Objective:To discuss the feasibility of using online and offline combined multidisciplinary team (MDT) diagnosis-treatment mode in cancers diagnosis and treatment by comparing the comprehensive diagnosis and treatment plans formulated by online and offline MDT diagnosis-treatment mode.Methods:A total of 168 esophageal cancer patients collected from March 17, 2020 to May 17, 2020 were took as the research objects in Shandong Cancer Hospital and Institute, through whom the consistency of the comprehensive diagnosis and treatment plans formulated by online and offline MDT diagnosis-treatment mode was evaluated. The clinical characteristics of patients with changed comprehensive diagnosis and treatment plans, such as age, Karnofsky performance status (KPS) score, whether combined with basic diseases, whether received anti-tumor treatment before and tumor location were analyzed, so as to explore the mechanism to improve the efficiency on the basis of quality assurance.Results:The results showed that 86.3% (145/168) of the comprehensive diagnosis and treatment plans obtained by offline MDT diagnosis-treatment mode were consistent with online diagnosis-treatment MDT mode. Cases with inconsistent comprehensive diagnosis and treatment plans were characterized by elderly (> 69 years) ( χ2=4.250, P=0.039), KPS score≥80 ( χ2=15.520, P<0.001) and combined with underlying disease ( χ2=7.135, P=0.008). Through further analysis, the changed cases were also characterized as with inadequate auxiliary examination or complex in imaging. Conclusion:The online and offline combined MDT diagnosis-treatment mode is feasible. For the patients characterized of elderly (> 69 years old), KPS score ≥80, combined with underlying diseases, with incomplete auxiliary examination or complex in imaging, the offline MDT diagnosis-treatment mode should be adopted or supplemented.

Background and purpose: We aimed to investigate the potential of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer (NSCLC). Materials and methods: Individually prescribed radiation doses were calculated based on NTC. Patients with total tumour radiation doses >= 66 Gy were assigned to the high dose (HD, >= 66 Gy) group, and all other patients were assigned to the standard-dose (SD, <66 Gy) group. Each patient was retrospectively assigned an Eighth edition of American Joint Committee on Cancer disease stage based on the imaging data of initial diagnosis to avoid over- and under-staging. Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival. Results: From March 2006 to September 2012, 140 patients were enrolled and assigned to two groups: 71 patients into the HD group and 69 patients into the SD group. The median survival time (MST) was significantly higher in the HD group (33.5 months) than in the SD group (21 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the HD group than in the SD group (37.8% vs 16.7%). Median progression-free survival was 19 months in the HD group and 11 months in the SD group (p < 0.0001). No difference in severe (grade 3-5) toxic effects was noted between the two groups. Conclusions: The significant positive association observed between prescribed dose and survival suggests that individualized isotoxic dose-escalated radiation based on NTC might improve survival in this cohort of stage III NSCLC Chinese patients. (C) 2019 Elsevier B.V. All rights reserved.

目的 分析农村老年人心理压力、孤独感及生活满意度的关系,并探讨孤独感在心理压力与生活满意度间的中介作用.方法 采用多阶段随机抽样的方法选取山东省5514位农村老年人,采用一般资料调查表、生活满意度量表(SWLS)、心理压力量表(K10)及孤独感量表(ULS-8)分别调查农村老年人的一般情况、生活满意度、心理压力及孤独感.SPSS19.0软件分层回归分析和Process宏程序对孤独感在心理压力和生活满意度间的中介效应进行检验.结果 农村老年人的生活满意度评分为(30.55±5.13)分.农村老年人的心理压力评分与孤独感评分和生活满意度评分呈负相关(均P<0.01).孤独感显著预测生活满意度的净解释量为2.7％,中介效应的效果量为13.5％.Bootstrap检验结果显示间接效应为β=-0.102(P<0.001,95％CI=-0.122～-0.083),说明孤独感在农村老年人心理压力与生活满意度间存在中介效应.结论 山东省农村老年人的生活满意度较高.农村老年人的心理压力和孤独感是影响生活满意度的因素,孤独感可以中介心理压力与生活满意度的关系.

This paper reviews the research progress of nurses' resilience from the definition and classification, evaluation tools, influencing factors and intervention status. In addition, the paper also explores the current situation and development trend of nurses'resilience research to point out that further research on nurses'resilience in China can deepen the research on factors of nurses'resilience.We should strengthen the intervention of nurses' resilience, develop localized measuring tools of nurses' team resilience, and strengthen the direction of qualitative research and longitudinal research.

目的 了解山东省老年人养老意愿及影响因素.方法 采用多阶段随机抽样的方法选取山东省6997例老年人,以Anderson行为模型为理论框架,利用二元logistic回归模型,将倾向、使能、需求三类因素分层纳入模型分析老年人养老意愿的影响因素.结果 山东省老年人选择家庭养老、社区居家养老和机构养老比例分别为89.1％、2.7％和8.2％;模型1～3的x2值和决定系数R2均逐步增大;女性、年龄低、文化程度高、目前有工作或退休金、收入水平高、城镇、东部地区、生活自理能力差、孤独感强烈的老年人倾向于选择社会化养老方式(P＜0.05).结论 家庭养老是山东省老年人首选的养老方式;老年人养老意愿受多种因素的影响,建议除加强家庭养老的作用外,还应根据老年人差异合理配置养老资源.

Objective To evaluate the effect of weight managementfor the quality of life of patients with chronic heart failure. Methods The randomized controlled trials (RCT) on the effect of weight management for the quality of life of patients with chronic heart failure interventions were collected using the databases of China National Knowledge Infrastructure (CNKI), The Wan fang database, CBM, Chinese Science and Technology Periodical Databases (VIP), PubMed, Cochrane Library, Web of Science, Embase, time for the construction of the database to December 2017. Quality evaluation and data extraction of the included literature. Data were analyzed with Revman5.3 software. Results Five RCTs were included in the study, with a total of 739 people. The results of Meta-analysis showed that the total score of QOL [MD=-10.38(95％CI-19.83--0.93), Z=2.15,P=0.03], QOL emotional domain score [MD=-2.45(95％CI-4.35--0.55), Z=2.53, P=0.01] and body domain score [MD=-6.61(95％CI-12.81--0.41), Z=2.09, P=0.04] of patients with chronic heart failure in weight management group were lower and statistically significant. Conclusions Weight management improve the quality of life in patients with chronic heart failure, weight management improve the quality of life in patients with chronic heart failure and the physical and emotional areas. However, it is necessary to carry out high-quality, large sample randomized controlled trials to confirm the above results.

Abstract Xerostomia induced by radiotherapy is a common toxicity for head and neck carcinoma patients. In this study, the deformable image registration of planning computed tomography (CT) and weekly cone‐beam CT (CBCT) was used to override the Hounsfield unit value of CBCT, and the modified CBCT was introduced to estimate the radiation dose delivered during the course of treatment. Herein, the beams from each patient's treatment plan were applied to the modified CBCT to construct the weekly delivered dose. Then, weekly doses were summed together to obtain the accumulated dose. A total of 42 parotid glands (PGs) of 21 nasopharyngeal carcinoma patients were analyzed. Doses delivered to the parotid glands significantly increased compared with the planning doses. V20, V30, V40, Dmean, and D50 increased by 11.3%, 28.6%, 44.4%, 9.5%, and 8.4% respectively. Of the 21 patients included in the study, eight developed xerostomia and the remaining 13 did not. Both planning and delivered PG Dmean for all patients exceeded tolerance (26 Gy). Among the 21 patients, the planning dose and delivered dose of Dmean were 30.6 Gy and 33.6 Gy, respectively, for patients with xerostomia, and 26.3 Gy and 28.0 Gy, respectively, for patients without xerostomia. The D50 of the planning and delivered dose for patients was below tolerance (30 Gy). The results demonstrated that the p‐value of V20, V30, D50, and Dmean difference of the delivery dose between patients with xerostomia and patients without xerostomia was less than 0.05. However, for the planning dose, the significant dosimetric difference between the two groups only existed in D50 and Dmean. Xerostomia is closely related to V20, V30, D50, and Dmean.

目的 食管鳞癌单纯手术治疗疗效欠佳,放化疗是术后常见的巩固治疗手段,但疗效仍存争议.本研究评估Ⅱ～Ⅲ期食管鳞癌根治性切除术后的失败模式及术后放化疗的有效性.方法 回顾性分析山东大学附属山东省肿瘤医院2008-10-27—2014-11-12行食管癌根治术的256例患者病例资料.随访评估首次治疗失败部位(包括区域复发和远处转移),分析术后失败模式与临床病理因素及术后辅助治疗方式之间的关系.统计分析采用SPSS 22.0进行.结果 256例术后随访的患者中,胸腔内局部复发162例(63.3％),吻合口复发22例(8.6％),纵隔淋巴结转移51例(19.9％),远处转移53例(20.7％),其中局部复发合并远处转移者28例(10.9％),中位复发转移时间11.8个月(2～57个月).Ⅲ期患者局部复发率高于Ⅱ期(69.9％vs 56.1％,χ2=5.258,P=0.022),影响远处转移率的因素中,不同的分化程度差异有统计学意义,χ2=12.660,P=0.002.生存分析表明,TNM分期(χ2=4.226,P=0.040、肿瘤分化程度(χ2=11.147,P=0.001)、有无术后辅助治疗(χ2=13.817,P<0.001)是影响无病生存期的独立因素.结论 Ⅱ～Ⅲ期食管鳞癌根治术后失败模式以局部区域复发尤其是纵隔淋巴结转移为主,肿瘤分化程度、临床分期、阳性淋巴结与术后复发转移相关,适当的术后辅助治疗能显著改善淋巴结阳性或Ⅲ期食管癌患者的无病生存期.

// Liyuan Fan 1, 2 , Hongsheng Li 2 , Minghao Li 1, 2 , Yang Zhang 2 , Jianping Zhang 3 and Baosheng Li 2 1 Cheeloo College of Medicine, Shandong University, Jinan, China 2 Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China 3 Department of Pathology, Qilu Hospital, Shandong University, Jinan, China Correspondence to: Baosheng Li, email: baoshli1963@163.com Keywords: pulmonary FDCS; copy number variants; high-throughput sequencing; tumor genomic profiling; REL Received: June 22, 2017 Accepted: December 28, 2017 Published: January 02, 2018 ABSTRACT Follicular dendritic cell sarcoma (FDCS) is an extremely rare neoplasm which involves both nodal and extranodal sites. The demographics, pathological characteristics and clinical features of this tumor have been reported a lot, but the genomic information is still insufficient. Here we presented the ninth case of pulmonary FDCS in English publication, whose diagnosis has been revised from “synovial sarcoma” to FDCS. The patient underwent a right pneumonectomy and died of sudden cardiac death within a week after the surgery. Because of the lack of genomic characterization of the tumor, we used the OncoScan ® gene chip, which has been optimized for detection of whole genome CNVs. By bioinformatics’ analysis and thoroughly literature review, we found the following suspicious functional genes REL , TET2 , CREBBP and CYLD . These genes we found may have important influence on the fate of the neoplasm. Further study for their role of diagnostic and therapeutic targets is needed.

目的 评价晨起服用与夜晚睡前服用小剂量阿司匹林对血压的影响.方法 通过计算机检索了中国知网、万方数据库、中国生物医学数据库、中文科技期刊数据库、PubMed、Cochrane Library、Web of Science数据库,检索时限为建库至2017年12月,纳入睡前和晨起服用阿司匹林的随机对照试验.对纳入的文献进行质量评价并提取数据,采用RevMan 5.3软件进行Meta分析.结果 共纳入6篇文献,共1 132例.Meta分析结果显示,晨起与睡前服用小剂量阿司匹林对血压收缩压和舒张压的影响无统计学意义.结论 鉴于纳入文献较少,研究样本量小,论证强度受到一定限制,上述结果有必要进一步开展高质量、大样本随机对照试验予以证实.

Many patients with technically unresectable or medically inoperable hepatocellular carcinoma (HCC) had hepatic anatomy variations as a result of interfraction deformation during fractionated radiotherapy. We conducted this retrospective study to investigate interfractional normal liver dosimetric consequences via reconstructing weekly dose in HCC patients. Twenty-three patients with HCC received conventional fractionated three-dimensional conformal radiation therapy (3DCRT) were enrolled in this retrospective investigation. Among them, seven patients had been diagnosed of radiation-induced liver disease (RILD) and the other 16 patients had good prognosis after treatment course. The cone-beam CT (CBCT) scans were acquired once weekly for each patient throughout the treatment, deformable image registration (DIR) of planning CT (pCT) and CBCT was performed to acquire modified CBCT (mCBCT), and the structural contours were propagated by the DIR. The same plan was applied to mCBCT to perform dose calculation. Weekly dose distribution was displayed on the pCT dose space and compared using dose difference, target coverage, and dose volume histograms. Statistical analysis was performed to identify the significant dosimetric variations. Among the 23 patients, the three weekly normal liver D-50 increased by 0.2 Gy, 4.2 Gy, and 4.7 Gy, respectively, for patients with RILD, and 1.0 Gy, 2.7 Gy, and 3.1 Gy, respectively, for patients without RILD. Mean dose to the normal liver (D-mean) increased by 0.5 Gy, 2.6 Gy, and 4.0 Gy, respectively, for patients with RILD, and 0.4 Gy, 3.1 Gy, and 3.4 Gy, respectively, for patients without RILD. Regarding patients with RILD, the average values of the third weekly D-50 and D-mean were both over hepatic radiation tolerance, while the values of patients without RILD were below. The dosimetric consequence showed that the liver dose between patients with and without RILD were different relative to the planned dose, and the RILD patients suffered from liver dose over hepatic radiation tolerance. Evaluation of routinely acquired CBCT images during radiation therapy provides biological information on the organs at risk, and dose estimation based on mCBCT could potentially form the basis for personalized response adaptive therapy.

Background: To assess the feasibility of texture analysis (TA) based on spectral attenuated inversion-recovery T2 weighted magnetic resonance imaging (SPAIR T2W-MRI) for the classification of hepatic hemangioma (HH), hepatic metastases (HM) and hepatocellular carcinoma (HCC).Methods: The SPAIR T2W-MRI data of 162 patients with HH (n = 55), HM (n = 67) and HCC (n = 40) were retrospectively analyzed. We used two independent cohorts for training (n = 112 patients) and validation (n = 50 patients). The TA was performed and textual parameters derived from the gray level co-occurrence matrix (GLCM), gray level gradient co-occurrence matrix (GLGCM), gray-level run-length matrix (GLRLM), Gabor wavelet transform (GWTF), intensity-size-zone matrix (ISZM), and histogram features were calculated. The capacity of each parameter to classify three types of single liver lesions was assessed using the Kruskal-Wallis test. Specificity and sensitivity for each of the studied parameters were derived using ROC curves. Four supervised classification algorithms were trained with the most influential textural features in the classification of tumor types. The test datasets validated the reliability of the models.Results: The texture analyses showed that the HH versus HM, HM versus HCC, and HH versus HCC could be differentiated by 9, 16 and 10 feature parameters, respectively. The model's misclassification rates were 11.7, 9.6 and 9.7% respectively. No texture feature was able to adequately distinguish among the three types of single liver lesions at the same time. The BP-ANN model had better predictive ability.Conclusion: Texture features of SPAIR T2W-MRI can classify the three types of single liver lesions (HH, HM and HCC) and may serve as an adjunct tool for accurate diagnosis of these diseases.

Objective To investigate the effects of numerous re-planning strategies on the anatomic and dosimetric outcomes of target volume and organs at risk (OARs) in patients with head and neck cancer receiving fractionated radiotherapy.Methods From 2015 to 2016,28 patients with head and neck cancer were enrolled in this study with Shandong Cancer Hospital,consisting of 19 patients with nasopharyngeal carcinoma, 4 patients with laryngocarcinoma, and 5 patients with carcinoma of the maxillary sinus.All of them received conventionally fractionated radiotherapy.Each patient had six weekly cone-beam CT (CBCT) scans, which were performed on the first day of every week, to obtain reference images.A virtual CT image was generated by registration of planning CT and each weekly CBCT image.The four re-planning strategies were used for the reconstruction of re-planned dose, while the initial planning was used as a reference.The weekly doses calculated using virtual CT were summed together to obtain the actual dose.The actual and initial planned doses were evaluated.The nonparametric Friedman test was used to evaluate the differences between multiple groups, and the differences between any two groups were analyzed by paired t test.Results The sizes of planning target volume, clinical target volume, and left/right parotid glands (PGs) changed significantly within the six weeks (P=0.041, 0.046, 0.024, and 0.017, respectively).For these four re-planning strategies, there were significant differences between the actual dose and the initial planned dose to the PGs (all P<0.05), with average values decreased by 5.02%, 11.17%, 12.08%, and 13.19%, respectively, compared with that in the reference strategy.Conclusions Re-planning during treatment course could ensure the sparing of OARs and allow for sufficient dose to the target volume.The higher the number of re-planning strategies, the more the actual dose is close to the initial planed dose;the efficiency of two re-planning strategies is the highest.

Radiomics is an emerging tumor diagnosis and auxiliary detection technique that has undergone rapid development in the past few decades.The availability of new imaging equipment and reagents, as well as the use of standardized imaging protocol, has made quantitative and standardized imaging analysis possible.Radiomics is a field of study that involves the extraction of a large number of quantitative features from areas of interest in medical images using data-characterization algorithms, and transformation of these data into first-order or high-order data.The accuracy of clinical diagnosis and prognostic value of radiomics can be further improved by analyzing the relationship between data layers.Although radiomics has many advantages and has made great progress, its standardization, reliability, and application in large data and multicenter studies will need to be further optimized.

Under the assumption that the highest therapeutic ratio could be achieved by increasing the total tumor dose (TTD) to the limits of normal tissues, the phase I trial was conducted in patients with unresectable stage III non-small cell lung cancer treated with concurrent chemoradiotherapy, to determine the feasibility and effects of individual isotoxic radiation dose escalation based on bilateral lung V20 and advanced technologies. Consecutive eligible patients were assigned to cohorts of eight. V20 of each cohort was increased from 27% to 30%, 33%, 35%, 37%, and so on. The criterion for cessation of dose escalation was defined as ≥ 2 patients in each cohort experienced dose limiting toxicity. Isotoxic dose escalation was based on V20, functional imaging was used to improve the accuracy of radiotherapy. To test the power of escalation dose, patients with TTD over 66 Gy were assigned to the higher dose group (HD), while the others to the standard dose one (SD). In result, the recommended value of V20 was 35%. For all patients, follow-up ranged from 1 to 112 months, median overall and progression free survivals were 25.0 and 13.0 months, respectively. The 1-, 3-, 5- and 8-year overall survival (OS) rates were 72.5%, 22.5%, 17.5%, and 10.0%, respectively. Especially, the OS and local recurrence-free survival of patients in HD group were significantly longer than those in SD one (P=0.035, P=0.007, respectively) without increasing severe toxicity. Thus, individual isotoxic dose escalation based on V20 with advanced technologies was feasible and effective.

This study aimed to investigate the relationship between dose and radiation-induced liver disease (RILD) in patients with hepatocellular carcinoma (HCC) receiving 3-dimensional conformal radiotherapy (3DCRT). Twenty-three patients with HCC who received conventional fractionated 3DCRT, including 7 who were diagnosed with classic RILD, were enrolled in this retrospective investigation. Cone-beam computed tomography (CBCT) scans were acquired at the time of treatment for each patient. The beams from each patient's treatment plan were applied to each pretreatment CBCT (the modified CBCT or mCBCT) to construct the delivered dose distribution of the day considering inter-treatment anatomy changes. The daily doses were summed together with the help of deformable image registration (DIR) to obtain the adjusted cumulative dose (Dadjusted). The dose changes to the normal liver between the original planned dose (Dplan) and Dadjusted were evaluated by V20, V30, V40, and the mean dose to normal liver (MDTNL). Univariate analysis was performed to identify the significant dose changes. Among the 23 patients, the liver V20, V30, V40, and MDTNL showed significant differences between Dplan and Dadjusted, with average values of these parameters increased by 4.1%, 4.7%, 4.5%, and 3.9 Gy, respectively (p < 0.05). The adjusted liver dose in 21 patients (91%) was higher than the planned value. For patients without and with RILD,the MDTNL was increased on average by 3.5 Gy and 4.7 Gy, and normal tissue complication probability (NTCP) increased on average by 2.8% and 7.5%, respectively. Our study found that the adjusted cumulative dose based on calculations using pretreatment mCBCT differs significantly from planned dose; the use of the dosimetric results of the initial plan was found to be less predictive of RILD as compared with Dadjusted. Determination of a reconstructed Dadjusted using the mCBCT scans are more accurate in predicting RILD and has the potential to reduce the risk of RILD.

Reactive oxygen species (ROS), formed as an indirect production of radiotherapy (RT), could cause DNA damage of normal tissues. Meanwhile, our body possesses the ability to restore the damage by DNA repair pathways. The imbalance between the two systems could finally result in radiation injury. Therefore, in this prospective cohort study, we explored the association of genetic variants in ROS metabolism and DNA repair pathway-related genes with radiation pneumonitis (RP). A total of 265 locally advanced esophageal squamous cell carcinoma (ESCC) patients receiving RT in Chinese Han population were enrolled. Five functional single nucleotide polymorphisms (SNPs) (rs1695 in GSTP1; rs4880 in SOD2; rs3957356 in GSTA1; and rs1801131, rs1801133 in MTHFR) were genotyped using the MassArray system, and rs1801131 was found to be a predictor of ≥ 2 RP. Our results showed that, compared with TT genotype, patients with GG/GT genotypes of rs1801131 had a notably lower risk of developing ≥ 2 RP (HR = 0.339, 95% CI = 0.137-0.839, P = 0.019). Further independent studies are required to confirm this findings.

Atlas-based segmentation utilizes a library of previously delineated contours of similar cases to facilitate automatic segmentation. The problem, however, remains challenging because of limited information carried by the contours in the library. In this studying, we developed a narrow-shell strategy to enhance the information of each contour in the library and to improve the accuracy of the exiting atlas-based approach.This study presented a new concept of atlas based segmentation method. Instead of using the complete volume of the target organs, only information along the organ contours from the atlas images was used for guiding segmentation of the new image. In setting up an atlas-based library, we included not only the coordinates of contour points, but also the image features adjacent to the contour. In this work, 139 CT images with normal appearing livers collected for radiotherapy treatment planning were used to construct the library. The CT images within the library were first registered to each other using affine registration. The nonlinear narrow shell was generated alongside the object contours of registered images. Matching voxels were selected inside common narrow shell image features of a library case and a new case using a speed-up robust features (SURF) strategy. A deformable registration was then performed using a thin plate splines (TPS) technique. The contour associated with the library case was propagated automatically onto the new image by exploiting the deformation field vectors. The liver contour was finally obtained by employing level set based energy optimization within the narrow shell. The performance of the proposed method was evaluated by comparing quantitatively the auto-segmentation results with that delineated by physicians.A novel atlas-based segmentation technique with inclusion of neighborhood image features through the introduction of a narrow-shell surrounding the target objects was established. Application of the technique to 30 liver cases suggested that the technique was capable to reliably segment liver cases from CT, 4D-CT, and CBCT images with little human interaction. The accuracy and speed of the proposed method are quantitatively validated by comparing automatic segmentation results with the manual delineation results. The Jaccard similarity metric between the automatically generated liver contours obtained by the proposed method and the physician delineated results are on an average 90%-96% for planning images.Incorporation of image features into the library contours improves the currently available atlas-based auto-contouring techniques and provides a clinically practical solution for auto-segmentation. The proposed mountainous narrow shell atlas based method can achieve efficient automatic liver propagation for CT, 4D-CT and CBCT images with following treatment planning and should find widespread application in future treatment planning systems.

Our aim was to evaluate the efficacy and safety of cisplatin with pemtrexed or vinorelbine and concurrent late course accelerated hyperfractionated radiotherapy (LCAHRT). Patients with unresectable stage III non-small-cell lung cancer (NSCLC) were randomly assigned to two regimens. The experimental (PP) arm included cisplatin, pemtrexed and concurrent LCAHRT based on bilateral lung V20 = 33%. The control (NP) arm used cisplatin, vinorelbine with the same radiotherapy protocol. The primary endpoint was overall survival. Median survival times were 26.0 months (95% CI 23.2 to 28.7 months) and 28.5 months (95% CI 17.1 to 39.9 months) for the NP and PP arms, respectively (P = 0.26). Median progression-free survival was 12.5 months and 17.5 months in the NP and PP arms (P = 0.07). In both arms of the study, there were no differences in overall survival between patients with squamous and nonsquamous NSCLC. The incidences of grade 3 or 4 toxicity were higher in NP than PP arm. With concurrent LCAHRT, pemetrexed/cisplatin was equally as efficacious as vinorelbine/cisplatin, but showed a more favorable toxicity profile.

Purpose: We proposed a new dictionary learning algorithm (AK‐SVD) based on K‐SVD. AK‐SVD can denoise the CBCT image, and did not need the noise information as prior knowledge. Methods: The AK‐SVD had two steps: signal sparse representation, and then dictionary optimization. The CBCT image was sparse, and there were limited big coefficients. The other coefficients were zero or near zero. In the sparse representation step of traditional K‐SVD, the noise variance was used as a threshold to select the big representation coefficients. This increased the complexity of the algorithm. The denoising result also was affected by the accuracy of the noise variance estimation, especially in non‐Gaussian noise. In AK‐SVD we used the average of the existing big coefficients as a threshold. The new found coefficient was compared with the threshold. If it was bigger than this threshold, it will be determined as the big coefficient, and be added to the set of existing big coefficients. The finding process continued. If it was smaller than this threshold, the finding process was end.This threshold was not related to the noise variance, and based on this method we improved the traditional K‐SVD. Results: In the synthetic experiments about designing dictionary from synthetic signals, the correct rate of dictionary learning by the AK‐SVD was similar with the ideal results of the K‐SVD where the noise variance was known. However, the AK‐SVD algorithm did not need to evaluate the noise variance, so it had lower computational complexity and wider adaptability. In the denoising experiment about the CBCT image corrupted by the non‐Gaussian noise, AK‐SVD has an advantage in terms of texture. Conclusion: The AK‐SVD can work well with the noise variance unknown, and it had lower computational complexity and wider adaptability than K‐SVD. This work was jointly supported by National Natural Science Foundation of China (61471226), Natural Science Foundation for Distinguished Young Scholars of Shandong Province (JQ201516), China Postdoctoral Science Foundation (2015T80739, 2014M551949), and research funding from Jinan (201401221).