Objective From the observation of pulmonary function changes in SARS patients during the convalescent period, we aimed to understand if there would be long-term pulmonary function lesions.Methods Pulmonary function tests were performed in 82 SARS patients 3 months after their discharge from hospital (study group) and the abnormal ones were performed pulmonary function tests 6 months after their discharge. The pulmonary function of 28 healthy persons were tesed(control group).Results Pulmonary function tests showed that the mean diffusing capacity of CO(DLCO) was (78.4?17.4)% in study group and (93.8?13.6)% in control group(P35%) in 28 and 11 cases,restrictive defect in 9 and 5 cases.According to the involved areas in chest X-ray during the hospital,the study group were divided into three subgroups:mild,moderate and severe.There was a positive relation between the severity of the disease and the diffusing function lesions 3 months after discharge from hospital.There was no obvious difference in the pulmonary function lesions between the severe patients treated with mechanical ventilation and those not.Conclusion Some of SARS patients have left pulmonary function lesions 3 months and 6 months after their discharge from hospital,which mainly are diffusing capacity abnormality.A few cases have small airway obstruction,residual volume increase and restrictive defect.

Twenty five patients with obstructive sleep apnea hypopnea syndrome (OSAHS) were classified as mild, moderate and severe grade according to apnea hyponea index and lowest oxyhemoglobin saturation.Lower limbs were examined with ultrasonography, blood routine and D-dimer levels were measured in all patients.The results revealed an increased incidence of deep vein thrombosis with the extent of obstructive sleep apnea.There was no deep vein thrombosis in patients with mild-grade OSAHS, while there were 2 in moderate and 3 in severe patients.The blood D-dimer levels were (498 ± 22) pg/L, (659 ±43 ) μg/L, ( 1528 ± 181 ) μg/L in mild, moderate and severe patients, respectively.The hemoglobin levels were (150 ± 8) g/L, ( 183 ± 15) g/L and (261 ± 26) g/L in mild, moderate and severe patients,respectively.There may be some association of obstructive sleep apnea hypopnea syndrome with deep vein thrombosis.

Objective To investigate the clinical pathologic significance of lymphangiogenesis in in colorectal cancer. Methods New lymphatic-specific markers D2-40 was used immunohistochemically to detect the lymphatic vessel density(LVD) in the intratumoural and peritumoral areas, and in normal tissue from 96 cases of colorectal cancer, which were analyzed with clinical pathologic parameters of those colorectal cancer. Results Significandy higher LVD was found in the intratumoural area(14.5±2.4), when compared with normal(5.9±1.1)and peritumoural areas(6.7±1.2) (P<0.01). LVD of the peritumoural area was higher than normal area (P< 0.01). However, peritumoural LVD was associated with both depth of invasion and liver metastasis (r=0.71,0.78 P<0.05), but not associated with tumour size, macroscopic type and lymph-node metastasis (P>0.05). Intratu-moural LVD was not correlated with tumour size, macroscopic type, the depth of invasion,lymph-node metastasis, and liver metastasis(P>0.05). Conclusion Lymphangiogenesis in the peritumoural area may be helpful in evalution of liver metastasis and prognosis.

Objective To study the efficacy and toxicity of the cyberknife in the treatment of medically inoperable patients with early stage lung cancer. Methods From September 2006 to July 2007,17 patients with clinical stage Ⅰ a- Ⅰ b lung cancer were treated with cyberknife at Tianjin Cancer Hospital. Of the 11 patients receiving CT guided biopsy, 3 were squamous cell cancer and 8 were adenocarcinoma. Six patients refused intrusive operation and were diagnosed by PET-CT scan. All patients were medically inoperable evaluated by a thoracic surgeon. The PTV = GTV + 3 ～ 5 mm, and the median volume of PTV was 36 cm3 (6-82 cm3 ). The median total prescription dose was 50 Gy(45-60 Gy) at 3-5 fractions. Results The median follow-up time was 7 months (3-11 months). All the patients finished the treatment and were alive by the last follow-up. Slight fatigue was the most common complain. Evaluated by CT scan, 13 were complete response and 4 were partial response. No recurrence, progression or distant metastasis occured. There were 3 patients with grade Ⅰ granulocytopenia,3 grade Ⅰ pneumonitis and 1 grade Ⅱ pneumonitis. Conclusions The cyberknife radiosurgery treatment in early stage lung cancer shows a high rate of local control and minimal toxicity. Long time follow-up is necessary to evaluate the survival data and late toxicity.

Objective To find a proper number of implanted fiducials in order to reconcile both more accurate image tacking and less pain for the patients.Methods The phantom was made of two parts of different materials.The inner part was a ball-cube phantom developed by Accuray Corporation, which could be regarded as a rigid body, with 5 fiducials inside using as the reference to align the whole phantom in the experiment.The outer part was made of additional silicone rubber with two components to simulate soft tissue as a non-rigid body, which was implanted with 8 fiducials inside.All combinations of different number of fiducials were tracked to aquire the target location information, which were then compared with the reference position that was set by the inner 5 fiducials to obtain the deviations of the translation and the rotation parameters.Thus the impact of the number of fiducials on image target localization accuracy could be analyzed easily.Results When 4 fiducials are used for tracking, the decline of translation and rotation errors for every fiducial is largest (0.086 mm and 0.033°).The translation error was decreased by 0.343 mm from 1 to 4 fiducials, while by only 0.077 mm from 4 to 8 fiducials;the same decline was observed for rotation errors (0.131° for 3 to 4 fiducials , and 0.09° for 4 to 8 fiducials , respectively) .Conclusions When 4 fiducials are used for tracking, the decline of errors for every fiducial is maximum.When one more fiducial is adding, the image target localization accuracy can be enhanced obviously from 1 to 4 fiducials, but not as obvious for more than 4 fiducials.

Objective To evaluate the response rate and efficacy of Cyberknife in the treatment of iliac lymph node metastases (ILNM).Methods Twenty-two patients with 27 ILNM were treated by Cyberknife from May 2010 to May 2016.Tumor volume range from 0.88 to 125.66 cm3 (median 18.87 cm3).The total doses ranged from 21 to 51 Gy (median 39 Gy) and biological effective doses from 35.7 to 100 Gy (median 72.6 Gy) in 3-8 fractions (median 5).Sixty-four percent to eighty-two percent (median 72％) isodose line covered planning target.The survival rates were calculated by Kaplan-Meier method and compared with Log-rank test.Results Follow-up time ranged from 8 to 97 months (median 33 months).The complete response,partial response,stable disease and progression disease rates were 37％,48％,7.5％,48％,respectively.In addition,effective rate was 92.5％.Overall survival range from 4 to 68 months (median 21 months).The 1-,2-,3-year local control rate was all 90.6％ and the survival rates were 78.8％,60.6％ and 43.3％,respectively.Adverse reactions after treatment were gastrointestinal reactions such as nausea,vomiting,fatigue.The chemotherapy before Cyberknife helped to improve overall survival.The patients with backache or edema of lower extremity got rapid relief after treatment.Conclusion The treatment of ILNM with Cyberknife has provided a high response rate with minimal side effects.Cyberknife is a safe and effective local treatment method for ILNM.

Objective To assess the efficacy and safety of CyberKnife radiotherapy in the treatment of locally advanced pancreatic carcinoma. Methods The data of 59 patients with locally advanced pancreatic carcinoma who were treated with CyberKnife radiotherapy from 2006 to 2014 were retrospectively analyzed. The tumor volume ranged from 13?? 0 cm3 to 125?? 1 cm3 with a median value of 27?? 1 cm3 . A dose of 35?50 Gy (median value= 45 Gy) in 3?8 fractions (median value = 5 fractions) was prescribed. The tumor progression was evaluated based on computed tomography. The overall survival (OS) and local progression?free survival ( LPFS) rates were calculated using the Kaplan?Meier method. Results The 1?and 2?year sample sizes were 26 and 17, respectively. The 1?and 2?year OS rates were 54% and 35%, respectively, while the 1?and 2?year LPFS rates were 91% and 70%, respectively. The median OS and LPFS times were 12?? 5 and 10?? 9 months, respectively. The overall incidence of grade 1?2 acute and late gastrointestinal toxicity was 61%. One patient with grade 3 late gastrointestinal toxicity had incomplete intestinal obstruction. Conclusions CyberKnife radiotherapy can achieve excellent treatment outcomes and mild complications in the treatment of locally advanced pancreatic carcinoma.

Objective To investigate the value of local progression-free survival (LPFS) for evaluating the local long-term outcome of peripheral lung cancer treated by cyberknife.Methods Retrospective analysis was performed on the clinical records of 81 cyberknife-treated lung cancer patients (90 foci),including 43 primary lung cancer patients (43 foci) and 38 metastatic lung cancer patients (47 foci).Of all the patients,58(63 foci) were treated at a dose of 60 Gy/3 fractions (20 Gy/fraction),and 23 (27 foci) at a dose of 54 Gy/3 fractions (18 Gy/fraction).The short-term treatment outcome and LPFS were used as the indices for observation;a logistic regression was used for analyzing the predictive value of LPFS for local long-term treatment outcome.Results After the evaluation of short-term treatment outcome,63％ of all the foci needed further evaluation.As the follow-up lasted,the number of foci which needed further evaluation decreased,most rapidly during 0.5-2 years after treatment.Re-evaluation results had predictive value for the treatment outcome in the subsequent follow-up,but the predictive value declined as the follow-up lasted.Conclusions LPFS is a recommendable index for evaluating the local outcome of primary or metastatic lung cancer treated by cyberknife,and it also has predicative value for local long-term treatment outcome.

Objective To investigate the impacts of fiducial tracking and X-sight tracking on the short-term therapeutic effect of cybernikife in the treatment of lung cancer.Methods Retrospective analysis was performed on 64 lung cancer patients (72 lesions),including 40 primary tumor patients (41 lesions) and 24 metastatic tumor patients (31 lesions),who were treated with cyberknife.Fiducial tracking was used for 45 lesions,while X-sight tracking was used for 27 lesions.The planning target volume was covered by 70％-94％ (median 80％) isodose contour.The irradiation dose was 60 Gy/3 fractions.The relationship between short-term therapeutic effect and tracking method was determined.Results Overall,the lesions undergoing fiducial tracking showed significantly higher response rate than those undergoing X-sight tracking (93％ vs.74％,x2 =6.84,P=0.033),and so was in lower lung lesions (15％ vs.7％,x2 ＝7.18,P=0.028).But the two tracking methods achieved similar effects in upper lung lesions (28％ vs.12％,x2 =2.36,P =0.310).In the lesions with treatment volumes smaller than 15 cm3,the fiducial tracking achieved significantly higher response rate than the X-sight tracking (25 ％ vs.12％,x2 =6.53,P =0.038),but the two tracking methods achieved similar effects in the lesions with treatment volumes not smaller than 15 cm3 (17％ vs 8％,x2 =1.57,P =0.460).Overall,the lesions undergoing X-sight tracking had significantly highertreatment failure rate than fiducial tracking (1 9 ％ vs.2 ％,x2 =6.33,P =0.021).Conclusions Different tracking methods may lead to different therapeutic effects of cyberknife in the treatment of lung cancer,which are related to lesion location and treatment volume.

Objective To evaluate quantitatively the extra absorbed dose generated by image guided system of the Cyberknife.Methods The exposure parameters and the average frequency of images acquisition during the treatments with G3 Cyberknife in 300 cases with various tumor locations and tracking modes were collected for analysis ;The measurements of the absorbed doses in the phantom with 5 points after single exposure generated by image guided system in various exposure parameters were performed with equipment of phantom CIRS Model 002LFC and 002 PRA with ion chamber PTW30010 included.Based on the data we collected andmeasured,the conclusion of how much extra absorbed dose generated by image guided system of Cyberknife the patients received during Cyberknife treatments was drawn.Results With an average fractions of 3.94(the median was 4),the average exposure frequency was 36.5 times for static tracking per patient per fraction,while it was 49.2 times for dynamic tracking.The experimental results with various exposure parameters,positions and tissue densities showed that the minimum absorbed dose after single exposure was 0.5 μGy,while the maximum was 385 μGy.Conclusions The image guided system of the Cyberknife can induce quite low absorbed dose in patient,while providing all three types of image guided function.