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Role of radiation therapy in gastric adenocarcinoma

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World Journal of Gastroenterology 2006年第10期12卷 1511-1520页

作者： Lisa Hazard John O'Connor Courtney Scaife Departments of radiation Oncology University of Utah School of Medicine Salt Lake CityUTUnited States Department of radiation Oncology Tulane University New OrleansLAUnited States Departments of Surgery University of Utah School of Medicine Salt Lake CityUTUnited States

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

关键词： radiation therapy Gastric cancer Stomach cancer Chemoradiation Adjuvant therapy Neoadjuvant therapy Intra-operative radiation therapy 3D conformal radiation therapy intensity modulated radiation therapy

Complete response to radiation therapy of orbital metastasis from hepatocellular carcinoma

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World Journal of Gastroenterology 2009年第47期15卷 6000-6003页

作者： Allison M Quick Mark Bloomston Edward Y Kim Nathan C Hall Nina A Mayr Department of radiation Medicine Arthur G.James Cancer HospitalThe Ohio State University Medical CenterColumbusOH 43210 United States Department of Surgical Oncology The Ohio State University Medical CenterColumbusOH 43210 United States Department of Radiology The Ohio State University Medical CenterColumbusOH 43210United States

The incidence of hepatocellular carcinoma(HCC)is increasing in the United States,and 50%-75%o patients with HCC will develop metastatic disease Orbital metastases from HCC are extremely *** report the case of a 52-year-old male with known metastatic HCC,who presented with severe proptosis and *** orbital mass was identified on magnetic resonance imaging(MRI)and confirmed to have hypermetabolic activity on positron emission tomography/computed *** received a palliative course of external beam radiation therapy to the right *** modulated radiation therapy (IMRT)was used to allow sparing of critical norma tissues in close proximity to the *** month after completion of IMRT to 58 Gray in 30 fractions delivered over 6 wk,the patient had a complete clinical,radiologic(MRI)and symptomatic response The patient continues to have local control in the orbi 1.7 years after therapy *** critical norma structures were kept below the tolerance dose using IMRT,and no toxicities were observed.

关键词： Hepatocellular carcinoma Eye neoplasms Metastasis intensity modulated radiation therapy Palliative therapy

Neoadjuvant chemoradiotherapy for locally advanced gastric cancer with bulky lymph node metastasis:Five case reports

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World Journal of Clinical Cases 2020年第18期8卷 4177-4185页

作者： Eiji Nomura Hajime Kayano Takashi Machida Hideki Izumi Soichiro Yamamoto Akitomo Sugawara Masaya Mukai Terumitsu Hasebe Department of Gastroenterological and General Surgery Tokai University Hachioji HospitalHachioji 192-0032TokyoJapan Department of Radiology Tokai University Hachioji HospitalHachioji 192-0032TokyoJapan

BACKGROUND Neoadjuvant chemoradiotherapy(NACRT)has not been accepted as a general therapy for gastric cancer because of its localized effect and toxicity for radiosensitive ***,if radiation therapy could compensate for the limited or inadequate treatment choices available for elderly patients and/or those at high risk,the available therapeutic options for advanced gastric cancer might *** this perspective,we present our experiences of five patients with advanced gastric cancer in whom we used NACRT therapy with interesting *** SUMMARY We admitted five patients with clinical Stage III gastric cancer and bulky lymph node metastasis or adjacent organ invasion at the time of diagnosis.A total of 50 Gy of preoperative intensity modulated radiation therapy was delivered to the patients in doses of 2.0 Gy/d,together with a regimen of concomitant chemotherapy comprising two courses of oral tegafur/gimeracil/oteracil(S-1;65 mg/m2 per day)for three consecutive weeks followed by two weeks of rest,starting at the same time as *** patients underwent no residual tumor resection and a pathological complete response of the primary tumors was achieved in two *** incidence of hematological toxicity was low,although the digestive toxicities of anorexia and diarrhea developed in three of the five patients,necessitating termination of radiation therapy at 30 Gy and S-1 at three ***,even 30 Gy of irradiation and half the dose of S-1 resulted in sufficient downstaging,indicating that even a reduced amount of NACRT could confer considerable *** Slightly reduced NACRT might be useful and safe for patients with locally advanced gastric cancer.

关键词： Advanced gastric cancer Neoadjuvant chemoradiotherapy intensity modulated radiation therapy Tegafur/gimeracil/oteracil Curative resection Case report Gastrectomy

Dose Distribution Verifications of IMRT for NPC

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2009年第5期29卷 673-676页

作者：李勤李良韩军梁志文 Cancer Center Union HospitalTongji Medical CollegeHuazhong University of Science and Technology

In order to explore a dose distribution verification procedure of intensity modulated radiation therapy （IMRT） for nasopharyngeal carcinoma （NPC） and establish its evaluation criteria, we performed 35 two-dimensional （2D） patient-specific IMRT verifications over the year i006. The percent of pixels passing 7 and the normalized agreement test （NAT） index were mainly used to represent the agreement between the measured and computed dose distributions with three criteria （2%/2 mm, 3%/3 mm and 5%/3 mm） as recommended in the literature. The results were that all cases passed through verifications with three criteria except that the NAT index of one case was beyond the limitation, and the three tolerance levels of 2%/2mm, 3%/3 mm and 5%/3 mm produced similar clinical verification results but led to different percent of pixels passing Y and NAT index. Our data showed that the percent of pixels passing y and the NAT index were complementary to evaluate future IMRT verifications as two significant metrics. Due to the influence of the noise and the trait of the software, we considered an IMRT plan as acceptable in case of the percent ofpixels passing y 〉95% and the NAT index 〈5 with the 5%/3 mm criteria for IMRT patient-specific quality assurance （QA）.

关键词： dose distribution dose verification intensity modulated radiation therapy

Treatment of Massive Low-Grade Chondrosarcoma of Nasal Septum with Helical Tomotherapy: A Case Report

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International Journal of Medical Physics, Clinical Engineering and radiation Oncology 2016年第4期5卷 263-269页

作者： Hamit Basaran Timur Koca Sibel Karaca Ozlem Eser K&iota l&iota nc Fikriye Gul Karauc Okan Ö zdemir Ozan Kuduban Arzu Tatar Sare Ş ipal Department of radiation Oncology Regional Training and Research Hospital Erzurum Turkey Department of Otorhinolaryngology Regional Training and Research Hospital Erzurum Turkey Department of Otorhinolaryngology Ataturk University Faculty of Medicine Erzurum Turkey Department of Pathology Ataturk University Faculty of Medicine Erzurum Turkey

Chondrosarcomas are malignant bone tumors which develop as a cartilaginous differentiation of primary mesenchymal cells and the second most frequently seen malignant tumor of the bone after osteosarcoma. These malignancies are slowly growing non-epithelial tumors with unknown etiology and most frequently seen during the 4 decades of life. They are frequently localized on pelvis, ribs and long bones. Nasal septum CSs are very rarely seen malignancies. They originate from septal mucosa or cartilage and it is difficult to make a diagnosis unless they reach a certain size. A few cases of CSs with nasal septum have been reported in the literature. In cases of CSs, surgery is the gold standard treatment modality;however in surgically unresectable cases or close to margins, radiotherapy plays a significant role in primary and adjuvant treatment. Based on the position of the tumor in head and neck and extremely closeness of the tumor to vital organs as optic nerve, chiasm and brain, image guided-intensity modulated radiation therapy (IG-IMRT) becomes very effective and reliable modalities and may be a favorable treatment alternative.

关键词： Chondrosarcoma Image Guided intensity modulated radiation therapy

Helical tomotherapy and volumetric modulated arc therapy:New therapeutic arms in the breast cancer radiotherapy

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World Journal of Radiology 2016年第8期8卷 735-742页

作者： Olivier Lauche Youlia M Kirova Pascal Fenoglietto Emilie Costa Claire Lemanski Celine Bourgier Olivier Riou David Tiberi Francois Campana Alain Fourquet David Azria Department of radiation Oncology Institut Curie Departement of radiation Oncology Institut du Cancer de Montpellier Department of radiation Oncology Centre Hospitalier de l’Universite de Montreal Hopital Notre Dame

AIM To analyse clinical and dosimetric results of helical tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in complex adjuvant breast and nodes *** Seventy-three patients were included(31 HT and 42 VMAT). Dose were 63.8 Gy(HT) and 63.2 Gy(VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes(SCN) and internal mammary chain(IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort(7 mm vs 5 mm).RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC:96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5%(HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2%(VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1%(HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9%(VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy(HT) and 4.6 ± 0.9 Gy(VMAT). Acute skin toxicity grade 3 was 5% in the two *** HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.

关键词： Three-dimensional conformal radiotherapy intensity modulated radiation therapy Toxicity Helical tomotherapy Volumetric modulated arc therapy Breast cancer radiotherapy

The role of radiotherapy in the treatment of oral cavity cancer

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Plastic and Aesthetic Research 2016年第1期3卷 158-166页

作者： Joaquín J.Cabrera-Rodríguez Department of radiation Oncology University Hospital Infanta Cristina06080 BadajozSpain

Radiotherapy plays a critical role in the treatment of oral cavity squamous cell carcinoma as monotherapy in early stage cancer or combined with surgery and/or chemotherapy in advances *** developments in the imaging of cancer and radiation technology have allowed developing more precise delivery of treatment with recent data demonstrating improvement in survival and lessening of adverse toxics effects of *** review will focus in the recent advances and current state-of-the-art in radiation oncology both external beam radiotherapy and *** complexity of cancer treatments increases a close coordination between head-neck surgeons and radiation oncologist is needed due to a significant proportion of patients will be treated with combined modality therapy.

关键词： Radiotherapy intensity modulated radiation therapy high dose rate low dose rate head neck cancer brachytherapy

Adaptive Dose-Compensation Technique for Image-Guided Radiotherapy of Prostate Cancer

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Chinese Journal of Biomedical Engineering(English Edition) 2018年第2期27卷 74-80页

作者： WU Qiu-wen Department of radiation Oncology Duke University Medical Center

Background: For image-guided radiotherapy(IGRT) of prostate cancer, the current standard is online image guidance which can effectively correct setup errors and inter-fraction rigid organ motion. However, planning margins are still necessary for deformation and intra-fraction motion. Objective: This paper aims to investigate an adaptive planning technique incorporating offline dose feedback to manage interfraction motion and residuals from online corrections. Methods:Repeated CT scans from 28 patients were studied. Online IG was simulated by matching center-of-mass of prostate. A seven-beam IMRT plan with zero margins was designed for each patient. Dose distribution at each fraction was evaluated based on actual target and OARs from that fraction. Cumulative dose was calculated using deformable registration and compared to initial plan. If deviation exceeded pre-defined 2% threshold in prostate D99 an adaptive planning technique called dose compensation was invoked, in which cumulative dose was fed back to the planning system and dose deficit was made up through boost radiation in future fractions through IMRT. Results: If 2% under-dose was allowed at the end of course, then 11 patients failed. If the same criteria was assessed at the end of each week(every 5 fractions), then 14 patients failed. The average dose deficit for these 14 patients was4.4%. They improved to 2% after weekly compensation. 10(out of 14) patients passed criterion after weekly dose compensation; 3 failed marginally; 1 failed significantly(10% deficit). A more aggressive compensation frequency(every 3 fractions) could reduce the dose deficit to the acceptable level for this patient. The doses to OARs were not significantly different from online IG only without dose ***: We demonstrated an offline dose compensation technique in prostate IGRT which can effectively account for residual uncertainties uncorrectable in online IG. Dose compensation allows further margin reduction an

关键词： adaptive radiation therapy image-guided radiation therapy intensity modulated radiation therapy prostate inter-fraction motion

Real-Time In Vivo Dose Verification for Serial Tomotherapy of Head and Neck Patients

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Real-Time In Vivo Dose Verification for Serial Tomotherapy o...