이 연구는 타이베이 의과대학 병원 (106TMUH-NE-02)에 의해 지원 되었다.

타이페이 의학 대학 공동 기관 검토 위원회 승인이이 연구에 대 한 얻은 했다.
1. SBRT 상담
<ol><li>여러 종양 보드 여 간 전이의 처리를 위한 SBRT에 대 한 환자 자격 평가. 참고: 로컬 제거 뿐만 아니라 작업에 대 한 필요성 및 다른 치료 옵션 종양 위원회에 의해 평가 되어야 합니다. 우리의 선택 기준 다음과 같이 했다: 좋은 성능 상태 (동부 협동 종양학 그룹 0-1), 2) 제어 1) 성인 환자 암 상태, 3) 간 장애의 수에에서만 oligometastases와 항 암 약물 치료를 통해 ≤3 및 큰 종양 ≤6 cm 직경, 4) 간 볼륨 (간 총 종양 제외) 700 cm3및 5 보다 큰) 급성 간염 또는 만성 B 형 간염 안정 항 바이러스 통제 없이.</li>
	<li>SBRT와 기존의 방사선 치료 환자9,19의 차이 뿐만 아니라 SBRT와 관련 된 위험을 설명 합니다.</li>
</ol>2. CT 시뮬레이션
<ol><li>
부정사 위치, 머리 위로 팔을 소파에 머리 처음에에서 환자를 배치 합니다.
	<ol>
<li>환자를 고정 하는 시스템 (예, BodyFIX)를 사용 합니다. 맞춤, 대피 진공 가방에 환자를 놓고 표지를 환자를 커버 합니다.</li>
		<li>복 부 압축기 (AC)를 적용 하 고 AC의 깊이 표시. 참고: AC 제한 환자의 호흡 모션; 따라서, 일부 환자는이 절차 동안 호흡을 개발할 수 있습니다. 비 강 캐 뉼 러를 통해 산소 보충은 그들의 불편을 해소 하기 위해 제공 되어야 한다.</li>
		<li>가슴 벽에 숨 결 추적 센서를 놓고 호흡 파형 모니터링 합니다.</li>
	</ol>
</li>
	<li>
방사선 치료 계획 CT 이미지를 취득 합니다.
	<ol>
<li>3mm 슬라이스 두께 4 D CT 스캔 모드를 선택 합니다.</li>
		<li>Surview 검사를 실시 (120 kV, 30 mA) 앞쪽 후부 (AP) 및 환자의 측면 보기. "Go에 클릭" 화면에 컨트롤 패널.</li>
		<li>"헬리컬 스캔" 페이지 매김 아래 CT 스캐닝 범위를 결정 하 고 "폐 게이팅 검색" 페이지 매김 아래 4 D CT의 검색 필드를 결정 합니다. 참고: 헬리컬 스캔의 범위 간의 꼬리 테두리에서 적어도 5 cm의 거리를 두는 폐의 정점에서 연장 해야 합니다. 헬리컬 스캔 보다 작습니다, 폐 제어 스캔 분야 커버 3-5 cm로 간 간 두개골과 꼬리 테두리에서 연장 해야 합니다.</li>
		<li>그것은 3 분 동안 안정적으로 유지 될 때까지 호흡 파형을 모니터링 합니다.</li>
		<li>(예, Omnipaque), 4-5 mL의 속도로 대비 에이전트의 100 mL 주입/s antecubital로 18 G i.v. 카 테 터를 통해 정 맥.</li>
		<li>대조 연속 된 나선형 CT 검사를 실시 (120 kV, 400 매스/슬라이스), 15 대조 주입 후 s.</li>
		<li>그 후 비 대조 4 D-CT 검사를 실시 (120 kV, 2000 매스/슬라이스) 시리즈 "다음"을 클릭 하 여.</li>
	</ol>
</li>
</ol>3. 방사선 치료 계획
<ol><li>
계획 시스템으로 CT 시뮬레이션 및 진단 검사에서 이미지를 가져옵니다. 참고: 진단 이미지는 양전자 방출 단층 촬영 (PET)를 포함할 수 있습니다 / 애완 동물 CT, 자기 공명 이미지, 또는 진단 나선형 CT 검사.</li>
	<li>
총 종양 볼륨 및 위험 (노)에 인접 한 기관으로 컨투어 전이성 종양.
	<ol>
<li>기관 (여기, 복 부)를 선택 하 고 브러시, 연필, 등을 사용 하 여. CT 이미지의 각 조각에 기관 컨투어 하. 동그라미 하거나 관심의 기관. 각 이미지 슬라이스를 "위로" 및 "아래로" 단추를 사용 합니다. 참고: 노가 포함 폐, 위, 십이지 장, 척수, 간, 작은 창, 갈비, 그리고 신장.</li>
	</ol>
</li>
	<li>
동적 추적 이미지에 관찰 기관 움직임에 따라 종양의 내부 대상 볼륨 (ITV) 컨투어. 계획 대상 볼륨 (PTV)를 얻기 위해 ITV에 5 m m 마진을 추가 합니다.
	<ol>
<li>기관 (여기, 복 부)를 선택 하 고 브러시, 연필, 등을 사용 하 여. CT 이미지의 각 조각에 기관 컨투어 하. 동그라미 하거나 관심의 기관. 각 이미지 슬라이스를 "위로" 및 "아래로" 단추를 사용 합니다.</li>
	</ol>
</li>
	<li>3 분수에 48 Gy 또는 비교적 큰 종양에 대 한 PTV 5 분수에 35 Gy의 방사선 복용량을 처방. 참고: 치료 계획 때문에 노; 제약을 고려해 야 노에 방사선 복용량은 (표 1) 제약 조건 내에서 상대적으로 높은 처방 복용량 허용 될 수 있습니다.</li>
</ol>4. 치료 배달
<ol><li>일일 품질 보증을 사용 하 여 방사선 빔을 데이터를 재확인 하 고 데이터 정상 범위 내에 있는지 확인 합니다.</li>
	<li>환자의 이름, 생년월일, 및 ID 카드를 사용 하 여 환자를 식별 합니다. 진공 가방, 장소, 표지 및 CT 시뮬레이션 섹션에 설명 된 절차에 따라 수정 AC 위치 환자입니다.</li>
	<li>
4 D 콘 빔 CT (CBCT) 이미지를 획득 하 고 소파 상관 4 D CBCT 이미지를 얻은 시뮬레이션 CT 이미지에는 대상 위치를 조정 합니다.
	<ol>
<li>4 D CBCT 모드를 선택 하 고 설정 데이터를 확인 합니다. 패널에서 "이동"을 클릭 합니다.</li>
	</ol>
</li>
	<li>
4 D CBCT, 후 IGRT 시스템에 인수 4 차원 CBCT 이미지를 로드 합니다. 그리고 상단 왼쪽 컨투어링 및 치료 계획 CT 시뮬레이션에서 낮은 오른쪽 이미지는. 바로 낮은 이미지 왼쪽 상단 4 D CBCT, 각 분수 전에 매일 수행에서 있습니다.
	<ol>
<li>소프트웨어를 사용 하 여 집합을 조정 하려면. 그런 다음, 수동으로 소파에 각 매개 변수 조정. 소파는 3 선형 동작에서 X, Y, 그리고 Z 축 시스템 6, 회전를 포함 하 여 조정 할 수 피치 롤. 따라서, 기술자 조정 확증 해야 합니다.</li>
		<li>기록 하 고 매일 조정에 대 한 매개 변수를 출력. 참고: 경우에 종양 위치 6 축 중 하나에 5 m m의 공차 한계 넘어 이동, 환자 해야 될 재배치.</li>
	</ol>
</li>
	<li>방사선 치료를 제공 합니다. 치료 계획 및 시스템 구성을 확인 합니다. 치료를 시작 하려면 이동을 클릭 합니다. 전체 치료 기간 동안 환자의 안전을 보장 하기 위해 실시간 카메라를 사용 하 여 환자를 모니터링 합니다.</li>
</ol>

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저자 아무 공개 있다.

호흡 유도 간 기형 기관 모션 (대상 묘사) 컨투어링 문제 뿐 아니라 방사선 납품과 관련 된 어려움에 공헌 한다. 기관 모션 관리에 사용 되는 기술에 개선 개선 치료 정확도와 정밀도, SBRT에 기본적인 끌고있다. 여러 이미지 기반 기술 및 호흡기 모션 관리 시스템을 현재 사용할 수 있습니다. 표준 마커 이식 대상 지역화에 대 한 일반적인 기법입니다. 표준 마커는 일반적으로 원통형 골드 씨앗, 2.5 ~ ...

전통적으로, 전이 암의 터미널 단계 이라고 여겨진다 고 가난한 예 후 및 생존 관련 된. 그러나, 산 외. 1984 년에는 그들의 20 년 경험에의 하면 폐 전이의 완전 한 외과 제거 결과 상대적으로 높은 생존 율에 사이트가 일 경우 기본 종양 조직의 통제 수술1시간에 보도 했다. 헬 맨 및 1995 첫번째 제안된 oligometastases, 지역화 된 병 변 및 추가 로컬 치료2,3를 사용 하 여 치료 될 수 있다 polymetastases와 조직의 질병 사이 중간 단계에서 Weichselbaum. 지난 수 십년 동안 전이, oligometastases (metastasectomy), 그리고 효과적인 화학 요법 치료에 대 한 새로운 수술 방법의 조기 발견 전이 환자에서 예 후를 개선 했습니다. 간 단단한 종양에 대 한 가장 일반적인 전이성 기관 중 하나 이며 간 oligometastases의 외과 절제는 생존을 향상 시킬 수 있습니다. 로컬 제거 방법은, 고주파, radioembolization, 및 간 전이 치료를 위한 방사선 치료를 포함 하 여 필요한 로컬 종양 제어3,4 를 달성 하기 위해 작동 일부 환자에 대 한 추천 , 5 , 6 , 7. 지난 몇 년 동안, 몇몇 잠재 및 회고전 연구와 쾌활 정위 적 절제 방사선 치료 라고도 몸 정위 적 방사선 치료 (SBRT) 통해 간 전이의 효과적인 현지 종양 제어 보고 독성4,5,,89.
환자 위치 및 동원 정지 방법;에서 향상 되었습니다. 이미지 수집, 통합 및 전송 방사선 치료 시스템; 호흡기 모션 관리; 높은 복용량 출력과 빠른 방사선 납품; 그리고 주위 정상 조직에 대상 병 변에서 가파른 복용량 그라디언트. 이러한 발전으로 인해 SBRT 최소한의 심각한 독성10,11매우 정확 하 고 정확한 방사선 치료를 달성 한다. 호흡기 모션 관리 SBRT, 특히 간 및 폐 병 변에 대 한 근본 이다. 비 침 투 고 임상 호흡기 관리 기술을 실질적으로 치료 옵션으로 SBRT의 인기를 증가 했다. 이 문서는 간 전이 대 한 이미지 기반 지원 및 간 모션 관리 복 부 압축기 (AC)와 4 차원 단층 (4 D-코네티컷)를 사용 하는 SBRT 프로토콜을 자세히 설명 합니다.

<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

전이성 암 환자의 예 후는 효과적인 화학 요법과 oligometastatic 수술 때문에 과거 십 년간에서 향상 되었습니다. 작동 환자에 대 한 로컬 제거 치료, 정위 적 몸 방사선 치료 (SBRT) 등 최소한의 독성으로 효과적인 현지 종양 통제를 제공할 수 있습니다. 높은 정밀도 및 정확도 SBRT 분수 당 더 높은 방사선 복용량을 제공, 더 효과적 이며 더 작은 방사선 볼륨 보다 기존의 방사선 치료 대상. 또한, 주변 정상 조직의 대상 병 변에서 가파른 복용량 그라디언트 SBRT;를 사용 하 여 달성 된다 따라서, SBRT 더 효과적인 종양 제어를 제공 하 고 기존 방사선 치료 보다 더 적은 부작용을 전시. SBRT 사용 (정위 적 radiosurgery로 알려진); intracranial 병 변 치료를 위한 유행 이다 그러나, 그것은 지금 또한 사용 척추 부 신 전이 치료. 이미지 기반 지원 및 호흡기 모션 관리 발전, 때문에 여러 연구 환자 통풍이 이동 폐 나 간 종양 치료를 위한 SBRT 사용 하 여를 조사 했습니다. 이러한 연구의 결과 SBRT 호의 장애를 이동 하는 경우 종양 제어 제안 했다.
복 부 압축기 (AC)와 4 차원 컴퓨터 단층 촬영 (4 D-코네티컷)은 임상적으로 효과적인 호흡 움직임 관리에 대 한 편리 합니다. 이 메서드는 비 침범 성 하 무료 호흡을 하기 때문에 그것의 사용 합병증을 감소 시킨다. 또한, 환자 고려이 방법은 편리 합니다. 또한, 그것 여겨진다 호흡기 모션 관리의 다른 방법 보다 더 효율적인 의사와 치료사에 의해. 폐 병 변 치료에 대 한 4 D-CT는 ac를 사용 하 여 광범위 하 게 조사도 하 고 기술 간 병 변 치료에 대 한 동의 얻고 있다. 그러나, 간 병 변 치료를 위한 AC를 4 D CT를 사용 하기 위한 프로토콜 폐 병 변 치료에 사용 되에서 다르다. 이 문서에서는, 우리 4 D CT와 치료 간 전이 대 한 AC SBRT에 대 한 새로운 프로토콜을 설명합니다.

SBRT 강렬한 변조 방사선 치료 (IMRT)에 의해 구현 될 수 있습니다 (와 함께 <img alt="image" src="/files/ftp_upload/57050/57050imgv2.jpg"> 6 방사선 광속) 또는 체적 아크 방사선 치료 (VMAT) (와 함께 지속적인 복용량 배달 및 갠트리 회전) 때문에 단일 수술 수 있습니다 단일 치료에서 모든 대상을 커버 모든 종양의 제거를 달성 하지. 대표 SBRT 치료 계획 성공적인 방사선 치료 수술 가능 하지 ?...

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

몸 정위 적 방사선 치료 (SBRT) 종양 제어를 개선 하 고 동시에 독성을 줄일 작은 치료 볼륨 분수 당 높은 방사선 복용량을 전달 하기 위한 엄격한 정확성과 정밀도 요구 한다. 여기, 우리는 현재 임상 편리 하 고 비 침 투 적인 호흡기 모션 관리 프로토콜 SBRT에 대 한 간 전이 대 한.

몸 정위 적 방사선 치료에 대 한 내부 대상 볼륨 메서드를 사용 하 여 간 전이의 치료

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

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Medicine

14.2K 조회수.  Taipei Medical University Hospital. 몸 정위 적 방사선 치료 (SBRT) 종양 제어를 개선 하 고 동시에 독성을 줄일 작은 치료 볼륨 분수 당 높은 방사선 복용량을 전달 하기 위한 엄격한 정확성과 정밀도 요구 한다. 여기, 우리는 현재 임상 편리 하 고 비 침 투 적인 호흡기 모션 관리 프로토콜 SBRT에 대 한 간 전이 대 한.

비디오: 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.

애완 동물 및 MRI 유도 세포종 쥐 모델의 방사선 마이크로 irradiator를 사용 하 여

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

연구

암 연구학

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.

Gynecologic 암에 대한 Stereotactic Radiosurgery의

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

의학

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.

암세포의 내경동맥 주입에 의한 뇌전이 모델링

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.

포도막 흑색 종의 간전이에 대한 치료로 고립 간 관류

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.

소세포폐암에 대한 방사선 치료 중 순환 면역 세포의 방사선 선량에 영향을 미치는 임상 요인

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.

정위 절제 바디 방사선 치료에 대한 동적 폐 종양 추적

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.

만능 줄기 세포 유래 Teratomas 외부 빔 방사선을 사용 하 여 작은 동물 모델에서의 타겟 및 선택적 치료

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.

양성자 치료 배달 및 선택 고체 종양 악성 종양에서의 임상 응용

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 ...

<meta charset="utf8"></head><body>Y-90 용기 및 PD-1 억제는 간세포 암종에서 가교 요법으로서의 억제

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.

<meta charset="utf8"></head><body>Y-90 방사선색전술 및 PD-1 억제제는 간세포암종에서 선행 치료제입니다.

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.

Y-90 방사선색전술 및 PD-1 억제제는 간세포암종에서 선행 치료제입니다.

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

몸 정위 적 방사선 치료에 대 한 내부 대상 볼륨 메서드를 사용 하 여 간 전이의 치료

요약

더 많은 비디오 탐색

애완 동물 및 MRI 유도 세포종 쥐 모델의 방사선 마이크로 irradiator를 사용 하 여

Gynecologic 암에 대한 Stereotactic Radiosurgery의

암세포의 내경동맥 주입에 의한 뇌전이 모델링

포도막 흑색 종의 간전이에 대한 치료로 고립 간 관류

소세포폐암에 대한 방사선 치료 중 순환 면역 세포의 방사선 선량에 영향을 미치는 임상 요인

정위 절제 바디 방사선 치료에 대한 동적 폐 종양 추적

만능 줄기 세포 유래 Teratomas 외부 빔 방사선을 사용 하 여 작은 동물 모델에서의 타겟 및 선택적 치료

양성자 치료 배달 및 선택 고체 종양 악성 종양에서의 임상 응용

Y-90 방사선색전술 및 PD-1 억제제는 간세포암종에서 선행 치료제입니다.

Y-90 방사선색전술 및 PD-1 억제제는 간세포암종에서 선행 치료제입니다.