Radiation therapy is one of the main means of treatment for non-small cell lung cancer (NSCLC). With the rapid development of modern technology, three dimensional conformal radiotherapy, intensity modulated radiotherapy, stereotactic radiotherapy play a very important role in this field. The use of the state-of-art radiation modality can definitely improves the accuracy of the treatment, which results in improving the local control rate of tumor and reducing the adverse reaction of normal tissue. Advances in modern imaging device and its clinical application is the premise of precise radiotherapy. Positron emission tomography and computed tomography (PET-CT) can effectively provide anatomical and functional information; it plays a more and more important role in the diagnosis of NSCLC before radiotherapy, the process of precise target delineation and also the evaluation of therapeutic efficacy after radiotherapy.

Objective To assess the optimal delay time of enhanced scanning with CT-based simulation before cyberknife treatment for pancreatic cancer and to analyze the correlations between the target delineation and the rating items.Methods One hundred and twenty pancreatic cancer patients underwent Philips 16 big core spiral CT before cyberknife treatment.Patients were assigned to three groups randomly with scan delays of 25,45 and 65 s;30,50 and 70 s;and 35,55 and 75 s respectively.After the scanning,the images were evaluated by three associate professors in the field of radiation oncology.To achieve the optimal delay time,the data were compared with a random intercept model of mathematical mean,the Sidak method and One-way ANOVA.Pearson method was used to analyze the correlations between the target delineation and the rating items.Results The tumor boundaries,retroperitoneal lymph nodes,duodenal images,accuracy of target volume delineations in 45 and 65 s,50 and 70 s,55 and 75 s items rating difference had no statistically significant differences (P ＞ 0.05),but significantly superior to those in 25,30,35 s groups respectively(t =3.59-21.68,13.34-15.46,12.42-13.83,P ＜0.05).Therefore,the proposed delay time interval was 50-65 s,and the average value of the target volume delineation was the highest in 55 s group (3.91-± 0.50).When the scan delay time was 55 s,the target delineation was positively correlated with the tumor boundary (r =0.914 4,P ＜ 0.05),and negatively related to the value of other imaging (r =-0.926 3,P ＜ 0.05).Conclusions The recommended delay time interval of pancreatic cancer before cyberknife treatment CT enhanced scanning was 50-65 s,and the optimal time point was 55 s.The target volume delineation was positively correlated with the boundary of the tumor,and significant negatively related to the value of other imaging.

Objective To measure and assess CT perfusion value for peri-pancreatic metastatic lymph node by using multiple spiral CT (MSCT) with body perfusion software package. Methods The MSCT perfusion imaging was performed for peri-pancreatic metastatic lymph nodes and muscle on a multi-section CT scanner (SOMATOM Sensation Cardiac 64). 4 x 5 mm collimation, 120 kV, 60mA. Contrast injection was done with 40 ml nonionic contrast agent (300 mg l/ml), at a flow rate of 4.0 ml/s, and 5 seconds delay, and data acquisition lasted for 40 seconds. The mean blood flow (BF) were measured and analyzed in patients with pathologically proven peri-pancreatic metastatic lymph nodes(n=29)and hyperplastic lymph nodes(n=15) on work station using body perfusion software (Siemens) with deconvolution method. Results The mean BF in peri-pancreatic metastatic lymph nodes were (53.63±18.82) ml·min-1·100 ml-1, in hyperplastic lymph nodes were 29.78±7.52 ml·min-1·100 ml-1, the difference was significant (P<0.001). Conclusions Perfusion imaging of MSCT was useful in differentiation between peri-pancreatic metastatic lymph nodes and hyperplastic lymph nodes.

OBJECTIVE: To observe and discuss the dynamic changes of interleukin-2 (IL-2) and soluble interleukin-2 receptor (sIL-2R) and their significance in the patients with primary liver cancer after transarterial chemoembolization (TACE) therapy combined with Jinglong Capsule. METHODS: A total of 48 patients with primary liver cancer, who failed to be treated by major surgery, were randomly divided into two groups: Jinlong Capsule group (TACE therapy plus Jinlong Capsule) and control group (TACE therapy alone). There were 24 cases in each group. The levels of peripheral blood IL-2 and slL-2R were measured before the first TACE and 1, 7 and 15 days after the second TACE respectively by using double-antibody sandwich enzyme-linked immunosorbent assay. The data from Jinlong Capsule group were compared with those from the control group. RESULTS: The level of sIL-2R in Jinlong Capsule group was significantly lower than that in the control group (P<0.05), while the level of IL-2 was significantly higher than that in the control group (P<0.05). CONCLUSION: Jinlong Capsule can significantly improve the lymphocyte function of the patients with primary liver cancer after TACE. The levels of IL-2 and sIL-2R can be considered as the valuable parameters for evaluating the effects on primary liver cancer, and Jinlong Capsule is helpful for the patients with primary liver cancer.

Objective To determine the significance of the quantitative parameters obtained from intravoxel incoherent motion ( IVIM) diffusion weighted imaging ( DWI) in differentiating renal tumors from normal renal tissues.Methods Twenty-four patients with surgical pathology-proven renal tumors and 13 volunteers with healthy kidneys were included.DWI was performed with 9 b-values (0, 20, 50, 100, 200, 400, 600, 800 and 1 000 s/mm2).The slow component of diffusion (Dslow), fast component of diffusion ( Dfast ) and fraction of fast ADC ( f) of the biexponential DWI were calculated for the clear cell renal cell carcinoma (CCRCC), the normal renal parenchyma and the non CCRCC ( NCCRCC) .The ADC was calculated for all b-values using linear regression yielding standard ADC ( ADCtot ) .The parameters were compared among the groups, and the receiver operating characteristic ( ROC ) analysis was performed. Results CCRCC showed higher ADCtot (1.73 ±0.43) ×10 -3 mm2/s, Dfast (14.75 ±14.73) ×10 -3 mm2/s, Dslow(1.34 ±0.38) ×10 -3 mm2/s than NCCRCC (ADCtot(1.23 ±0.26) ×10 -3 mm2/s, Dfast(9.47 ± 5.27) ×10 -3 mm2/s, Dslow(0.58 ±0.15) ×10 -3 mm2/s), and the differences of ADCtot(P=0.037) and Dslow(P=0.001) were significant.The normal renal parenchyma showed higher ADCtot (2.25 ±0.11) × 10 -3 mm2/s, Dslow ( 1.74 ±0.17 ) ×10 -3 mm2/s, f ( 35.00% ±9.37%) than CCRCC ( f, 31.13% ± 10.75%) and NCCRCC(f, 33.76%±24.02%), and the differences between the normal renal parenchyma and CCRCC of ADCtot ( P =0.000 ) and Dslow ( P =0.001 ) were significant.There were no differences between the normal renal parenchyma and the tumor ipsilateral renal parenchyma of all parameters.Dslow had higher accuracy ( sensitivity 95%, specificity 100%) in distinguishing CCRCC and NCCRCC, with area under the curve of 0.988.Conclusions Multi-b-value DWI derived quantitative parameters including ADCtot and Dslow may differ significantly between the renal tumor and normal renal parenchyma.Dslow is the best parameter in distinguishing CCRCC and NCCRCC.

Objective To investigate the characteristics of minimal fat renal angiomyolipoma (MFAML)and clear cell renal cell carcinoma(CCRCC)in high resolution multi-slice spiral CT(MSCT)and to improve the diagnosis accuracy for the renal tumors.Methods A retrospective analysis was performed on 24 MFAML patients(16 females,8 males)with mean age of 43(19-74)years and 24 CCRCC patients(16 females,8 males)with mean age of 44(21-76)years.All patients had undergone MSCT and proved histopathologically after surgery.The characteristics included tumor location,tumor attenuation on unenhanced CT,enhancement characteristics(degree of tumor enhancement in the early corticomedullary phase,homogeneity of enhancement,amount of enhancement,enhancement pattern over time),tumor margin,intratumoral calcification,and perinephric changes.The predictive value of each CT characteristic was determined by using multivariate logistic regression analysis.Results The tumor location in the kidney (upper pole:MFAML,6 cases,CCRCC,6 cases;middle:MFAML,7 cases,CCRCC,9 cases;lower pole:MFAML,11 cases,CCRCC,9 cases)and smooth tumor margin(MFAML,n=21;CCRCC,n=19)were not significantly different between MFAML patients and those with CCRCC,P＞0.05.Twenty-one cases of both MFAMLs and CCRCCs had the significant enhancement in the early corticomedullary phase,which were hypovascular tumors,whereas the mean amount of tumor enhancement was greater in CCRCC than in MFAML in both the early corticomedullary and the corticomedullary phases(CCRCC:175 HU,196 HU;MFAML:125 HU,145 HU;P＜0.05.MFAML usually showed homogeneous enhancement(n=15)rather than heterogeneous enhancement(n =9),whereas most CCRCC showed heterogeneous enhancement(n =17)rather than homogeneous enhancement(n =7),P＜0.05).Enhancement pattern was not a significant predictor.Within the 13 MFAML cases,8 cases had sufficient blood supply(6 cases showed obvious wash-in-and-wash-out,2 cases were with prolonged enhancement),5 cases with hypovascular showed a pattern of prolonged or gradual enhancement,while 21 CCRCC cases had sufficient blood supply and 71％ of them showed obvious wash-in-and-wash-out.High tumor attenuation on unenhanced scans(MFAML:17 patients (75％);CCRCC:2 patients(8％),P=0.002,OR=0.010)and threshold enhancement values of 129.5 HU in the corticomedullary phase(MFAML:5 patients(20％);CCRCC:20 patients(83％),P =0.004,OR =0.057)were valuable predictors for differentiating MFAML from CCRCC at multivariate logistic regression analysis.Conclusions MSCT is useful in differentiating MFAML from CCRCC,with high tumor attenuation on unenhanced scans and threshold enhancement values of 129.5 HU in the corticomedullary phase being the most valuable CT findings.75％ of MFAMLs with sufficient blood supply also show a pattern of wash-in-and-wash-out,which can easily misdiagnosed as a renal cancer.

Objective:To compare the dose distribution among CyberKnife, Tomotherapy, Edge, Triology and γ-knife in stereotactic body radiation therapy (SBRT) for pancreatic cancer.Methods:Clinical data of 10 panreatic cancer patients receiving CyberKinife treatment were retrospectively analyzed. The treatment plans were designed by five apparatuses from five centers according to the uniform requirement. All plans were transferred to MIM system for the extraction of parameters, which mainly included D min, D mean and D max of PTV, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), coverage, D max and dose-volume of the stomach and bowel. Results:The best CI and nCI were obtained in Triology ( P<0.001), and the worst HI was found in γ-knife ( P<0.001). The best GI was found in CyberKnife, followed by γ-knife and Tomotherapy, and Edge showed the worst GI ( P<0.001). The highest D min of PTV was found in both Edge and Triology, while lower D min of PTV was found in CyberKnife and Tomotherapy ( P<0.001). Additionally, γ-knife provided the highest D mean and D max of PTV ( P<0.001). Regarding the organs at risk, the lowest D max and D 5cm 3 of the bowel ( P<0.001), D max of the stomach ( P=0.003), D max( P=0.001), D 5cm 3 ( P<0.001) and D 10cm 3 ( P=0.005) of the duodenum, D max( P<0.001) and D 0.35cm 3 ( P<0.001) of the spinal cord were found in CyberKnife. The highest D max of the bowel was found in γ-knife. Furthermore, the highest D 5cm 3 of the duodenum was demonstrated in Edge ( P<0.001) and Tomotherapy provided the highest D max( P<0.001) and D 0.35cm 3 of the spinal cord ( P<0.001). Conclusions:All five radiotherapy apparatuses can meet the requirement of SBRT for pancreatic cancer. More rapid dose fall-off could be obtained via CyberKnife and γ-knife. Triology and Edge provide better target conformity. CyberKnife can better protect the gastrointestinal tract.

Objective To explore the value of Multiple b value DWI ( MbDWI ) in the short-term efficacy evaluation of cyberknife radiotherapy for locally advanced pancreatic cancer ( LAPC ) .Methods A total of 36 patients underwent both conventional sequence and respiratory triggered MbDWI ( b=0, 25, 50, 75, 100, 150, 200, 400, 600, 800, 1 000 s/mm2 ) before cyberknife radiotherapy, 1month and 3 months after the radiotherapy, respectively.ADCtot, f, Dfast and Dslow were calculated using single and double exponential model and the changes before and after radiotherapy were observed.Results Before radiotherapy, 1 month and 3 months after radiotherapy, the ADCtot values of solid lesions were (1.56 ±0.29) ×10-3 mm2/s, (1.75 ±0.31) ×10 -3 mm2/s and (18.6 ± 0.46) ×10 -3 mm2/s;the values of Dslow were (1.10 ±0.73) × 10 -3 mm2/s, ( 1.19 ±0.97 ) ×10 -3 mm2/s and ( 1.49 ±04.6 ) ×10 -3 mm2 s/; the values of Dfast were (83 .33 ±62 .57) ×10 -3 mm2/s,(124.57 ±123.10) ×10 -3 mm2/s and (108.07 ±96 .67) ×10 -3 mm2 /s; f values were (26.81 ±23.74)%,(23.61 ±22.75)% and (21.34 ±15.36)%, respectively.ADCtot values 1 month and 3 months after treatment were significantly higher than those before treatment and Dslow 3 months post-treatment was higher than that before treatment, and the differences were statistically significant ( both P<0.05) and no other differences between two groups were significant.There were no statistical differences on Dfast and f before and after radiotherapy.Conc lusions ADCtot and Dslow both showed a significant growth trend after cyberknife radiotherapy.The advanced degree of parenchymal cystic in the targeted lesion could reflect the short-term efficacy of cyberknife treatment.

Objective To determine the effectiveness and safety of stereotactic body radiotherapy (SBRT)-CyberKnife for oligometastatic prostate cancer.Methods From May 2012 to February 2017,31 patients treated by CyberKnife were retrospectively reviewed,with a median age of 67 years(range 52 to 83 years),including 50 oligometastatic and 2 primary prostate cancer patients.The median PSA level was 8.4 ng/ml(range 0 to 300.0 ng/ml) and PSA test was performed every month.PSA progression-free survival (PSA-PFS),time to initiation of androgen deprivation therapy (ADT) and local control rate (LCR) were measured as the main outcomes.Results SBRT was well tolerated and were performed as planned in all patients.No SBRT related acute or late toxicities were observed.No bone fracture was observed in patients treated by bony targeted radiotherapy.The median follow-up after SBRT was 20.7.months (range 1.2-58.3 months).The median PSA-PFS was 5.3 months (range 0-58.3 months).1-year,2-year,and 4-year PSA-PFS was 52.0％,36.7％ and 36.7％ respe ctively.PSA level decrease was observed in 21 oligometastatic prostate cancer patients after SBRT,with median PSA-PFS of 12.3 months (range 1.2-58.3 months).PSA level increase was observed in 29 oligometastatic prostate cancer patients after SBRT.Six local recurrence were observed resulting in an actuarial 1-year,2-year and 3-year LCR of 90.4％,86.9％ and 82.6％,respectively.Twelve patients treated without ADT after SBRT,with median follow-up of 8.6 months (range 2.9-58.3 months) in this subgroup.Seven patients were added ADT after SBRT,with the median time from SBRT to initiation of ADT of 13.3 months (range 3.0-24.0 months) in this subgroup.Twelve patients were treated with ADT continuously after SBRT.Conclusions CyberKnife seems to be a safe and effective treatment with tolerated adverse events and good local control for patients with oligometastatic prostate cancer.

Objective To evaluate the short-term therapeutic efficacy of Cyberknife in alleviating the pain of locally advanced pancreatic cancer (LAPC) and explore the application of DWI in the pain evaluation.Methods Visual analogue scale (VAS) and Quality of life score KPS were conducted in 36 LAPC patients before and 1 month,3 month after radiotherapy,who underwent conventional MRI examination and DWI scan.The changes of VAS and KPS scores were observed before and after the treatment,as well as the apparent diffusion coefficients (ADC) changes of region of interest (ROI) in the DWI images,and the correlation of ADC with KPS and VAS was analyzed.Results VAS before and at 1 month and 3 month after the treatment was (4.89 ± 2.89),(1.08 ± 2.06) and (0.51 ± 1.48).KPS before and at 1 month and 3 month after the treatment was (72.47 ± 14.74),(93.33 ± 10.69) and (92.86 ± 10.73).ADC of DWI before and at 1 month and 3 month after the treatment was 1.47 ± 0.28,1.79 ± 0.33 and 1.94 ± 0.41,and the differences were statistically significant (all P values ＜0.001).VAS was obviously decreased at 1 month and 3 month after the treatment,while KPS and ADC were greatly increased,and the differences were statistically significant (P value ＜ 0.05).There was no statistical difference between those at 1 month and those at 3 month.There was no obvious correlation between ADC and VAS and KPS at 1 month and 3 month after the treatment.Conclusions After Cyberknife treatment,the pain was obviously relieved and the life quality was greatly improved within short period,but ADC of DWI can not sensitively monitor the changes of the pain.