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Clinical treatment considerationsin the intensity-modulated radiotherapy era for patients with NO-category nasopharyngeal carcinoma and enlarged neck lymph nodes

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Chinese Journal of Cancer 2017年第7期36卷 306-314页

作者： Hao Peng Lei Chen Rui Guo Yuan Zhang Wen.Fei Li Yan.Ping Mao Ying Sun Fan Zhang Li.Zhi Liu Li Tian Jun Ma State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Sun Yat-sen University Cancer Center Guangzhou 510060 Guangdong P. R. China Department of Radiation Oncology Sun Yat-sen University Cancer Center Guangzhou 510060 Guangdong P. R. China Imaging Diagnosis and Interventional Center Sun Yat-sen University Cancer Center Guangzhou 510060 Guangdong P. R. China State Key Laboratory of Oncology in South China Department of Radiation OncologySun Yat-sen University Cancer Center 651 Dongfeng Road East Guangzhou 510060 P. R. China

Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive ***,no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes(ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph *** study aimed to determine the prognostic value and radiation dose for ENLNs in NO-category NPC patients treated with intensity-modulated radiotherapy(IMRT).Methods:We reviewed the medical data of 251 patients with non-metastatic,NO-category NPC treated with *** operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease *** biological equivalent dose(BED) for ENLNs was *** survival was compared between the small and large ENLN *** prognostic factors were identified using the Cox proportional hazards ***:The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs 0.05 for all survival rates).In the subgroup analysis,patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN *** multivariate analysis also confirmed that BED≥72 Gy was not associated with significantly improved prognosis in patients with NO-category ***:A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with NO-category *** studies are warranted to validate the findings in the present study.

关键词： Nasopharyngeal carcinoma N0-category Enlarged neck lymph node Biological equivalent dose intensity-modulated radiotherapy Prognosis

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Quantifying lateral penumbra advantages of collimated spot-scanning beam for intensity-modulated proton therapy

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Nuclear Science and Techniques 2019年第11期30卷 52-59页

作者： Chun-Bo Liu Yun-Tao Song Hong-Dong Liu Hai-Zhou Xue Han-Sheng Feng University of Science and Technology of China Hefei 230026China Institute of Plasma Physics Hefei Institutes of Physical ScienceChinese Academy of SciencesHefei 230031China Hefei CAS Ion Medical and Technical Devices Co. LtdHefei 230088China

intensity-modulated proton therapy(IMPT)is becoming essential for proton therapy and is under rapid ***,for IMPT,the lateral penumbra of the spot-scanning proton beam is still an urgent issue to be ***-specific block collimators(PSBCs),which can block unnecessary doses,play a crucial role in passive scattering delivery technology but are rarely used in spot *** objective of this study is to investigate the lateral penumbra variations of intensity-modulated spot scanning with and without a *** fields with varying degrees of sharpness and at varying depths in a water phantom,the lateral penumbral widths were calculated using a Monte Carlo-based dose engine from RayStation *** results suggest that the lateral penumbral widths can be reduced by more than 30%for uniform target volumes,regardless of whether a range-shifter is used,and that the maximum dose beyond the field edges can be reduced *** results of patient cases show that the doses in organs-at-risk near the edge of the target volume decrease if a PSBC is *** study demonstrates that intensity-modulated spot scanning with a PSBC can effectively reduce the lateral penumbra and block unnecessary doses and is therefore promising for clinical applications in spot-scanning proton therapy.

关键词： Lateral penumbra Patient-specific block collimator Monte Carlo intensity-modulated proton therapy

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Long-term outcomes of a phase Ⅱ randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma

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Chinese Journal of Cancer 2016年第4期35卷 181-189页

作者： Ying Guan Shuai Liu Han-Yu Wang Ying Guo Wei-Wei Xiao Chun-Yan Chen Chong Zhao Tai-Xiang Lu Fei Han Department of Radiation Oncology Affiliated Cancer Hospital of Guangxi Medical University Cancer Institute of Guangxi Zhuang Autonomous RegionNanning 530021 Guangxi P. R. China Department of Radiotherapy Oncology The Sixth Affiliated Hospital of Sun Yat-sen University Guangzhou 510655Guangdong P. R. China Department of Radiotherapy Oncology Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medical 651 Dongfeng Road East Guangzhou 510060 Guangdong P. R. China Department of Clinical Trial Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medical Guangzhou 510060 Guangdong P. R. China

Background:Salvage treatment for locally recurrent nasopharyngeal carcinoma(NPC) is complicated and relatively ***,combined with effective concomitant chemotherapy,may improve clinical treatment *** conducted a phase Ⅱ randomized controlled trial to evaluate the efficacy of intensity-modulated radiotherapy with concomitant weekly cisplatin on locally recurrent ***:Between April 2002 and January 2008,69 patients diagnosed with non-metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group(n = 34) or radiotherapy alone group(n = 35).All patients received intensity-modulated *** radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days(range 23-53 days).The concomitant chemotherapy schedule was cisplatin 30 mg/m^2 by intravenous infusion weekly during ***:The median follow-up period of all patients was 35 months(range 2-112 months).Between concomitant chemoradiotherapy and radiotherapy groups,there was only significant difference in the 3-year and 5-year overall survival(OS) rates(68.7%vs.42.2%,P = 0.016 and 41.8%vs.27.5%,P = 0.049,respectively).Subgroup analysis showed that concomitant chemoradiotherapy significantly improved the 5-year OS rate especially for patients in stage rT3-4(33.0%vs.13.2%,P = 0.009),stages Ⅲ-Ⅳ(34.3%vs.13.2%,P = 0.006),recurrence interval >30 months(49.0%vs.20.6%,P = 0.017),and tumor volume >26 cm^3(37.6%vs.0%,P = 0.006).Conclusion:Compared with radiotherapy alone,concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC,especially those with advanced T category(rT3-4) and stage(lll-IV) diseases,recurrence intervals >30 months,and tumor volume >26 cm^3.

关键词： Recurrence Nasopharyngeal carcinoma intensity-modulated radiation therapy Concomitant chemoradiotherapy Cisplatin

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Intensified intensity-modulated radiotherapy in anal cancer with prevalent HPV p16 positivity

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World Journal of Gastroenterology 2015年第37期21卷 10688-10696页

作者： Liliana Belgioia Stefano Vagge Dario Agnese Stefania Garelli Roberto Murialdo Giuseppe Fornarini Silvana Chiara Fabio Gallo Almalina Bacigalupo Renzo Corvò Department of Radiation Oncology AOU IRCCS San Martino - IST National Cancer Research Institute and University Department of Medical Physics AOU IRCCS San Martino - IST National Cancer Research Institute and University Department of Internal Medicine University of Genoa Department of Medical Oncology AOU IRCCS San Martino - IST National Cancer Research Institute and University Section of Biostatistics Department of Health Sciences University of Genoa

AIM: To investigate the toxicity and response of intensity-modulated radiotherapy schedule intensified with a simultaneous integrated boost in anal canal ***: From March 2009 to March 2014, we retrospectively analyzed 41 consecutive patients treated with intensity-modulated radiotherapy(IMRT) and concurrent chemotherapy for anal canal squamous cell carcinoma at our center. Radiotherapy was delivered via simultaneous integrated boost(SIB) technique by helical tomotherapy, and doses were adapted to two clinical target volumes according to the tumor-nodemetastasis(TNM) stage: 50.6 Gy and 41.4 Gy in 23 fractions in T1N0, 52.8 Gy and 43.2 Gy in 24 fractionsin T2N0, and 55 Gy and 45 Gy in 25 fractions in all patients with N positive and/or ≥ T3, respectively, to planning target volumes 1 and 2. The most common chemotherapy regimen was 5-fluorouracil and mitomycin-based. Human papilloma virus(HPV) p16 expression was performed by immunohistochemistry and evaluated in the majority of patients. Acute and late toxicity was scored according to CTCAe v 3.0 and RTOG ***: The median follow-up was 30 mo(range:12-71). Median age was 63 years(range 32-84). The stage of disease was: stage Ⅰ in 2 patients, stage Ⅱin 13 patients, stage ⅢA in 12 patients, and stage ⅢB in 14 patients, respectively. Two patients were known to be HIV positive(4.9%). HPV p16 expression status was positive in 29/34(85.3%) patients. The 4-year progression-free survival and overall survival in HPVpositive patients were 78% and 92%, *** grade 3 skin and gastrointestinal toxicities were reported in 5% and 7.3% of patients, respectively;patients' compliance to the treatment was good due to a low occurrence of severe acute toxicity, although treatment interruptions due to toxicity were required in 7.3% of patients. At 6 mo from end of treatment,36/40(90%) patients obtained complete response;during follow-up, 5(13.8%) patients presented with disease progression(local or systemic)

关键词： Anal canal cancer intensity-modulated radiotherapy

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Significant value of 18F-FDG-PET/CT in diagnosing small cervical lymph node metastases in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

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Chinese Journal of Cancer 2017年第12期36卷 757-766页

作者： Hao Peng Lei Chen Ling-Long Tang Wen-Fei Li Yan-Ping Mao Rui Guo Yuan Zhang Li-Zhi Liu Li Tian Xu Zhang Xiao-Ping Lin Ying Guo Ying Sun Jun Ma Department of Radiation Oncology State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Imaging Diagnosis and Interventional Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Nuclear Medicine State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China Department of Clinical Trials Center State Key Laboratory of Oncology in Southern ChinaCollaborative Innovation Center for Cancer MedicineSun Yat-sen University Cancer CenterGuangzhou 510060GuangdongP.R.China

Background: Little is known about the nature of metaistasis to small cervical lymph nodes(SCLNS) in the patients with nasopharyngeal carcinoma(NPC)examined by using 18-fluoro-2-deoxy-glucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT).The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC ***: Magnetic resonance images(MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined ***: In total, 2082 SCLNs were identified, with 808(38.8%) ≥ 5 and < 6 mm in diameter(group A), 526(25.3%)≥ 6 and < 7 mm in diameter(group B),374(18.0%)≥ 7 and < 8 mm in diameter(group C), 237(11.4%) ≥8 and<9 mm in diameter(group D),and 137(6.5%) ≥ 9 and <10 mm in diameter(group E).The overall metastatic rates examined by using PET/CT for groups A, B,C,D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively(P< 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modification of N category and overall stage for 135(28.7%) and 46(9.8%) patients, respectively. The areas under curve of MRIdetermined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free ***: PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.

关键词： Nasopharyngeal carcinoma 18-fluoro-2-deoxy-glucose positron emission tomography with computed tomography (18F-PET/CT) Magnetic resonance image intensity-modulated radiotherapy Small cervical lymph nodes

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Selective partial salivary glands sparing during intensity-modulated radiation therapy for nasopharyngeal carcinoma

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Oncology and Translational Medicine 2017年第2期3卷 65-70页

作者： Guangjin Yuan Qianwen Li Shixian Chen Chengwei Zheng Jiang Tang Jiang Hu Ximing Xu Department of Oncology Nationality Hospital of Qianjiang Cancer Center The 82nd Hospital of the Chinese People’s Liberation Army Cancer Center Renmin Hospital of Wuhan University

Objective This study evaluated the dosimetric consequences of selective partial salivary gland sparing during intensity-modulated radiotherapy(IMRT) for patients with nasopharyngeal carcinoma(NPC).Methods Ten patients with NPC were enrolled in the *** IMRT plans were produced for each patient:conventional(control) and partial salivary glands-sparing(treatment),with dose constraints to the entire parotid glands or partial salivary glands(including the parotid and submandibular glands,delineated with the adjacent distance of at least 0.5 cm between the glands and PTV,the planning target volume) in planning,*** parameters were compared between the two plans,including the V_(110%),V_(100%),V_(95%)(the volume covered by more than 110%,100%,or 95% of the prescribed dose),Dmin(the minimum dose) of PTV,homogeneity index(HI),conformity index(CI),and the mean dose and percentage of the volume receiving 30 Gy or more(V_(30)) for the parotid glands and submandibular *** Treatment plans had significantly lower mean doses and V_(30) to both the entire parotid glands and partial parotid glands than those in control *** mean doses to the partial submandibular glands were also significantly lower in treatment plans than in control *** PTV coverage was comparable between the two plans,as indicated by V_(100%),V_(95%),Dmin,CI,and *** doses to critical structures,including brainstem and spinal cord,were slightly but not significantly higher in treatment plans than in control *** A selective partial salivary gland-sparing approach reduces the doses to parotid and submandibular glands during IMRT,which may decrease the risk of post-radiation xerostomia while not compromising target dose coverage in patients with NPC.

关键词： nasopharyngeal carcinoma intensity-modulated radiotherapy selective partial salivarygland sparing

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Dose Comparison between Eclipse Dose Calculation and Fast Dose Calculator in Single- and Multi-Field Optimization intensity-modulated Proton Therapy Plans with Various Multi-Beams for Brain Cancer

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2017年第4期6卷 421-432页

作者： Ryosuke Kohno Wenhua Cao Pablo Yepes Xuemin Bai Falk Poenisch David R. Grosshans Tetsuo Akimoto Radhe Mohan Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX USA Division of Radiation Oncology and Particle Therapy Exploratory Oncology Research & Clinical Trial Center National Cancer Center Hospital East Kashiwa Japan Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston TX USA

The purpose of this study was to grasp current potential problems of dose error in intensity-modulated proton therapy (IMPT) plans. We were interested in dose differences of the Varian Eclipse treatment planning system (TPS) and the fast dose calculation method (FDC) for single-field optimization (SFO) and multi-field optimization (MFO) IMPT plans. In addition, because some authors have reported dosimetric benefit of a proton arc therapy with ultimate multi-fields in recent years, we wanted to evaluate how the number of fields and beam angles affect the differences for IMPT plans. Therefore, for one brain cancer patient with a large heterogeneity, SFO and MFO IMPT plans with various multi-angle beams were planned by the TPS. Dose distributions for each IMPT plan were calculated by both the TPS’s conventional pencil beam algorithm and the FDC. The dosimetric parameters were compared between the two algorithms. The TPS overestimated 400 - 500 cGy (RBE) for minimum dose to the CTV relative to the dose calculated by the FDC. These differences indicate clinically relevant effect on clinical results. In addition, we observed that the maximum difference in dose calculated between the TPS and the FDC was about 900 cGy (RBE) for the right optic nerve, and this quantity also has a possibility to have a clinical effect. The major difference was not seen in calculations for SFO IMPT planning and those for MFO IMPT planning. Differences between the TPS and the FDC in SFO and MFO IMPT plans depend strongly on beam arrangement and the presence of a heterogeneous body. We advocate use of a Monte Carlo method in proton treatment planning to deliver the most precise proton dose in IMPT.

关键词： Fast Dose Calculator Monte Carlo intensity-modulated Proton Therapy Single-Field Optimization (SFO) Multi-Field Optimization (MFO)

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A prospective trial of volumetric intensity-modulated arc therapy vs conventional intensity modulated radiation therapy in advanced head and neck cancer

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World Journal of Clinical Oncology 2012年第4期3卷 57-62页

作者： Simon D Fung-Kee-Fung Rachel Hackett Lee Hales Graham Warren Anurag K Singh Department of Radiation Medicine Roswell Park Cancer Institute University at Buffalo School of Medicine Elm and Carlton Streets Buffalo NY 14214 United States

AIM: To prospectively compare volumetric intensitymodulated arc therapy(VMAT) and conventional intensity-modulated radiation therapy(IMRT) in coverage of planning target volumes and avoidance of multiple organs at risk(OARs) in patients undergoing definitive chemoradiotherapy for advanced(stage Ⅲ or Ⅳ)squamous cell cancer of the head and neck. METHODS: Computed tomography scans of 20 patients with advanced tumors of the larynx, naso-, oroand hypopharynx were prospectively planned using IMRT(7 field) and VMAT using two arcs. Calculated doses to planning target volume(PTV) and OAR were compared between IMRT and VMAT plans. Dose-volume histograms(DVH) were utilized to obtain calculated doses to PTV and OAR, including parotids, cochlea,spinal cord, brainstem, anterior tongue, pituitary and brachial plexus. DVH's for all structures were compared between IMRT and VMAT plans. In addition the planswere compared for dose conformity and homogeneity. The final treatment plan was chosen by the treating radiation oncologist. RESULTS: VMAT was chosen as the ultimate plan in 18 of 20 patients(90%) because the plans were thought to be otherwise clinically equivalent. The IMRT plan was chosen in 2 of 20 patients because the VMAT plan produced concentric irradiation of the cord which was not overcome even with an avoidance structure. For all patients, VMAT plans had a lower number of average monitor units on average(MU = 542.85) than IMRT plans(MU = 1612.58)(P < 0.001). Using the conformity index(CI), defined as the 95% isodose volume divided by the PTV, the IMRT plan was more conformal with a lower conformity index(CI = 1.61) than the VMAT plan(CI = 2.00)(P = 0.003). Dose homogeneity, as measured by average standard deviation of dose distribution over the PTV, was not different with VMAT(1.45 Gy) or IMRT(1.73 Gy)(P = 0.069). There were no differences in sparing organs at ***: In this prospective study, VMAT plans were chosen over IMRT 90% of the time. Compared to IMRT, V

关键词： Volumetric intensity-modulated arc therapy intensity-modulated radiation therapy Target coverage Organs at risk

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A Novel Temperature-Compensated, intensity-modulated Fiber Bragg Grating Sensor System

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Journal of Electronic Science and Technology of China 2008年第4期6卷 434-437页

作者： Xin-Yong Dong Hwa-Yaw Tam Key Laboratory of Zhejiang Province on ModemMeasurement Technology and Instrument and College of Optical ＆Electronic Technology China Jiliang University Hangzhou 310018China Photonics Research Centre and Department of Electrical Engineering The Hong Kong Polytechnic University Hong Kong

An intensity-modulated, fiber Bragg grating （FBG） sensor system based on radio-frequency （RF） signal measurement is presented. The RF signal is generated at a photodetector by two modulated optical signals reflected from the sensing FBG and a reference one. Bragg wavelength shift of the sensing FBG changes intensity of the RF signal by changing phase difference between the two optical signals, with temperature effect being compensated automatically by the reference FBG, Strain measurement with a maximum sensitivity of -0.34 μV/με has been achieved.

关键词： Optical fiber sensing fiber Bragg gratings intensity-modulated strain.

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Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis

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Oncology and Translational Medicine 2019年第1期5卷 25-29页

作者： Yi Cheng Nan Huang Jing Zhao Jianhua Wang Chen Gong Kai Qin Department of Oncology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Allergy Department Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two grou

关键词： simultaneous integrated dose-increasing intensity-modulated radiation therapy late-course dose-increasing intensity-modulated radiation therapy cervical cancer complicated with pelvic lymph node metastasis clinical efficacy safety

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