目的:对比观察特瑞普利单抗联合立体定向放射治疗(SBRT)复发转移鼻咽癌患者的疗效及安全性,并评估长期预后及其影响因素。方法:选择2023年1月至2024年12月于我院就诊的复发转移鼻咽癌患者60例,随机分为观察组和对照组,各30例。观察组采...目的:对比观察特瑞普利单抗联合立体定向放射治疗(SBRT)复发转移鼻咽癌患者的疗效及安全性,并评估长期预后及其影响因素。方法:选择2023年1月至2024年12月于我院就诊的复发转移鼻咽癌患者60例,随机分为观察组和对照组,各30例。观察组采用特瑞普利单抗联合SBRT治疗;对照组采用常规治疗。比较两组患者主要疗效终点、免疫调控指标和安全性。结果:观察组ORR(70.0%vs 43.3%,P=0.037)、mPFS(11.5 vs 8.6个月)及mOS(26.5 vs 18.9个月)均优于对照组(P<0.001)。观察组免疫调控指标改善较对照组显著:VEGF降幅更高、CD4+/CD8+比值提升、NLR下降(P<0.001)、EBV-DNA转阴率更高(P=0.017)。两组主要不良事件为肝/血液毒性(发生率相近),观察组甲状腺功能减退及胆红素升高更常见,但3/4级不良反应发生率无差异。结论:特瑞普利单抗联合SBRT显著提升复发转移性鼻咽癌患者疗效及生存,兼具免疫调节作用,且安全性可控。展开更多
Purpose: The experimental verification of the Acuros XB (AXB) algorithm was conducted in a heterogeneous rectangular slab phantom, and compared to the Anisotropic Analytical Algorithm (AAA). The dosimetric impact of t...Purpose: The experimental verification of the Acuros XB (AXB) algorithm was conducted in a heterogeneous rectangular slab phantom, and compared to the Anisotropic Analytical Algorithm (AAA). The dosimetric impact of the AXB for stereotactic body radiation therapy (SBRT) and RapidArc planning for 16 non-small-cell lung cancer (NSCLC) patients was assessed due to the dose recalculation from the AAA to the AXB. Methods: The calculated central axis percentage depth doses (PDD) in a heterogeneous slab phantom for an open field size of 3 ×3 cm2 were compared against the PDD measured by an ionization chamber. For 16 NSCLC patients, the dose-volume parameters from the treatment plans calculated by the AXB and the AAA were compared using identical jaw settings, leaf positions, and monitor units (MUs). Results: The results from the heterogeneous slab phantom study showed that the AXB was more accurate than the AAA;however, the dose underestimation by the AXB (up to ?3.9%) and AAA (up to ?13.5%) was observed. For a planning target volume (PTV) in the NSCLC patients, in comparison to the AAA, the AXB predicted lower mean and minimum doses by average 0.3% and 4.3% respectively, but a higher maximum dose by average 2.3%. The averaged maximum doses to the heart and spinal cord predicted by the AXB were lower by 1.3% and 2.6% respectively;whereas the doses to the lungs predicted by the AXB were higher by up to 0.5% compared to the AAA. The percentage of ipsilateral lung volume receiving at least 20 and 5 Gy (V20 and V5 respectively) were higher in the AXB plans than in the AAA plans by average 1.1% and 2.8% respectively. The AXB plans produced higher target heterogeneity by average 4.5% and lower plan conformity by average 5.8% compared to the AAA plans. Using the AXB, the PTV coverage (95% of the PTV covered by the 100% of the prescribed dose) was reduced by average 8.2% than using the AAA. The AXB plans required about 2.3% increment in the number of MUs in order to achieve the same PTV coverage as in the AAA plans. Conclusion: The AXB is more accurate to use for the dose calculations in SBRT lung plans created with a RapidArc technique;however, one should also note the reduced PTV coverage due to the dose recalculation from the AAA to the AXB.展开更多
The purpose of the study was to evaluate a treatment dose using planning computed tomography (pCT) that was deformed to pre-treatment cone beam computed tomography (CBCT) for lung stereotactic body radiation therapy (...The purpose of the study was to evaluate a treatment dose using planning computed tomography (pCT) that was deformed to pre-treatment cone beam computed tomography (CBCT) for lung stereotactic body radiation therapy (SBRT) treatment. Five lung SBRT patients were retrospectively selected, and their daily CBCTs were employed in this study. Dosimetric comparison was performed between the original and recalculated plans from the deformed pCT (dose per fraction) by comparing a target coverage and organs at risk. Dose summation of five fractions was computed and compared to the original plan. A phantom study was conducted to evaluate the dosimetric accuracy for the dose per fraction. In the phantom study, the difference between the mean Hounsfield Unit (HU) values of the original and deformed pCTs is less than 0.5%. In patient study, the mean HU deviation of the five deformed pCTs compared to that of the original pCT was within ±5%, which is dosimetrically insignificant. While the internal target volume (ITV) shrank by 17% on average among the five patients, mean lung dose (MLD) increased by up to 7%, and D95% of PTV decreased slightly but stayed within 5%. Results showed that MLD might be a better indicative metric of normal lung dose than V20Gy as the ITV volume decreases. This study showed a feasibility to use a deformed pCT for evaluation of the dose per fraction and for a possible plan adaptation in lung SBRT cases. Readers should be cautious in selecting patients before clinical application due to the image quality of CBCT.展开更多
Purpose: To evaluate planning quality of Stereotactic body Radiotherapy (SBRT) with multiple lungmetastases generated by the Pinnacle and Tomotherapy planning systems, respectively. Methods and Materials: Nine randoml...Purpose: To evaluate planning quality of Stereotactic body Radiotherapy (SBRT) with multiple lungmetastases generated by the Pinnacle and Tomotherapy planning systems, respectively. Methods and Materials: Nine randomly selected patients diagnosed with non-small cell lung carcinoma with multiple lesions were planned with Philips Pinnacle (version 9.2, Fitchburg, WI) and Tomotherapy (version 4.2, Madison, WI), respectively. Both coplanar and non-coplanar IMRT plans were generated on Pinnacle system. A total dose of 60 Gy was prescribed to cover 95% of Planning Target Volume (PTV) in 3 fractions based on the RTOG0236 protocol prescription [1]. All plans with single isocenter setting were used for multiple lesions planning. A set of nine static beams were used for Pinnacle plansusing Direct Machine Parameters Optimization (DMPO) algorithm of RTOT0236 dose constraints. Planning outcomes such as minimum and mean doses, V95, D95 (95% of target volume receivesprescription dose), D5, and D1 to PTV, maximum dose to heart, esophagus, cord, trachea, brachial plexus, rib, chest wall, and liver, mean dose toliver, total lung, right and left lung, volume of chest wall receives 30 Gy, volume of lungs receives 5 Gy and 20 Gy (V5 and V20), conformity index (CI) and heterogeneity index (HI) were all reported for evaluation. Results: Mean volume of PTV was 37.77 ± 23.4 cm3. D95 of PTV with Tomotherapy, coplanar, non-coplanar plan was 60.2 ± 0.3 Gy, 58.6 ± 1.2 Gy, and 59.1 ± 0.7 Gy, respectively. Mean dose to PTV was lower for Tomotherapy (p 5 (p 1 (p = 0.001). CI was higher with Tomotherapyplans (p p 5 which needs more attention for toxicity analysis.展开更多
Purpose: Patients with locally recurrent lung cancer after definitive radiation therapy pose a challenge in management. Surgery is often not an option and chemotherapy offers poor long-term local control. Stereotactic...Purpose: Patients with locally recurrent lung cancer after definitive radiation therapy pose a challenge in management. Surgery is often not an option and chemotherapy offers poor long-term local control. Stereotactic body radiotherapy (SBRT) was investigated in an attempt to salvage locally recurrent lung cancer. Materials and Methods: From March, 2009 to January, 2010, 8 patients who had previous definitive radiation therapy for lung cancer at least six months prior to the diagnosis of locally recurrent disease underwent SBRT. Local recurrence was documented by CT, PET, and/or biopsy. Patients had to have Karnofsky Performance Score (KPS) > 70, no distant metastases by CT/PET and brain MRI, and lesions amenable to SBRT. SBRT dose deliveries were 12 Gy x 4, 10 Gy x 5, 8 Gy x 5, or 20 Gy x 3 at the treating physician’s discretion. No adjuvant chemotherapy was delivered. Results: Eight patients were included in this study. Patient characteristics were: 6 females and 2 males;ages 50 - 85 (median 71);KPS 70 - 100 (median 80);previous stage I (T1/2 N0) in 4 and stage II/III (T1/2 N1/N2) in 3, 1 pt had limited stage small cell;previous radiation doses 50 - 68 Gy in 1.8/2.5 Gy fractions;time interval from previous RT to SBRT 8 - 57 months (median 36 months);target lesion diameters 1.2 - 7.3 cm (median 4.5 cm). With a median FU of 18 months (11 - 20 months), 7 patients are alive. Crude local/regional control to date is 86% with distant metastases in 1/7 surviving patients. Acute pulmonary toxicities: cough grade 0 7/8, grade 1 1/8;pain grade 0 6/8, grade 1 2/8;dyspnea grade 2 8/8. 1 patient died 12 months after SBRT due to complications from a hip fracture. Her disease was locally controlled at the time of death. Discussion: In carefully selected patients who recur locally after previous conventional radiation therapy for lung cancer, SBRT can offer a well tolerated salvage therapy. Further follow up is needed to assess long-term local control, survival and toxicities.展开更多
体部立体定向放射治疗(Stereotactic Body Radiation Therapy,SBRT)是应用立体定位技术和特殊射线装置,将多源、多线束或多野三维空间聚焦的高能射线聚焦于体内某一靶区,使病灶组织受到高剂量照射,周围正常组织受量减少,从而获得临床疗...体部立体定向放射治疗(Stereotactic Body Radiation Therapy,SBRT)是应用立体定位技术和特殊射线装置,将多源、多线束或多野三维空间聚焦的高能射线聚焦于体内某一靶区,使病灶组织受到高剂量照射,周围正常组织受量减少,从而获得临床疗效高,副作用小的一类放疗技术的总称,采用γ射线所完成的SBRT简称为γ刀,采用X射线所完成的SBRT简称为X刀。SBRT的优势是采用高分次剂量、短疗程分割模式,具有明显的放射生物学优势。无论是国外还是国内,SBRT治疗肿瘤的临床结果均令人鼓舞,治疗早期非小细胞肺癌的3年生存率和局控率均优于常规放疗,与手术效果无差异,而且副作用小,治疗肝癌和胰腺癌的局控率和生存率也获得了大幅度提高。我国的γ刀技术具有独特的剂量聚焦优势和完全自主知识产权,符合我国"十一五"科技自主创新的要求,而且疗效显著、性价比高、易于推广应用符合我国国情。但由于种种原因,SBRT技术在中国尚未引起足够重视,中国γ刀技术需要从设备完善、加大政府支持力度和规范临床应用三个方面进行改进,SBRT的健康发展对推动我国放射肿瘤专业发展具有重要意义。展开更多
文摘目的:对比观察特瑞普利单抗联合立体定向放射治疗(SBRT)复发转移鼻咽癌患者的疗效及安全性,并评估长期预后及其影响因素。方法:选择2023年1月至2024年12月于我院就诊的复发转移鼻咽癌患者60例,随机分为观察组和对照组,各30例。观察组采用特瑞普利单抗联合SBRT治疗;对照组采用常规治疗。比较两组患者主要疗效终点、免疫调控指标和安全性。结果:观察组ORR(70.0%vs 43.3%,P=0.037)、mPFS(11.5 vs 8.6个月)及mOS(26.5 vs 18.9个月)均优于对照组(P<0.001)。观察组免疫调控指标改善较对照组显著:VEGF降幅更高、CD4+/CD8+比值提升、NLR下降(P<0.001)、EBV-DNA转阴率更高(P=0.017)。两组主要不良事件为肝/血液毒性(发生率相近),观察组甲状腺功能减退及胆红素升高更常见,但3/4级不良反应发生率无差异。结论:特瑞普利单抗联合SBRT显著提升复发转移性鼻咽癌患者疗效及生存,兼具免疫调节作用,且安全性可控。
文摘Purpose: The experimental verification of the Acuros XB (AXB) algorithm was conducted in a heterogeneous rectangular slab phantom, and compared to the Anisotropic Analytical Algorithm (AAA). The dosimetric impact of the AXB for stereotactic body radiation therapy (SBRT) and RapidArc planning for 16 non-small-cell lung cancer (NSCLC) patients was assessed due to the dose recalculation from the AAA to the AXB. Methods: The calculated central axis percentage depth doses (PDD) in a heterogeneous slab phantom for an open field size of 3 ×3 cm2 were compared against the PDD measured by an ionization chamber. For 16 NSCLC patients, the dose-volume parameters from the treatment plans calculated by the AXB and the AAA were compared using identical jaw settings, leaf positions, and monitor units (MUs). Results: The results from the heterogeneous slab phantom study showed that the AXB was more accurate than the AAA;however, the dose underestimation by the AXB (up to ?3.9%) and AAA (up to ?13.5%) was observed. For a planning target volume (PTV) in the NSCLC patients, in comparison to the AAA, the AXB predicted lower mean and minimum doses by average 0.3% and 4.3% respectively, but a higher maximum dose by average 2.3%. The averaged maximum doses to the heart and spinal cord predicted by the AXB were lower by 1.3% and 2.6% respectively;whereas the doses to the lungs predicted by the AXB were higher by up to 0.5% compared to the AAA. The percentage of ipsilateral lung volume receiving at least 20 and 5 Gy (V20 and V5 respectively) were higher in the AXB plans than in the AAA plans by average 1.1% and 2.8% respectively. The AXB plans produced higher target heterogeneity by average 4.5% and lower plan conformity by average 5.8% compared to the AAA plans. Using the AXB, the PTV coverage (95% of the PTV covered by the 100% of the prescribed dose) was reduced by average 8.2% than using the AAA. The AXB plans required about 2.3% increment in the number of MUs in order to achieve the same PTV coverage as in the AAA plans. Conclusion: The AXB is more accurate to use for the dose calculations in SBRT lung plans created with a RapidArc technique;however, one should also note the reduced PTV coverage due to the dose recalculation from the AAA to the AXB.
文摘The purpose of the study was to evaluate a treatment dose using planning computed tomography (pCT) that was deformed to pre-treatment cone beam computed tomography (CBCT) for lung stereotactic body radiation therapy (SBRT) treatment. Five lung SBRT patients were retrospectively selected, and their daily CBCTs were employed in this study. Dosimetric comparison was performed between the original and recalculated plans from the deformed pCT (dose per fraction) by comparing a target coverage and organs at risk. Dose summation of five fractions was computed and compared to the original plan. A phantom study was conducted to evaluate the dosimetric accuracy for the dose per fraction. In the phantom study, the difference between the mean Hounsfield Unit (HU) values of the original and deformed pCTs is less than 0.5%. In patient study, the mean HU deviation of the five deformed pCTs compared to that of the original pCT was within ±5%, which is dosimetrically insignificant. While the internal target volume (ITV) shrank by 17% on average among the five patients, mean lung dose (MLD) increased by up to 7%, and D95% of PTV decreased slightly but stayed within 5%. Results showed that MLD might be a better indicative metric of normal lung dose than V20Gy as the ITV volume decreases. This study showed a feasibility to use a deformed pCT for evaluation of the dose per fraction and for a possible plan adaptation in lung SBRT cases. Readers should be cautious in selecting patients before clinical application due to the image quality of CBCT.
文摘Purpose: To evaluate planning quality of Stereotactic body Radiotherapy (SBRT) with multiple lungmetastases generated by the Pinnacle and Tomotherapy planning systems, respectively. Methods and Materials: Nine randomly selected patients diagnosed with non-small cell lung carcinoma with multiple lesions were planned with Philips Pinnacle (version 9.2, Fitchburg, WI) and Tomotherapy (version 4.2, Madison, WI), respectively. Both coplanar and non-coplanar IMRT plans were generated on Pinnacle system. A total dose of 60 Gy was prescribed to cover 95% of Planning Target Volume (PTV) in 3 fractions based on the RTOG0236 protocol prescription [1]. All plans with single isocenter setting were used for multiple lesions planning. A set of nine static beams were used for Pinnacle plansusing Direct Machine Parameters Optimization (DMPO) algorithm of RTOT0236 dose constraints. Planning outcomes such as minimum and mean doses, V95, D95 (95% of target volume receivesprescription dose), D5, and D1 to PTV, maximum dose to heart, esophagus, cord, trachea, brachial plexus, rib, chest wall, and liver, mean dose toliver, total lung, right and left lung, volume of chest wall receives 30 Gy, volume of lungs receives 5 Gy and 20 Gy (V5 and V20), conformity index (CI) and heterogeneity index (HI) were all reported for evaluation. Results: Mean volume of PTV was 37.77 ± 23.4 cm3. D95 of PTV with Tomotherapy, coplanar, non-coplanar plan was 60.2 ± 0.3 Gy, 58.6 ± 1.2 Gy, and 59.1 ± 0.7 Gy, respectively. Mean dose to PTV was lower for Tomotherapy (p 5 (p 1 (p = 0.001). CI was higher with Tomotherapyplans (p p 5 which needs more attention for toxicity analysis.
文摘Purpose: Patients with locally recurrent lung cancer after definitive radiation therapy pose a challenge in management. Surgery is often not an option and chemotherapy offers poor long-term local control. Stereotactic body radiotherapy (SBRT) was investigated in an attempt to salvage locally recurrent lung cancer. Materials and Methods: From March, 2009 to January, 2010, 8 patients who had previous definitive radiation therapy for lung cancer at least six months prior to the diagnosis of locally recurrent disease underwent SBRT. Local recurrence was documented by CT, PET, and/or biopsy. Patients had to have Karnofsky Performance Score (KPS) > 70, no distant metastases by CT/PET and brain MRI, and lesions amenable to SBRT. SBRT dose deliveries were 12 Gy x 4, 10 Gy x 5, 8 Gy x 5, or 20 Gy x 3 at the treating physician’s discretion. No adjuvant chemotherapy was delivered. Results: Eight patients were included in this study. Patient characteristics were: 6 females and 2 males;ages 50 - 85 (median 71);KPS 70 - 100 (median 80);previous stage I (T1/2 N0) in 4 and stage II/III (T1/2 N1/N2) in 3, 1 pt had limited stage small cell;previous radiation doses 50 - 68 Gy in 1.8/2.5 Gy fractions;time interval from previous RT to SBRT 8 - 57 months (median 36 months);target lesion diameters 1.2 - 7.3 cm (median 4.5 cm). With a median FU of 18 months (11 - 20 months), 7 patients are alive. Crude local/regional control to date is 86% with distant metastases in 1/7 surviving patients. Acute pulmonary toxicities: cough grade 0 7/8, grade 1 1/8;pain grade 0 6/8, grade 1 2/8;dyspnea grade 2 8/8. 1 patient died 12 months after SBRT due to complications from a hip fracture. Her disease was locally controlled at the time of death. Discussion: In carefully selected patients who recur locally after previous conventional radiation therapy for lung cancer, SBRT can offer a well tolerated salvage therapy. Further follow up is needed to assess long-term local control, survival and toxicities.
文摘体部立体定向放射治疗(Stereotactic Body Radiation Therapy,SBRT)是应用立体定位技术和特殊射线装置,将多源、多线束或多野三维空间聚焦的高能射线聚焦于体内某一靶区,使病灶组织受到高剂量照射,周围正常组织受量减少,从而获得临床疗效高,副作用小的一类放疗技术的总称,采用γ射线所完成的SBRT简称为γ刀,采用X射线所完成的SBRT简称为X刀。SBRT的优势是采用高分次剂量、短疗程分割模式,具有明显的放射生物学优势。无论是国外还是国内,SBRT治疗肿瘤的临床结果均令人鼓舞,治疗早期非小细胞肺癌的3年生存率和局控率均优于常规放疗,与手术效果无差异,而且副作用小,治疗肝癌和胰腺癌的局控率和生存率也获得了大幅度提高。我国的γ刀技术具有独特的剂量聚焦优势和完全自主知识产权,符合我国"十一五"科技自主创新的要求,而且疗效显著、性价比高、易于推广应用符合我国国情。但由于种种原因,SBRT技术在中国尚未引起足够重视,中国γ刀技术需要从设备完善、加大政府支持力度和规范临床应用三个方面进行改进,SBRT的健康发展对推动我国放射肿瘤专业发展具有重要意义。
