Tumor motion can reduce the dose to the target volume while give unnecessary irradiation to the surrounding normal tissues and is an important factor to influence the precision radiotherapy. Many resear-ches find tumor motion exist in the radiotherapy for many tumors in thoracic and abdominal. Its main reason is respiration movement. Nowadays, there are some measurements to control it. The precision of radiotherapy can got further improved through the appropriate control to minimize the disadvantages influence of tumor motion in the precision radiotherapy.

Background Acquired immune deficiency syndrome (AIDS) is an infectious disease caused by human immunodeficiency virus (HIV).Highly active antiretroviral therapy (HAART) is an effective treatment for AIDS,but it cannot completely eliminate the viral load in the body for the existence of HIV reservoir.Previous studies demonstrated that HIV could be detected in tears of virus load negative AIDS patients who received effective HAART,suggesting that lacrimal gland is another member of HIV reservoirs.Objective The aim of this study was to explore whether lacrimal gland has a molecular basis of HIV infection and the mechanism of lacrimal gland infection of HIV.Methods Fourteen specimens of lacrimal gland were collected during the surgery from 14 patients with lacrimal gland diseases in Peking Union Medical College Hospital from November 2013 to December 2015,including 13 non-HIV-infected patients and 1 HIV-infected patient.In 13 non-HIV infected patients,lacrimal glands prolapse was in 12 patients with the normal pathological tissue structure and dacryoadenitis was in 1 patient with the histopathological diagnosis of interstitial lymphoid tissue hyperplasia.The clinical manifestation of HIV-infected patient was dacryoadenitis with the histopathological diagnosis of interstitial lymphoid tissue hyperplasia.The paraffin sections of 12 non-HIV-infected specimens and 1 HIV-infected specimen were prepared,and the expressions of CD4,C-X-C chemokine receptor 4 (CXCR4) and C-C chemokine receptor type 5 (CCR5) in lacrimal gland specimens were detected by immunohistochemistry and verified in 1 specimen of non-HIV-infected specimen by immunofluorescence technology.Results Immunohistochemistry showed that CD4 was suspiciously positive expression in non-HIV-infected specimens with the strong background staining.CXCR4 was positively expressed in cytoplasm and nuclei of most lacrimal epithelial cells of lacrimal gland epithelial cells in each specimen,and CCR5 was focally expressed in few lacrimal gland epithelial cells in each specimen.In addition,CD4,CXCR4 and CCR5 were positively expressed in intercellular scattered lymphocytes on the specimens.Immunofluorescence assay showed that CD4,CXCR4 and CCR5 were expressed in the specimens with the red fluorescence,with the linear-and patchy-like distribution mainly in cellular membrane for CD4 or spot-like distribution for CXCR4 and CCR5 in the cytoplasm.Conclusions HIV receptor CD4 and accessory receptor CXCR4,CCR5 are positively expressed in the lacrimal gland epithelial cells,which is the molecular basis of HIV infection and become a potential HIV reservoir preventing HIV eradication.

Objective To measure the setup errors and organ movements of patients with esophagus carcinoma during radiotherapy and find a reasonable margin from the clinic target volume (CTV) to the planning target volume (PTV). Methods (1) Set-up veri cation: Forty-two cases of untreated esophageal cancer were enrolled into this study. The physicist firstly made the planning according to the doctor requests and ensured the best distribution at the target. Thereafter, the 0° and 90° digitally reconstructed radiograph (DRR) was transmitted to the iView GT workshop. Meanwhile, two copies of cross-cut electronic portal image (EPI) were required before radiotherapy. Two doctors confirmed the variance of the osteal mark from the EPI and DRR,and output a 3D direction (left to right, superior to inferior, anterior to posterior) of the setup errors through the iView GT software. (2)Breathing motion:Ten cases of untreated esophageal cancer were enrolled into this study.Three distinct breathing levels were deflned: FB (free breathing), EBH (expiration with breath-held) and IBH (inspiration with breath-held). We gave the treatment planning in FB, then by moving the isocenter to EBH and IBH, we recalculated the dose distribution without changing the field angle, shape and weighing (Mus). Displacements were analyzed at four points (anterior, posterior, right lateral and left lateral) and five levels of target (upper, quarter, isocenter, three-quarter and lower). Results (1) The systematic setup errors were -0.23 cm, -0.02 cm and -0.06 cm, and the random errors were 0.44 cm, 0.45 cm and 0.44 cm at the direction of left to right(LR), superior to inferior (SI), anterior to posterior(AP), respectively. (2) The organ movements were 0.3 cm, 0.6cm and 0.3cm at the LR, SI, AP, respectively. Conclusions As an alternative, the root-sum-of-squares of set-up error and organ motion are suggested by σtot=√ (σITV2+σSM2). The CTV to PTV margins are 0.8cm left to right, 0.78cm superior to inferior, 0.5cm anterior to posterior.

Objective To systematically evaluate the efficacy and safety of 125I seed implantation for treatment of advanced pancreatic cancer.Methods An electronic literatuire search was performed about randomized controlled trials(RCTs) of 125I implantation for treamtent of advanced pancreatic cancer in CNKI,Wanfang Data,CBM,Cochrane Library,PubMed and Embase (from the date of building the database to November 2016).Two investigators independently screened literature,extracted data and assessed the risk bias of included studies,and the Meta-analysis was performed by using Revman 5.3software.Results There were 12 RCTs (n =689) included.Meta-analysis showed that the objective respond rate(ORR) (OR =3.24,95％CI2.33-4.52,P＜0.001),the 6-month survival rate(OR =3.61,95％ CI 1.53-8.52,P =0.003),the 12-month survival rate(OR =4.80,95％ CI 2.40-9.57,P ＜ 0.001) and the relief rate of pain were higher than those in the control group.However,there were no significant differences between both groups in the 2-year survival rate and the adverse reaction rate,which were (OR=2.36,95％ CI 0.47-11.74,P =0.29) and (OR =4.94,95％ CI 1.05-23.23,P =0.04),respectively.Conclusions The limited current evidence showed that 125I implantation for treatment of advanced pancreatic cancer is effective and safety.125I implantation can improve the ORR,short-time survival rate and pain relief rate.In addition,there was no significant increase in the incidence of related adverse events except for seed malposition.Although the quality and quantity of evidences is limited,it merits further study to provide high quality evidences.

Objective To investigate the efficacy and side effects of radioactive seed implantation in the treatment of non-surgical early stage non-small cell lung cancer (NSCLC) based on CT guidance combined with template.Methods Twenty-one patients with inoperable T1 2N0M0 NSCLC who underwent CT-guided radioactive seed implantation therapy were retrospectively analyzed from December 2010 to October 2016 in the Second Hospital of Tianjin Medical University.All patients were diagnosed by histopathology.All seeds,with the activity of 18.5-29.6 MBq and prescription dose of 120-160 Gy,were completed in an operation of the radioactive seed implantation.The preoperative and postoperative TPS treatment plans and quality verification were corducted.In addition,the local control rate of tumors,overall survival (OS),progression free survival time (PFS),satisfaction rate of dose validation and adverse reactions were evaluated.Results The median follow-up was 25.1 months (range 4.4-72.7months).The local control rate of primary tumor in 1-,2-and 3-year was 100％,95.2％ and 95.2％,respectively.Of all patients,the median OS was 48 months with the median PFS 43.4 months.In particular,the 1-,2-and 3-year survival rate was 100％,91.7％ and 72.9％,respectively.Moreover,the rate of 3-year PFS was 70.2％ and the satisfactory rate of postoperative quahty verification was 100％.The treatment-related adverse events included pneumothorax,bronchial hemorrhage,pleural effusion,cough,pulmonary fibrosis and seed shifts.In all,7 (33.3％) patients had grade 1 adverse events and 4 (19％) patients with grade 2,but no grade 3 adverse event.Conclusions CT and template-guided radioactive seed implantation in NSCLC with T1 2 N0 M0 has a high tumor local control rate and low treatment-related adverse reactions,suggesting that it might provide an alternative way for the treatment of inoperable early stage NSCLC.

Objective To explore the safety,effectivity and dosimetric continence of 3D-printing coplanar template(3D-PCT)combined with CT-guided 125I seed implantation in the treatment of non-small cell lung cancer(NSCLC).Methods From May 2014 to November 2016,a total of 20 NSCLC patients who were suitable for 125I seed implantation were recruited in this study.Of all the patients,10 received 125I seed implantation treatment by CT-guided combined with 3D-PCT (3D group),and the rest,by freehand puncture combined with CT-guided 125I seed implantation (free-hand group).During two days before the surgery,the patients received the CT scan.Then the digital imaging and communications in medicine (DICOM) was collected to input to the Brachytherapy Treatment Planning System (BTPS).The dose parameters including D90,D100,V100,V150,conformal index(CI),external index(EI),and homogneneity index(HI) were compared between pre-operation and post-operation.Pair t-test and single sample t-test were performed.Results V150 in 3D group between preoperation and postoperation showed statistically significant difference (t =-2.916,P ＜ 0.05),and there was no significant difference in the rest parameters(P ＞ 0.05).However,the number of seeds,V100,EI,HI in free-hand group between preoperation and postoperation showed statistically significant difference (t =-2.516,2.492,4.725,7.258,P ＜0.05),and there was no significant difference in the rest parameters(P ＞0.05).Comparison of indicuted that there was significant difference in V100,V150,CI,EI,HI and dose error rate between the 3D group and the free-hand group with single sample t test,the result showed V100,CI,EI,HI between two groups(t =2.598,2.278,4.637,4.616,-4.785,P ＜0.05),and there was no significant difference in V150 (P ＞ 0.05).Conclusions CT-guided 125I seed implantation brachytherapy combined with 3D-PCT for treatment of NSCLC safe is feasible,and dose controllable,and there is a certain advantage in the spatial distribution of seed compared with free-hand puncture.

Objective To investigate thc clinical effect of midazolam in CT-guided 125I seed implantation.Methods Totally 86 patients who underwent CT-guided radioactive 125I seed implantation were collected from December 2015 to February 2017 in the Second Hospital of Tianjin Medical University and randomly divided into two groups:the test group and the control group.The test group was given intravenous infusion of midazolam and local anesthesia of lidocaine while the control group were given the same amount of saline and lidocaine.The changes of heart rate (HR),mean arterial pressure (MAP),respiration (RR) and oxygen saturation (SpO2) were observed and compared between the two groups at 15 min before the midazolam(T0),15 min after the midazolam (T1),15 min after lidocaine local anesthesia (T2),the moments the lesion was punctured (T3),and after implantation of the seeds (T4) and the end of the operation (T5),respectively.In addition,the body reaction,operation time,the amount of lidocaine,the effect of analgesic and adverse reactions were also observed.Results The levels of HR,MAP,RR and SpO2 in test group were significantly lower than those in control group (t =38.9,31.0,14.1,2.4,P ＜0.05),but there was no significant difference at T1,T2,T3,T4 and T5(P ＞0.05).In control group,HR,MAP and RR were significantly higher than those before operation (t =-23.6,-18.0,-9.5,P＜0.05).The difference ofHR,MAP,RR and SpO2 among T1,T2,T3,T4 and T5 was statistically significant (F =997.3,833.7,120.1,77.5,P ＜ 0.05).In addition,the incidence of adverse reactions was both less in the two groups,and the incidence of response of patients,operation time,the amount of lidocaine and other indicators and analgesic effect in the test group were superior to the control group (-15.4,9.2,-56.3,P ＜ 0.05).Conclusions Midazolam in CT-guided 125I particle implantation can improve the patient's tolerance and shorten the operation time,guarantec security.

Objective:To explore the value of digital information line mark coplanar template (also referred to as the line mark template) in 125I radioactive seed implantation for the treatment of lung cancers. Methods:A retrospective analysis was conducted for 58 cases of lung cancers who were treated with template-assisted seed implantation in Oncology Department of the Second Hospital of Tianjin Medical University from Aug 2017 to May 2019.Line mark templates were adopted for 30 cases (the line mark template group) and general standard coplanar templates (also referred to as the general template) were used for 28 cases (the general template group). Pre-plan and post-implant parameters were compared, including the minimum prescription dose delivered to 90% of target volume ( D90), minimum peripheral dose (MPD), mean percentages of volume receiving 100%, 150% and 200% of the prescription doses ( V100, V150 and V200), external index (EI), conformity index (CI), and homogeneity index (HI) of target volume.The operation duration was also compared between the two groups. Results:There was no statistical difference between pre-plan and post-implant D90, MPD, V100, V150 and V200 in the line mark template group ( P>0.05). There was also no statistical difference between pre-plan and post-implant D90, MPD, V100, V150 and V200 of the general template group ( P>0.05). The operation duration of the line mark template group and the general template group was (44.3±12.4) and (60.0±12.8) min, respectively ( t=-3.03, P<0.05). Conclusions:The use of template-assisted seed implantation can accurately achieve preoperative planning, while the line mark template shortens the operation duration and thus improves the tolerance of patients.

Objective:To evaluate the pre- and post-implantation dosimetric consistency and efficacy of CT-guided 125I radioactive seed implantation for the treatment of the local recurrence of lung cancers under the assistance of a universal coplanar template (also referred to as the universal template). Methods:This study involved 38 patients with a local recurrence of non-small cell lung cancers who received universal template-assisted 125I radioactive seed implantation in the Second Hospital of Tianjin Medical University from Jan 2009 to Dec 2015.Preoperative planning was carried out before implantation, and the prescription dose was 110 Gy.The paired T-test was adopted for cooperation between intraoperative verification result and pre-plan values of the dosimetric parameters including minimum peripheral dose (MPD), the minimum prescription doses delivered to 90% and 100% of the target volume ( D90 and D100), conformity index (CI), external index (EI), and homogeneity index (HI). The efficacy was evaluated at the 6th month after implantation according to the RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). Results:All patients successively received the seed implantation.The pre-plan and post-implant dosimetric parameters were as follows: MPD (222.7±26.2), (227.74±29.8) Gy; D90(130.8±13.6), (134.8±12.8) Gy; D100 (106.4±10.6), (110.7±11.8) Gy, CI ( 0.75±0.06), (0.74±0.04), EI(22.7±5.8)%, (24.3±4.8)%; HI(36.8±4.7)%, (37.2±5.3)%, the mean irradiation dose of hearts (19.3±7.2), (21.3±6.8) Gy( P> 0.05). The median follow-up period was 22.5 months (8-98 months). The median survival was 21 months (95% CI, 7.4-34.6), and the 2-year overall survival (OS), progression-free survival (PFS), and local control (LC) rate were 47.4%, 39.5%, and 83.5%, respectively. Conclusions:The universal template-assisted and CT-guided 125I radioactive seed implantation in the treatment of postoperative local recurrence of non-small cell lung cancers can achieve the goal of the preoperative TPS planning during the operation and achieve good efficacy.It is a minimally invasive, accurate, safe and effective therapy.

Objective:To investigate the feasibility, efficacy, and safety of CT- and bronchoscopy-guided 125I seed implantation in the treatment of central lung cancer complicated with atelectasis. Methods:Retrospective analysis was conducted on twenty-nine patients who were treated from May 2016 to Oct 2019 in the Second Hospital of Tianjin Medical University for central non-small-cell lung carcinoma complicated with pulmonary atelectasis that was inoperable due to medical reasons. 125I seeds were implanted into the trachea under the guidance of bronchoscopy first.The 125I seeds were then implanted into the hilum of the lungs by percutaneous puncture under the guidance of the CT and template.The seed activity was 18.5-29.6 MBq, and the prescription dose was 120 Gy.TPS planning and quality verification were performed before and after the operations.The rate of atelectasis recanalization, the satisfactory rate of dose verification, the improvement of dyspnea index, the survival time, and the adverse events during and after operation were observed. Results:All 29 patients with lung cancer complicated with atelectasis successfully completed the seed implantation, and the satisfactory rate of quality verification was 93.1%.The rate of atelectasis recanalization at 2, 6, 12, 18, and 24 months was 93.1%, 89.7%, 78.6%, 76.2%, and 60%, respectively.Their dyspnea and anoxia symptoms were significantly relieved in 5-28 months after treatment.The results showed that the patients′ dyspnea index was 2.8-0.8 before treatment and 1.4-0.9 after treatment.The median follow-up period was 20 months and median survival was 21 months.Adverse events associated with the radiation therapy included pneumothorax, hemoptysis, cough, fever, and particle displacement.No level-3 or more serious adverse events occurred.Conclusions:The CT- and bronchoscopy-guided 125I seed implantation is a safe and effective therapy option for the treatment of central non-small-cell lung carcinoma associated with atelectasis.It contributes to a high rate of local recanalization, and can rapidly improve clinical conditions and quality of life of the patients with few adverse reactions.