Explicit standards for buildup-bolus applications in post-mastectomy radiotherapy remain unclear. This study aimed to perform a dosimetric evaluation of target volumes and organs at risk associated with various buildup-bolus thicknesses and application frequencies to identify the optimal buildup-bolus regimen. Thirty-eight post-mastectomy patients were randomly selected between 2017 and 2024. Four sets of simulated treatment plans were created using virtual buildup-boluses with different protocols: daily 3-mm-thick, daily 5-mm-thick, half-time 5-mm-thick, and half-time 10-mm-thick. Cumulative dose-volume histograms were generated for each buildup-bolus regimen to assess dosimetric differences in target volumes and organs at risk. Equivalent uniform dose and normal tissue complication probability were evaluated for the skin. In terms of target volumes, the daily 5-mm-thick buildup-bolus regimen could reduce hot-spot doses while ensuring adequate target dose coverage, and improved dose homogeneity and conformity; For organs at risk, it could deliver necessary chest wall dose while minimizing high-dose exposure to the skin. Radiobiological evaluation of the skin indicated that the daily 5-mm-thick buildup-bolus regimen could reduce recurrence risk. Additionally, this regimen required the fewest monitor units, thereby reducing treatment time and alleviating machine wear and tear. It is concluded that the daily 5-mm-thick buildup-bolus regimen represented the optimal balance for target coverage and chest-wall skin sparing. These findings provide clinical guidance for treatment planning in post-mastectomy radiotherapy.

Introduction:It is worth to explore a more effective treatment method to minimize the damage for patients during the treatment process.Aim:To explore the method, feasibility and efficacy of B-ultrasound or computed tomography (CT)-guided 3D printing individualized non-coplanar template brachytherapy in the treatment of locally uncontrolled recurrent head and neck squamous cell carcinoma.Material and methods:Ten patients with locally uncontrolled recurrent head and neck squamous cell carcinoma who were treated in our department from August 2021 to February 2023 were collected and treated by 3D printing individualized non-coplanar template brachytherapy under the guidance of B-ultrasound or CT, using the 192Ir high-dose rate afterloading treatment machine of NUCLETRON Technologies GmbH. The radiation source was 192Ir, with a diameter of 0.5 mm, a length of 3.5 mm, a total dose of 10-24 Gy, 5-8 Gy/time, once a week.Results:According to the efficacy evaluation criteria, CT scan was performed after 1-6 months, followed up for 24 months, including CR 40% (4/10), PR 50% (5/10), NC 10% (5/10), PD 0 (0). The total effective rate of CR + PR was 90% (9/10), the 6-month local control rate was 90%, the 12-month local control rate was 80%, the 18-month local control rate was 70%, and the 24-month local control rate was 70%. The overall survival rate at 24 months was 100%.Conclusions:Safe and effective interpolation is used to guide the 3D printing of a single non-coplanar template with B-ultrasound or CT in the radiotherapy of local and uncontrolled recurrent head and neck squamous cell carcinoma. According to the guidance of B-ultrasound or CT, the 3D printing individualized non-coplanar template has an obvious healing effect especially in the brachytherapy, and can also protect the functional organs well, with less side effects and fewer complications. Therefore, this method is the most effective for the treatment of locally uncontrolled recurrent head and neck squamous cell carcinoma.

The study aimed to analyze and compare dosimetric differences with various thicknesses and frequencies of bolus in post-mastectomy intensity-modulated radiotherapy. Based on the Oncentra4.1 treatment planning system, Thirty-eight post-mastectomy patients were selected randomly between 2017 and 2021. Three sets of simulated treatment planning with 5_mm all, 5_mm half, and 10_mm half virtual boluses were formed. A total prescribed dose of 50 Gy regimen was delivered in 25 fractions over 5 weeks, in which half-time bolus was used for 15 out of 25 fractions. The dosimetric parameters of target areas, skin, and organs at risk were compared. Furthermore, normal tissue complication probability (NTCP) was evaluated for the skin. Regarding the D2, D50, V90, V95, and V115 of the clinical target volume, the 5_mm all bolus group was prominently better than other groups, and the D50 and V90 of the clinical target volumes were statistically significant (p < 0.05). Regarding the D2, D50, D95, D98, Dmax, V90, V95, V115, homogeneity index (HI), and conformity index of the planning target volume, the 5_mm thick bolus group was prominently better than other groups, and the D50, D95, D98, V90, V95, and HI of the clinical target volumes were statistically significant (p < 0.05). For organs at risk, there was no statistical significance for the three planning groups, but the 5_mm all bolus group was prominently better than other groups in the V45 of the esophagus, V30, V40, and Dmax of the heart, V50, Dmax, and Dmean of the humerus head, V20, V30, and Dmax of the left lung, Dmax and Dmean of the thyroid, and Dmean of the trachea. Calculated with the 5_mm all bolus, the mean dose, V40, V45, and V50 for the skin structure, were all higher than other bolus regimens, while the dose maxima (Skinmax and V55) were all lower than others. Regarding the skin radiobiological evaluation, the NTCP of the 5_mm all bolus group was prominently better than other groups and was statistically significant (p < 0.05). Besides, the monitor unit of 5_mm all bolus regimen was the minimum compared with other groups and was statistically significant (p < 0.05). Therefore, the 5_mm all bolus group can not only improve the dose but also reduce the hot dose of skin and target volume, as well as reduce the NTCP. Our study provides a clinical reference in the delivery of post-mastectomy radiotherapy.

Multi-modal imaging technology was used to screen the cervical microlymph nodes of patients with head and neck squamous cell carcinoma. Based on the pathological results, radiotherapy was optimized to improve the quality of life of patients. CT or magnetic resonance imaging (MRI) examination before radiotherapy was performed in 36 patients with head and neck squamous cell carcinoma. Fifty-one microlymph nodes with ≤1 cm diameter were selected. Following the ultrasonic detection of relevant indicators, ultrasound-guided puncture biopsy was performed to confirm the pathology. Based on the multi-modal evaluation results, the target area and plan of radiotherapy was confirmed. We evaluated the dose to organs at risk before and after target optimization. The difference in the detection results was compared, and the 3-year local control rate of the lymph node region of interest was observed. The Dmean and V30 of the parotid (left and right) and submandibular gland (left and right) and the V50 of the mandibular gland (left and right) had significant differences before and after optimization in the microlymph node target area of the neck (p<0.05). After 3 years of follow-up, four patients had cervical lymph node recurrence in the high-dose irradiated field. The recurrence rate was 11.11%, and no local recurrence was observed in the microlymph node area of interest. Thus, multi-modal imaging technology is a safe and reliable method to further optimize radiotherapy target planning to distinguish between benign and malignant cervical microlymph nodes of head and neck squamous cell carcinoma.

Objective. To evaluate the efficacy, safety, and prognostic value of low-dose apatinib in combination with temozolomide in the treatment of primary or recurrent high-grade gliomas (HGGs). Methods. A retrospective analysis of patients with postoperative and recurrent HGGs treated in our hospital from April 1, 2018, to April 30, 2020. Patients should be treated by combination therapy (surgery + radiotherapy + chemotherapy). Patients who received apatinib combined with temozolomide chemotherapy were allocated to the research group (RG), while patients who received temozolomide chemotherapy alone were allocated to the control group (CG). The efficacy and toxic side effects were compared between the two groups. Results. There were 67 qualified patients retrieved, including 37 cases in the RG and 30 cases in the CG. There were no significant differences in objective remission rate (ORR) or disease control rate (DCR) between the control group and the study group ( P > 0.05 ). However, the overall improvement of clinical efficacy in the observation group was better than that in the control group ( P < 0.05 ). There was no significant difference in the incidence of adverse effects between the two groups ( P > 0.05 ). There were no significant differences in overall survival (OS) or progression-free survival (PFS) between the two groups ( P > 0.05 ). Conclusion. Low-dose apatinib combined with temozolomide and radiotherapy for HGGs is effective in improving efficacy, relieving brain edema, reducing the use of glucocorticoid drugs, and improving patients’ quality of life. It has mild adverse effects and is well tolerated by patients.

Objective . To evaluate the efficacy, safety, and prognostic value of low-dose apatinib in combination with temozolomide in the treatment of primary or recurrent high-grade gliomas (HGGs). Methods . A retrospective analysis of patients with postoperative and recurrent HGGs treated in our hospital from April 1, 2018, to April 30, 2020. Patients should be treated by combination therapy (surgery + radiotherapy + chemotherapy). Patients who received apatinib combined with temozolomide chemotherapy were allocated to the research group (RG), while patients who received temozolomide chemotherapy alone were allocated to the control group (CG). The efficacy and toxic side effects were compared between the two groups. Results . There were 67 qualified patients retrieved, including 37 cases in the RG and 30 cases in the CG. There were no significant differences in objective remission rate (ORR) or disease control rate (DCR) between the control group and the study group ( P > 0.05). However, the overall improvement of clinical efficacy in the observation group was better than that in the control group ( P < 0.05). There was no significant difference in the incidence of adverse effects between the two groups ( P > 0.05). There were no significant differences in overall survival (OS) or progression-free survival (PFS) between the two groups ( P > 0.05). Conclusion . Low-dose apatinib combined with temozolomide and radiotherapy for HGGs is effective in improving efficacy, relieving brain edema, reducing the use of glucocorticoid drugs, and improving patients’ quality of life. It has mild adverse effects and is well tolerated by patients.

目的:基于三维后装不同模式近距离治疗方案,分析研究不同技术后装治疗过程中靶区和危及器官(OARs)的物理剂量差异.方法:选取72例宫颈癌患者进行回顾性分析,根据施源器的不同模式分为以下3类:常规三维腔内治疗(ICBT)组、徒手插植(ISBT)组和3D打印阴道塞(3DP-ISBT)组.分析不同组别的OARs受量情况.结果:ISBT组平均4根插植针,3DP-ISBT组平均6根插植针,3D打印阴道塞针数多于徒手插植针数量,差异有统计学意义(P<0.001).3组两两比较,HR-CTV靶区剂量D90和HR-CTV靶区体积差异均没有统计学意义(P>0.05).以ICBT组作为对照,膀胱受量(D0.1cc、D1cc和D2cc)ISBT组和3DP-ISBT组均显著低于ICBT组(P<0.01),但是ISBT组和3DP-ISBT组之间差异没有统计学意义(P=0.993).直肠D0.1 cc、D1 cc和D2 cc 3组之间差异没有统计学意义.以ICBT组作为对照,小肠受量(D0.1 cc、D1 cc和D2 cc)ISBT组和3DP-ISBT组显著低于ICBT组(P<0.01).ISBT组和3DP-ISBT组比较,小肠D0.1 cc、D1 cc和D2 cc 3DP-ISBT组显著低于ISBT组(P<0.01).结论:通过分析3种近距离治疗模式的OARs受照剂量情况,ISBT技术相比ICBT技术在保护膀胱和小肠方面有较大的优势,其中3DP-ISBT在膀胱和小肠的保护方面是最优的,在直肠保护方面没有显示出明显优势.

通过分析探讨裴正学教授对放射性口腔黏膜炎病因病机的认识,总结裴正学教授辨治放射性口腔黏膜炎的临床经验.裴正学教授认为放射线为放射性口腔黏膜炎的主要病因,属于中医火热毒邪,具备火热邪气"其性炎上、火易耗气伤津、火易生风动血、火易致肿疡"的一般特性和致病特点,但又不完全符合中医"外感六淫"致病的一般特点.首先,其致病形式不同于其他外感六淫之邪的"六经传变""卫气营血"等传变过程,而是直中脏腑,损伤肺胃.其次,其致病力极强,放疗初期便导致机体津伤气耗,并且鸱张不解,机体并未出现邪正相争之高热、恶寒等表现,而是很快出现气阴亏虚之证,成为放射性口腔黏膜炎本虚(气阴亏虚)的根本病机.第三,其对机体的损伤,在未合并感染时,属于无菌性炎症,主要是放射线所致的微血管闭塞及纤维化,导致口腔黏膜炎的发生发展,患者出现疼痛、溃疡不易愈合等临床表现,以上病理机制符合中医"火热毒邪灼伤络脉"之病机,放射治疗初期便会出现,并贯穿放射治疗之始终.由此,裴正学教授总结出放射性口腔黏膜炎的病因病机具有三大特点:火热毒邪直中脏腑肺胃、伤津耗气为首发主要表现、络脉损伤贯穿全程.因此,裴正学教授在防治放射性口腔黏膜炎临床实践中以益气养阴生津治其本、清热泻火解毒治其标、全程配合活血化瘀止痛之法,并总结出行之有效的方剂和药物,临床效果良好.

目的 比较CT扫描重建模体(CT-Scan)和均匀模体(Uniform)的验证结果,定量评估二者差异,提高患者剂量质量保证的准确性和可靠性.方法 回顾性分析2017-06-05-2018-08-01甘肃省肿瘤医院放疗科10例头颈部肿瘤患者临床资料,采用Delta4三维矩阵进行验证计划的剂量测量.每个病例在制定验证计划时分别采用CT-Scan和Uniform生成验证计划,并采集治疗计划系统(TPS)上对模体的有效测量体积内的照射剂量进行比较,且对每组数据的剂量偏差/吻合距离(DD/DTA)分别采用1 mm/1％、2 mm/2％和3 mm/3％的参数设置,统计相应的验证通过率分析结果.组间差异采用配对t检验及Wilcoxon秩次符号检验,SPSS 19.0对数据进行统计学分析.结果 CT-Scan组的外轮廓最小剂量(Dmin)为(0.73±0.44) cGy,最大剂量(Dmax)为(251.86±49.83) cGy,平均剂量(Dmean)为(58.10±10.93) cGy,计划等中心处总剂量(Dtotal)为(154.67±20.28) cGy;Uniform组Dmin为(0.44±0.26)cGy,Dmax为(248.34±48.59) cGy,Dmean为(57.20±10.77)cGy,计划等中心处Dtotal为(151.57±19.73) cGy.统计学分析表明,CT-Scan组与Uniform组剂量学指标差异均有统计学意义,P值分别为0.013、0.007、＜0.001和＜0.001;CT-Scan组在Delta4分析软件上的DD、DTA以及γ通过率在3 mm/3％的标准下分别为(73.39±10.75)％、(95.25±1.00)％和(96.67±1.42)％,Uniform组分别为(83.36±10.15)％、(98.61±0.81)％和(99.38±0.45)％,γ通过率差异达到3％,差异有统计学意义,P值分别为＜0.001、＜0.001和0.005.随着DD和DTA参数值逐渐变大,二者的差异逐渐缩小.对于调强放射治疗计划的验证通常采用3 mm/3％标准,二者均能满足γ通过率＞95％的临床要求,但Uniform组的通过率更高.结论 采用数字模体生成的验证计划更加准确和可靠,在临床实践中推荐使用数字模体来生成验证计划.

目的:观察我院鼻咽癌患者EBV DNA检测阳性率情况.方法:收集我院2018年3月至2019年3月88例鼻咽癌住院患者行EBV DNA检测的临床资料.结果 以4.0E+2作为分界值:<4.0E+2为阴性,≥4.0E+2为阳性,分析检测结果.结果:88例患者阳性率为67.0％(59/88).59例阳性患者中男性占74.6％(44/59),女性占25.4％(15/59);少年组占1.7％(1/59),青年组占18.6％(11/59),中年组占62.7％(37/59),老年组占16.9％(10/59);Ⅰ期占1.7％(1/59),Ⅱ期0例,Ⅲ期占33.9％(20/59),Ⅳ期占64.4％(38/59).阳性患者中约55.9％(33/59)出现不同程度免疫功能低下.结论:我院鼻咽癌患者EBV DNA检测阳性率达67.0％,好发于41～65岁,Ⅳ期阳性率最高,Ⅲ期次之,Ⅰ期较少,多数阳性患者免疫功能不同程度下降.

探讨Orem自护理论对鼻咽癌放疗患者口腔黏膜反应及生活质量的影响.选取2019年4月～2020年1月甘肃省肿瘤医院放疗科收治的首诊鼻咽癌放疗患者60例,随机分为对照组和观察组各30例,对照组实施常规护理,观察组实施Orem护理模式,对比两组患者放疗后口腔黏膜反应发生情况及放疗30Gy、放疗结束时生活质量状况.观察组口腔黏膜反应程度明显低于对照组,患者生活质量评分显著高于对照组(P＜0.05).鼻咽癌放疗患者应用Orem护理模式,可有效降低口腔黏膜反应的程度,进一步改善患者生活质量.

Objective:This work focused on the function role and underlying mechanism of BLACAT1 in regulating the radiosensitivity of head and neck squamous cell carcinoma (HNSCC) cells via PSEN1.Methods:BLACAT1 and PSEN1 expression in HNSCC tissues and cells were measured by qRT-PCR. Kaplan–Meier method and Spearman’s correlation analysis determined the prognostic roles and association of BLCAT1 and PSEN1 in HNSCC. The impacts of BLACAT1 and PSEN1, alone and in combination, on radiosensitivity of HNSCC cells were separately assessed through CCK-8, colony formation, flow cytometry, western blot and γH2AX foci staining assays.Results:Our study disclosed that BLACAT1 and PSEN1 were both in association with poor prognosis and radioresistance of HNSCC cells. BLACAT1 knockdown improved the radiosensitivity of HNSCC cells by changing cellular activities containing repressed cell viability, accelerated cell apoptosis, induced cell cycle arrest, and stimulated DNA damage response. Further, we found that PSEN1 was positively correlated with BLACAT1. Rescue assays confirmed that BLACAT1 regulated the radiosensitivity of HNSCC cells by modulating PSEN1.Conclusion:We revealed that BLACAT1 knockdown enhanced radioresistance of HNSCC cells via regulating PSEN1, exposing the probable target role of BLACAT1 in HNSCC.Advances in knowledge:This was the first time that the pivotal role of BLACAT1 was investigated in HNSCC, which provided a novel therapeutic direction for HNSCC patients.

目的 分析并总结头颈部恶性肿瘤患者围放疗期应用护理营养管理的临床效果.方法 使用回顾性资料搜集的方法 ,将我院2017年4月～2019年7月入院进行治疗的140例头颈部恶性肿瘤患者作为临床研究的主要对象,并使用数字随机的方法 将其分为每组各为70例的对照组和观察组,对照组患者应用常规的饮食护理方法 ,观察组患者则在常规基础上予以护理营养管理进行指导,对比两组患者护理前后各营养指标的情况以及临床护理工作的满意度.结果 观察组患者在应用护理营养管理后,其白蛋白、前白蛋白、转铁蛋白及血红蛋白等指标的水平明显要优于对照组,且观察组患者对护理工作的满意度也高于对照组,差异有统计学意义(P<0.05).结论 在头颈部肿瘤患者围放疗期护理中,应用护理营养管理,可以有效的改善患者的营养指标,还能提升护理工作的满意度[1],值得在临床上应用和推广.

Abstract Objective This study compared the dose verification results between plans created based on computed tomography (CT) scan and digital virtual phantom. Methods We retrospectively analyzed the treatment plan of 10 patients with head and neck cancer. CT scanned phantom and digital virtual phantom measured using Delta4 3‐D matrix were used to generate verification plans for each patient. The doses based on the effective measurement volume of the two phantoms were compared, and the verification results were analyzed using gamma index analysis. Results For the body, the minimum dose, the maximum dose, the average dose, and the total dose were 0.72 ± 0.46 cGy, 251.86 ± 49.83 cGy, 58.10 ± 10.93 cGy, and 154.67 ± 20.28 cGy, respectively, in the CT‐scan group, and 0.62 ± 0.36 cGy, 248.34 ± 48.59 cGy, 57.20 ± 10.77 cGy, and 151.57 ± 19.73 cGy, respectively in the Uniform group. The difference between the groups was significant (P < 0.05). In the Delta4 analysis software, the dose deviation, distance to agreement, and gamma passing rates were 73.39 ± 10.75%, 95.25 ± 1.00%, and 96.67 ± 1.415%, respectively in the CT‐scan group, and 83.36 ± 10.15%, 98.61 ± 0.810%, and 99.38 ± 0.452%, respectively, in the Uniform group. The two plans were significantly different (P < 0.05), and there was a 3% difference in the gamma passing rate. Therefore, the conclusions relating to the examined dose applied, the groups were significantly higher than those of CT‐scan groups. (both P‐values were <0.05). As the parameter value increases, the difference decreases. In the 3 mm/3% standard, both groups met the clinical requirement of gamma passing rate of >95%, but the Uniform group had a higher passing rate than the CT‐scan group. Conclusions Because the passing rate was higher in the Uniform group than in the CT‐scan group, it is recommended to use digital virtual phantom modules to generate verification plans in clinical practice.

Lysosomal protein transmembrane 4 beta (LAPTM4B) is a protein that contains four transmembrane domains. The impact of LAPTM4B on the malignancy of nasopharyngeal carcinoma (NPC) remains unclear. In the present study, we aimed to investigate the role of LAPTM4B in NPC. NPC tissue samples were used to evaluate the expression of LAPTM4B and its relationship with patient prognosis. Furthermore, we inhibited the expression of LAPTM4B in NPC cell lines and examined the effects of LAPTM4B on NPC cell proliferation, migration, and invasion. We found that LAPTM4B protein was mainly localized in the cytoplasm and intracellular membranes of NPC cells. LAPTM4B protein was upregulated in NPC tissues and cell lines. High LAPTM4B expression was closely related to pathological subtypes and disease stages in NPC patients. NPC patients with high LAPTM4B expression had a worse prognosis. LAPTM4B knockdown inhibited the proliferation, migration, and invasion ability of NPC cells. LAPTM4B plays a cancer-promoting role in the progression of NPC and may be a potential target for NPC therapy.

乳腺癌是女性最常见的恶性肿瘤之一,内分泌治疗是激素受体阳性乳腺癌治疗中重要的治疗手段,他莫昔芬是绝经前乳腺癌患者主要的激素治疗药物,服用他莫昔芬的乳腺癌患者在治疗过程中及后期复诊中常合并有脂肪肝,本文就他莫昔芬治疗后诱发非酒精性脂肪肝病(NAFLD)的发病机制及相关治疗进行综述.

目的 观察加味冰硼散漱口液含漱对头颈癌放疗患者免疫功能的影响.方法 将2017年10月—2018年12月就诊于甘肃省肿瘤医院放疗科的98例符合入组条件的头颈肿瘤放疗患者依据就诊顺序按照随机数字表法分成中药组和西药组,其中,试验中脱落12例,中药组与西药组各43例纳入统计.从放疗第1天开始至放疗结束,分别给予中药组自拟加味冰硼散漱口液含漱、西药组常规西药漱口液含漱.并在放疗前后,运用流式细胞术检测两组受试者血T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+,并进行比较.结果 两组治疗后CD4+、CD4+/CD8+均低于治疗前,且西药组低于中药组,差异有统计学意义(P<0.05).治疗后两组CD3+、CD8+与治疗前比较,差异无统计学意义(P>0.05).结论 头颈肿瘤放疗可损伤影响患者细胞免疫功能,造成患者T细胞亚群CD4+、CD4+/CD8+数值降低;加味冰硼散漱口液含漱可减轻放疗造成的T细胞亚群CD4+、CD4+/CD8+降低.

目的:使用自制口腔支架对颊黏膜癌患者放疗危及器官起到了明显的保护作用,解决了特殊时期患者治疗时危及器官的保护问题.方法:选取甘肃省肿瘤医院放疗科1例颊黏膜癌患者,自制合适的软木塞和口塞支架用以分离瘤床照射区域和正常组织,同时制作两套计划进行分析评价使用和不使用自制口腔支架危及器官的受量变化进行对比.结果:下颌骨V40从61％下降至35％,口底V40从39％降至25.4％,下颌骨V50从28％下降至7.4％.口底V50从3.9％降至2.7％,下颌骨和口底的受量显著降低.结论:使用自制口腔支架取得了较好的临床效果,解决了特殊时期临床实际工作难题.