In this paper,the beam quality and percent depth dose curves for different field sizes of CyberKnife? system were investigated by Monte Carlo simulations using the PENELOPE code,which has been used to simulate 6 MV ph...In this paper,the beam quality and percent depth dose curves for different field sizes of CyberKnife? system were investigated by Monte Carlo simulations using the PENELOPE code,which has been used to simulate 6 MV photon beam.In water phantom,the absolute doses were calculated for Φ10–60 mm collimators,and percent depth dose curves were evaluated for Φ30–60 mm collimators.The agreement of dose distributions of the calculation with measurement was within 3.0%.The mean energy of photon spectrum was 1.46 MeV,and the beam quality index was 0.632,which was slightly smaller than that of measurement.展开更多
AIM: To investigate the safety and efficacy of the Cyberknife treatment for patients with advanced or terminal stage hepatocellular carcinoma(HCC).METHODS: Patients with HCC with extrahepatic metastasis or vascular or...AIM: To investigate the safety and efficacy of the Cyberknife treatment for patients with advanced or terminal stage hepatocellular carcinoma(HCC).METHODS: Patients with HCC with extrahepatic metastasis or vascular or bile duct invasion were enrolled between May 2011 and June 2015. The Cyberknife was used to treat each lesion. Treatment response scores were based on Response Evaluation Criteria in Solid Tumors v1.1. The trends of tumor markers,including alpha fetoprotein(AFP) and proteins induced by vitamin K absence Ⅱ(PIVKA Ⅱ) were assessed. Prognostic factors for tumor response and tumor markers were evaluated with Fisher's exact test and a logistic regression model. Survival was evaluated with the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards model.RESULTS: Sixty-five patients with 95 lesions were enrolled. Based on the Barcelona Clinic Liver Cancer classification,all patients were either in the advanced or terminal stage of the disease. The target lesions were as follows: 52 were bone metastasis; 9,lung metastasis; 7,brain metastasis; 9,portal vein invasion;4,hepatic vein invasion; 4,bile duct invasion; and 10 other lesion types. The response rate and disease control rate were 34% and 53%,respectively. None of the clinical factors correlated significantly with tumor response. Fiducial marker implantation was associated with better control of both AFP(HR = 0.152; 95%CI: 0.026-0.887; P = 0.036) and PIVKA Ⅱ(HR = 0.035; 95%CI: 0.003-0.342; P = 0.004). The median survival time was 9 mo(95%CI: 5-15 mo). Terminal stage disease(HR = 9.809; 95%CI: 2.589-37.17,P < 0.001) and an AFP of more than 400 ng/m L(HR = 2.548; 95%CI: 1.070-6.068,P = 0.035) were associated with worse survival. A radiation dose higher than 30 Gy(HR = 0.274; 95%CI: 0.093-0.7541,P = 0.012) was associated with better survival. In the 52 cases of bone metastasis,36 patients(69%) achieved pain relief. One patient had cerebral bleeding and another patient had an esophageal ulcer after treatment.CONCLUSION: The Cyberknife can be safely administered to patients with advanced or terminal stage HCC. High AFP levels were associated with worse survival,but a higher radiation dose improved the survival.展开更多
Objective:Multiple brain metastases are a severe condition for cancer patients.To date,no general consensus exists regarding the optimal treatment procedure for multiple brain metastases.Radiotherapy is the most commo...Objective:Multiple brain metastases are a severe condition for cancer patients.To date,no general consensus exists regarding the optimal treatment procedure for multiple brain metastases.Radiotherapy is the most commonly used treatment option.The role of surgical resection for multiple brain metastases is unclear.The aim of this study was to compare the outcomes of patients with multiple brain metastases treated with either surgery or stereotactic radiosurgery(SRS).Methods:The medical records of 279 consecutive adult patients with multiple brain metastases treated with either surgery(26 patients)or SRS(253 patients)were retrospectively reviewed.Propensity score matching was conducted to correct for discrepancies in the baseline characteristics,and 78 patients(26 receiving surgery and 52 receiving SRS)were chosen for comparison of outcomes,such as overall survival,local tumor control rate,and symptom improvement.Results:The tumor size in the surgery group was significantly greater than that in the SRS group after propensity score matching.However,the neurological recovery rate,incidence of leptomeningeal metastasis after surgery,1-year local tumor control rate,and overall survival were not significantly different between groups.Conclusions:Our data demonstrate that surgery and radiosurgery have identical overall survival and local tumor control rates in patients with 2 to 4 brain metastases.Although SRS remains the primary and standard option for patients with brain metastasis,surgery offers several distinct advantages,such as establishing a diagnosis or relieving mass effects,and may additionally be beneficial in carefully selected patients with 2–4 brain metastases.展开更多
Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the do...Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord.The purpose of this study was to evaluate the safety and efficacy of CyberKnife(R) radiation therapy for spinal metastases.Methods Seventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed.Thirteen tumors in 12 patients had received prior radiation.Patients were followed clinically and radiographically for at least 12 months or until death.In all patients,the spinal cord and thecal sac were contoured for dose-volume constraints,and maximum doses to 0.1,0.5,1,2,and 5-ml volumes were analyzed.Results Using the CyberKnife System,20-48 Gy in one to five fractions for unirradiated patients,and 21-38 Gy in one to five fractions for the previously irradiatied patients,were delivered.Median 2-Gy normalized Biological Equvaient Dose (nBED) of unirradiated targets and irradiated targets were 49.6 Gy10/2 (range,31.25-74.8 Gy10/2) and 46.9 Gy10/2 (range,29.8-66 Gy10/2),respectively.With a median follow-up of 9.4 months (range,2.5-45 months),twenty-nine patients (46.7%) were alive,whereas the others died of progressive disease.Fifty-six patients (93.3%) reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up,17 patients (28.3%) reported some degree of pain relief after first fraction of the treatment course.Two patients experienced local recurrence at fifth and ninth months postradiotherapy.Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 (range,8.3-154.5Gy2/2) and 83.5 Gy2/2 (range,10.5-180.5 Gy2/2),respectively.Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 (range,17.7-140 Gy2/2) and 70.5 Gy2/2 (range,21.7-141.3 Gy2/2),respectively.No patient developed radiation related myelopathy during the follow-up period.Conclusion Cyberknife radiotherapy is clinically effective and safe for spinal metastases,even in previously irradiated patients.展开更多
基金Supported by Shanghai Science and Technology Committee (08JC1410200)Shanghai Leading Academic Disciplines (S30109)
文摘In this paper,the beam quality and percent depth dose curves for different field sizes of CyberKnife? system were investigated by Monte Carlo simulations using the PENELOPE code,which has been used to simulate 6 MV photon beam.In water phantom,the absolute doses were calculated for Φ10–60 mm collimators,and percent depth dose curves were evaluated for Φ30–60 mm collimators.The agreement of dose distributions of the calculation with measurement was within 3.0%.The mean energy of photon spectrum was 1.46 MeV,and the beam quality index was 0.632,which was slightly smaller than that of measurement.
文摘AIM: To investigate the safety and efficacy of the Cyberknife treatment for patients with advanced or terminal stage hepatocellular carcinoma(HCC).METHODS: Patients with HCC with extrahepatic metastasis or vascular or bile duct invasion were enrolled between May 2011 and June 2015. The Cyberknife was used to treat each lesion. Treatment response scores were based on Response Evaluation Criteria in Solid Tumors v1.1. The trends of tumor markers,including alpha fetoprotein(AFP) and proteins induced by vitamin K absence Ⅱ(PIVKA Ⅱ) were assessed. Prognostic factors for tumor response and tumor markers were evaluated with Fisher's exact test and a logistic regression model. Survival was evaluated with the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards model.RESULTS: Sixty-five patients with 95 lesions were enrolled. Based on the Barcelona Clinic Liver Cancer classification,all patients were either in the advanced or terminal stage of the disease. The target lesions were as follows: 52 were bone metastasis; 9,lung metastasis; 7,brain metastasis; 9,portal vein invasion;4,hepatic vein invasion; 4,bile duct invasion; and 10 other lesion types. The response rate and disease control rate were 34% and 53%,respectively. None of the clinical factors correlated significantly with tumor response. Fiducial marker implantation was associated with better control of both AFP(HR = 0.152; 95%CI: 0.026-0.887; P = 0.036) and PIVKA Ⅱ(HR = 0.035; 95%CI: 0.003-0.342; P = 0.004). The median survival time was 9 mo(95%CI: 5-15 mo). Terminal stage disease(HR = 9.809; 95%CI: 2.589-37.17,P < 0.001) and an AFP of more than 400 ng/m L(HR = 2.548; 95%CI: 1.070-6.068,P = 0.035) were associated with worse survival. A radiation dose higher than 30 Gy(HR = 0.274; 95%CI: 0.093-0.7541,P = 0.012) was associated with better survival. In the 52 cases of bone metastasis,36 patients(69%) achieved pain relief. One patient had cerebral bleeding and another patient had an esophageal ulcer after treatment.CONCLUSION: The Cyberknife can be safely administered to patients with advanced or terminal stage HCC. High AFP levels were associated with worse survival,but a higher radiation dose improved the survival.
基金This study was supported by research grants from the Tianjin Municipal Science and Technology Commission(Grant No.18JCYBJC27600).
文摘Objective:Multiple brain metastases are a severe condition for cancer patients.To date,no general consensus exists regarding the optimal treatment procedure for multiple brain metastases.Radiotherapy is the most commonly used treatment option.The role of surgical resection for multiple brain metastases is unclear.The aim of this study was to compare the outcomes of patients with multiple brain metastases treated with either surgery or stereotactic radiosurgery(SRS).Methods:The medical records of 279 consecutive adult patients with multiple brain metastases treated with either surgery(26 patients)or SRS(253 patients)were retrospectively reviewed.Propensity score matching was conducted to correct for discrepancies in the baseline characteristics,and 78 patients(26 receiving surgery and 52 receiving SRS)were chosen for comparison of outcomes,such as overall survival,local tumor control rate,and symptom improvement.Results:The tumor size in the surgery group was significantly greater than that in the SRS group after propensity score matching.However,the neurological recovery rate,incidence of leptomeningeal metastasis after surgery,1-year local tumor control rate,and overall survival were not significantly different between groups.Conclusions:Our data demonstrate that surgery and radiosurgery have identical overall survival and local tumor control rates in patients with 2 to 4 brain metastases.Although SRS remains the primary and standard option for patients with brain metastasis,surgery offers several distinct advantages,such as establishing a diagnosis or relieving mass effects,and may additionally be beneficial in carefully selected patients with 2–4 brain metastases.
基金This study was supported by grants from the National Natural Science Foundation of China (No. 81302003) and Tianjin Science and Technology Foundation (No. 2012KZ065).
文摘Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord.The purpose of this study was to evaluate the safety and efficacy of CyberKnife(R) radiation therapy for spinal metastases.Methods Seventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed.Thirteen tumors in 12 patients had received prior radiation.Patients were followed clinically and radiographically for at least 12 months or until death.In all patients,the spinal cord and thecal sac were contoured for dose-volume constraints,and maximum doses to 0.1,0.5,1,2,and 5-ml volumes were analyzed.Results Using the CyberKnife System,20-48 Gy in one to five fractions for unirradiated patients,and 21-38 Gy in one to five fractions for the previously irradiatied patients,were delivered.Median 2-Gy normalized Biological Equvaient Dose (nBED) of unirradiated targets and irradiated targets were 49.6 Gy10/2 (range,31.25-74.8 Gy10/2) and 46.9 Gy10/2 (range,29.8-66 Gy10/2),respectively.With a median follow-up of 9.4 months (range,2.5-45 months),twenty-nine patients (46.7%) were alive,whereas the others died of progressive disease.Fifty-six patients (93.3%) reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up,17 patients (28.3%) reported some degree of pain relief after first fraction of the treatment course.Two patients experienced local recurrence at fifth and ninth months postradiotherapy.Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 (range,8.3-154.5Gy2/2) and 83.5 Gy2/2 (range,10.5-180.5 Gy2/2),respectively.Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 (range,17.7-140 Gy2/2) and 70.5 Gy2/2 (range,21.7-141.3 Gy2/2),respectively.No patient developed radiation related myelopathy during the follow-up period.Conclusion Cyberknife radiotherapy is clinically effective and safe for spinal metastases,even in previously irradiated patients.