Liver hanging maneuver(LHM)was first performed to assist right hepateetomy by Jacques Belghiti in 2001.During the procedure of hepatectomy,the liver is lifted by a tape which passes between the anterior Surface of the inferior vena cava and the liver.LHM provides effective vascular control and makes the anterior approach safer and easier.As one of the most important innovations in the field of liver resection,LHM has some definite advantages over the classical approach,including less hemorrhage,less tumoral manipulation and rupture,better hemodynamic stability,reduced ischemic damage of the liver remnant and better survival for patients with hepatocellular carcinoma.Moreover,LHM can serve as a guide to the correct analomical transection plane,and help to improve the exposure of the deep parenchymal plane.LHM developed rapidly in the past few years and it has been widely adopted not only in the treatment of liver cancer,but also in living donor liver transplanration,orthotopic liver transplantation and the treatment of benign liver diseases.Furthermore,many surgeons utilize LHM to facilitate various anatomical liver resections.Although the concept of LHM is widely accepted,its limits and contraindications still need to be investigated in the future.

Objective To research the structure and principle of Helical Tomotherapy, and study the clinical application value of the equipment system. Methods As the first helical radiotherapy system in the mainland of China, its constructions, structure and principle were analyzed and discussed. Results Helical Tomotherapy is a new kind of radiotherapy equipment. The Hi-Art treatment system is a combination of a LINAC and a CT scanner capable of having the function of both systems. It was approved to achieve the best intensity modulated radiation therapy (IMRT), used for adjusting the setup position of the patient with MVCT and as the basis for dose reconstruction and other adaptive radiotherapy processes. It is the first integrated planning, delivery and verification system for IMRT. Conclusion Image-guided radiation therapy (IGRT) and IMRT have introduced a new era in radiation oncology which will better fight cancer and simultaneously improve the patients' quality of life. Having been designed from the ground up for IGRT and IMRT, the tomotherapy system is in the forefront of technical advancements for efficacy and processes to make it efficiently.

Objective To study the role of three-dimensional conformal radiation therapy(3DCRT) in the treatment of elderly non-small cell lung cancer(NSCLC) patients.Methods From 2000 to 2004,39 elderly NSCLC patients(range 70-87 years) were treated by 3DCRT.Their Karnovsky performance score was 50-60 in 20 patients and those of the other 19 patients were not less than 70.Prescription dose were 40-60?Gy,with a median of 50?Gy.Results Thirty-six(92%) patients'symptoms were relieved at the end of treatment,with the other three patients' symptoms steady.Complete response and partial response was achieved in 19 and 17 patients respectively.The 1-year survival rate was 60%,with a median survival time of 10 months.Conclusions Three dimensional conformal radiotherapy is effective for elderly NSCLC patients in terms of symptom relief.For treatment choice of these senior NSCLC patients,the balance between tumor control and quality of life should be carefully considered.

Objective To investigate the biological characteristics , therapy selection of tubular breast carcinoma.Relationship between axillary lymph node metastasis and other factors are analyzed retrospectively . Methods Tubular carcinoma patients were collected in our hospital from June ,1987 to March,2014.Paraffin tis-sues were re-checked again by pathology doctors and all patients were performed follow -up by telephone to e-valuate the prognosis .Results Sixty eight cases of tubular carcinoma of the breast were chosen .Axillary lymph node metastasis was closely related to tumor size and tumor grade in our research .In all patients ,only one patient was relapsed ,24 patients died of other diseases ,without distant metastasis or death of breast cancer .Conclusion Tubular breast carcinoma has a good prognosis with low recurrence rate .The treatment of tubular carcinoma is not quite reasonable .Preoperative core needle biopsy and surgery axillary staging should be paid more attention and breast conserving rate is still needed for improvement .

In previous studies,low expression of human epidermal growth factor receptor 2(HER2)was considered ineffec-tive against HER2-targeted therapy.After the announcement of the efficacy of new antibody conjugated drug,Detrastuzumab in the treatment of breast cancer with low expression of HER2,the diagnosis and treatment options of breast cancer patients with low expres-sion of HER2 have become the focus of breast cancer experts.In order to standardize the clinical rational diagnosis and treatment of breast cancer with low expression of HER2,the Breast Oncology Group of Heilongjiang Medical Association,referring to the latest clin-ical research at home and abroad and the consensus of experts at home and abroad,formed the consensus of breast cancer with low ex-pression of HER2 clinicopathological diagnosis experts after the discussion by the expert group in Heilongjiang province,to guide clini-cians to make diagnosis and treatment decisions for breast cancer patients with low expression of HER2,so as to improve the survival and prognosis of patients.The consensus mainly includes the definition and interpretation of breast cancer with low expression of HER2,factors influencing the results of HER2 low expression,new detection methods,clinicopathological and molecular biological characteristics,and clinical diagnosis and treatment guidance for breast cancer patients with low expression of HER2,which systemati-cally and comprehensively demonstrates the consensus of clinicopathological diagnosis and treatment for breast cancer with low expres-sion of HER2.

To investigate the patient-specific dose verification method using ArcCHECK for total marrow irradiation (TMI) with Volumetric Modulated Arc Therapy (VMAT) and Helical Tomotherapy (HT). The kVCT images collected from 8 patients were respectively designed for RapidArc and Tomotherapy plans in total marrow irradiation. ArcCHECK was used for dose verification for the head-neck, chest-abdomen and pelvic. The merging function of ArcCHECK was used in VMAT and the method of double plans (reference and delivery plans) were used in HT. The γ-analysis passing rates for the head-neck, chest-abdomen, pelvic were 98.9% ± 1.9%, 98.4% ± 1.8%, 97.4% ± 2.1% for VMAT plans and 94.3% ± 1.5%, 96.5 ± 1.2%, 94.1% ± 1.9% for HT plans. The results show that using the merging function of ArcCHECK can achieve the dose verification well for VMAT plans with TMI. The method of double plans was done for the dose verification of HT plans with TMI as well as the plans with the targets keeping away from the set-up center.
Bone Marrow ; radiation effects ; Humans ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

Objective To investigate the feasibility of dose verification of intensity modulated (IM) planning of helical tomotherapy (HT) using two-dimensional ion chamber array (2DICA),and develop an efficient way to validate the dose delivered under the parameters mirroring those during the treatment. Meth-ods A 2DICA,I'mRT MatriXX and MULTICube equivalent solid water phantom from IBA company were used to verify the dose distribution of 10 IM planning. The combined phantom was set up to measure the dose distributions on coronal and sagittal surface. The precise setup of phantom was guided by HTMVCT images. After the irradiation, the measured dose distributions on the coronal and sngittal plane were compared with those calculated by the IM planning system for verification. The results were evaluated and the feasibility of the different measuring methods was studied. Results The dose distribution measured by the MatriXX 2DICA was well consistent with that calculated by the treatment planning system. The errors between the measured dose and predicted dose in the selected points were within ±3%. In the comparison of the pixel-segmented ionization chamber versus treatment planning system using the 3 mm/3% γ criteria, the passing ratio of pixels with γ parameter ≤1 was 97.76% and 96.83%, respectively. Conclusions MatriXX is a-ble to measure the absolute and relative dose distributions simultaneously,which can be used for dose verifi-cation of IM planning.

Objective To evaluate the clinical feasibility of quality assurance of helical tomotherapy intensity modulated radiation therapy (IMRT) through a series of clinical case studies. Methods Tomotherapy planning system was used to provide optimized IMRT treatment plans. To verify the dose of IMRT plans,the cylindrical Virtual Water phantom,0.056cm3 AISL, ion chamber and EDR2 film were used for getting the absolute and relative doses from tomotherapy IMRT planning. The film and ion chamber were placed into the phantom. The doses of the interesting points and isodose distribution of the axial plane were measured,then the results were compared with those from the calculation in planning system for verification. Before the irradiation,kVCT images of the phantom were registered by tomotherapy MVCT images. So the setup of phantom was guided for verifying the position. Results The isedose distribution (on the axial plane) measured by the film was well consistent with that calculated by tomotherapy planning system. The error between the measured dose and predicted dose in the measured points was less than 3%. The setup error of the phantom was able to be kept within 1 mm. There was 2 mm offset along the vertical direction of couch from the virtual isocenter to beam isocenter,which should be considered during the phantom/patient setup. Conclusions The procedures for quality assurance of tomotherapy IMRT are feasible in our experience. And helical tomotherapy IMRT QA system has been constituted.

Objective To study dosimetric characteristics of helical tomotherapy (HT) by comparing its treatment plans with linear accelerator-based step-and-shoot intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma(NPC). Methods Targets on CT images of 10 NPC patients were delineated and transferred to HT and IMRT treatment plan systems. The prescription dose was 70 Gy/33 f for pGTV and GTVnd,60 Gy/33 f for FTV1 ,and 54 Gy/33 f for PTV2. The limit dose of organ at risk was parotid V35 ＜50% ,brain-stem＜54 Gy,spinal cord ＜45 Gy and lens ＜9 Gy. Data of the two groups were compared by paired t-test. Results The dose distribution, conformality and homogeneity were good in both groups.But the homogeneity index(HI) and Dmean of PTV1 in HT group were better than IMRT group( P ＜ 0.01 ).The Dmean of PTV1 in HT group(63.84 Gy)was lower than IMRT group(70.30 Gy). The Dmean, V35 and V30 of parotids,and the Dmax of larynx-esophagus were lower in HT group than IMRT group. Conclusions Helical tomotherapy treatment plan has a better homogeneity, steeper dose gradient, and a better protection for organs at risk.

Objective To quantify dose variations of the parotid glands and spinal cord in nasopharyngeal carcinoma (NPC) patients during helical tomotherapy (HT) by using megavolt (MV) CT and planned adaptive application. Methods Five patients with advanced local-regional NPC were treated by HT with a prescription dose of 70 Gy in 35 fractions in primary tumor and involved lymph nodes. Daily MV CT scans were registered with the planning CT images. The parotid glands were re-contoured every 4 fractions to a total of 45 times, and location of the spinal cord were corrected by MVCT IGRT system every 2 fractions to a total of 85 times. The actual doses delivered to these organs were evaluated by using the planned adaptive application software of HT system. Results At the end of therapy, the mean volume of the parotid gland was decreased by 42% (left) and 33% (right) , respectively. The average V1 of the parotid was increased by 26. 0% (left) and 31.4% (right), and the D50 increased by 15. 8% (left) and 17. 3% (right), respectively. The average Dmax of the spinal cord was increased by 1.3%. Conclusions During HT, the parotid glands receive a higher actual dose due to the volume shrinkage, while the Dmax of the spinal cord changes little. By using adaptive radiation therapy technique, constant monitoring anatomic changes of organs at risk and selective replanning are necessary during radiation therapy for NPC.