For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained careful...For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained carefully to the patient to obtain his informed consent.External beam radiotherapy is now delivered by intensity modulated radiotherapy,considered as the gold standard.From a radiotherapy perspective,low-risk localized prostate cancer is treated by image guided intensity modulated radiotherapy,or brachytherapy if patients meet the required eligibility criteria.Intermediate-risk patients may benefit from intensity modulated radiotherapy combined with 4e6 months of androgen deprivation therapy;intensity modulated radiotherapy alone or combined with brachytherapy can be offered to patients unsuitable for androgen deprivation therapy due to co-morbidities or unwilling to accept it to preserve their sexual health.High-risk prostate cancer,i.e.high-risk localized and locally advanced prostate cancer,requires intensity modulated radiotherapy with long-term(≥2 years)androgen deprivation therapy with luteinizing hormone releasing hormone agonists.Post-operative irradiation,either immediate or early deferred,is proposed to patients classified as pT3pN0,based on surgical margins,prostate-specific antigen values and quality of life.Whatever the techniques and their degree of sophistication,quality assurance plays a major role in the management of radiotherapy,requiring the involvement of physicians,physicists,dosimetrists,radiation technologists and computer scientists.The patients must be informed about the potential morbidity of radiotherapy and androgen deprivation therapy and followed regularly during and after treatment for tertiary prevention and evaluation.A close cooperation is needed with general practitioners and specialists to prevent and mitigate side effects and maintain quality of life.展开更多
Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with dail...Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with daily cone-beam computed tomography (CBCT) as part of a rescan protocol for large offset, and to evaluate the efficacy of our protocol. Materials and Methods: Eligible patients were treated with the following protocol: 1) magnesium oxide and dimethylpolysiloxane were administered to ensure that patients had regular bowel movements;2) the patients were instructed to have an appropriately distended bladder during the planning CT and daily irradiation;3) the daily CBCT image was fused with the planning CT image using the prostate outline;and 4) if large offset was recognized, a rescan CBCT image was obtained after appropriate countermeasures, such as the discharge of gas and defecation, and re-registration was performed. Three shifts for the inter-fractional motion of the prostate were analyzed, in the fractions which needed the CBCT rescan;the displacement data after the final rescan were used. Results: Sixty-one patients were eligible, and a total of 2302 fractions were available for the analysis. Rescans of the CBCT for large offset were performed in 113 (5%) of the 2302 fractions. After the first rescan, the large offset was resolved in 106 (94%) of the 113 fractions. Excessive rectal gas was the reason for the large offset in 94 (83%) of the 113 fractions. The total mean and standard deviation of the inter-fractional motion of the prostate in the AP, LR, and SI directions were 1.1 ± 2.4, -0.1 ± 2.3, and 0.7 ± 3.0 mm, respectively. Conclusion: Large offset was recognized in 5% of all fractions. Daily CBCT with our rescan protocol could resolve the large offset, which was mainly caused by excessive rectal gas, and it may therefore be promising to reduce the inter-fractional motion of the prostate.展开更多
目的:研究iCBCT引导前列腺癌调强放疗中盆腔淋巴引流区和前列腺精囊腺靶区位移的差异性,为临床上选择合理的图像引导策略提供参考依据。方法:回顾性选取2023年01月至2023年09月在中山大学肿瘤防治中心进行调强放疗的21例前列腺癌患者,...目的:研究iCBCT引导前列腺癌调强放疗中盆腔淋巴引流区和前列腺精囊腺靶区位移的差异性,为临床上选择合理的图像引导策略提供参考依据。方法:回顾性选取2023年01月至2023年09月在中山大学肿瘤防治中心进行调强放疗的21例前列腺癌患者,要求患者在定位及治疗前充盈膀胱、排空直肠,对患者治疗前扫描的iCBCT影像分别以盆腔骨性结构、前列腺精囊腺为参考进行离线配准(自动配准后手动调整),分别评估盆腔淋巴引流区、前列腺精囊腺的靶区位移误差,得到左右(left-right,LR)、头脚(superior-inferior,SI)和前后(anterior-posterior,AP)方向的位移数值,分析两个区域位移的差异性、相关性,并且计算相对位移,应用公式M_(PTV)=2.5Σ+0.7σ计算PTV外扩边界。结果:盆腔淋巴引流区、前列腺精囊腺在左右、头脚、前后平移方向位移误差分别为LR:(0.27±0.58)mm vs (0.31±0.61)mm;SI:(0.53±0.91)mm vs (0.68±0.98);AP:(2.03±1.86)mm vs (2.79±2.52)mm。头脚、前后方向位移差异有统计学意义(H=4.577、5.035,P<0.05),左右方向为高度相关(r=0.736),头脚方向为中度相关(r=0.542),前后方向为极低度相关(r=0.190)。两个区域在LR、SI和AP的相对位移5 mm的百分比分别为4.9%、5.3%和29.2%。盆腔淋巴引流区LR、SI、AP方向PTV外扩范围分别为1.08 mm、1.96 mm、6.38 mm,前列腺精囊腺LR、SI、AP方向PTV外扩范围为1.20 mm、2.39 mm、8.74 mm。结论:在前列腺癌调强放疗中,盆腔淋巴引流区和前列腺精囊腺靶区在分次治疗间前后方向位移较大,且两区域靶区在前后方向容易发生较大的相对位移,无法通过影像引导校正误差,应尽可能保持膀胱和直肠状态与CT定位时一致。展开更多
目的:探讨食管癌三维放疗+化疗生存情况及预后影响因素。方法:收集在我院首次行放化疗的167例中晚期食管癌患者的临床资料,并进行回顾性分析。放疗设备为Elekta-6m V X线直线加速器,放疗方案采用三维适形放疗(3-DCRT)或调强放疗(IMRT),...目的:探讨食管癌三维放疗+化疗生存情况及预后影响因素。方法:收集在我院首次行放化疗的167例中晚期食管癌患者的临床资料,并进行回顾性分析。放疗设备为Elekta-6m V X线直线加速器,放疗方案采用三维适形放疗(3-DCRT)或调强放疗(IMRT),放疗中位剂量为62Gy。化疗方案为氟尿嘧啶+顺铂或多西紫杉醇+顺铂,分别行4~6周期。采用SPSS 17.0软件行Kaplan-Meier法计算总生存率(OS),并绘制生存曲线,Log-rank法检验P值,对P<0.05的单因素行Cox回归多因素分析。结果:全组患者1年、3年、5年生存率分别为73.7%、51.5%、26.3%,中位生存时间36个月。单因素结果显示治疗方式、肿瘤位置、肿瘤长度、肿瘤分期、放疗剂量、放射性肺炎为影响食管癌患者生存的主要因素(P=0.022、0.017、0.040、0.001、0.000、0.002)。Cox多因素分析发现治疗方式、肿瘤长度、肿瘤分期、放射性肺炎为影响食管癌预后生存的独立影响因素(P=0.018、0.001、0.004、0.000)。结论:同步放化疗可明显提高中晚期食管癌患者总生存率,当肿瘤长度<5cm、肿瘤分期越早、放射性肺炎级别越低时患者预后较佳。展开更多
文摘For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained carefully to the patient to obtain his informed consent.External beam radiotherapy is now delivered by intensity modulated radiotherapy,considered as the gold standard.From a radiotherapy perspective,low-risk localized prostate cancer is treated by image guided intensity modulated radiotherapy,or brachytherapy if patients meet the required eligibility criteria.Intermediate-risk patients may benefit from intensity modulated radiotherapy combined with 4e6 months of androgen deprivation therapy;intensity modulated radiotherapy alone or combined with brachytherapy can be offered to patients unsuitable for androgen deprivation therapy due to co-morbidities or unwilling to accept it to preserve their sexual health.High-risk prostate cancer,i.e.high-risk localized and locally advanced prostate cancer,requires intensity modulated radiotherapy with long-term(≥2 years)androgen deprivation therapy with luteinizing hormone releasing hormone agonists.Post-operative irradiation,either immediate or early deferred,is proposed to patients classified as pT3pN0,based on surgical margins,prostate-specific antigen values and quality of life.Whatever the techniques and their degree of sophistication,quality assurance plays a major role in the management of radiotherapy,requiring the involvement of physicians,physicists,dosimetrists,radiation technologists and computer scientists.The patients must be informed about the potential morbidity of radiotherapy and androgen deprivation therapy and followed regularly during and after treatment for tertiary prevention and evaluation.A close cooperation is needed with general practitioners and specialists to prevent and mitigate side effects and maintain quality of life.
文摘Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with daily cone-beam computed tomography (CBCT) as part of a rescan protocol for large offset, and to evaluate the efficacy of our protocol. Materials and Methods: Eligible patients were treated with the following protocol: 1) magnesium oxide and dimethylpolysiloxane were administered to ensure that patients had regular bowel movements;2) the patients were instructed to have an appropriately distended bladder during the planning CT and daily irradiation;3) the daily CBCT image was fused with the planning CT image using the prostate outline;and 4) if large offset was recognized, a rescan CBCT image was obtained after appropriate countermeasures, such as the discharge of gas and defecation, and re-registration was performed. Three shifts for the inter-fractional motion of the prostate were analyzed, in the fractions which needed the CBCT rescan;the displacement data after the final rescan were used. Results: Sixty-one patients were eligible, and a total of 2302 fractions were available for the analysis. Rescans of the CBCT for large offset were performed in 113 (5%) of the 2302 fractions. After the first rescan, the large offset was resolved in 106 (94%) of the 113 fractions. Excessive rectal gas was the reason for the large offset in 94 (83%) of the 113 fractions. The total mean and standard deviation of the inter-fractional motion of the prostate in the AP, LR, and SI directions were 1.1 ± 2.4, -0.1 ± 2.3, and 0.7 ± 3.0 mm, respectively. Conclusion: Large offset was recognized in 5% of all fractions. Daily CBCT with our rescan protocol could resolve the large offset, which was mainly caused by excessive rectal gas, and it may therefore be promising to reduce the inter-fractional motion of the prostate.
文摘目的:研究iCBCT引导前列腺癌调强放疗中盆腔淋巴引流区和前列腺精囊腺靶区位移的差异性,为临床上选择合理的图像引导策略提供参考依据。方法:回顾性选取2023年01月至2023年09月在中山大学肿瘤防治中心进行调强放疗的21例前列腺癌患者,要求患者在定位及治疗前充盈膀胱、排空直肠,对患者治疗前扫描的iCBCT影像分别以盆腔骨性结构、前列腺精囊腺为参考进行离线配准(自动配准后手动调整),分别评估盆腔淋巴引流区、前列腺精囊腺的靶区位移误差,得到左右(left-right,LR)、头脚(superior-inferior,SI)和前后(anterior-posterior,AP)方向的位移数值,分析两个区域位移的差异性、相关性,并且计算相对位移,应用公式M_(PTV)=2.5Σ+0.7σ计算PTV外扩边界。结果:盆腔淋巴引流区、前列腺精囊腺在左右、头脚、前后平移方向位移误差分别为LR:(0.27±0.58)mm vs (0.31±0.61)mm;SI:(0.53±0.91)mm vs (0.68±0.98);AP:(2.03±1.86)mm vs (2.79±2.52)mm。头脚、前后方向位移差异有统计学意义(H=4.577、5.035,P<0.05),左右方向为高度相关(r=0.736),头脚方向为中度相关(r=0.542),前后方向为极低度相关(r=0.190)。两个区域在LR、SI和AP的相对位移5 mm的百分比分别为4.9%、5.3%和29.2%。盆腔淋巴引流区LR、SI、AP方向PTV外扩范围分别为1.08 mm、1.96 mm、6.38 mm,前列腺精囊腺LR、SI、AP方向PTV外扩范围为1.20 mm、2.39 mm、8.74 mm。结论:在前列腺癌调强放疗中,盆腔淋巴引流区和前列腺精囊腺靶区在分次治疗间前后方向位移较大,且两区域靶区在前后方向容易发生较大的相对位移,无法通过影像引导校正误差,应尽可能保持膀胱和直肠状态与CT定位时一致。
文摘目的:探讨食管癌三维放疗+化疗生存情况及预后影响因素。方法:收集在我院首次行放化疗的167例中晚期食管癌患者的临床资料,并进行回顾性分析。放疗设备为Elekta-6m V X线直线加速器,放疗方案采用三维适形放疗(3-DCRT)或调强放疗(IMRT),放疗中位剂量为62Gy。化疗方案为氟尿嘧啶+顺铂或多西紫杉醇+顺铂,分别行4~6周期。采用SPSS 17.0软件行Kaplan-Meier法计算总生存率(OS),并绘制生存曲线,Log-rank法检验P值,对P<0.05的单因素行Cox回归多因素分析。结果:全组患者1年、3年、5年生存率分别为73.7%、51.5%、26.3%,中位生存时间36个月。单因素结果显示治疗方式、肿瘤位置、肿瘤长度、肿瘤分期、放疗剂量、放射性肺炎为影响食管癌患者生存的主要因素(P=0.022、0.017、0.040、0.001、0.000、0.002)。Cox多因素分析发现治疗方式、肿瘤长度、肿瘤分期、放射性肺炎为影响食管癌预后生存的独立影响因素(P=0.018、0.001、0.004、0.000)。结论:同步放化疗可明显提高中晚期食管癌患者总生存率,当肿瘤长度<5cm、肿瘤分期越早、放射性肺炎级别越低时患者预后较佳。
