Reactive oxygen species (ROS)-mediated immunogenic cell death (ICD) is crucial in radioimmunotherapy by boosting innate antitumor immunity. However, the hypoxic tumor microenvironment (TME) often impedes ROS production, limiting the efficacy of radiotherapy. To tackle this challenge, a combination therapy involving radiotherapy and immune checkpoint blockade (ICB) with anti-programmed death-ligand 1 (PD-L1) has been explored to enhance antitumor effects and reprogram the immunosuppressive TME. Here, we introduce a novel PD-L1 aptamer-functionalized nanoradiosensitizer designed to augment radiotherapy by increasing X-ray deposition specifically at the tumor site. This innovative X-ray-activated nanoradiosensitizer, comprising gold-MnO2 nanoflowers, efficiently enhances ROS generation under single low-dose radiation and repolarizes M2-like macrophages, thereby boosting antitumor immunity. Additionally, the ICB inhibitor BMS-202 synergizes with the PD-L1 aptamer-assisted nanoradiosensitizer to block the PD-L1 receptor, promoting T cell activation. Furthermore, this nanoradiosensitizer exhibits exceptional photothermal conversion efficiency, amplifying the ICD effect. The PD-L1-targeted nanoradiosensitizer effectively inhibits primary tumor growth and eliminates distant tumors, underscoring the potential of this strategy in optimizing both radioimmunotherapy and photothermal therapy.

Replacement of CRT-D battery 2021 3 rd catheter ablation failed 2021 Received stereotactic body radiotherapy After 6-week blanking period Significant improvement of VT After 6-month post-ablation period No recurrences of VT and complications VT, ventricular tachycardia; CRT-D, cardiac resynchronization therapy-defibrillator.

目的:探究头颈部放疗的肿瘤患者随着放疗剂量的累积口腔菌群的变化及不同程度的放疗相关性口腔黏膜炎、口腔菌群的变化.方法:选取2019年11月至2020年4月在某医院放疗科接受头颈部放射治疗的患者20名,放射剂量为6996 cGy,均行动态调强放射治疗.在患者放疗累积剂量为0～19 Gy、20～39 Gy、40 Gy时,采集患者口腔唾液,颊黏膜咽拭子.利用lllumina测序技术检测微生物群落的组成与多样性.结果:在唾液菌群中,厚壁菌门、变形菌门随放疗剂量的累积相对丰度升高,奇古菌门、广古菌门、泉古菌门等随着放疗剂量的累积相对丰度明显降低;在颊黏膜中厚壁菌门、拟杆菌门、梭杆菌门相对丰度随黏膜炎程度加重而降低,放线菌门相对丰度随黏膜炎程度加重而升高;唾液菌群中厚壁菌门、放线菌门相对丰度与黏膜炎严重程度呈正相关,其他高丰度菌门与黏膜炎严重程度呈负相关.结论:放疗累积剂量增加肿瘤患者RIOM分级逐渐提高,口腔唾液菌群相对丰度改变,α多样性降低;黏膜炎程度加重,颊黏膜菌群与唾液菌群菌群相对丰度发生较大变化,α多样性降低.

Objective:To introduce the stereotactic cardiac radioablation (SCRA) based on the stereotactic body radiotherapy (SBRT), and comprehensively evaluate the new approach by short-term effectiveness and safety.Methods:Patients with ventricular arrhythmia (VA) were evaluated and included in this clinical trial, who were immobilized by vacuum bag and performed simulation with 4-dimensional computed tomography (4DCT). In this study, the planning target volume (PTV) was set as the target to design a SBRT plan using volumetric modulated arc therapy (VMAT), which was evaluated by dose parameters such as R 50%, homogeneity index and conformity index, etc. The results of Holter and echocardiography were monitored during the follow-up and compared with the data before treatment. Results:Three subjects with ventricular tachycardia (VT) and one with premature ventricular contraction (PVC) received the same prescription of 25 Gy in a single fraction. The average volume of PTV was 71.4 cm 3(60.3-89.4 cm 3). The average time of beam delivery was 12.0 min (4.5-21.0 min). And the short-term follow-up lasted for an average of 18 weeks (14-25 weeks), which showed significant decrease in both VT and PVC load without complications. Conclusion:This study reports the implementation method of SCRA and proves its short-term effectiveness and safety, but the effects and standards of the key radiotherapy techniques still need to be explored.

注入器作为医用直线加速器的子系统为电子枪提供稳定的电源,其故障会影响加速器的正常使用,然而注入器组件电路复杂,检修难度较高.本文针对国产AccStar直线加速器的2例注入器组件故障导致的设备无法出束问题,利用示波器、万用表对注入器组件内的灯丝电压电路、注入器高压电阻及注入器注入板电压电路进行测量排查.发现2例故障原因分别为由注入器组件中灯丝稳压芯片U2和注入器输入电路内TVS管损坏导致.基于2例注入器组件故障检修分析,本文总结了一套检修流程,实现快速判断故障原因,缩短检修时间,为医用直线加速器的维修提供参考借鉴.

Radiotherapy is a compatible regimen for synergizing immune checkpoint blockade therapy by promoting immunogenic cell death. To improve the efficiency of irradiation-induced neoantigen generation, we de-signed and developed an ozone-carrying liposome perfluorodecalin (PFD) nano-system (O3_PFD@ Liposome) which promoted ozone solubility by 18.4-fold compared to that in water solution. The O3_PFD@ Liposome particle remarkably improved the irradiation-induced hydroxyl radical generation. Evaluation of sub-cellular biodistribution indicated that the nano-system could be efficiently internalized by tumor cells. Upon released inside tumor cells, ozone generated reactive oxygen species under the stimulation of X-ray irradiation. Notably, O3_PFD@Liposome significantly prompted anti-tumor efficacy of radiotherapy without inducing severe adverse effects. The combo regimen with radiotherapy and ozone potently enhanced the infiltration of lymphocytes in the tumor microenvironment by inducing immunogenic cell death, releasing neoantigens, and relieving hypoxia symptom. Consequently, the combination of ozone-fueled irradiation and PD-1 blockade synergistically inhibited the growth of primary and abscopal tumors.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Pacemaker implantation is becoming increasingly common in patients with breast cancer. Comprehensive treatment options, such as surgery, chemotherapy, radiation therapy, targeted therapy and immunotherapy, have greatly improved the prognosis of patients with breast cancer. In particular, radiotherapy is an important means of comprehensive breast cancer treatment that can reduce recurrence and prolong survival in high-risk patients who underwent mastectomy. The pacemaker electrical pulse generator is typically implanted subcutaneously in the left subclavian area above the pectoral muscle through the subclavian vein. The present report implemented a new method of ‘temporary pacemaker electrode and permanent artificial pacemaker placement’ through the right axillary vein in a patient with breast cancer. An electrical pulse generator was placed in the right subcutaneous subclavian tissue. The pacemaker was placed under the right clavicle, and the pacemaker was included as organ at risk (OAR). Dose of planning organ at risk volume (PRV) with additional 6 mm margin to the pacemaker was limited during radiotherapy planning design. This patient with breast cancer, who was also complicated with other underlying comorbidities (such as atrial fibrillation, coronary atherosclerosis, cardiac insufficiency, hypertension, type 2 diabetes mellitus) and implanted with a cardiac pacemaker, was treated with safe (means that the patient has not developed heart disease because of the pacemaker problem) and effective (tumor can be effectively controlled under the condition that the pacemaker does not malfunction) radiotherapy. At present, the patient has successfully completed radiation therapy for breast cancer with no recurrence or metastasis. To the best of our knowledge, the present report is the first to document this application, demonstrating the treatment of a patient with breast cancer and cardiac pacemaker implantation, which is worthy of further study and continuous improvement in clinical practice.

应用瓦里安机器性能检测(MPC)晨检工具对医用电子直线加速器的性能状态进行长期检测,通过每日加速器性能检测,精确监控加速器性能状态的变化,及时发现并排除两例医用电子直线加速器的潜在故障,在确保加速器高性能状态的同时,避免了更严重的故障发生.

Objective:To retrospectively analyze the setup errors of thermoplastic head and shoulder molds alone or combined with vacuum pad in hypofractionated stereotactic radiotherapy (HFSRT) for non-small cell lung cancer (NSCLC) with brain metastases.Methods:Fifty-four NSCLC patients with brain metastases who received HFSRT from 2017 to 2019 were enrolled in this study. Twenty-four patients were fixed with thermoplastic head and shoulder molds (group A), and 30 patients were fixed with thermoplastic head and shoulder molds plus vacuum pad (group B). The interfraction and intrafraction setup errors were acquired from cone-beam CT online image registration before and after the HFSRT. Optical surface system was applied in monitoring the intrafraction setup errors. The setup errors in each direction between two groups were analyzed by independent samples t-test. Results:For the interfraction setup errors of the whole group, the proportion of the horizontal setup errors of ≥3mm was 7.0% to 15.4% and 7.0% to 12.6% for the rotation setup errors of ≥2°. In group A, the anteroposterior setup error was (1.035±1.180)mm, significantly less than (1.512±0.955)mm in group B ( P=0.009). In group A, the sagittal rotation setup error was 0.665°±0.582°, significantly less than 0.921°±0.682° in group B ( P=0.021). For the intrafraction setup errors of the whole group, the proportion of horizontal setup errors of ≥1mm was 0% to 0.7%, whereas no rotation setup error of ≥1° were observed. In group B, bilateral, anteroposterior and sagittal rotation setup errors were (0.047±0.212)mm, (0.023±0.152)mm and 0.091°±0.090°, significantly less compared with (0.246±0.474)mm, (0.140±0.350)mm and 0.181°±0.210° in group A ( P=0.004, P=0.020, P=0.001), respectively. Optical surface monitoring data were consistent with the obtained results. Conclusions:Thermoplastic head and shoulder molds (with or without vacuum pad) combined with online image registration and six-dimensional robotic couch correction can be applied in HFSRT for brain metastases from NSCLC. The intrafraction setup errors in group B are smaller than those in group A. Optical surface system has certain value in monitoring the intrafractional movement.

化疗相关性恶心呕吐(CINV)是肿瘤患者化疗期间最常见的毒副作用,CINV不仅会导致患者食欲下降,电解质紊乱,更会影响患者的情绪及心理,产生焦虑抑郁等严重后果,甚至中断治疗,影响预后.本文就国内外CINV的临床现状及进展进行综述.结果 表明,随着近年来止吐药物的发展和临床止吐观念的逐渐深入,止吐药物的效果有所改进,以及患者恶心呕吐自我管理(NVSM)行为的概念的提出,有效控制CINV的方式越来越多,因此也需要我们的医护人员更多地学习相关专业知识并致力于降低化疗所致恶心呕吐的发生率.

Purpose: To evaluate the impacts of different leaf-width of multileaf collimator (MLC) on the fixed-beam intensity-modulated radiotherapy (IMRT) planning for prostate cancer patients with intermediate risk factors.Materials and methods: Sixteen prostate cancer patients with intermediate risk factors were retrospectively recruited. For each patient, the two IMRT plans using MLC leaf width of 10 mm and 4 mm (sIMRT and mIMRT) were compared. All of plans were generated with the same setup and optimized parameters and methods. Homogeneity index (HI), conformity index (CI), dose distribution for planning tumor volume (PTV) and organs at risk (OARs) were analyzed to evaluate the quality of the plans. Delivery time (DT), monitor units (MUs) and control points (CPs) were used to assess the efficiency of treatment.Results: For the target dose distribution, the mean HI values of the two plans for 16 patients are similar (sIMRT vs. mIMRT: 1.120 +/- 0.13 vs. 1.103 +/- 0.099, p > 0.05). The mean CI of the mIMRT plans was significantly better than that of the sIMRT plans (sIMRT vs. mIMRT: 0.648 +/- 0.11 vs. 0.688 +/- 0.10, p < 0.05). For the OARs sparing, the mIMRT plans failed to reduce the dose to OARs compared to the sIMRT plans, except for the rectum, in which the mIMRT plans gained significantly lower V40, V50 and V70 (percentage of countered volume receiving >= 40, 50 and 70 Gy). For the efficiency of treatment, the mean DTs and CPs of the mIMRT plans were obviously higher than that of the sIMRT plans.Conclusions: For the IMRT of the prostate cancer patients with intermediate risk factors, the plans with the narrower leaf-width MLC failed to promote the quality of plans, OARs dose sparing and the efficiency of treatment, and could only improve the conformity of the plans. (C) 2016 Elsevier Ltd. All rights reserved.

目的 初步探讨MitcaFx制剂对体外SKOV-3人卵巢癌细胞株模型的生长抑制作用.方法 本实验采用MTT法、划痕实验、流式细胞术(FCM)实验方法,分析MitcaFx对SKOV-3细胞株迁徙能力、增殖能力和细胞周期的影响.结果 MTT、划痕实验结果显示,MitcaFx制剂能显著抑制卵巢癌细胞的增殖和迁徙能力;流式细胞术分析结果表明,实验组细胞周期被阻滞于细胞分裂DNA合成后期(S期),侧向角散射光信号(SSC)值明显下降,但前向角散射光信号(FSC)值仍然恒定,同时未出现细胞凋亡峰.结论 本研究表明,MitcaFx制剂能干扰细胞DNA分裂周期,并在体外具有抑制卵巢癌细胞增殖和迁徙的能力的作用.

Intensity-modulated radiotherapy planning for nasopharyngeal carcinoma is very complex. The quality of plan is often closely linked to the experience of the treatment planner. In this study, 10 nasopharyngeal carcinoma patients at different stages were enrolled. Based on the scripting of Pinnacle 9. 2 treatment planning system, the computer program was used to set the basic parameters and objective parameters of the plans. At last, the nasopharyngeal carcinoma intensity-modulated radiotherapy plans were completed automatically. Then, the automatical and manual intensity-modulated radiotherapy plans were statistically compared and clinically evaluated. The results showed that there were no significant differences between those two kinds of plans with respect to the dosimetry parameters of most targets and organs at risk. The automatical nasopharyngeal carcinoma intensity-modulated radiotherapy plans can meet the requirements of clinical radiotherapy, significantly reduce planning time, and avoid the influence of human factors such as lack of experience to the quality of plan.

Purpose: This study aimed to transfer the hPNAS-4 gene, a novel apoptosis-related human gene, into Lewis lung cancer (LL2) and observe its radiosensitive effect on radiation therapy in vitro and in vivo.Methods and Materials: The hPNAS-4 gene was transfected into LL2 cells, and its expression was detected via western blot. Colony formation assay and flow cytometry were used to detect the growth and apoptosis of cells treated with irradiation/PNAS-4 in vitro. The hPNAS-4 gene was transferred into LL2-bearing mice through tail vein injection of the liposome/gene complex. The tumor volumes were recorded after radiation therapy. Proliferating cell nuclear antigen (PCNA) immunohistochemistry staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were performed to detect the tumor cell growth and apoptosis in vivo.Results: The hPNAS-4 gene was successfully transferred into LL2 cells and tumor tissue, and its overexpressions were confirmed via western blot analysis. Compared with the control, empty plasmid, hPNAS-4, radiation, and empty plasmid plus radiation groups, the hPNAS-4 plus radiation group more significantly inhibited growth and enhanced apoptosis of LL2 cells in vitro and in vivo (P<.05).Conclusions: The hPNAS-4 gene was successfully transferred into LL2 cells and tumor tissue and was expressed in both LL2 cell and tumor tissue. The hPNAS-4 gene therapy significantly enhanced growth inhibition and apoptosis of LL2 tumor cells by radiation therapy in vitro and in vivo. Therefore, it may be a potential radiosensitive treatment of radiation therapy for lung cancer. (C) 2012 Elsevier Inc.

Radiation therapy has been developed more than 100 years.Recently,with the rapid development of scientific technology,equipment for radiation therapy has been significantly improved from the application of original X-ray equipment for radiotherapy,60Co teletherapy unit to a current application of a system including main therapy equipment such as linear accelerator,brachytherapy machine and including auxiliary apparatus such as simulator,treatment planning system,image-guided apparatus and various body position fixing devices and so on.A staff including doctor,therapist,physicist,engineer and nurse was constructed with work dividing deepen.In recent years,researchers have tried their best to manage various departments collaboratively and efficiently,to ensure quality control and quality assurance,to avoid radiation accident,and to improve therapeutic effect in radiation therapy.In this paper,establishment of an integrated management system or workflow by introducing MOSAIQ(⑧) system and combining with actual situation in hospital was described,and experience for optimization of workflow in radiation therapy management with MOSAIQ⑧ system was summarized.It was shown that MOSAIQ(⑧) system could be a potentially tool to optimize workflow in radiation therapy management,strengthen personnel or information management,enhance quality control and save patients’ treatment time.

Background and purpose: To evaluate the feasibility and validity of cone beam computed tomography (CBCT) and active breath control (ABC) by long breath-holding in hypofraction radiotherapy of liver tumor.Methods and materials: Twenty-four patients received hypofraction radiotherapy of liver tumor with long breath-holding at end-inhale; four prescriptions were used: 6 Cy x 7 (n = 8), 10 Gy x 4 (71 = 7), 5 Gy x 9 (n = 6), 4 Gy x 10 (n = 3). For each fraction, all patients received pre-correction CBCT scans with ABC, some patients received post-correction and post-treatment CBCT. The interfraction and intrafraction liver positioning errors on medial-lateral (ML), cranial-caudal (CC) and anterior-posterior (AP) directions were obtained. The theoretic margin from clinical target volume (CTV) to planning target volume (PTV) was calculated based on post-treatment error. The dosimetric parameters of PTV and normal tissue were compared between ABC and free breathing (FB).Results: The interfraction error in liver positioning showed system errors (Sigma) of 3.18 mm (ML), 6.80 mill (CC) and 3.05 mm (AP); random error (sigma) of 3.03 mm (ML), 6.78 mm (CC) and 3.62 mm (AP). These errors were significantly reduced with CBCT guided online correction. The intrafraction systematic error was 0.72 mm (ML), 2.21 mm (CC), 1.49 mm (AP), and random error was 2.30 mm (ML), 3.58 mm (CC), 2.49 mm (AP). Dosimetric parameters such as PTV, the liver's volume included by 23, 30 Gy isodose curve (V23, V30), mean dose to normal liver (MDTNL) and mean dose to cord were significantly larger for FB (P < 0.05).Conclusion: Liver radiotherapy with long time breath-holding at end-inhale is an effective method to reduce liver motion, PTV and dose to normal tissue. Interfraction and intrafraction liver positioning errors were substantial. CBCT guided online correction of positioning error is recommended for liver radiotherapy with end-inhale ABC. (c) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 104 (2012) 379-385

Objective To compare the cone beam CT(CBCT) and electronic portal image device(EPID) in measuring the positioning errors in guiding thorax tumor radiotherapy.Methods From February to September 2011,CBCT images and EPID images were acquired respectively for 21 patients with thorax tumor who received intensity-modulated radiation therapy(IMRT) immobilized by thermoplastic.The CBCT images were aligned with simulation planning CT images.The EPID images were acquired by anterior-posterior direction and right-left direction,which were transported to MOSAIQ system and aligned with digital reconstructed radiography(DRR) images generated by the planning system.These aligned results for CBCT images in right-left,inferior-superior and anterior-posterior directions for translation error and X,Y and Z direction for rotation error were calculated to means and standard deviations,and we compared the means with aligned results for EPID.The rotation errors for EPID images were neglected.Results A total of 106 paired samples of CBCT images and EPID images were acquired and analyzed.The translation errors for CBCT images and EPID images were(.0.103 ± 0.240) cm,(.0.086 ± 0.342) cm,(0.017 ± 0184) cm and(0.005 ± 0.214) cm,(.0.004 ± 0.0.315) cm,(.0.113 ± 0.239) cm respectively.The rotation error in X,Y and Z direction for CBCT images were(0.792 ± 1.173)°,(.0.130 ±1.407)° and(0.793 ± 0.960)° respectively.The possibility for ≤ 3° in rotation errors were 98.2%,97.2%,and 99.1%.The P value of paired sample t test for aligned results of CBCT images and EPID images was > 0.05 in Y direction and < 0.05 in X and Z directions. There was a negative line correlation between these two systems.Conclusion There is a significant difference between aligned results of CBCT and EPID systems,which indicates that CBCT is a primary choice for image guiding if available.

PURPOSE:Bcl2/adenovirus EIB 19 kDa-interacting protein 3 (BNIP3) is a proapoptotic member of the Bcl-2 family. To address its potential as a therapeutic target for radiosensitization, this study investigated the effect of Bnip3 expression on radiosensitivity of cervical cancer in vitro and in vivo.MATERIALS AND METHODS:In vitro: A plasmid expressing the BNIP3 gene was transfected into human cervical cancer HeLa cells using Lipofectamine(2000), and western blot and immunohistochemistry analysis were performed to evaluate the expression of BNIP3 in transfected cells. The effects on radiation-induced apoptosis were investigated using a clone formation assay and flow cytometry. In vivo: A total of 6 × 10⁶ HeLa cells were subcutaneously inoculated into the dorsal flank of nude mice, and plasmids expressing the BNIP3 gene were injected into the mice via the tail vein. Tumor volume was calculated, and immunohistochemistry was used to detect the expression of BNIP3 in tumor cells. TUNEL assays were performed to determine the apoptosis rates in tumor tissues.RESULTS:Transfection with the recombinant BNIP3 plasmid increased expression of the Bnip3 protein in tumor cells. This apoptosis regulator significantly decreased the viability of cells (p < 0.01) and increased the apoptosis rates (p < 0.01) both in vitro and in vivo. The antitumor effect of radiotherapy was enhanced by overexpression of BNIP3, as revealed by tumor growth curve analysis.CONCLUSIONS:Radiosensitization in human cervical cancer cells was observed after treatment with the recombinant BNIP3 plasmid in vitro and in vivo. Results suggested that BNIP3 may play a role in enhancement of radiotherapy efficiency, and its expression may have a synergistic effect on radiation treatments.

Objective To investigate the rotation errors due to neck deformation in nasopharyngeal cancer (NPC) radiotherapy with different match areas to register conebeam CT(CBCT) from image guiding and fanbeam (FBCT) from simulation. Methods A total of 198 pre-correction CBCT data sets from 23 NPC patients from April 2007 to December 2008 were retrospectively analyzed. The matching areas in CBCT images were divided into up and down region of interest (ROI). For the up ROI, the superior, inferior, left and right, anterior, and posterior boundary were set parallel with sphenoid sinus up side, C4 down side, mandible outside, and 1/2 of maxillary air sinus and acanthi. For the down ROI, the lines were set parallel with C4 down side, T2-3 down side, neck outside, skin surface and acanthi respectively in all directions. All registrations were performed automatically by bony anatomy and the results were compared. Results The registration results by the up and the down ROI showed significant difference except Y direction for rotation. The translation error was (1.14±2.80),(0.47±1.41),and (0.58±3.88) mm, respectively; and the rotation error was (0.90±1.98),(0.80 ±2.03),and (0.68±1.90) ° in X, Y, and Z direction, respectively. Conclusions There are some significant deformation errors at neck areas in NPC radiotherapy. It is important to find out the deformation and correct it with CBCT image guiding. This kind of error information may provide clues for re-planning in addition to clinical practice and the changes of clinical targets and involved organs.

目的:分析CBCT技术在放射治疗过程中对放疗精度的影响及注意事项.方法:选取NPC患者23例,胸部肿瘤患者17例,分别采用热塑头模和体模固定,全部行CT模拟定位.放疗时行3次CBCT图像,第一次在摆位后,第二次在根据第一次匹配结果纠正后,第三次在放疗结束后.将扫描图像与CT定位图像匹配,记录并分析匹配结果.结果:NPC患者纠正后放疗精度在左右,前后,头脚方向为(-0.05±0.08)cm,(0.01±0.09)cm,(0.01±0.07)cm;胸部肿瘤为(-0.03±0.09)cm,(0.00±0.12)cm,(-0.02±0.12)cm.结论:CBCT能减少分次间的摆位误差,配合良好的固定,正确的匹配区域与匹配方式,保证放疗摆位精度.