 0.01 level for the lung plans.RT may be used to calculate the dose in CK head plans,but when the dose of organs at risk is close to the limit,it is necessary to refer to the MC results or to further optimize the CK plan to reduce the dose.For lung plans,the MC algorithm is recommended.For early models without the MC algorithm,a lower PIDL plan is recommended;otherwise,a large PIDL plan risks serious underdosage in the target area.

关键词： cyberknife prescription isodose line Monte Carlo ray tracing phantom

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cyberknife治疗颅底肿瘤的初步观察

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中华神经外科杂志 2008年第8期24卷 634-635页

作者：王晓光刘群袁智勇李丰彤宋勇春董洋王境生杨树源王平天津医科大学肿瘤医院Cyberkinfe中心 300060

颅底肿瘤的手术风险及难度是神经外科医生面临的巨大挑战，放射外科对于许多病人来说是一个理想的选择。但目前常用的放射外科由于设备本身的缺陷，对于一些较大的、形状不规则、临近放射线比较敏感的重要结构的肿瘤治疗效果欠佳。射波... 详细信息

颅底肿瘤的手术风险及难度是神经外科医生面临的巨大挑战，放射外科对于许多病人来说是一个理想的选择。但目前常用的放射外科由于设备本身的缺陷，对于一些较大的、形状不规则、临近放射线比较敏感的重要结构的肿瘤治疗效果欠佳。射波刀（cyberknife）是近年来出现的放射外科设备，它依靠影像引导，不需要框架，同时可以做到高度适形，并且精度与伽玛刀相近或更好。我院自2006年8月至2008年3月，应用cyberknife已治疗了300多病人，500多个病灶，取得了良好的治疗效果。其中58例颅底肿瘤已得到3个月以上的随访。现总结如下，以供商榷。

关键词： cyberknife 颅底肿瘤治疗效果放射外科外科设备神经外科手术风险影像引导

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Field Size Evaluation with a High Resolution 2D Diode Array for Variable-Aperture Collimators Used in Robotic Radiosurgery

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2023年第3期12卷 84-97页

作者： Xiaofeng Zhu Wei Nie James David George Qianyi Xu Dandan Zheng Jiajin Fan Inova Schar Cancer Institute Fairfax Virginia USA University of Rochester Medical Center Rochester NY USA

Robotic radiosurgery/Radiotherapy is increasingly adopted in clinics, and quality assurance (QA) of cyberknife’s variable-aperture IrisTM collimators requires sub-millimeter precision. Conventional film-based QA for the 12 IrisTM cone sizes (ranging from 5 to 60 mm) is both time consuming (120 minutes for all or 30 minutes for 3 cone sizes) and highly experience dependent. To improve the efficiency, a high-resolution 2D diode detector array, sampling every 2.5 mm, was evaluated for IrisTM aperture size QA. This study focused on a spatial frequency analysis, a dose profile reconstruction, and a sensitivity study to beam size variances. Dose profiles of the 12 cones scanned with a high-resolution diode in a water tank were utilized as the gold standard for comparison. Spatial Fourier transform of these profiles were analyzed to explore applicable sampling frequency. Next, the dose profiles were artificially sampled with a 2.5 mm gap, and then interpolated using a Python-based cubic B-spline. Finally, sensitivity of the diode array system to various field sizes was measured by changing source to detector distance. We found, utilizing the diodes system, QA time was reduced to less than 10 minutes. Spatial frequency of the dose profile showed little contribution beyond 0.2 mm-1, so a Nyquist sampling of 0.4 mm-1 is appropriate for dose verification, corresponding to a 2.5 mm gap. Dose profiles were reconstructed using Cubic B-spline with good agreements to nominal for cones 7.5 mm and larger. The measured IrisTM size using the SRS MapCheck had a standard error of ±0.12 mm. Primarily, the 2D Diode array with a spatial resolution 0.4 mm-1 is appropriate for dose verification for these cones above 7.5 mm, and its application would substantially improve IrisTM QA efficiency.

关键词： cyberknife Diode Array QA FFT

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cyberknife中Fixed/Iris准直器对肝癌患者治疗计划的影响及评价

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中国医学物理学杂志 2017年第8期34卷 762-765页

作者：朴俊杰徐寿平段学章曲宝林丁俊强王金媛徐慧军解放军总医院放疗科北京100853 解放军第302医院肿瘤放射治疗中心北京100039

目的:探讨及评价不同准直器(Fixed/Iris)的选择对治疗计划剂量学特点的影响。方法:选取12例肝癌患者影像数据,统一给予靶区剂量50 Gy/5 F,在相同条件下分别对每例患者选择Fixed与Iris准直器进行治疗计划设计,通过靶区适形度指数(CI)、... 详细信息

目的:探讨及评价不同准直器(Fixed/Iris)的选择对治疗计划剂量学特点的影响。方法:选取12例肝癌患者影像数据,统一给予靶区剂量50 Gy/5 F,在相同条件下分别对每例患者选择Fixed与Iris准直器进行治疗计划设计,通过靶区适形度指数(CI)、均匀性指数(HI)、梯度指数(GI)、正常肝脏平均受量以及治疗时间等参数,分析评估计划优化质量及实施效率。结果:Iris组计划执行的平均治疗时间明显优于Fix组[(48.33±1.92)min vs(51.50±1.88)min,t=4.23,P=0.001],而CI(0.79±0.07 vs 0.80±0.08,t=0.52,P=0.613)、HI(0.42±0.14 vs 0.41±0.14,t=0.35,P=0.733)、GI(3.66±0.61 vs 3.60±0.50,t=1.15,P=0.273)、处方剂量归一值[(76.92±6.55)%vs(77.00±6.34)%,t=0.18,P=0.857]以及正常肝脏平均受量[(5.15±1.25)Gy vs(5.16±1.27)Gy,t=0.63,P=0.542]则无统计学差异。结论:cyberknife系统中使用Iris相对Fixed准直器而言,除治疗时间明显缩短外,没有显著的剂量学差异。而对于其他部位肿瘤患者的治疗计划有无差异,还需进一步探讨和研究。

关键词：肝癌 cyberknife Fixed准直器 Iris准直器剂量

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cyberknife治疗脊柱脊髓肿瘤的初步观察

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中华放射肿瘤学杂志 2008年第4期17卷 317-318页

作者：王晓光刘群袁智勇宋勇春李丰彤董洋王境生杨树源王平天津医科大学附属肿瘤医院神经肿瘤科cyberknife中心 300060

由于脊髓对放射线的耐受量较低，使得传统的立体定向放射外科设备对于脊柱脊髓肿瘤的治疗难以达到颅内病变的治疗效果。cyberknife通过实时影像追踪病变的位置变化，及时校正射线的方向，克服了精确定位的难题；而且它可以控制每条射线... 详细信息

由于脊髓对放射线的耐受量较低，使得传统的立体定向放射外科设备对于脊柱脊髓肿瘤的治疗难以达到颅内病变的治疗效果。cyberknife通过实时影像追踪病变的位置变化，及时校正射线的方向，克服了精确定位的难题；而且它可以控制每条射线的剂量和入射角度，从而可以达到极佳的适形效果，使得脊柱脊髓病变的放射外科达到了和颅内病变相同的精确性和适形性，

关键词： cyberknife 脊柱脊髓肿瘤治疗效果颅内病变立体定向放射放射线外科设备位置变化

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