AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent fou...AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.展开更多
Aim: The simultaneous irradiation of target volumes of different total dose levels using intensity modulated radiotherapy leads to reduced doses per fraction and longer treatment times in target volumes of 2nd?to 4th?...Aim: The simultaneous irradiation of target volumes of different total dose levels using intensity modulated radiotherapy leads to reduced doses per fraction and longer treatment times in target volumes of 2nd?to 4th?order. Does the thereby caused reduced biological effectiveness induce an increased recurrence risk? The current work deals with the problem of recurrences of patients with head and neck carcinomas treated either with an intensitiy (IMRT) or with a volumetric modulated (VMAT) irradiation technique. Methods: From October 2002 to September 2014, 699 patients with carcinomas of the head and neck were irradiated using IMRT or VMAT. The median follow up of the patients was 21.9 months (2 to 145 months). Primary tumor regions (1st?order target volume) of 565 patients were treated with doses per fraction of 2 Gy. Accordingly, further 133 target volumes of the primary tumor received reduced doses per fraction. In 1 patient, the lymphatic drainage was treated solely without irradiation of the primary region. For the lympatic drainage, 854 1st?order target volumes were treated with a dose per fraction of 2 Gy. Reduced doses per fraction were applied to further 1780 target volumes. Results: 54 of 699 patients developed a recurrence in the primary tumor region after radio-(chemo) therapy, 4 patients developed a recurrence of the primary tumor and a unilateral recurrence of the lymphatic drainage, 2 patients a recurrence of the primary tumor and a bilateral lymph node recurrence. 18 patients showed an isolated unilateral recurrence and additionally 2 patients a bilateral recurrence of the lymphatic drainage. 619 patients stayed recurrence free. In primary tumor regions, receiving a dose per fraction of 2 Gy 55 patients (9.7%) developed a recurrence, whereas in target volumes receiving a reduced dose per fraction 5 patients (3.8%) developed a recurrence (p < 0.001). In lympatic drainage target volumes receiving a dose per fraction of 2 Gy, 25 target volumes (2.9%) developed a recurrence, whereas in target volumes receiving a reduced dose per fraction, 5 patients (0.3%) developed a recurrence (p = 0.001). Conclusion: The recurrence risk in target volumes of 2nd?to 4th?order was not increased due to reduced doses per fraction deposited by means of a simultaneous integrated boost technique. Therefore, the simultaneous irradiation of target volumes with different dose levels is safely applicable within one treatment plan.展开更多
PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS ...PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional展开更多
AIM:To determine the feasibility and safety of high dose rate intraluminal brachytherapy(HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.METHODS:Between 2008 and 2009,thirty-six patients with loca...AIM:To determine the feasibility and safety of high dose rate intraluminal brachytherapy(HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.METHODS:Between 2008 and 2009,thirty-six patients with locally advanced rectal cancer(≥ T3 or N+),were treated initially with concurrent capecitabine(825 mg/m2 oral twice daily) and pelvic external beam radiotherapy(EBRT)(45 Gy in 25 fractions),then were randomized to group A;HDR-ILBT group(n = 17) to receive 5.5-7 Gy×2 to gross tumor volume(GTV) and group B;EBRT group(n = 19) to receive 5.4 Gy×3 fractions to GTV with EBRT.All patients underwent total mesorectal excision.RESULTS:Grade 3 acute toxicities were registered in 12 patients(70.6%) in group A and in 8(42.1%) in group B.Complete pathologic response of T stage(ypT0) in group A was registered in 10 patients(58.8%) and in group B,3 patients(15.8%) had ypT0(P < 0.0001).Sphincter preservation was reported in 6/9 patients(66.7%) in group A and in 5/10 patients(50%) in group B(P < 0.01).Overall radiological response was 68.15% and 66.04% in Group A and B,respectively.During a median follow up of 18 mo,late grade 1 and 2 sequelae were registered in 3 patients(17.6%) and 4 patients(21.1%) in the groups A and B,respectively.CONCLUSION:HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers,with higher response rates,downstaging and with manageable acute toxicities.展开更多
This paper presents the design and implementation of a monolithic CMOS DC-DC boost converter that is hardened for total dose radiation.In order to improve its radiation tolerant abilities,circuit-level and device-leve...This paper presents the design and implementation of a monolithic CMOS DC-DC boost converter that is hardened for total dose radiation.In order to improve its radiation tolerant abilities,circuit-level and device-level RHBD（radiation-hardening by design） techniques were employed.Adaptive slope compensation was used to improve the inherent instability.The H-gate MOS transistors,annular gate MOS transistors and guard rings were applied to reduce the impact of total ionizing dose.A boost converter was fabricated by a standard commercial 0.35μm CMOS process.The hardened design converter can work properly in a wide range of total dose radiation environments,with increasing total dose radiation.The efficiency is not as strongly affected by the total dose radiation and so does the leakage performance.展开更多
文摘AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.
文摘Aim: The simultaneous irradiation of target volumes of different total dose levels using intensity modulated radiotherapy leads to reduced doses per fraction and longer treatment times in target volumes of 2nd?to 4th?order. Does the thereby caused reduced biological effectiveness induce an increased recurrence risk? The current work deals with the problem of recurrences of patients with head and neck carcinomas treated either with an intensitiy (IMRT) or with a volumetric modulated (VMAT) irradiation technique. Methods: From October 2002 to September 2014, 699 patients with carcinomas of the head and neck were irradiated using IMRT or VMAT. The median follow up of the patients was 21.9 months (2 to 145 months). Primary tumor regions (1st?order target volume) of 565 patients were treated with doses per fraction of 2 Gy. Accordingly, further 133 target volumes of the primary tumor received reduced doses per fraction. In 1 patient, the lymphatic drainage was treated solely without irradiation of the primary region. For the lympatic drainage, 854 1st?order target volumes were treated with a dose per fraction of 2 Gy. Reduced doses per fraction were applied to further 1780 target volumes. Results: 54 of 699 patients developed a recurrence in the primary tumor region after radio-(chemo) therapy, 4 patients developed a recurrence of the primary tumor and a unilateral recurrence of the lymphatic drainage, 2 patients a recurrence of the primary tumor and a bilateral lymph node recurrence. 18 patients showed an isolated unilateral recurrence and additionally 2 patients a bilateral recurrence of the lymphatic drainage. 619 patients stayed recurrence free. In primary tumor regions, receiving a dose per fraction of 2 Gy 55 patients (9.7%) developed a recurrence, whereas in target volumes receiving a reduced dose per fraction 5 patients (3.8%) developed a recurrence (p < 0.001). In lympatic drainage target volumes receiving a dose per fraction of 2 Gy, 25 target volumes (2.9%) developed a recurrence, whereas in target volumes receiving a reduced dose per fraction, 5 patients (0.3%) developed a recurrence (p = 0.001). Conclusion: The recurrence risk in target volumes of 2nd?to 4th?order was not increased due to reduced doses per fraction deposited by means of a simultaneous integrated boost technique. Therefore, the simultaneous irradiation of target volumes with different dose levels is safely applicable within one treatment plan.
文摘PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional
文摘AIM:To determine the feasibility and safety of high dose rate intraluminal brachytherapy(HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.METHODS:Between 2008 and 2009,thirty-six patients with locally advanced rectal cancer(≥ T3 or N+),were treated initially with concurrent capecitabine(825 mg/m2 oral twice daily) and pelvic external beam radiotherapy(EBRT)(45 Gy in 25 fractions),then were randomized to group A;HDR-ILBT group(n = 17) to receive 5.5-7 Gy×2 to gross tumor volume(GTV) and group B;EBRT group(n = 19) to receive 5.4 Gy×3 fractions to GTV with EBRT.All patients underwent total mesorectal excision.RESULTS:Grade 3 acute toxicities were registered in 12 patients(70.6%) in group A and in 8(42.1%) in group B.Complete pathologic response of T stage(ypT0) in group A was registered in 10 patients(58.8%) and in group B,3 patients(15.8%) had ypT0(P < 0.0001).Sphincter preservation was reported in 6/9 patients(66.7%) in group A and in 5/10 patients(50%) in group B(P < 0.01).Overall radiological response was 68.15% and 66.04% in Group A and B,respectively.During a median follow up of 18 mo,late grade 1 and 2 sequelae were registered in 3 patients(17.6%) and 4 patients(21.1%) in the groups A and B,respectively.CONCLUSION:HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers,with higher response rates,downstaging and with manageable acute toxicities.
基金Project supported by the National Defense Pre-Research Project of China(No.51311050202)
文摘This paper presents the design and implementation of a monolithic CMOS DC-DC boost converter that is hardened for total dose radiation.In order to improve its radiation tolerant abilities,circuit-level and device-level RHBD（radiation-hardening by design） techniques were employed.Adaptive slope compensation was used to improve the inherent instability.The H-gate MOS transistors,annular gate MOS transistors and guard rings were applied to reduce the impact of total ionizing dose.A boost converter was fabricated by a standard commercial 0.35μm CMOS process.The hardened design converter can work properly in a wide range of total dose radiation environments,with increasing total dose radiation.The efficiency is not as strongly affected by the total dose radiation and so does the leakage performance.
