这项研究得到台北医科大学医院 (106 tmuh-02) 的支持。

本研究获得台北医科大学联合机构评审委员会批准。
1. SBRT 咨询
<ol><li>通过咨询多学科肿瘤委员会, 评估 SBRT 治疗肝转移瘤患者的资格。 注意: 需要进行局部消融以及手术和其他治疗选择必须由肿瘤委员会评估。我们的选择标准如下: 1) 具有良好表现状态的成年患者 (东方合作肿瘤组 0-1), 2) 通过抗癌药物控制癌症状态, 仅在肝脏 oligometastases, 3) 肝损害数≤3和最大的肿瘤≤6厘米直径, 4) 肝体积 (肝脏不包括总肿瘤) 大于700厘米3, 5), 没有急性肝炎或慢性乙型肝炎在稳定的抗病毒控制。</li>
	<li>讨论 SBRT 及其相关的风险以及 SBRT 与常规放疗之间的差异与患者9,19。</li>
</ol>2. CT 模拟
<ol><li>
把病人放在仰卧位, 头先放在沙发上, 手臂放在头上。
	<ol>
<li>使用系统 (例如, BodyFIX) 来固定病人。将病人放置在一个个性化的, 真空的减压袋中, 用盖子盖住病人。</li>
		<li>应用腹部压缩机 (ac), 并标记交流的深度。 注意: AC 限制患者的呼吸运动;因此, 有些病人可能会在这个过程中产生呼吸困难。应提供通过鼻腔插管补充氧气, 以减轻他们的不适。</li>
		<li>将呼吸跟踪传感器放在胸腔壁上, 并监测呼吸波形。</li>
	</ol>
</li>
	<li>
获得放射治疗计划的 CT 图像。
	<ol>
<li>选择4维 CT 扫描模式, 3 毫米切片厚度。</li>
		<li>进行 surview 扫描 (120 伏, 30 mA), 以获得患者的前后 (AP) 和侧面视图。在屏幕和控制面板上单击"转到"。</li>
		<li>确定 "螺旋扫描" 分页下的 ct 扫描覆盖率, 并在 "肺门扫描" 分页中决定4维 ct 扫描范围。 注: 螺旋扫描的覆盖范围应从肺的顶端延伸到离肝尾缘至少5厘米的距离。肺门扫描的领域, 这是小于螺旋扫描, 应该覆盖肝脏与3-5 厘米延伸从颅和尾部的肝脏。</li>
		<li>监测呼吸波形, 直到它保持稳定3分钟。</li>
		<li>注射100毫升造影剂 (例如, 欧乃派克), 速度为4-5 毫升/秒, 通过18克静脉注射导管进入 antecubital 静脉。</li>
		<li>进行对比螺旋 CT 扫描 (120 kV, 400 mAs/切片), 十五年代后造影注射。</li>
		<li>随后通过点击 "下一个系列" 进行非对比的4维 CT 扫描 (120 伏, 2000 mAs/切片)。</li>
	</ol>
</li>
</ol>3. 放疗治疗计划
<ol><li>
将图像从 CT 模拟和诊断扫描导入计划系统。 注: 诊断图像可能包括正电子发射断层扫描 (pet)/pet-ct, 磁共振图像, 或诊断螺旋 CT 扫描。</li>
	<li>
轮廓转移肿瘤成总肿瘤体积和相邻器官的危险 (桨)。
	<ol>
<li>选择一个器官 (这里, 胃) 和使用刷子, 铅笔,等。在 CT 图像的每个切片中对器官进行轮廓。圈或定义感兴趣的器官。使用 "向上" 和 "向下" 按钮查看每个图像切片。 注: 桨叶包括肺部、胃、十二指肠、脊髓、肝脏、小肠、肋骨和肾脏。</li>
	</ol>
</li>
	<li>
根据动态跟踪图像观察到的器官运动, 对肿瘤的内靶容积 (ITV) 进行轮廓分析。在 ITV 中添加一个5毫米的边距以获得规划目标卷 (PTV)。
	<ol>
<li>选择一个器官 (这里, 胃) 和使用刷子, 铅笔,等。在 CT 图像的每个切片中对器官进行轮廓。圈或定义感兴趣的器官。使用 "向上" 和 "向下" 按钮查看每个图像切片。</li>
	</ol>
</li>
	<li>为相对较大的肿瘤, 在五个馏分中规定辐射剂量为48至三分或 35 PTV。 注: 治疗计划必须考虑因桨而造成的限制;如果桨的辐射剂量在约束范围内 (表 1), 则相对较高的处方剂量是可以接受的。</li>
</ol>4. 治疗分娩
<ol><li>使用每日质量保证确认辐射光束数据, 确保数据在正常范围内。</li>
	<li>使用病人的姓名、出生日期和身份证识别病人。将病人放置在真空袋中, 放置盖板, 并根据 CT 模拟部分所描述的程序固定 AC。</li>
	<li>
获取4D 锥束 CT (总站) 图像, 调整沙发, 使其与在模拟 CT 图像上获得的4维总站图像的目标位置相关联。
	<ol>
<li>选择4D 总站模式并确认安装数据。单击面板上的"转到" 。</li>
	</ol>
</li>
	<li>
4D 总站后, 将获得的4D 总站图像加载到 IGRT 系统中。左上、右下图像均由 CT 模拟作为轮廓和治疗计划。右上角和下左图像来自4D 总站, 每天在每个分数之前执行。
	<ol>
<li>使用软件调整设置。然后, 手动调整沙发上的每个参数。沙发在 X、Y 和 Z 轴上只有3直线运动, 而系统在6中可以调整, 包括旋转、俯仰和滚动。因此, 技术员需要证实调整。</li>
		<li>记录和打印每日调整的参数。 注: 如果肿瘤位置在任何一个六轴上超过5毫米的公差限制, 病人应重新定位。</li>
	</ol>
</li>
	<li>提供放射治疗。确认处理计划和系统配置。单击 "转到" 开始治疗。在整个治疗过程中用实时摄像头监控病人, 以确保病人的安全。</li>
</ol>

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作者没有披露。

呼吸引起的肝畸形和器官运动导致了与辐射传递有关的困难, 以及轮廓 (目标划定) 问题。对器官运动管理技术的改进提高了治疗的准确性和精确度, 这对 SBRT 是至关重要的。目前有几种图像引导技术和呼吸运动管理系统。基准标记植入是目标定位的常用技术。基准标记通常是圆柱形的金籽, 长度为2.5 到5毫米, 直径为0.8 毫米. 在病变附近植入一个基准标记, 使基于 X 射线的图像引导系统能够定位目标...

传统上, 转移被认为是癌症的末期阶段, 与预后和生存率差有关。但是, 山et al。在1984年报告说, 根据他们20年的经验, 完整的手术切除肺转移导致一个相对较高的存活率, 如果主要肿瘤部位是在系统控制的时候, 手术1。赫尔曼和 Weichselbaum 在1995年首次提出 oligometastases, 一个中间阶段之间的局部病变和系统性疾病与 polymetastases, 这可以治愈使用额外的局部治疗2,3。在过去的几十年中, 早期发现转移, 新的手术方法治疗 oligometastases (后) 和有效的化疗改善了预后的转移。肝脏是实体肿瘤最常见的转移器官之一, 肝 oligometastases 的手术切除可以改善生存。局部消融方法, 包括射频消融, radioembolization 和放疗, 为治疗肝转移已建议一些无法手术的病人, 以实现必要的局部肿瘤控制3,4,5,6,7. 在过去几年中, 一些前瞻性和回顾性的研究报告通过立体定向体放疗 (SBRT), 也称为立体定向消融放疗, 对肝转移瘤进行有效的局部肿瘤控制, 可耐受毒性4,5,8,9。
在病人定位和固定化方法方面已经有了改进;图像采集、整合和转移到放疗系统;呼吸运动管理;高剂量输出和快速辐射输送;以及从靶病变到周围正常组织的陡峭剂量梯度。由于这些进展, SBRT 实现高度精确和精确的放射治疗与极小的严重毒性10,11。呼吸运动管理是 SBRT 的基础, 特别是对肝脏和肺部病变。一种无创、临床方便的呼吸管理技术将极大地提高 SBRT 作为治疗方案的普及程度。本文详细介绍了肝转移的 SBRT 协议, 使用四维计算机断层扫描 (4 d-CT) 与腹部压缩机 (AC) 的图像引导帮助和肝脏运动管理。

<table><tbody><tr><td>CT scan</td><td>Philips</td><td>Brilliance&amp;nbsp;Big Bore&amp;nbsp;16 Slice&amp;nbsp;CT, 7387</td><td>Acquire CT images for contouring and planning</td></tr><tr><td>CT contrast</td><td>GE Healthcare</td><td>Omnipaque 350 mg L/mL</td><td>Enhence lesion in CT images</td></tr><tr><td>Linear accelerator</td><td>Elekta</td><td>Synergy</td><td>Deliver radiotherapy</td></tr><tr><td>Palnning system</td><td>Pinnacle</td><td>Pinnacle 9.8</td><td>Implement radiotherapy planning</td></tr><tr><td>Immobilization: BlueBag BodyFix</td><td>Elekta</td><td>900 mm x 2325 mm, P10104840</td><td>Immobilize the patient</td></tr><tr><td>Immobilization: BodyFix Cover sheet</td><td>Elekta</td><td>2700 mm x 1400 mm, P10102-304</td><td>Immobilize the patient</td></tr><tr><td>Immobilization: BodyFix abdominal compressor</td><td>Elekta</td><td>diaphragm control, P10102-149</td><td>Restrict breath motion and organ/lesion motion</td></tr><tr><td>Immobilization: vacuum pump</td><td>Elekta</td><td>vacuum pump, p2 120V, P10102-110</td><td>Shape body bag and cover sheet according to the patient</td></tr></tbody></table>

treatment of liver metastases using an internal target volume method for stereotactic body radiotherapy

由于有效的化疗和 oligometastatic 手术, 在过去数十年中, 转移性癌症患者的预后有所改善。对于无法手术的病人, 局部消融治疗, 如立体定向体放射治疗 (SBRT), 可以提供有效的局部肿瘤控制和最小的毒性。由于它的高精度和准确性, SBRT 提供了更高的辐射剂量每分数, 是更有效的, 并针对较小的辐射量比常规放疗。此外, 利用 SBRT 实现了靶向病灶向周围正常组织的陡峭剂量梯度;因此, SBRT 提供更有效的肿瘤控制, 并表现出较少的副作用比常规放疗。使用 SBRT 是普遍的治疗颅内病变 (称为立体定向放射外科);然而, 它现在也被用于治疗脊柱和肾上腺转移。由于在图像引导辅助和呼吸运动管理方面的进步, 一些研究已经研究了使用 SBRT 治疗肺或肝肿瘤, 这是作为一个病人呼吸移动。这些研究的结果表明, SBRT 有利控制肿瘤的运动性病变。
四维计算机断层扫描 (4 维 ct) 与腹部压缩机 (AC) 是临床上方便有效的呼吸运动管理。因为这种方法是无创的, 并允许自由呼吸, 它的使用减少并发症。此外, 病人认为这种方法很方便。此外, 它被认为比其他方法的呼吸运动管理的医生和治疗师。应用4维 CT 和 AC 治疗肺部病变也得到了广泛的研究, 该技术正在获得接受治疗肝损害。然而, 使用4维 CT 的交流治疗肝脏病变的协议与治疗肺部病变的方法不同。在本文中, 我们描述了一个新的协议 SBRT 4 维 CT 和交流治疗肝转移。

SBRT 可以通过强调制放疗 (IMRT) (与6辐射束) 或容积式电弧放疗 (VMAT) (连续剂量传递和龙门旋转) 来覆盖所有目标的单一治疗, 因为单一的手术可能<img alt="image" src="/files/ftp_upload/57050/57050imgv2.jpg">不能达到切除所有肿瘤的效果。有代表性的 SBRT 治疗计划表明, 手术不可行时两种肝转移瘤的放疗计划成功。两个转移肿瘤的长度为 3cm (从段4到段 8) 和4.3 厘米 (段 8), 其体积分别为13厘...

Watch this Scientific Journal Video about Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy at JoVE.com

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

立体定向体放疗 (SBRT) 需要严格的准确性和精确度, 以提供高辐射剂量每分数到小的治疗量, 以改善肿瘤控制和同时减少毒性。在此, 我们提出了一个无创和临床方便的呼吸运动管理协议 SBRT 肝转移。

内靶容积法治疗肝转移瘤的立体定向体放疗

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

treatment-liver-metastases-using-an-internal-target-volume-method-for

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

14.1K 次观看.  Taipei Medical University Hospital. 立体定向体放疗 (SBRT) 需要严格的准确性和精确度, 以提供高辐射剂量每分数到小的治疗量, 以改善肿瘤控制和同时减少毒性。在此, 我们提出了一个无创和临床方便的呼吸运动管理协议 SBRT 肝转移。

视频: Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

PET and MRI Guided Irradiation of a Glioblastoma Rat Model Using a Micro-irradiator

For decades, small animal radiation research was mostly performed using fairly crude experimental setups applying simple single-beam techniques without the ability to target a specific or well-delineated tumor volume. The delivery of radiation was achieved using fixed radiation sources or linear accelerators producing megavoltage (MV) X-rays. These devices are unable to achieve sub-millimeter precision required for small animals. Furthermore, the high doses delivered to healthy surrounding tissue hamper response assessment. To increase the translation between small animal studies and humans, our goal was to mimic the treatment of human glioblastoma in a rat model. To enable a more accurate irradiation in a preclinical setting, recently, precision image-guided small animal radiation research platforms were developed. Similar to human planning systems, treatment planning on these micro-irradiators is based on computed tomography (CT). However, low soft-tissue contrast on CT makes it very challenging to localize targets in certain tissues, such as the brain. Therefore, incorporating magnetic resonance imaging (MRI), which has excellent soft-tissue contrast compared to CT, would enable a more precise delineation of the target for irradiation. In the last decade also biological imaging techniques, such as positron emission tomography (PET) gained interest for radiation therapy treatment guidance. PET enables the visualization of e.g., glucose consumption, amino-acid transport, or hypoxia, present in the tumor. Targeting those highly proliferative or radio-resistant parts of the tumor with a higher dose could give a survival benefit. This hypothesis led to the introduction of the biological tumor volume (BTV), besides the conventional gross target volume (GTV), clinical target volume (CTV), and planned target volume (PTV).
At the preclinical imaging lab of Ghent University, a micro-irradiator, a small animal PET, and a 7 T small animal MRI are available. The goal was to incorporate MRI-guided irradiation and PET-guided sub-volume boosting in a glioblastoma rat model.

In the past, small animal irradiation was usually performed without the ability to target a well-delineated tumor volume. The goal was to mimic the treatment of human glioblastoma in rats. Using a small animal irradiation platform, we performed MRI-guided 3D conformal irradiation with PET-based sub-volume boosting in a preclinical setting.

PET 与 MRI 引导下微器对大鼠胶质瘤模型的照射

For decades, small animal radiation research was mostly performed using fairly crude experimental setups applying simple single-beam techniques without ...

科研

癌症研究

Stereotactic Radiosurgery for Gynecologic Cancer

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, intricate treatment planning, on-board imaging, and reduced number of ablative radiation doses to cancer targets usually refractory to chemotherapy and conventional radiation. Steep SBRT radiation dose drop-off permits narrow 'pencil beam' treatment fields to be used for ablative radiation treatment condensed into 1 to 3 treatments.
Treating physicians must appreciate that SBRT comes at a bigger danger of normal tissue injury and chance of geographic tumor miss. Both must be tackled by immobilization of cancer targets and by high-precision treatment delivery. Cancer target immobilization has been achieved through use of indexed customized Styrofoam casts, evacuated bean bags, or body-fix molds with patient-independent abdominal compression.1-3 Intrafraction motion of cancer targets due to breathing now can be reduced by patient-responsive breath hold techniques,4 patient mouthpiece active breathing coordination,5 respiration-correlated computed tomography,6 or image-guided tracking of fiducials implanted within and around a moving tumor.7-9 The Cyberknife system (Accuray [Sunnyvale, CA]) utilizes a radiation linear accelerator mounted on a industrial robotic arm that accurately follows patient respiratory motion by a camera-tracked set of light-emitting diodes (LED) impregnated on a vest fitted to a patient.10 Substantial reductions in radiation therapy margins can be achieved by motion tracking, ultimately rendering a smaller planning target volumes that are irradiated with submillimeter accuracy.11-13
Cancer targets treated by SBRT are irradiated by converging, tightly collimated beams. Resultant radiation dose to cancer target volume histograms have a more pronounced radiation "shoulder" indicating high percentage target coverage and a small high-dose radiation "tail." Thus, increased target conformality comes at the expense of decreased dose uniformity in the SBRT cancer target. This may have implications for both subsequent tumor control in the SBRT target and normal tissue tolerance of organs at-risk. Due to the sharp dose falloff in SBRT, the possibility of occult disease escaping ablative radiation dose occurs when cancer targets are not fully recognized and inadequate SBRT dose margins are applied. Clinical target volume (CTV) expansion by 0.5 cm, resulting in a larger planning target volume (PTV), is associated with increased target control without undue normal tissue injury.7,8 Further reduction in the probability of geographic miss may be achieved by incorporation of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET).8 Use of 18F-FDG PET/CT in SBRT treatment planning is only the beginning of attempts to discover new imaging target molecular signatures for gynecologic cancers.

Stereotactic body radiotherapy (SBRT) involves image-guided, ablative radiation delivered to cancer targets refractory to chemotherapy or to conventional radiation treatment. The robotic-armed Cyberknife SBRT system, using sophisticated target localization, delivers hypofractionated radiation doses capable of sterilizing cancer targets. This article will consider new therapeutic roles of SBRT for gynecological cancers.

妇科肿瘤的立体定向放射外科

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, ...

医学

Modeling Brain Metastasis by Internal Carotid Artery Injection of Cancer Cells

Brain metastasis is a cause of severe morbidity and mortality in cancer patients. Critical aspects of metastatic diseases, such as the complex neural microenvironment and stromal cell interaction, cannot be entirely replicated with in vitro assays; thus, animal models are critical for investigating and understanding the effects of therapeutic intervention. However, most brain tumor xenografting methods do not produce brain metastases consistently in terms of the time frame and tumor burden. Brain metastasis models generated by intracardiac injection of cancer cells can result in unintended extracranial tumor burden and lead to non-brain metastatic morbidity and mortality. Although intracranial injection of cancer cells can limit extracranial tumor formation, it has several caveats, such as the injected cells frequently form a singular tumor mass at the injection site, high leptomeningeal involvement, and damage to brain vasculature during needle penetration. This protocol describes a mouse model of brain metastasis generated by internal carotid artery injection. This method produces intracranial tumors consistently without the involvement of other organs, enabling the evaluation of therapeutic agents for brain metastasis.

Brain metastasis is a cause of severe morbidity and mortality in cancer patients. Most brain metastasis mouse models are complicated by systemic metastases confounding analysis of mortality and therapeutic intervention outcomes. Presented here is a protocol for internal carotid injection of cancer cells that produces consistent intracranial tumors with minimal systemic tumors.

通过颈内动脉注射癌细胞模拟脑转移

Brain metastasis is a cause of severe morbidity and mortality in cancer patients. Critical aspects of metastatic diseases, such as the complex neural ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.
In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Clinical Factors Influencing the Radiation Dose of Circulating Immune Cells during Radiotherapy for Small Cell Lung Cancer

Small cell lung cancer (SCLC) has garnered significant attention due to its high malignancy, propensity for distant metastasis, and poor prognosis. Radiotherapy remains the cornerstone of treatment for limited-stage small cell lung cancer (LS-SCLC). However, outcomes with radiotherapy alone or in combination with chemotherapy remain suboptimal. Radiotherapy can induce lymphopenia by directly irradiating hematopoietic organs or destroying mature circulating lymphocytes, leading to immunosuppression and consequently diminishing therapeutic efficacy. The estimated dose of radiation to immune cells (EDRIC) model integrates factors such as hemodynamics, lymphocyte radiosensitivity, and proliferation capacity. This study employs the EDRIC model with enhancements to calculate the circulating immune cell radiation dose. By utilizing the EDRIC methodology, the study explores the correlation between EDRIC and tumor target size, average lung dose, average heart dose, clinical features, and peripheral blood lymphocytopenia during radiotherapy for LS-SCLC, aiming to inform personalized patient treatment strategies.
This study analyzed data from 64 LS-SCLC patients who met the inclusion criteria at the General Hospital of Ningxia Medical University from January 2023 to January 2024, all of whom received radical thoracic conventional fractionated radiotherapy. Lymphocyte counts were recorded at the following points: before radiotherapy, at the lowest observed value during radiotherapy, at the end of radiotherapy, and one-month post-radiotherapy. Dosimetric data, including average lung, heart, and body doses, were extracted from the treatment planning system, and the circulating EDRIC was calculated using this model. The relationship between EDRIC values and therapeutic outcomes was analyzed. In LS-SCLC, the EDRIC model effectively predicts lymphocyte count reduction, correlating with planning target volume (PTV; cm3), TNM stage, and the percentage of target lesion shrinkage. Post-radiotherapy, there was a significant decrease in peripheral blood lymphocyte counts, with greater EDRIC values indicating more pronounced lymphocyte reduction.

Here, we present a protocol to evaluate the effects of radiation therapy on immune system lymphocytes in small cell lung cancer.

Small cell lung cancer (SCLC) has garnered significant attention due to its high malignancy, propensity for distant metastasis, and poor prognosis. ...

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable risks for normal tissue injury and the hazards of physical tumor miss. A first-of-its-kind SBRT platform achieves high-precision ablative radiation treatment through a combination of versatile real-time imaging solutions and sophisticated tumor tracking capabilities. It uses dual-diagnostic kV x-ray units for stereoscopic open-loop feedback of cancer target intrafraction movement occurring as a consequence of respiratory motions and heartbeat. Image-guided feedback drives a gimbaled radiation accelerator (maximum 15 x 15 cm field size) capable of real-time &#177;4 cm pan-and-tilt action. Robot-driven &#177;60&#176; pivots of an integrated &#177;185&#176; rotational gantry allow for coplanar and non-coplanar accelerator beam set-up angles, ultimately permitting unique treatment degrees of freedom. State-of-the-art software aids real-time six dimensional positioning, ensuring irradiation of cancer targets with sub-millimeter accuracy (0.4 mm at isocenter). Use of these features enables treating physicians to steer radiation dose to cancer tumor targets while simultaneously reducing radiation dose to normal tissues. By adding respiration correlated computed tomography (CT) and 2-[18F] fluoro-2-deoxy-&#7429;-glucose (18F-FDG) positron emission tomography (PET) images into the planning system for enhanced tumor target contouring, the likelihood of physical tumor miss becomes substantially less1. In this article, we describe new radiation plans for the treatment of moving lung tumors.

Stereotactic ablative body radiation therapy (SBRT) involves the precise delivery of high-dose radiation to cancer tumor targets. A novel SBRT platform offers a first-of-its-kind gimbaled radiation accelerator mounted within a pivoting O-ring gantry capable of dynamic image-guided tumor tracking. Here, we describe dynamic tumor tracking for lung targets.

动态肺肿瘤跟踪烧蚀立体定向放射身体治疗

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable ...

Targeted and Selective Treatment of Pluripotent Stem Cell-derived Teratomas Using External Beam Radiation in a Small-animal Model

The growing number of victims of &#34;stem cell tourism,&#34; the unregulated transplantation of stem cells worldwide, has raised concerns about the safety of stem cell transplantation. Although the transplantation of differentiated rather than undifferentiated cells is common practice, teratomas can still arise from the presence of residual undifferentiated stem cells at the time of transplant or from spontaneous mutations in differentiated cells. Because stem cell therapies are often delivered into anatomically sensitive sites, even small tumors can be clinically devastating, resulting in blindness, paralysis, cognitive abnormalities, and cardiovascular dysfunction. Surgical access to these sites may also be limited, leaving patients with few therapeutic options. Controlling stem cell misbehavior is, therefore, critical for the clinical translation of stem cell therapy.
External beam radiation offers an effective means of delivering targeted therapy to decrease the teratoma burden while minimizing injury to surrounding organs. Additionally, this method avoids genetic manipulation or viral transduction of stem cells-which are associated with additional clinical safety and efficacy concerns. Here, we describe a protocol to create pluripotent stem cell-derived teratomas in mice and to apply external beam radiation therapy to selectively ablate these tumors in vivo.

Research on treatment strategies for pluripotent stem cell-derived teratomas is important for the clinical translation of stem cell therapy. Here, we describe a protocol to, first, generate stem cell-derived teratomas in mice and, then, to selectively target and treat these tumors in vivo using a small-animal irradiator.

利用外束辐射对小型动物模型的多能干细胞衍生畸胎瘤进行靶向选择性治疗

The growing number of victims of &#34;stem cell tourism,&#34; the unregulated transplantation of stem cells worldwide, has raised concerns about the ...

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies

Radiation therapy is a frequently used modality for the treatment of solid cancers. Although the mechanisms of cell kill are similar for all forms of radiation, the in vivo properties of photon and proton beams differ greatly and maybe exploited to optimize clinical outcomes. In particular, proton particles lose energy in a predictable manner as they pass through the body. This property is used clinically to control the depth at which the proton beam is terminated, and to limit radiation dose beyond the target region. This strategy can allow for substantial reductions in radiation dose to normal tissues located just beyond a tumor target. However, the degradation of proton energy in the body remains highly sensitive to tissue density. As a consequence, any changes in tissue density during the course of treatment may significantly alter proton dosimetry. Such changes may occur through alterations in body weight, respiration, or bowel filling/gas, and may result in unfavorable dose deposition. In this manuscript, we provide a detailed method for the delivery of proton therapy using both passive scatter and pencil beam scanning techniques for prostate cancer. Although the described procedure directly pertains to prostate cancer patients, the method may be adapted and applied for the treatment of virtually all solid tumors. Our aim is to equip readers with a better understanding of proton therapy delivery and outcomes in order to facilitate the appropriate integration of this modality during cancer therapy.

The fundamentals of radiation planning and delivery for proton therapy using prostate cancer as a model are presented. The application of these principles to other selected disease sites highlights how proton radiotherapy may enhance clinical outcomes for cancer patients.

质子治疗在实体肿瘤恶性肿瘤选择中的临床应用

Radiation therapy is a frequently used modality for the treatment of solid cancers. Although the mechanisms of cell kill are similar for all forms of ...

Y-90 TARE and PD-1 Inhibition as Bridging Therapy in Hepatocellular Carcinoma

Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 transarterial radioembolization (TARE) and Programmed Cell Death-1 (PD-1) inhibitors as neoadjuvant therapy. Highlighted through a case report, it offers a step-by-step reference for similar therapeutic interventions. A retrospective analysis was conducted on a patient who underwent hepatectomy following Y-90 TARE and PD-1 inhibitor treatment. Key demographic and clinical details were recorded at admission to guide therapy selection. Y-90 TARE suitability and dosage calculation were based on Technetium-99m (Tc-99m) macroaggregated albumin (MAA) perfusion mapping tests. Lesion coverage by Y-90 microspheres was confirmed through single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging, and adverse reactions and follow-up outcomes were meticulously documented. The patient, with a 7.2 cm HCC in the right hepatic lobe (T1bN0M0, BCLC A, CNLC Ib) and an initial alpha-fetoprotein (AFP) level of 66,840 ng/mL, opted for Y-90 TARE due to high recurrence risk and initial surgery refusal. The therapy's parameters, including the lung shunting fraction (LSF) and non-tumor ratio (TNR), were within therapeutic limits. A total of 1.36 GBq Y-90 was administered. At 1 month post-therapy, the tumor shrank to 6 cm with partial necrosis, and AFP levels dropped to 21,155 ng/mL, remaining stable for 3 months. After 3 months, PD-1 inhibitor treatment led to further tumor reduction to 4 cm and AFP decrease to 1.84 ng/mL. The patient then underwent hepatectomy; histopathology confirmed complete tumor necrosis. At 12 months post-surgery, no tumor recurrence or metastasis was observed in follow-up sessions. This protocol demonstrates the effective combination of Y-90 TARE and PD-1 inhibitor as a bridging strategy to surgery for HCC patients at high recurrence risk, providing a practical guide for implementing this approach.

This study illustrates the methodological potential of combining Yttrium-90 Trans-Arterial Radioembolization (Y-90 TARE) with an anti-PD-1 monoclonal antibody as an effective neoadjuvant strategy leading to hepatectomy in hepatocellular carcinoma (HCC) patients with a high initial recurrence risk. It emphasizes the safety, feasibility, and step-by-step procedural guidance of this approach.

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 ...

Application of Separation Surgery Combined with Radiofrequency Ablation and Bone Cement Strengthening in Thoracolumbar Metastasis

The spine is a common site for metastatic tumors, with 5%-10% of patients developing epidural spinal cord compression (ESCC), which significantly reduces their quality of life and accelerates the process of death. When total en-bloc spondylectomy (TES) radical surgery does not achieve the desired tumor control, palliative care remains the primary treatment option. Traditional laminar decompression or partial tumor resection can only relieve local compression. Although the surgical trauma and complications are less, these methods cannot effectively address tumor recurrence and secondary compression. Therefore, separation surgery combined with radiofrequency ablation and bone cement strengthening was used to treat thoracolumbar metastatic tumors, aiming to achieve good clinical results. In this protocol, the steps and key points of separation surgery combined with radiofrequency ablation and bone cement reinforcement for thoracolumbar metastatic tumors are introduced in detail. Meanwhile, the clinical data of 67 cases of thoracolumbar metastatic tumors in our hospital meeting the inclusion criteria were retrospectively analyzed. Different treatment methods divided the patients into two groups: separation surgery combined with radiofrequency ablation and bone cement strengthening (group A, 33 cases) and the radiotherapy group (group B, 34 cases). All patients were evaluated using improved Tokuhashi, Tomita, SINS, and ESCC scores before treatment. VAS score, Frankel grading, and Karnofsky scores during different periods of the two treatments were compared to assess the clinical outcomes. Studies have shown that separation surgery combined with radiofrequency ablation and bone cement strengthening can significantly reduce pain, promote neurological function recovery, enhance mobility, and improve quality of life in treating thoracolumbar metastatic tumors.

This study investigates the efficacy of combining separation surgery with radiofrequency ablation and radiotherapy in treating thoracolumbar metastatic tumors.

The spine is a common site for metastatic tumors, with 5%-10% of patients developing epidural spinal cord compression (ESCC), which significantly reduces ...