Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth fa...Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth factor receptortyrosine kinase inhibitors(EGFR-TKIs)and concurrent once-daily thoracic radiotherapy(TRT)remain unclear.We aim to analyze the values of clinical factors and dose-volume histogram(DVH)parameters to predict the risk for symptomatic RP in these patients.Methods:Between 2011 and 2019,we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and oncedaily TRT simultaneously(EGFR-TKIs group)and 129 patients who had received concurrent chemoradiotherapy(CCRT group).The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event(CTCAE)criteria(grade 2 or above).Statistical analyses were performed using SPSS 26.0.Results:In total,the incidences of symptomatic(grade≥2)and severe RP(grade≥3)were 43.5%(37/85)and 16.5%(14/85)in EGFR-TKIs group vs 27.1%(35/129)and 10.1%(13/129)in CCRT group respectively.After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching,chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group(χ^(2)=4.469,P=0.035).In EGFRTKIs group,univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving≥30 Gy(ilV_(30))[odds ratio(OR):1.163,95%CI:1.036-1.306,P=0.011]and the percentage of total lung volume receiving≥20 Gy(tlV_(20))(OR:1.171,95%CI:1.031-1.330,P=0.015),with chronic obstructive pulmonary disease(COPD)or not(OR:0.158,95%CI:0.041-0.600,P=0.007),were independent predictors of symptomatic RP.Compared to patients with lower iIV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)<cut-off point values)and without COPD,patients with higher ilV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)>cut-off point values)and COPD had a significantly higher risk for developing symptomatic RP,with a hazard ratio(HR)of 1.350(95%CI:1.190-1.531,P<0.001).Conclusion:Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy.The ilV_(30),tlV_(20),and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.展开更多
Objective： The aim of the study was to study the effect of the size and location of tumors on the normal lung dose-volume parameters for lung cancer. Methods： Three spheres with diameters of 2, 3 and 4 cm made of ti...Objective： The aim of the study was to study the effect of the size and location of tumors on the normal lung dose-volume parameters for lung cancer. Methods： Three spheres with diameters of 2, 3 and 4 cm made of tissue-equivalent materials used for simulating tumors were inserted into the upper lobe, middle lobe, lower lobe of the right lung, upper lobe, lower lobe of the left lung of the Rando phantom, respectively. Five-field simplified IMRT （slMRT） planning were designed. The prescribed dose was 60 Gy/2 Gy/30 f, 99% of the planning target volume received this dose. Dose-volume parameters of normal lung tissues including relative volume of lung receiving 〉 5, 10, 20, 30 and 50 Gy （V5, Vl0, V2o, V30, V50）, and mean lung dose （MLD） were analyzed and compared. Results： For the dose-volume parameters, the diameter and the position of the tumor had a significant effect （P 〈 0.05）. With the diameter expanding from 2 to 3 cm, the parameters associated with tumor lying in various lobes increased by a range between 3.83%-125.38%, while the parameters linked with tumors on different lobes increased by a range between 10.46%-51.46% with the diameter expanding from 3 to 4 cm. Conclusion： Location and size of sphere-like tumor have an obvious effect on dose-volume parameters. Knowing about the degree of influence will help oncologists and physicists better evaluate treatment planning, then the probability of radiation pneumonitis can be reduced.展开更多
This study aimed to investigate the dose-volume effects of γ-ray stereotactic body radiotherapy (SBRT) on clinical outcomes of patients with huge-size (≥10 cm) unresectable hepatocellular carcinoma (HCC). A total of...This study aimed to investigate the dose-volume effects of γ-ray stereotactic body radiotherapy (SBRT) on clinical outcomes of patients with huge-size (≥10 cm) unresectable hepatocellular carcinoma (HCC). A total of 59 patients with huge-size unresectable HCC were treated with SBRT following TACE between May 2006 and Dec. 2009. The analyzed parameters included fractional dose, marginal dose, maximal dose, and mean dose that the target received, as well as percentages of tumor volume encompassed by 60% (P<sub>60</sub>), 70% (P<sub>70</sub>), and 80% (P<sub>80</sub>) of isodose curves in entire tumor. The clinical outcomes included objective response rate (ORR), disease-free survival (DFS), overall survival (OS), and adverse event (AE). During median follow-up of 18.4 months, 81.4% of ORR (8.5% CR and 72.9% PR) was achieved, higher than 28.9% of ORR recently reported for TACE alone. 1- and 3-year DFS rates were 31.1% and 2.6% with median DFS of 8.7 months;1-, 3-, and 5-year OS rates were 46.5%, 13.7%, and 2.9%, with median OS of 11.8 months. P<sub>70</sub> was the only factor significantly correlating to DFS (P = 0.009) and OS (P = 0.01). Neither severe radiation-related liver disease nor > grade 3 AE was observed. In conclusion, SBRT was a safe and effective option for treatment of huge-size unresectable HCC. P<sub>70</sub> represented a parameter for predicting DFS and OS, and high dose-volume (e.g., P<sub>70</sub>) might be required to achieve improved clinical outcomes of patients with this type of HCC.展开更多
Objective: To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT u...Objective: To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT using the software of FOCUS-3D planning system. The beam was a 6MV X-ray from a Varian 2300C. The analysis data of Dose-volume statistics was from the technique used for: (1) 2–12 arcs; (2) 20°–45° separation angle of arcs; (3) 80°–160° of gantry rotation. Then we studied the difference of DVH with various irradiation techniques and the influence of target positions and field size by calculated to the distribution of dose from 20%–90% of the six targets in the lung with 3×3 cm2, 4×4 cm2 and 5×5 cm2 field size. Results: The volume irradiated pulmonary tissue was the smallest using a six non-coplanar 120° arcs with 30° separation between arcs in the hypothetical set up, the non-coplanar SRI was superiority than conventional one’s. The six targets were chosen in the right lung, the volume was the largest in geometric center and was decreased in hilus, bottom, anterior chest wall, lateral wall and apex of the lung in such an order. The DVH had significant change with an increasing field size. Conclusion: the irradiation damage of normal pulmonary tissue was the lowest using the six non-coplanar 120° arcs with a 30° separation between arcs by <5×5 cm2 field and the position of target was not a restricting factor.展开更多
Lung cancer is the main cause of cancer related death owing to its destructive nature and postponed detection at advanced stages.Early recognition of lung cancer is essential to increase the survival rate of persons a...Lung cancer is the main cause of cancer related death owing to its destructive nature and postponed detection at advanced stages.Early recognition of lung cancer is essential to increase the survival rate of persons and it remains a crucial problem in the healthcare sector.Computer aided diagnosis(CAD)models can be designed to effectually identify and classify the existence of lung cancer using medical images.The recently developed deep learning(DL)models find a way for accurate lung nodule classification process.Therefore,this article presents a deer hunting optimization with deep convolutional neural network for lung cancer detection and classification(DHODCNNLCC)model.The proposed DHODCNN-LCC technique initially undergoes pre-processing in two stages namely contrast enhancement and noise removal.Besides,the features extraction process on the pre-processed images takes place using the Nadam optimizer with RefineDet model.In addition,denoising stacked autoencoder(DSAE)model is employed for lung nodule classification.Finally,the deer hunting optimization algorithm(DHOA)is utilized for optimal hyper parameter tuning of the DSAE model and thereby results in improved classification performance.The experimental validation of the DHODCNN-LCC technique was implemented against benchmark dataset and the outcomes are assessed under various aspects.The experimental outcomes reported the superior outcomes of the DHODCNN-LCC technique over the recent approaches with respect to distinct measures.展开更多
目的比较常规CT征象和直方图参数对腺泡型、非腺泡型肺腺癌的鉴别效能的差异。方法回顾性收集在本院手术的185例患者共195个肺结节,其中腺泡型104个,非腺泡型91个。收集患者的人口学资料、肿瘤标记物。采用单因素分析及二元Logistic回...目的比较常规CT征象和直方图参数对腺泡型、非腺泡型肺腺癌的鉴别效能的差异。方法回顾性收集在本院手术的185例患者共195个肺结节,其中腺泡型104个,非腺泡型91个。收集患者的人口学资料、肿瘤标记物。采用单因素分析及二元Logistic回归分析建立常规CT征象模型、直方图(HA)模型及二者联合模型,通过曲线下面积(AUC)比较三种模型对鉴别腺泡型、非腺泡型肺腺癌的鉴别效能。结果单因素分析显示,腺泡型中,纯磨玻璃结节的占比低于非腺泡型(P=0.040);腺泡型中,病灶的CT平均值(P=0.023)、CT中位数数值(P=0.027)、紧凑度(P=0.003)、球形度(P=0.013)、熵(P<0.001)高于非腺泡型,病灶的峰度(P<0.001)、偏度(P<0.001)低于非腺泡型。二元Logistic回归分析以及ROC曲线显示联合模型及HA模型较常规CT征象模型具有更高的鉴别效能(AUC:直方图VS常规CT:0.763 VS 0.550,P<0.001;联合模型VS常规CT:0.768 VS 0.550,P<0.001);联合模型较HA模型无统计学差异(联合模型VS直方图:0.768 VS 0.763,P=0.768)。结论HA参数较常规CT征象能够更有效的鉴别腺泡型和非腺泡型肺腺癌。展开更多
文摘Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth factor receptortyrosine kinase inhibitors(EGFR-TKIs)and concurrent once-daily thoracic radiotherapy(TRT)remain unclear.We aim to analyze the values of clinical factors and dose-volume histogram(DVH)parameters to predict the risk for symptomatic RP in these patients.Methods:Between 2011 and 2019,we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and oncedaily TRT simultaneously(EGFR-TKIs group)and 129 patients who had received concurrent chemoradiotherapy(CCRT group).The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event(CTCAE)criteria(grade 2 or above).Statistical analyses were performed using SPSS 26.0.Results:In total,the incidences of symptomatic(grade≥2)and severe RP(grade≥3)were 43.5%(37/85)and 16.5%(14/85)in EGFR-TKIs group vs 27.1%(35/129)and 10.1%(13/129)in CCRT group respectively.After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching,chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group(χ^(2)=4.469,P=0.035).In EGFRTKIs group,univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving≥30 Gy(ilV_(30))[odds ratio(OR):1.163,95%CI:1.036-1.306,P=0.011]and the percentage of total lung volume receiving≥20 Gy(tlV_(20))(OR:1.171,95%CI:1.031-1.330,P=0.015),with chronic obstructive pulmonary disease(COPD)or not(OR:0.158,95%CI:0.041-0.600,P=0.007),were independent predictors of symptomatic RP.Compared to patients with lower iIV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)<cut-off point values)and without COPD,patients with higher ilV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)>cut-off point values)and COPD had a significantly higher risk for developing symptomatic RP,with a hazard ratio(HR)of 1.350(95%CI:1.190-1.531,P<0.001).Conclusion:Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy.The ilV_(30),tlV_(20),and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.
文摘Objective： The aim of the study was to study the effect of the size and location of tumors on the normal lung dose-volume parameters for lung cancer. Methods： Three spheres with diameters of 2, 3 and 4 cm made of tissue-equivalent materials used for simulating tumors were inserted into the upper lobe, middle lobe, lower lobe of the right lung, upper lobe, lower lobe of the left lung of the Rando phantom, respectively. Five-field simplified IMRT （slMRT） planning were designed. The prescribed dose was 60 Gy/2 Gy/30 f, 99% of the planning target volume received this dose. Dose-volume parameters of normal lung tissues including relative volume of lung receiving 〉 5, 10, 20, 30 and 50 Gy （V5, Vl0, V2o, V30, V50）, and mean lung dose （MLD） were analyzed and compared. Results： For the dose-volume parameters, the diameter and the position of the tumor had a significant effect （P 〈 0.05）. With the diameter expanding from 2 to 3 cm, the parameters associated with tumor lying in various lobes increased by a range between 3.83%-125.38%, while the parameters linked with tumors on different lobes increased by a range between 10.46%-51.46% with the diameter expanding from 3 to 4 cm. Conclusion： Location and size of sphere-like tumor have an obvious effect on dose-volume parameters. Knowing about the degree of influence will help oncologists and physicists better evaluate treatment planning, then the probability of radiation pneumonitis can be reduced.
文摘This study aimed to investigate the dose-volume effects of γ-ray stereotactic body radiotherapy (SBRT) on clinical outcomes of patients with huge-size (≥10 cm) unresectable hepatocellular carcinoma (HCC). A total of 59 patients with huge-size unresectable HCC were treated with SBRT following TACE between May 2006 and Dec. 2009. The analyzed parameters included fractional dose, marginal dose, maximal dose, and mean dose that the target received, as well as percentages of tumor volume encompassed by 60% (P<sub>60</sub>), 70% (P<sub>70</sub>), and 80% (P<sub>80</sub>) of isodose curves in entire tumor. The clinical outcomes included objective response rate (ORR), disease-free survival (DFS), overall survival (OS), and adverse event (AE). During median follow-up of 18.4 months, 81.4% of ORR (8.5% CR and 72.9% PR) was achieved, higher than 28.9% of ORR recently reported for TACE alone. 1- and 3-year DFS rates were 31.1% and 2.6% with median DFS of 8.7 months;1-, 3-, and 5-year OS rates were 46.5%, 13.7%, and 2.9%, with median OS of 11.8 months. P<sub>70</sub> was the only factor significantly correlating to DFS (P = 0.009) and OS (P = 0.01). Neither severe radiation-related liver disease nor > grade 3 AE was observed. In conclusion, SBRT was a safe and effective option for treatment of huge-size unresectable HCC. P<sub>70</sub> represented a parameter for predicting DFS and OS, and high dose-volume (e.g., P<sub>70</sub>) might be required to achieve improved clinical outcomes of patients with this type of HCC.
文摘Objective: To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT using the software of FOCUS-3D planning system. The beam was a 6MV X-ray from a Varian 2300C. The analysis data of Dose-volume statistics was from the technique used for: (1) 2–12 arcs; (2) 20°–45° separation angle of arcs; (3) 80°–160° of gantry rotation. Then we studied the difference of DVH with various irradiation techniques and the influence of target positions and field size by calculated to the distribution of dose from 20%–90% of the six targets in the lung with 3×3 cm2, 4×4 cm2 and 5×5 cm2 field size. Results: The volume irradiated pulmonary tissue was the smallest using a six non-coplanar 120° arcs with 30° separation between arcs in the hypothetical set up, the non-coplanar SRI was superiority than conventional one’s. The six targets were chosen in the right lung, the volume was the largest in geometric center and was decreased in hilus, bottom, anterior chest wall, lateral wall and apex of the lung in such an order. The DVH had significant change with an increasing field size. Conclusion: the irradiation damage of normal pulmonary tissue was the lowest using the six non-coplanar 120° arcs with a 30° separation between arcs by <5×5 cm2 field and the position of target was not a restricting factor.
基金This work was funded by the Deanship of Scientific Research(DSR),King Abdulaziz University,Jeddah,Under Grant No.(D-782-980-1443).
文摘Lung cancer is the main cause of cancer related death owing to its destructive nature and postponed detection at advanced stages.Early recognition of lung cancer is essential to increase the survival rate of persons and it remains a crucial problem in the healthcare sector.Computer aided diagnosis(CAD)models can be designed to effectually identify and classify the existence of lung cancer using medical images.The recently developed deep learning(DL)models find a way for accurate lung nodule classification process.Therefore,this article presents a deer hunting optimization with deep convolutional neural network for lung cancer detection and classification(DHODCNNLCC)model.The proposed DHODCNN-LCC technique initially undergoes pre-processing in two stages namely contrast enhancement and noise removal.Besides,the features extraction process on the pre-processed images takes place using the Nadam optimizer with RefineDet model.In addition,denoising stacked autoencoder(DSAE)model is employed for lung nodule classification.Finally,the deer hunting optimization algorithm(DHOA)is utilized for optimal hyper parameter tuning of the DSAE model and thereby results in improved classification performance.The experimental validation of the DHODCNN-LCC technique was implemented against benchmark dataset and the outcomes are assessed under various aspects.The experimental outcomes reported the superior outcomes of the DHODCNN-LCC technique over the recent approaches with respect to distinct measures.
文摘目的比较常规CT征象和直方图参数对腺泡型、非腺泡型肺腺癌的鉴别效能的差异。方法回顾性收集在本院手术的185例患者共195个肺结节,其中腺泡型104个,非腺泡型91个。收集患者的人口学资料、肿瘤标记物。采用单因素分析及二元Logistic回归分析建立常规CT征象模型、直方图(HA)模型及二者联合模型,通过曲线下面积(AUC)比较三种模型对鉴别腺泡型、非腺泡型肺腺癌的鉴别效能。结果单因素分析显示,腺泡型中,纯磨玻璃结节的占比低于非腺泡型(P=0.040);腺泡型中,病灶的CT平均值(P=0.023)、CT中位数数值(P=0.027)、紧凑度(P=0.003)、球形度(P=0.013)、熵(P<0.001)高于非腺泡型,病灶的峰度(P<0.001)、偏度(P<0.001)低于非腺泡型。二元Logistic回归分析以及ROC曲线显示联合模型及HA模型较常规CT征象模型具有更高的鉴别效能(AUC:直方图VS常规CT:0.763 VS 0.550,P<0.001;联合模型VS常规CT:0.768 VS 0.550,P<0.001);联合模型较HA模型无统计学差异(联合模型VS直方图:0.768 VS 0.763,P=0.768)。结论HA参数较常规CT征象能够更有效的鉴别腺泡型和非腺泡型肺腺癌。
