Among the existing radiotherapy technologies, ?(X) stereotatic radiotherapy,especially the whole body ? knife,provides better dose distribution and has advantages in increasing target volume dose and reducing normal tissue damage.The whole body ? knife,patented in China with unique characteristics of dose focusing and dose distribution,could provide higher curative effect and minimal toxicity in the treatment of cancers of the lung,liver,pancreas,etc.It has initiated a new phase of Chinese mode of ?(X) stereotatic radiotherapy and was drawn great attention at home and abroad.In this review,the clinical application criteria,treatment progress,existing problem and expectation of ?(X) stereotatic radiotherapy have been summarized.

With the development of imaging techniques of CT , MRI, and PET-CT, the clinical applications of the above-men-tioned imaging modalities have become increasingly mature , which makes early diagnosis rate of pancreatic cancer has been improved to some extent.However, choosing the most effective and economical imaging method need to be addressed in the clinical work .This pa-per will show the research progress of imaging in pancreatic carcinoma detection at home and abroad .

Stereotactic body radiation therapy had a history for over 20 years since it was applied in elinical treatment,with promising outcomes in early-stage non-small cell lung cancer (NSCLC) and lung metastases.Air Force General Hospital was one of the earliest institutes which had launched SBRT in China.Our self-developed γ-ray SBRT technology was used to treat early-stage NSCLC and lung metastases.The adverse effects and cost of γ-ray SBRT were less than those for foreign technology.In conclusion,it is suitable for our national situation and worth to be widely introduced.

Objective:Total lesion glycolysis (TLG) on PET scans were calculated using custom-designed software, then we analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing radiation therapy.Methods: 33 patients with newly diagnosed LAPC who underwent 18F- FDG PET/CT scan for staging before radiation therapy were retrospectively included in this study. Patients were divided into two different groups by the median value of TLG. TLG lower than 55.3 was A group and TLG higher or equal to 55.3 was B group. TLG of tumor tissue were calculated from PET/CT images with the SUV cut-off value of 2.5. We analyzed the relationship between TLG and other clinical factors and prognosis in patients with pancreatic cancer by Kaplan-Meier method and log-rank test.Results: By Log-rank univariate analysis showed that the differences in group A and group B related significantly (r=7.765,P=0.005). And their middle survival time was 15.5 months and 8 months respectively. GTV dose of the patients in two groups and CA19-9 before treatment were also statistically different (x2=7.162, x2=10.476;P=0.05). Multivariate analysis showed that the TLG (P=0.009) were independent risk factors that prevented the long-term survival of the prognosis of patients in this group.Conclusion: The value of CA19-9 and GTV dose before treatment were the risk factors of radiotherapy for patients with locally advanced pancreatic cancer. The parameters of TLG were independent prognostic factors. TLG have a certain clinical value in predicting the prognosis of patients with pancreatic cancer, and can guide clinical diagnosis and treatment planning, and extend the lifespan of patients with pancreatic cancer.

Objective:To investigate the prognostic value of18F-FDG PET/CT by calculating maximal standard uptake values(SUVmax) in patients with pancreatic carcinoma of TOMO knife radiotherapy.Methods:Sixty five cases of pancreatic carcinoma who underwent18F-FDG PET/CT scan before TOMO radiotherapy were reviewed retrospectively, the18F-FDG uptake of primary tumors was measured with the SUVmax. SUVmax<3.0 was divided into group A(32 cases), SUVmax≥3.0 was divided into group B(33 cases), the relationship of SUVmax and other clinical factors with the survival of the 65 patients were analyzed.Results:By Log-rank univariate analysis showed that the differences in group A(SUVmax<3.0) and group B(SUVmax≥3.0) in patiengts with middle survival time was statistically significant(15.5:7 months)atP=0.001. TNM stages(x2=6.625,P<0.010), CA19-9(x2=10.298,P<0.001) and GTV dose(x2=8.054, P<0.005) were also statistically different at (P<0.05). Multivariate analysis showed that the SUVmax and preoperative serum CA19-9 level were independent risk factors that prevent the long-term survival of the prognosis of patients in this group.Conclusion: SUVmax has a certain clinical value in predicting the prognosis of patients with pancreatic cancer, and can guide clinical diagnosis and treatment planning, and extend the lifespan of patients with pancreatic carcinoma.

In recent years, the incidence of pancreatic cancer shows rising trend and higher mortality. Pancreatic cancer lacks early diagnostic methods with high sensitivity and specificity, and the surgical resection rate is 10 %-20 % with high operation mortality, poor long-term curative effect and less than 5 %survival rate within 5 years. At present, researchers indicate that radiotherapy can improve the quality of life, increase tumor local control rate and prolong the overall survival time of patients with pancreatic cancer in different levels. Diffusion weighted imaging (DWI), as a functional imaging technology of magnetic resonance imaging (MRI), is the only way to react cell levels. This paper will summarize the application of DWI in radiotherapy of pancreatic cancer.

80% of low density area in tumor), 10 PR(50%-80%) and 3 NC(0.05). Conclusion For tumor treated with hyperthermia plus radiotherapy, the response evaluation should be based on both the change in the mass size and the percentage of low density area in the tumor.

Objective To identify dosimetric predictors for the development of gastrointestinal toxicity in patients with pancreatic adenocarcinoma treated with TOMO radiotherapy .Methods From January 2014 to Janu-ary 2015 ,we analysed the medical records of 68 pancreatic cancer patients who received helical tomotherapy from Air Force General Hospital .The stomach and duodenum were contoured separately to determine their dose volume histogram(DVH)parameters.Chi-square test was employed to analyze the count data .Spearman correlation anal-ysis was used to analyze the relationship between occurrence of gastrointestinal toxicity and clinical and physical factors.Logistic regression models was performed to identify risk factors associated with gastrointestinal toxicity . Results The median follow-up was 9 months(4~16 months).18 patients experienced grade II acute gastroin-testinal toxicity ,1 patient experienced grade Ⅲ acute gastrointestinal toxicity , whereas 17 patients experienced grade II late gastrointestinal toxicity ,1 patient experienced grade Ⅲlate gastrointestinal toxicity .On UVA,the vol-ume,Dmean,D1,D3,D5,D10,V5 to V40,and V5′to V45′of duodenum were significantly associated with GradeⅡor higher gastrointestinal toxicity ( P <0.05 ) .The MVA, V45′of duodenum was independent predictor for gradeⅡor higher gastrointestinal toxicity(P<0.05).The ROC analysis also showed that V45′of 0.5cm3 was the optimal threshold to predict for gastrointestinal toxicity for the entire cohort .Conclusion V45′of duodenum is of greater importance in the judgment of occurrence of hypofractioned radiation -induced gastrointestinal toxici-ty.

Objective To analyze the result of dose-escalated radiotherapy vs conventional radiotherapy for spinal metastases. Methods Ninety patients (118 lesions) underwent radiotherapy..There were 52 patients (63 lesions) in target in target radiotherapy (TIT) receiving PTV 30~40 Gy, GTV 50~60 Gy/15~25 f. 38 patients (55 lesions) received PTV 30~40 Gy/10~20 f in the conventional radiotherapy. Results The overall responses were 90.4% and 81.6%,respectively.but no significant difference was found. There were 31 and 25 improved lesions, 28 and 20 steady lesions, 4 and 10 worsening lesions,in two goups, respectively. 1-year local control rates and survival were 84.7%vs 68.6%and 49.4%vs 32.2%, respectively. The significant differences were found in 1-year local control rates and survival. The main acute adverse reactions were mainly hematologic toxicities , no significant difference was found. Conclusion TIT for spinal metastases is a more safe and effective treatment, with better efficacy and fewer side-reactions.

ObjectiveTo further evaluate the value of the stereotactic gamma-ray body radiation therapy ( γ-SBRT ) for patients with stage Ⅰ / Ⅱ non-small cell lung cancer ( NSCLC ) basing on the preliminary studies.MethodsTwenty-nine eligible patients with stage Ⅰ / Ⅱ NSCLC who is unable or unwilling to receive surgery underwent treatment prospectively with γ-SBRT (OUR-QGD).Patients were fixed by vacuum bag.Each patient underwent slow CT simulation at 5 s/slide with thickness of 5 mm and interval of 5 mm to take into consideration tumor motion.A total dose of 50 Gy was delivered at 5 Gy/fraction to 50％ isodose line covering 100％ of the PTV,with 60 Gy at 6 Gy/fraction to 60％ isodose line covering 90％ of the CTV,70 Gy at 7 Gy/fraction to 70％ isodose line covering 80％ of the GTV,and 10 times finished in 2 weeks,5 fractions per week.ResultsThe follow-up rate was 97％.The 6 month local tumor response rate was 93％,with CR 86％,and PR 7％.The 1-,2-year local control rates were both 93％.The 1-,2-year overall survival rates for the whole group,stage Ⅰ and stage Ⅱ were 97％ and 89％,100％ and 92％,67％ and 67％,respectively.The 1-,2-year progression-free survival were 90％ and 86％,respectively.34％ of the patients had acute radiation toxicities ( grade 1,2 and 3 in 6,2 and 2patients,respectively),and 38％ late radiation toxicities ( grade 1 and 2 in 10 and 1,patients).Conclusions γ-SBRT is a safe and effective treatment regimen,resulted in promising local control and survival with minor toxicity.