Objective:To assess the performance and advantages of HyperArc for radiotherapy of multiple brain metastases with dosimetric parameters with respect to coplanar volumetric modulated arc radiotherapy(c-VMAT),and charac...Objective:To assess the performance and advantages of HyperArc for radiotherapy of multiple brain metastases with dosimetric parameters with respect to coplanar volumetric modulated arc radiotherapy(c-VMAT),and characterize implicit correlations between tumor features and dosimetric parameters.Methods:This retrospective study involved 40 patients with multiple brain metastases(4–16 tumors,12.8–240.8 cm3)who received simultaneous radiotherapy at the Department of Radiation Oncology,Shenzhen People's Hospital from January 2019 to December 2022.Both HyperArc and c-VMAT plans were designed by the same and qualified physicist using the Eclipse system with Truebeam.A single isocenter and a 6 MV flattening filter-free(6FFF)photon beam were used for radiotherapy of multiple brain metastases in each plan.Dosimetric parameters of tumors and organs at risk(OARs)were compared between HyperArc and c-VMAT plans.Corre-lations between tumor features(number and volume)and dosimetric parameters were revealed and analyzed.Furthermore,monitor units(MUs)of both plan types were recorded to assess rays utilization and delivery efficiency.Results:Compared to c-VMAT plans,HyperArc plans achieved higher maximum dose(D_(max))(5.23%,t=7.87,P<0.01),but lower minimum dose(Dmin)(3.94%,t=-2.12,P=0.04)and mean dose(D_(mean))(1.05%,t=-3.29,P<0.01)for planning gross tumor volumes(PGTVs).The conformity index(CI),homogeneity index(HI),gradient index(GI)and R50%of PGTVs with HyperArc were better than those with c-VMAT,with the improve-ments of 20.78%,1.68%,19.83%and 36.20%,respectively(P<0.01).The dosimetric parameters of OARs were significantly improved in HyperArc plans compared to c-VMAT plans.Specifically,the D_(max)and the D_(mean)to the brainstem decreased by 16.14%and 11.37%,respectively.The D_(max)for eye_L decreased by 16.88%,for eye_R decreased by 11.67%,for optical nerve_L decreased by 12.56%,and for chiasm decreased by 18.12%.Few correlations were observed between the differences of CI/HI/GI/R50%and the number of PGTVs between the two plan types.Whereas,regression analysis indicated that the differences of CI/GI/R50%were negatively correlated with the volume of PGTVs,respectively.Moreover,although HyperArc plans reduced the MUs by 4.74%compared to c-VMAT,no significant difference was observed(P>0.05).Conclusions:This study demonstrates the promising performance of HyperArc for radiotherapy of multiple brain metastases,including better dose conformity for the tumors,more rapid dose drop and less dose spillage outside the tumors area,effective reduction of dose bridges among close tumors,and sparing OARs.It also reveals the correlations between the number or volume of tumors and dose parameters,which can help optimize the use of HyperArc and predict clinical benefits.展开更多
We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography...We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography （MRC） revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas （BDHs）. Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.展开更多
A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the ...A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the left wall, however, computed tomography (CT) revealed no regional lymph node or liver metastases. In addition, cytological and pathological examinations did not show malignancy. At the time of admission, the white blood cell count was 21 460 cells/μL (neutrophils, 18 240 cells/μL) and this elevated to 106 040 before death. In addition, serum granulocyte colony-stimulating factor (G-CSF) was elevated. At 28 d after admission, the patient died. An autopsy showed a poorly differentiated adenocarcinoma with sarcomatous change, which had slightly invaded into the pancreas around the bile duct, and was found in the distal bile duct with multiple metastases to the chest wall, lung, kidney, adrenal body, liver, mesentery, vertebra and mediastinal and para-aortic lymph nodes, without locoregional lymph node and liver metastasis. The cancer cells showed positive immunohistochemical staining for anti-G-CSF antibody. This is believed to be the first report of an extrahepatic bile duct carcinoma that produces G-CSF. Since G-CSF-producing carcinoma and sarcomatous change of the biliary tract leads to poor prognosis, early diagnosis and treatment are needed. When infection is ruled out, the G-CSF in serum should be examined. In addition, examinations such as bonescintigraphy and chest CT should also be considered for distant metastasis.展开更多
文摘Objective:To assess the performance and advantages of HyperArc for radiotherapy of multiple brain metastases with dosimetric parameters with respect to coplanar volumetric modulated arc radiotherapy(c-VMAT),and characterize implicit correlations between tumor features and dosimetric parameters.Methods:This retrospective study involved 40 patients with multiple brain metastases(4–16 tumors,12.8–240.8 cm3)who received simultaneous radiotherapy at the Department of Radiation Oncology,Shenzhen People's Hospital from January 2019 to December 2022.Both HyperArc and c-VMAT plans were designed by the same and qualified physicist using the Eclipse system with Truebeam.A single isocenter and a 6 MV flattening filter-free(6FFF)photon beam were used for radiotherapy of multiple brain metastases in each plan.Dosimetric parameters of tumors and organs at risk(OARs)were compared between HyperArc and c-VMAT plans.Corre-lations between tumor features(number and volume)and dosimetric parameters were revealed and analyzed.Furthermore,monitor units(MUs)of both plan types were recorded to assess rays utilization and delivery efficiency.Results:Compared to c-VMAT plans,HyperArc plans achieved higher maximum dose(D_(max))(5.23%,t=7.87,P<0.01),but lower minimum dose(Dmin)(3.94%,t=-2.12,P=0.04)and mean dose(D_(mean))(1.05%,t=-3.29,P<0.01)for planning gross tumor volumes(PGTVs).The conformity index(CI),homogeneity index(HI),gradient index(GI)and R50%of PGTVs with HyperArc were better than those with c-VMAT,with the improve-ments of 20.78%,1.68%,19.83%and 36.20%,respectively(P<0.01).The dosimetric parameters of OARs were significantly improved in HyperArc plans compared to c-VMAT plans.Specifically,the D_(max)and the D_(mean)to the brainstem decreased by 16.14%and 11.37%,respectively.The D_(max)for eye_L decreased by 16.88%,for eye_R decreased by 11.67%,for optical nerve_L decreased by 12.56%,and for chiasm decreased by 18.12%.Few correlations were observed between the differences of CI/HI/GI/R50%and the number of PGTVs between the two plan types.Whereas,regression analysis indicated that the differences of CI/GI/R50%were negatively correlated with the volume of PGTVs,respectively.Moreover,although HyperArc plans reduced the MUs by 4.74%compared to c-VMAT,no significant difference was observed(P>0.05).Conclusions:This study demonstrates the promising performance of HyperArc for radiotherapy of multiple brain metastases,including better dose conformity for the tumors,more rapid dose drop and less dose spillage outside the tumors area,effective reduction of dose bridges among close tumors,and sparing OARs.It also reveals the correlations between the number or volume of tumors and dose parameters,which can help optimize the use of HyperArc and predict clinical benefits.
文摘We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography （MRC） revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas （BDHs）. Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.
文摘A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the left wall, however, computed tomography (CT) revealed no regional lymph node or liver metastases. In addition, cytological and pathological examinations did not show malignancy. At the time of admission, the white blood cell count was 21 460 cells/μL (neutrophils, 18 240 cells/μL) and this elevated to 106 040 before death. In addition, serum granulocyte colony-stimulating factor (G-CSF) was elevated. At 28 d after admission, the patient died. An autopsy showed a poorly differentiated adenocarcinoma with sarcomatous change, which had slightly invaded into the pancreas around the bile duct, and was found in the distal bile duct with multiple metastases to the chest wall, lung, kidney, adrenal body, liver, mesentery, vertebra and mediastinal and para-aortic lymph nodes, without locoregional lymph node and liver metastasis. The cancer cells showed positive immunohistochemical staining for anti-G-CSF antibody. This is believed to be the first report of an extrahepatic bile duct carcinoma that produces G-CSF. Since G-CSF-producing carcinoma and sarcomatous change of the biliary tract leads to poor prognosis, early diagnosis and treatment are needed. When infection is ruled out, the G-CSF in serum should be examined. In addition, examinations such as bonescintigraphy and chest CT should also be considered for distant metastasis.
