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Hypofractionated and intensity-modulated radiotherapy combined with systemic therapy in metastatic hepatocellular carcinoma:A case report
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作者 Qiu-Qiu Chen Chun-Qiao Chen +3 位作者 Jin-Kun Liu Ming-Yue Huang Min Pan Hui Huang 《World Journal of Clinical Oncology》 2024年第10期1342-1350,共9页
BACKGROUND Liver cancer treatment is characterized by multidisciplinary participation and coexistence of multiple treatment methods.Hypofractionated and intensity-modulated radiotherapy is a new precise radiotherapy t... BACKGROUND Liver cancer treatment is characterized by multidisciplinary participation and coexistence of multiple treatment methods.Hypofractionated and intensity-modulated radiotherapy is a new precise radiotherapy technique applied to the treatment of systemic malignant tumors.There is a lack of understanding of hypofractionated and intensity-modulated radiotherapy combined with systemic therapy in metastatic hepatocellular carcinoma(HCC).CASE SUMMARY We report a case of metastatic HCC treated with hypofractionated and intensity-modulated radiotherapy combined with systemic therapy.A 41-year-old man was diagnosed with metastatic HCC(T3N1M1 stage IVB).Because it was found to be in the late stage of cancer and had already metastasized,it was impossible to undergo surgical treatment.In addition to aggressive comprehensive treatment for the primary lesion,local treatment for metastatic cancer can improve the patient's survival potential.Hypofractionated and intensity-modulated radiotherapy can provide a larger single treatment dose within a shorter overall treatment time,and improve the local control rate of the tumor.Follow-up examination demonstrated that the tumor and metastatic lesions had shrunk after therapy.The treatment has showed good efficacy.The patient survived for 18 months without disease progression and stable disease persisted for>38 months.CONCLUSION Targeted therapy and immunotherapy followed by hypofractionated and intensity-modulated radiotherapy are also effective for advanced metastatic HCC. 展开更多
关键词 hypofractionated therapy intensity-modulated radiation Hepatocellular carcinoma METASTASIS Case report
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Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy 被引量:44
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作者 Yan-Ping Mao Ling-Long Tang +7 位作者 Lei Chen Ying Sun Zhen-Yu Qi Guan-Qun Zhou Li-Zhi Liu Li Li Ai-Hua Lin Jun Ma 《Chinese Journal of Cancer》 SCIE CAS CSCD 2016年第12期673-682,共10页
Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of ... Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially. 展开更多
关键词 Nasopharyngeal carcinoma intensity-modulated radiotherapy PROGNOSIS Failure pattern Tumor staging
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Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy 被引量:12
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作者 Yu-Xiang He Ying Wang +9 位作者 Peng-Fei Cao Lin Shen Ya-Jie Zhao Zi-Jian Zhang Deng-Ming Chen Tu-Bao Yang Xin-Qiong Huang Zhou Qin You-Yi Dai Liang-Fang Shen 《Chinese Journal of Cancer》 SCIE CAS CSCD 2016年第12期725-734,共10页
Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NP... Background: Gross target volume of primary tumor(GTV?P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma(NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity?modulated radiotherapy(IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to ind a suitable cut?of value of GTV?P for prognosis prediction.Methods: Clinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver oper?ating characteristic(ROC) curves were used to identify the cut?of values of GTV?P for the prediction of diferent end?points [overall survival(OS), local relapse?free survival(LRFS), distant metastasis?free survival(DMFS), and disease?free survival(DFS)] and to test the prognostic value of GTV?P when compared with that of the American Joint Committee on Cancer T staging system.Results: The 358 patients with locally advanced NPC were divided into two groups by the cut?of value of GTV?P as determined using ROC curves: 219(61.2%) patients with GTV?P ≤46.4 mL and 139(38.8%) with GTV?P >46.4 mL. The 3?year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV?P ≤46.4 mL than in those with GTV?P > 46.4 mL(all P < 0.05). Multivariate analysis indicated that GTV?P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve veriied that the predictive ability of GTV?P was superior to that of T category(P < 0.001). The cut?of values of GTV?P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.Conclusion: In patients with locally advanced NPC, GTV?P >46.4 mL is an independent unfavorable prognostic indi?cator for survival after IMRT, with a prognostic value superior to that of T category. 展开更多
关键词 Nasopharyngeal carcinoma intensity-modulated radiotherapy Gross target volume of primary tumor PROGNOSIS
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A model to predict the risk of lethal nasopharyngeal necrosis after re-irradiation with intensity-modulated radiotherapy in nasopharyngeal carcinoma patients 被引量:5
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作者 Ya-Hui Yu Wei-Xiong Xia +9 位作者 Jun-Li Shi Wen-Juan Ma Yong Li Yan-Fang Ye Hu Liang Liang-Ru Ke Xing Lv Jing Yang Yan-Qun Xiang Xiang Guo 《Chinese Journal of Cancer》 SCIE CAS CSCD 2016年第11期617-624,共8页
Background:For patients with nasopharyngeal carcinoma(NPC) who undergo re-irradiation with intensity-modulated radiotherapy(IMRT),lethal nasopharyngeal necrosis(LNN) is a severe late adverse event.The purpose of this ... Background:For patients with nasopharyngeal carcinoma(NPC) who undergo re-irradiation with intensity-modulated radiotherapy(IMRT),lethal nasopharyngeal necrosis(LNN) is a severe late adverse event.The purpose of this study was to identify risk factors for LNN and develop a model to predict LNN after radical re-irradiation with IMRT in patients with recurrent NPC.Methods:Patients who underwent radical re-irradiation with IMRT for locally recurrent NPC between March 2001 and December 2011 and who had no evidence of distant metastasis were included in this study.Clinical characteristics,including recurrent carcinoma conditions and dosimetric features,were evaluated as candidate risk factors for LNN.Logistic regression analysis was used to identify independent risk factors and construct the predictive scoring model.Results:Among 228 patients enrolled in this study,204 were at risk of developing LNN based on risk analysis.Of the 204 patients treated,31(15.2%) developed LNN.Logistic regression analysis showed that female sex(P = 0.008),necrosis before re-irradiation(P = 0.008),accumulated total prescription dose to the gross tumor volume(GTV) ≥ 145.5 Gy(P = 0.043),and recurrent tumor volume >25.38 cm3(P = 0.009) were independent risk factors for LNN.A model to predict LNN was then constructed that included these four independent risk factors.Conclusions:A model that includes sex,necrosis before re-irradiation,accumulated total prescription dose to GTV,and recurrent tumor volume can effectively predict the risk of developing LNN in NPC patients who undergo radical re-irradiation with IMRT. 展开更多
关键词 Nasopharyngeal carcinoma RE-IRRADIATION intensity-modulated radiotherapy NECROSIS
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Intensity-modulated radiotherapy for breast cancer:a systematic review 被引量:2
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作者 Xiupeng Ye Ling Su +9 位作者 Xiaohu Wang Kehu Yang inhui Tian Qiuning Zhang Qiang Wang Xiaojun Li Yuqing Kang Liyun Guo Ruifeng Liu Shifang Feng 《The Chinese-German Journal of Clinical Oncology》 CAS 2010年第12期708-713,共6页
Objective:The aim of this study was to assess the long-term effect of breast conservation with breast intensitymodulated radiotherapy (IMRT) for early-stage breast cancers.Methods:Pub Med,EMBASE,Cochrane Library,Chine... Objective:The aim of this study was to assess the long-term effect of breast conservation with breast intensitymodulated radiotherapy (IMRT) for early-stage breast cancers.Methods:Pub Med,EMBASE,Cochrane Library,Chinese Biomedical Literature Database were searched to identify relevant original published trails,and the references of eligible studies were manually screened.Randomized controlled trails reported in any language,comparing breast IMRT with conventional radiotherapy (RT) in patients with early-stage breast cancer were eligible for inclusion.Two investigators independently assessed the quality of included trials and extracted data.The RevMan 5.0 software was used for statistical analysis.Results:Four trials involving 1440 patients were included.The results showed that in the IMRT group,the occurrence of acute moist dermatitis,the edema of the mammary gland and the occurrence of hyperpigmentation were lower than those of RT group,the pooled risk ratio value and 95% confidence interval were 0.28 (0.17-0.48),0.03 (0.00-0.21) and 0.06 (0.02-0.15) respectively.The use of IMRT did not correlate with pain and quality of life,but the presence of moist desquamation did significantly correlate with pain and reduced quality of life.Conclusion:The currently available evidence showed that IMRT significantly reduces the occurrence of moist acute dermatitis anywhere in the breast and alleviates the suffering of patients and improves the quality of life of patients.Future large-scale,high-quality,double-blind trials are needed. 展开更多
关键词 breast cancer breast-conserving surgery intensity-modulated radiotherapy (IMRT) systematic review
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Dosimetric study of five-field intensity-modulated radiotherapy compared with conventional three-dimensional conformal radiotherapy for rectal cancer 被引量:1
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作者 Bo Yao Mingmin Zheng Ping Wang 《The Chinese-German Journal of Clinical Oncology》 CAS 2009年第10期607-610,共4页
Objective: The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk (OAR) between five-field intensity-modulated radiotherapy (IMRT) and conventional thr... Objective: The aim of the study was to compare the difference of dose distribution in clinical target volume and organ at risk (OAR) between five-field intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy (3DCRT) in the radiotherapy of rectal cancer. Methods: Fifteen patients with rectal cancer treated with radio- therapy (RT) were retrospectively analyzed. Among the patients, seven received RT preoperatively and 8 postoperatively. The target volume and the OARs such as the small bowel, bladder and femoral heads were contoured for each patient. 3DCRT-plan and IMRT-plan were performed for each patient respectively, with the prescribed dose covering at least 95% of the planning target volume (PTV). The conformity index (CI) and homogeneity index (HI) were used for evaluation of the dose distribution in the target volume, and the Dx% (the lowest dose to the x% volume of the OARs that received the highest dose of irradiation) and the mean dose were used for evaluation of the dose to OARs. Paired-T test was used for companson of the difference between the two plans. Results: In the IMRT-plan and 3DCRT-plan, the CI were 0.94 and 0.87 (P = 0.000) and the HI were 1.13 and 1.17, respectively (P = 0.001). For small bowel, the D30%, D50% and the mean dose were 19.67 Gy, 15.13 Gy and 18.81 Gy in the IMRT-plan and 25.20 Gy, 22.20 Gy and 22.89 Gy in the 3DCRT-plan, respectively (P 〈 0.001 for all pairs of parameters). For bladder, the D30%, D50%, and the mean dose were 24.80 Gy, 34.20 Gy and 28.70 Gy in the IMRT- plan, and 35.07 Gy, 44.67 Gy and 35.68 Gy in the 3DCRT-plan, respectively (P 〈 0.001 for all pairs of parameters). For femoral heads, the D5% in the IMRT-plan and 3DCRT-plan were 40.6 Gy and 40.47 Gy, respectively (P = 0.936), and the mean dose were 30.14 Gy and 25.57 Gy, respectively (P = 0.001). Conclusion: Five-field IMRT-plan is better than 3DCRT-plan in the conformity and the dose homogeneity within target volume and also better in sparing the small bowel and bladder. 展开更多
关键词 intensity-modulated radiotherapy (IMRT) three-dimensional conformal radiotherapy (3DCRT) rectal neoplasm dosimetry
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Bone marrow-sparing intensity-modulated radiotherapy for postoperative treatment of cervical cancer
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作者 Fuli Zhang Mingmin Zheng Junmao Gao Weidong Xu 《The Chinese-German Journal of Clinical Oncology》 CAS 2011年第6期349-353,共5页
Objective: The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy (IMRT) with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer... Objective: The aim of this study was to compare bone marrow-sparing intensity-modulated radiotherapy (IMRT) with IMRT without entering pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods: For a cohort of 10 patients, bone marrow-sparing IMRT and routine IMRT planning were designed. The prescribed dose was 45 Gy/1.8 Gy/25f, 95% of the planning target volume received this dose. Doses were computed with a commercially available treatment planning system (TPS) using convolution/superimposition (CS) algorithm. Plans were compared according to dose-volume histogram (DVH) analysis in terms of planning target volume (PTV) homogeneity and conformity indices (HI and CI) as well as organs at risk (OARs) dose and volume parameters. Results: Bone marrow-sparing IMRT had an vantages over routine IMRT in terms of CI, but inferior to the latter for HI. Compared with routine IMRT, V5, Vl0, V20, V30, V40 of pelvic bone marrow of bone marrow-sparing IMRT reduced by 1.81%, 8.61%, 31.81%, 29.50%, 28.29%, respectively. No statistically significant differences were observed between bone marrow-sparing IMRT and routine IMRT in terms of small bowel, bladder and rectum. Conclusion: For patients with cervical cancer after hysterectomy, bone marrowsparing IMRT reduced the pelvic bone marrow volume irradiated at all dose levels and might be conducive to preventing the occurrence of acute bone marrow toxicity. 展开更多
关键词 bone marrow sparing cervical cancer DOSIMETRY HYSTERECTOMY POSTOPERATIVE intensity-modulated radiotherapy
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Dosimetric consequences of tumor volume changes after kilovoltage cone-beam computed tomography for non-operative lung cancer during adaptive intensity-modulated radiotherapy or fractionated stereotactic radiotherapy
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作者 Jian Hu Ximing Xu +4 位作者 Guangjin Yuan Wei Ge Liming Xu Aihua Zhang Junjian Deng 《Oncology and Translational Medicine》 CAS 2015年第5期195-200,共6页
Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography (kV-CBCT) and their dosimetric consequences for non-operative lung cancer during intensity-modul... Objective The aim of this study was to investigate tumor volume changes with kilovoltage cone-beam computed tomography (kV-CBCT) and their dosimetric consequences for non-operative lung cancer during intensity-modulated radiotherapy (IMRT) or fractionated stereotactic radiotherapy. Methods Eighteen patients with non-operative lung cancer who received IMRT consisting of 1.8-2.2 Gy/fraction and five fractions per week or stereotactic radiotherapy with 5-8 Gy/fraction and three fractions a week were studied, kV-CBCT was performed once per week during IMRT and at every fraction during stereotactic radiotherapy. The gross tumor volume (GTV) was contoured on the kV-CBCT images, and adaptive treatment plans were created using merged kV-CBCT and primary planning computed tomogra- phy image sets. Tumor volume changes and dosimetric parameters, including the minimum dose to 95% (D95) or 1% (D1) of the planning target volume (PTV), mean lung dose (MLD), and volume of lung tissue that received more than 5 (Vs), 10 (Vl0), 20 (V20), and 30 (V30) Gy were retrospectively analyzed. Results The average maximum change in GTV observed during IMRT or fractionated stereotactic radio- therapy was -25.85% (range, -13.09% --56.76%). The D95 and Dr of PTV for the adaptive treatment plans in all patients were not significantly different from those for the initial or former adaptive treatment plans. In patients with tumor volume changes of 〉20% in the third or fourth week of treatment during IMRT, adap- tive treatment plans offered clinically meaningful decreases in MLD and V5, V10, V20, and V30; however, in patients with tumor volume changes of 〈 20% in the third or fourth week of treatment as well as in patients with stereotactic radiotherapy, there were no significant or clinically meaningful decreases in the dosimetric parameters. Conclusion Adaptive treatment planning for decreasing tumor volume during IMRT may be beneficial for patients who experience tumor volume changes of 〉20% in the third or fourth week of treatment. 展开更多
关键词 lung cancer kilovoltage cone-beam computed tomography (kV-CBCT) intensity-modulated radiotherapy (IMRT) stereotactic radiotherapy tumor changes adaptive planning
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Dosimetric analysis of tomotherapy-based intensity-modulated radiotherapy with and without bone marrow sparing for the treatment of cervical cancer
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作者 Fuli Zhang Weidong Xu +8 位作者 Huayong Jiang Yadi Wang Junmao Gao Qingzhi Liu Na Lu Diandian Chen Bo Yao Jianping Chen Heliang He 《Oncology and Translational Medicine》 CAS 2015年第3期135-139,共5页
Objective The aim of the study was to compare tomotherapy-based bone marrow-sparing intensity-mod- ulated radiotherapy (BMS-IMRT) with intensity-modulated radiotherapy (IMRT) without entering the pelvic bone marro... Objective The aim of the study was to compare tomotherapy-based bone marrow-sparing intensity-mod- ulated radiotherapy (BMS-IMRT) with intensity-modulated radiotherapy (IMRT) without entering the pelvic bone marrow as a planning constraint in the treatment of cervical cancer after hysterectomy. Methods BMS-IMRT and IMRT plans were designed for a cohort of nine patients. The prescribed dose was 45 Gy in 1.8 Gy daily fractions, and 95% of the planned target volume received this dose. The doses were computed using a commercially available treatment planning system with the convolution/superposition algorithm. Plans were compared according to dose-volume histogram analysis in terms of planning target volume homogeneity and conformity indices (HI and CI) as well as organ at risk dose and volume parameters. Results BMS-IMRT had advantages over IMRT in terms of CI, but was equivalent to the latter in H1. V5, V10, V20, V30, and V40 of pelvic bone marrow in BMS-IMRT decreased by 0.06%, 17.33%, 22.19%, 13.85%, and 16.46%, respectively, compared with IMRT. Except for V30 of the small bowel and V30 and V40 of the bladder, no statistically significant differences were found between BMS-IMRT and IMRT in the small bowel, bladder, and rectum. Conclusion For cervical cancer patients receiving tomotherapy-based radiotherapy after hysterectomy, BMS-IMRT reduced pelvic bone marrow volume receiving low-dose radiation, and it may be conducive to preventing acute hematologic toxicity. 展开更多
关键词 cervical neoplasm helical tomotherapy intensity-modulated radiotherapy (IMRT) DOSIMETRY
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Observation of Intensity-Modulated Radiotherapy with Different Fractionated Doses Used in 58 Cases with Astrocytoma
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作者 Yun-qin LIU Li-ting QIAN Hong-yan ZHANG Jun MA Yu-fei ZHAO Wei-wei WU 《Clinical oncology and cancer researeh》 CAS CSCD 2010年第2期116-121,共6页
OBJECTIVE To analyze the therapeutic effects and side effects of intensity-modulated radiotherapy (IMRT) with different fractionated doses in treating astrocytoma.METHODS During a period from October 2001 to Decemb... OBJECTIVE To analyze the therapeutic effects and side effects of intensity-modulated radiotherapy (IMRT) with different fractionated doses in treating astrocytoma.METHODS During a period from October 2001 to December 2006, 58 patients with astrocytoma were treated using IMRT. Based on the World Health Organization (WHO) classification, 32 of the 58 cases were grade-Ⅱ, 20 grade-Ⅲ and 6 grade-IV (glioblastoma multiforme, GBM). Thirty-two of the 58 patients (3 with grade IV, 11 with grade Ⅲ, and the other 18 with grade II who were over 40 years) were treated with hyperfractionated IMRT (Hyper Fr IMRT), and the other 26 patients were treated with standard fractionated IMRT (St Fr IMRT).RESULTS The 1-, 3- and 5-year overall survival (OS) rates were respectively 86%, 52%, and 45%, and the 1-, 3- and 5-year progression-free survival (PFS) rates were respectively 77%, 38%, and 25%. Using an analytical hierarchy process it was shown that concerning the patients with grade II astrocytoma classified based on WHO grading, the therapeutic effect was much better in the group of Hyper Fr IMRT than in the St Fr IMRT group. There was no statistical significance of the differences in the OS and PFS rates between the 2 groups (P = 0.049 and P = 0.006). The OS and PFS rates of the patients with grade-III astrocytoma were both higher in the group with Hyper Fr IMRT than in the St Fr IMRT group. However, there was no statistical significance of the differences between the 2 groups. Advanced RTOG grade-Ⅲ(radiation therapy oncology group, RTOG) neurotoxicity occurred only in 1 of the cases.CONCLUSION Compared with the St Fr IMRT, the Hyper Fr IMRT may help to prolong the survival of patients with astrocytoma. 展开更多
关键词 ASTROCYTOMA intensity-modulated radiotherapy conformal 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 被引量:19
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作者 Hao Peng Lei Chen +11 位作者 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 《Chinese Journal of Cancer》 SCIE CAS CSCD 2017年第12期757-766,共10页
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 emiss... 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 patients.Methods: 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 stage.Results: 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 survival.Conclusions: 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. 展开更多
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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Clinical treatment considerationsin the intensity-modulated radiotherapy era for patients with NO-category nasopharyngeal carcinoma and enlarged neck lymph nodes 被引量:4
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作者 Hao Peng Lei Chen +8 位作者 Rui Guo Yuan Zhang Wen.Fei Li Yan.Ping Mao Ying Sun Fan Zhang Li.Zhi Liu Li Tian Jun Ma 《Chinese Journal of Cancer》 SCIE CAS CSCD 2017年第7期306-314,共9页
Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive nodes.However,no irradiation guidelines have been proposed for patien... Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive nodes.However,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 nodes.This 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 IMRT.Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure.The biological equivalent dose(BED) for ENLNs was calculated.Patient survival was compared between the small and large ENLN groups.Independent prognostic factors were identified using the Cox proportional hazards model.Results:The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs <5.5 mm(100%vs.98.8%,P=0.049),whereas disease-free,overall,and distant metastasis-free survival rates were similar between the two groups.After adjusting for various factors,ENLN diameter was not identified as an independent prognostic factor(P > 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 groups.The multivariate analysis also confirmed that BED≥72 Gy was not associated with significantly improved prognosis in patients with NO-category NPC.Conclusions:A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with NO-category NPC.Prospective studies are warranted to validate the findings in the present study. 展开更多
关键词 NASOPHARYNGEAL carcinoma N0-category ENLARGED NECK lymph node Biological equivalent dose intensity-modulated radiotherapy Prognosis
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Intensified intensity-modulated radiotherapy in anal cancer with prevalent HPV p16 positivity 被引量:2
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作者 Liliana Belgioia Stefano Vagge +7 位作者 Dario Agnese Stefania Garelli Roberto Murialdo Giuseppe Fornarini Silvana Chiara Fabio Gallo Almalina Bacigalupo Renzo Corvò 《World Journal of Gastroenterology》 SCIE CAS 2015年第37期10688-10696,共9页
AIM: To investigate the toxicity and response of intensity-modulated radiotherapy schedule intensified with a simultaneous integrated boost in anal canal cancer.METHODS: From March 2009 to March 2014, we retrospective... AIM: To investigate the toxicity and response of intensity-modulated radiotherapy schedule intensified with a simultaneous integrated boost in anal canal cancer.METHODS: 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 scales.RESULTS: 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%, respectively.Acute 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).CONCLUSION: In our experience, intensified SIBIMRT with chemotherapy is very feasible in clinical practice, with excellent results in terms of overall survival and local control. 展开更多
关键词 ANAL CANAL cancer intensity-modulated radiotherapy
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Intensity-modulated Radiotherapy for Sinonasal Teratocarcinosarcoma
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作者 彭纲 柯杨 +3 位作者 王涛 冯一鸣 李跃华 伍钢 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2011年第6期857-860,共4页
Surgical excision and postoperative radiotherapy are widely accepted therapeutic modalities for sinonasal teratocarcinosarcoma (SNTCS). Previous studies have shown that intensity-modulated radiation therapy (IMRT)... Surgical excision and postoperative radiotherapy are widely accepted therapeutic modalities for sinonasal teratocarcinosarcoma (SNTCS). Previous studies have shown that intensity-modulated radiation therapy (IMRT) is safe and effective for the treatment of some sinonasal malignancies. We hypothesize that use of IMRT for SNTCS may result in clinical benefits. We report here two cases of SNTCS that were treated by IMRT. One patient was given extensive IMRT involving elective neck irradiation. Follow-up examinations revealed no recurrence and metastasis 3.5 years after IMRT. Another patient simultaneously suffered from multiple systematical diseases and was administered involved-field radiotherapy. He was found to have a marginal recurrence during the follow up and eventually died 8 months after disease diagnosis. It was suggested in this study that appropriate use of IMRT for the treatment of SNTCS may achieve excellent local control. 展开更多
关键词 sinonasal teratocarcinosarcoma radiotherapy head and neck cancer intensity-modulated radiation therapy paranasal sinus
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Effect of intensity-modulated radiotherapy combined with local hyperthermia on Mortalin expression in advanced liver cancer lesions and its relationship with cell proliferation and EMT
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作者 Dong Li 《Journal of Hainan Medical University》 2018年第20期61-64,共4页
Objective:To investigate the effect of intensity-modulated radiotherapy combined with local hyperthermia on Mortalin expression in advanced liver cancer lesions and its relationship with cell proliferation and EMT.Met... Objective:To investigate the effect of intensity-modulated radiotherapy combined with local hyperthermia on Mortalin expression in advanced liver cancer lesions and its relationship with cell proliferation and EMT.Methods: A total of 82 patients with advanced liver cancer who were treated in this hospital between February 2016 and September 2017 were chosen as the research subjects, and the therapeutic regimens were reviewed and used to divide these patients into the control group (n=43) who received intensity-modulated radiotherapy and the combined treatment group (n=39) who received intensity-modulated radiotherapy combined with local hyperthermia. Abdominal puncture was done after treatment to obtain liver cancer tissue samples, and the differences in Mortalin gene, cell proliferation gene and EMT gene expression in tissues were compared.Results: After treatment, Mortalin mRNA expression in liver cancer tissues of combined treatment group was lower than that of control group;Fbxw7 mRNA expression in liver cancer tissues was higher than that of control group whereas NCX1, PRMT5 and XBP1S mRNA expression were lower than those of control group;Twist, ZEB-1, ZEB-2, Snail and HOXB7 mRNA expression in liver cancer tissues were lower than those of control group. Pearson test showed that the Mortalin gene expression in liver cancer tissues was directly correlated with cell proliferation genes and EMT genes.Conclusion:Intensity-modulated radiotherapy combined with local hyperthermia can effectively reduce Mortalin gene expression, and further optimize patients'condition by inhibiting hepatic cell proliferation, EMT activity and other pathways. 展开更多
关键词 Advanced liver cancer intensity-modulated radiotherapy Local HYPERTHERMIA Mortalin Cell proliferation EMT
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Long-term outcome of a moderately hypofractionated, intensity-modulated radiotherapy approach using an endorectal balloon for patients with localized prostate cancer 被引量:5
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作者 Bin S.Teh Gary D.Lewis +3 位作者 Weiyuan Mai Ramiro Pino Hiromichi Ishiyama Edward Brian Butler 《Cancer Communications》 SCIE 2018年第1期136-144,共9页
Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate can... Background:Technical advances in radiotherapy delivery have simultaneously enabled dose escalation and enhanced bladder and rectal sparing.However,the optimal radiation fractionation regimen for localized prostate cancer is unclear.Laboratory and clinical evidence suggest that hypofractionation may improve the therapeutic ratio of radiotherapy.We report our institutional outcomes using moderately hypofractionated,intensity-modulated radio-therapy(IMRT),and an endorectal balloon,with emphasis on long-term biochemical control and treatment-related adverse events in patients with localized prostate cancer.Methods:Between January 1997 and April 2004,596 patients with cT1-T3 prostate cancer underwent IMRT using a moderate hypofractionation regimen(76.70 Gy at 2.19 Gy/fraction)with an endorectal balloon.Using D’Amico clas-sification,226(37.9%),264(44.3%),and 106(17.8%)patients had low-,intermediate-,or high-risk disease,respectively.The majority of intermediate-and high-risk patients received androgen deprivation therapy.Biochemical relapse-free survival(bRFS)was evaluated using 2005 Phoenix criteria and estimated using the Kaplan-Meier method.Results:The median follow-up was 62 months.Overall 5-and 10-year bRFS rates were 92.7%and 87.7%.For low-,intermediate-,and high-risk patients,the 5-year bRFS rates were 96.9%,93.3%,and 82.0%,respectively;the 10-year bRFS rates were 91.4%,89.3%,and 76.2%,respectively.Prostate-specific antigen,Gleason score,and T stage were significant predictors of bRFS(all P<0.01).The 5-year rates of severe(≥Grade 3)adverse events were very low:1.2%for gastrointestinal events and 1.1%for genitourinary events.Conclusions:Long-term outcomes after moderately hypofractionated IMRT are encouraging.Moderate hypofrac-tionation represents a safe,efficacious,alternative regimen in the treatment of localized prostate cancer. 展开更多
关键词 Prostate cancer intensity-modulated radiotherapy Moderate hypofractionation
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The impact of artificial intelligence-assisted intensity-modulated radiotherapy plan optimization on the radiation doses received by the rectum and bladder as well as radiation-induced injuries in patients with locally advanced cervical cancer
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作者 Fu Hang 《Modern General Practice》 2024年第1期45-49,共5页
This study aimed to investigate the impact of artificial intelligence-assisted intensity-modulated radiotherapy(IMRT)plan optimization on the radiation doses received by the rectum and bladder as well as radiation-ind... This study aimed to investigate the impact of artificial intelligence-assisted intensity-modulated radiotherapy(IMRT)plan optimization on the radiation doses received by the rectum and bladder as well as radiation-induced injuries in patients with locally advanced cervical cancer.A total of 100 patients with locally advanced cervical cancer were enrolled and divided into a conventional IMRT group and an artificial intelligence-assisted IMRT group.The results showed that in terms of the radiation doses to the rectum and bladder,all dosimetric parameters(such as mean dose,maximum dose,and volume-dose parameters,etc.)in the artificial intelligence-assisted group were significantly lower than those in the conventional group(p<0.05).Regarding radiation-induced injuries,the incidences and severities of both acute and late radiation-induced proctitis and cystitis in the artificial intelligence-assisted group were lower than those in the conventional group(p<0.05).These findings suggest that artificial intelligence-assisted IMRT plan optimization can effectively reduce the radiation doses to the rectum and bladder and decrease radiation-induced injuries in patients with locally advanced cervical cancer,which is expected to provide a more precise and safer treatment strategy for radiotherapy of locally advanced cervical cancer.However,this study has limitations such as a limited sample size and being a single-center study.Future research with multi-center,large-sample,and more in-depth investigations is needed. 展开更多
关键词 Artificial intelligence intensity-modulated radiotherapy Locally advanced cervical cancer Rectal dose Bladder dose radiotherapy-induced injury
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Minimally invasive surgery alone compared with intensity-modulated radiotherapy for primary stage I nasopharyngeal carcinoma 被引量:22
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作者 You-Ping Liu Xing Lv +17 位作者 Xiong Zou Yi-Jun Hua Rui You Qi Yang Le Xia Shao-Yan Guo Wen Hu Meng-Xia Zhang Si-Yuan Chen Mei Lin Yu-Long Xie Li-Zhi Liu Rui Sun Pei-Yu Huang Wei Fan Xiang Guo Ming-Huang Hong Ming-Yuan Chen 《Cancer Communications》 SCIE 2019年第1期634-644,共11页
Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-rel... Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients.Endoscopic nasopharyngectomy(ENPG)was successfully applied in recurrent NPC with radiation free and relatively low medical costs.In this study,we examined whether ENPG could be an effective treatment for localized stage I NPC.Methods:Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center.Simultaneously,the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort.The survival outcomes,quality of life(QOL),and medical costs between two groups were compared.Results:After a median follow-up of 59.0 months(95%CI 53.4-64.6),no death,locoregional recurrence,or distant metastasis was observed in the 10 patients treated with ENPG.The 5-year overall survival,local relapse-free survival,regional relapse-free survival,and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients(100%vs.99.1%,100%vs.97.7%,100%vs.99.0%,100%vs.97.4%,respectively,P>0.05).In addition,compared with IMRT,ENPG was associated with decreased total medical costs($4090.42±1502.65 vs.$12620.88±4242.65,P<0.001)and improved QOL scores including dry mouth(3.3±10.5 vs.34.4±25.8,P<0.001)and sticky saliva(3.3±10.5 vs.32.6±23.3,P<0.001).Conclusions:ENPG alone was associated with promising long-term survival outcomes,low medical costs,and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy.However,the application of ENPG should be prudent,and prospective clinical tri-als were needed to further verify the results. 展开更多
关键词 Nasopharyngeal carcinoma Localized Early stage Endoscopic nasopharyngectomy intensity-modulated radiotherapy Survival Medical cost Quality of life
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Effect of intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy on clinical outcomes in patients with glioblastoma multiforme 被引量:5
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作者 CHEN Yi-dong FENG Jin +3 位作者 FANG Tong YANG Ming QIU Xiao-guang JIANG Tao 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第12期2320-2324,共5页
Background Few studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in the treatment of glioblastoma mu... Background Few studies were reported on the comparison of clinical outcomes between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in the treatment of glioblastoma multiforme (GBM).This study aimed to determine whether IMRT improves clinical outcomes compared with 3D-CRT in patients with GBM.Methods The records of 54 patients with newly-diagnosed GBM from July 2009 to December 2010 were reviewed.The patients underwent postoperative IMRT or 3D-CRT with concurrent and adjuvant temozolomide.Kaplan-Meier method and log rank test were used to estimate differences of patients' survival.Results The median follow-up was 13 months.Of the 54 patients,fifty (92.6%) completed the combined modality treatment.The 1-year overall survival rate (OS) was 79.6%.The pattern of failure was predominantly local.A comparative analysis revealed that no statistical difference was observed between the IMRT group (n=21) and the 3D-CRT group (n=33) for 1-year OS (89.6% vs.75.8%,P=0.795),or 1-year progression-free survival (PFS) (61.0% vs.45.5%,P=0.867).In dosimetric comparison,IMRT seemed to allow better sparing of organs at risk than 3D-CRT did (P=0.050,P=0.055).However,there was no significant difference for toxicities of irradiation between the IMRT group and the 3D-CRT group.Conclusions Our preliminary results suggested that delivering standard radiation doses by IMRT is unlikely to improve local control or overall survival for GBM compared with 3D-CRT.Given this lack of survival benefit and increased costs of IMRT,the utilization of IMRT treatment for GBM needs to be carefully rationalized. 展开更多
关键词 glioblastoma multiforme three-dimensional conformal radiotherapy intensity-modulated radiotherapy
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COMBINATION OF PRONE POSITION AND INTENSITY-MODULATED RADIATION THERAPY (IMRT) REDUCES SMALL BOWEL DOSES IN RADIATION THERAPY FOR GYNECOLOGIC MALIGNANCIES
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作者 李文彬 李明华 +1 位作者 乐维婕 Nina A. Mayr 《Chinese Journal of Cancer Research》 SCIE CAS CSCD 2006年第1期51-56,共6页
Objective: To evaluate if the combination of both prone position on a belly board and intensity-modulated radiotherapy (IMRT) further reduces the radiation dose to small bowel in pelvic RT for gynecologic malignanc... Objective: To evaluate if the combination of both prone position on a belly board and intensity-modulated radiotherapy (IMRT) further reduces the radiation dose to small bowel in pelvic RT for gynecologic malignancies. Methods: Conformal pelvic RT plans were computed in 13 patients with gynecologic malignancies who had pre-existing planning computed tomography (CT) scans in both the supine position and prone position on a belly board. There were 10 cervical cancer and 3 endometrial cancer patients. A limited arc technique (180° arc length) and an extended arc technique (340° arc length) were used in IMRT plans. Normal tissue regions of interest (ROI) included small bowel, large bowel and bladder. Dose and volume for normal tissue structures were traced and compared between supine and prone plans using the paired t-test. Results: For the limited arc technique, prone position using a belly board device improved small bowel sparing. Analysis of the results showed a 12~26 Gy reduction of volume of small bowel irradiation compared to the supine position. With the extended arc technique, there was no obvious radiation reduction in the prone position. Large bowel and bladder dose showed no significant differences between prone and supine position with either technique. Conclusion: Prone positioning on a belly board decreases the small bowel dose in gynecologic pelvic IMRT, and the magnitude of improvement depended on the limited arc IMRT technique used. 展开更多
关键词 intensity-modulated radiotherapy Bowel complications Patient positioning Gynecologic malignancies radiotherapy
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