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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

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

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

An Overview of cyberknife Radiosurgery

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Chinese Journal of Clinical Oncology 2006年第4期3卷 229-243页

作者： John R.Adler Department of Neurosurgery Stanford University Medical School Stanford Jr.

Stereotactic radiosurgery is a non-invasive procedure that utilizes precisely targeted radiation as an ablative surgical tool. Conventional radiosurgery devices, such as the Gamma Knife, rely upon skeletally attached Stereotactic frames to immobilize the patient and precisely determine the 3D spatial position of a tumor. A relatively new instrument, the cyberknife (Accuray, Inc., Sunnyvale, CA), makes it possible to administer radiosurgery without a frame. The cyberknife localizes clinical targets using a very accurate image-to-image correlation algorithm, and precisely cross-fires high-energy radiation from a lightweight linear accelerator by means of a highly manipulable robotic arm. cyberknife radiosurgery is an effective alternative to conventional surgery or radiation therapy for a range of tumors and some non-neoplastic disorders. This report will describe cyberknife technology and oncologic applications in neurosurgery and throughout the body.

关键词： radiosurgery cyberknife imaged.-guided tumor ablation stereotactic.

Evaluation of Magnetic Resonance Imaging Findings and Short-Term Outcome in Brain Metastatic Tumors after cyberknife Treatment

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2016年第1期5卷 96-99页

作者： Jiashou Hu Hongzi Tian Na Guo Di Wang Jinfeng Sun Medical Imaging Department The People’s Liberation Army 107th Hospital Yantai China The Whole Army Tumor Therapy Center The People’s Liberation Army 107th Hospital Yantai China

Objective: To evaluate the treatments’ outcomes in brain metastatic tumors after cyberknife treatment according to magnetic resonance imaging (MRI) findings and improvement of symptoms. Methods: A retrospective analysis of cyberknife treatment;63 cases of patients with brain metastases;the use of cyberknife treatment;short-term outcome evaluation after treatment and the MRI findings and measured before treatment and underwent diffusion-weighted imaging MRI scan of apparent diffusion coefficient (ADC) values. Results: 3 months after cyberknife treatment and effectiveness were 82.5% and 96.8% respectively;6 months and one year survival rates were 82.5% and 55.6% respectively;the median survival time was 16 months. MRI of 52 patients (67 lesions) ADC values after treatment increased to some extent than before treatment. There are 38 lesions volume to shrink or disappear, no enhancement or slight enhancement in the lesion, no edema zone;27 lesions does not change in volume, no edema (18 lesions significantly weakened the degree of enhancement;6 lesions showed no obvious change enhancement;3 lesions showed ring enhancement, internal cystic);2 lesions volume were larger, heterogeneous enhancement, peripheral edema. Conclusion: cyberknife is an effective method for treating brain metastatic tumor. MRI can accurately evaluate tumor lesions after treatment.

关键词： Brain Metastases Radiation Therapy cyberknife

Absorbed Dose to Water Rate in a cyberknife VSI System Reference Field Using Ionization Chambers and Gafchromic Films

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2017年第1期6卷 80-92页

作者： Guerda Massillon-JL Nestor Aragó n-Martí nez Arnulfo Gó mez-Muñ oz Instituto de Fí sica Universidad Nacional Aut&oacute noma de Mé xico Ciudad de M&eacute xico M&eacute xico Hospital de Oncologí a Centro M&eacute dico Nacional Siglo XXI Ciudad de M&eacute xico México

This work investigated the absorbed dose to water rate under reference conditions in a cyberknife VSI system using radiochromic films EBT3 and MD-V3 and three ionization chambers: an Exradin A12 and two FC65P Welhöfer Scanditronix with different serial numbers. The correction factor,, was studied using a Varian iX linac and the cyberknife system. The measurements in the Varian iX were performed in a 10 × 10 cm2 field, 10 cm depth in liquid water at 90 cm and 70 cm SSD and in a 5.4 × 5.4 cm2 field, 10 cm depth at 70 cm SSD to simulate the cyberknife conditions. In the cyberknife system, measurements were performed using ionization chambers and both film types at 70 cm SSD and 10 cm depth in its 6 cm diameter reference field. The results indicate that ?is independent of the dosimeters and the evaluation methods. Maximum differences of 0.22% - 0.55% (combined uncertainties of 1.22% - 1.98%, k = 1) are obtained on ?using Varian iX, whereas discrepancies of 2.08% - 2.09% (combined uncertainties of 1.87% - 2.13%, k = 1) are observed using the cyberknife system. Given the agreement between detectors and the combined standard uncertainties, the data from Varian iX could be considered the most accurate and consequently a weighted average factor of 0.902 ± 0.006 could be used for the cyberknife VSI system reference field. Within measurement uncertainties, the absorbed dose rate measured in the cyberknife VSI system reference field was found to be independent of the dosimeters used. These results suggest that the absorbed dose measured at a point within a given field size should be the same, regardless the dosimeter used, if their dosimetric characteristics are well known. This highlighted the importance of performing dosimetry by controlling all parameters that could affect the dosimeter response. One can conclude that radiochromic film dosimetry can be considered as an appropriate alternative for measuring absorbed dose to water rate.

关键词： Small Field Dosimetry Reference Field cyberknife Gafchromic Films Ionization Chambers Dose Rate EBT3 MD-V3 6 MV X-Rays

基于蒙特卡罗模拟cyberknife剂量校准与验证的研究

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基于蒙特卡罗模拟CyberKnife剂量校准与验证的研究

作者：朴俊杰中国人民解放军医学院

学位级别：硕士

cyberknife系统采用小射野对患者肿瘤进行立体定向放射治疗,考虑到小射野易形成射线束电子不平衡状态以及探测器介质及其体积的影响,会带来临床剂量测量、计算及评估的困难。本研究通过实施cyberknife系统精确地蒙特卡罗模拟,拟建立一... 详细信息

cyberknife系统采用小射野对患者肿瘤进行立体定向放射治疗,考虑到小射野易形成射线束电子不平衡状态以及探测器介质及其体积的影响,会带来临床剂量测量、计算及评估的困难。本研究通过实施cyberknife系统精确地蒙特卡罗模拟,拟建立一套第三方系统模型,以探讨实现临床非标准参考条件下剂量校准和特定患者计划的剂量验证可能。本研究利用BEAMnrc与DOSXYZnrc软件平台,通过模拟实际cyberknife治疗机头的物理结构,并与射线测量数据(PDDs、OARs、射野输出因子等)的比对,以确定束流参数,从而实施非标准参考条件下剂量标定的研究。选取30例患者治疗计划(其中头部、肺部及肝部肿瘤各10例),相同的射野参数条件下运用治疗计划系统(TPS)中射线追踪算法、蒙特卡罗算法以及开发的BEAM蒙特卡罗模拟算法分别计算出其三维剂量分布,采用Gamma分析方法(3mm/3%)定量评估不同算法之间计算精度的差异性,进而探讨建立基于蒙特卡罗算法模拟(第三方软件)患者计划的剂量验证方法。通过确立束流的平均能量和强度分布半高宽值,蒙卡模拟束流模型与射线束测量数据(PDDs及OARs)比较,均在可接受的偏差范围内(全局90%以上的点误差在2%以内),从而建立了12个准直器(5-60mm)的较为理想蒙卡束流模型,并实现了非标准参考条件下剂量标定工作。对三种算法的剂量计算精度实施了定量评估,Gamma分析结果表明：BEAM蒙卡模拟与TPS蒙卡算法在30例患者治疗计划中均保持了较高的通过率(头部84.882±9.666%,肝部98.830±1.049%,肺部98.263±1.867%);而BEAM蒙卡模拟与TPS射线追踪算法在头部、腹部肿瘤患者计划中通过率较高(头部95.933±3.120%,肝部99.836±0.334%),但在肺部肿瘤患者治疗计划中剂量体积直方图上剂量偏差较为明显,从而两者Gamma通过率相差较大(51.263士38.964%)。因此,基于蒙特卡罗算法模拟(第三方软件工具)实施cyberknife系统患者计划剂量验证的方法是可行的。本课题研究建立的cyberknife系统蒙特卡罗模拟算法将可作为第三方软件的基准工具,在非标准射野剂量校准和患者计划剂量验证中发挥重要的作用。

关键词： cyberknife 蒙特卡罗剂量校准剂量验证 Gamma分析

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cyberknife机房改造辐射防护评价

医疗卫生装备 2014年第7期35卷 88-91页

作者：周振山王军良申戈盛洪国齐伟华解放军307医院放疗科北京100071

目的:介绍某院的cyberknife机房改造情况,对其防护水平进行评价,给出cyberknife机房屏蔽设计的建议。方法:防护设计以Accuray公司生产的cyberknife G3机型治疗时的最大散射条件(6 MV X线,SSD(源皮距)=800 mm、准60 mm准直器,输出剂量率... 详细信息

目的:介绍某院的cyberknife机房改造情况,对其防护水平进行评价,给出cyberknife机房屏蔽设计的建议。方法:防护设计以Accuray公司生产的cyberknife G3机型治疗时的最大散射条件(6 MV X线,SSD(源皮距)=800 mm、准60 mm准直器,输出剂量率为400 cGy/min),按照NCRP151报告屏蔽设计要求进行计算。结果:理论计算中工作人员所受外照射剂量值约为10μSv/a,公众约为27.5μSv/a;实测结果中工作人员所受外照射剂量约为19.5μSv/a,公众约为7.2μSv/a。结论:改造后的cyberknife机房达到了防护设计的要求。

关键词： cyberknife 辐射防护剂量

cyberknife在肿瘤立体定向放射治疗中的应用

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国外医学（肿瘤学分册） 2004年第12期31卷 901-904页

作者：韩俊庆盛巍刘奇山东省立医院肿瘤治疗中心济南250021

cyberknife是一种新型的立体定向放射治疗设备 ,在许多方面具有传统立体定向放射治疗设备无可比拟的优势 ,并已在临床应用中取得了较好的疗效。现主要介绍cyberknife的临床特点及应用。

关键词：立体定位技术放射外科手术肿瘤 cyberknife