OBJECTIVETo compare the radiation injuries of the temporomandibular joint (TMJ) following three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC).

METHODSThirty-nine NPC patients without previous radiotherapy underwent 3D-CRT and another 32 received IMRT in our institute. The distance between the 2 dens incisivus medialis (DDIM) and LENT SOMA criteria were employed to evaluate TMJ injuries, clinical outcomes, and the performance-to-price ratios.

RESULTSThe short-term local response rates were similar between the two groups (P=0.878). The mean radiation doses of the TMJ were significantly higher in 3D-CRT group than in IMRT group (57.06 vs 40.90 Gy, P<0.001). The DDIM showed significant changes in 3D-CRT groups after the radiotherapy (P<0.05). No significant difference was found in the TMJ injuries between the two groups according to the SOMA criteria (P>0.05).

CONCLUSIONRadiation injuries of the TMJ are tolerable in both 3D-CRT and IMRT groups, and 3D-CRT is a more economic choice for patients who can not afford IMRT.

Carcinoma ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiation Injuries ; etiology ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; adverse effects ; methods ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Temporomandibular Joint ; injuries

OBJECTIVETo review the appearance of radiation-induced liver injury on computer tomography for quantitative assessment of dosimetric changes in different radiological reactions and the influence of time-effect.

METHODSThe focal liver reactions of 35 patients treated with three-dimensional conformal radiation therapy (3-D CRT) for liver malignancies were evaluated, with the applied doses of 36-65 Gy in 4-28 fractions completed in 8-41 days. All patients received nonenhanced CT scan and arterial-dominant phase contrast-enhanced CT scan 1-6 months after therapy. The liver tissue density in irradiated and nonirradiated liver was compared, and the reaction type and the threshold dose determined radiologically.

RESULTSOn at least one follow-up examination, 51.4% of patients were found to have a focal radiation reaction in the liver. The radiation reaction was hypodense in 43.75% of the follow-up nonenhanced CT examinations and in 19.23% of arterial-dominant phase contrast-enhanced CT scans. It was hyperdense in 42.31% of arterial-dominant phase contrast-enhanced CT scans. The median threshold dose inducing a radiation reaction was 30.8 Gy (range 18-42.8 Gy). The detected threshold dose was positively correlated with the time of detection of the reaction (P=0.041), with a correlation coefficient of -0.473. On arterial-dominant phase contrast-enhanced CT scans, the threshold dose was significantly higher for hyperdense than for hypodense changes (P=0.017). In additional follow-up, the reaction volume decreased and the reaction types changed on arterial-dominant phase contrast-enhanced CT scans.

CONCLUSIONSThe threshold dose can be different in different radiological reaction types on multiphase CT scans. The detected threshold dose is inversely correlated with the time of detection of the early reaction. Multiphase contrast-enhanced CT is helpful to distinguish radiation reactions from recurrent tumors.

Adult ; Aged ; Carcinoma, Hepatocellular ; radiotherapy ; Female ; Humans ; Liver ; diagnostic imaging ; pathology ; radiation effects ; Liver Neoplasms ; radiotherapy ; Male ; Middle Aged ; Radiation Injuries ; diagnostic imaging ; etiology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Reproducibility of Results ; Tomography, X-Ray Computed ; methods

OBJECTIVETo summarize the experiences in gallbladder cancer treatment, evaluate the efficacy of postoperative radiotherapy, and investigate the method of improving the survival of gallbladder cancer patients.

METHODSOne hundred and twenty-seven gallbladder cancer patients, treated in our center by radical resection (84 cases) and combined with postoperative radiotherapy (43 cases), between June 2003 to December 2009 were included in this study. Their clinical data and follow-up results were retrospectively analyzed. According to AJCC staging criteria, the survival time and 1-, 3- and 5-year survival rates of the surgery group and the postoperative radiotherapy group at the different pathological stages and resection margin status were compared.

RESULTSThe median survival time of postoperative radiotherapy patients in stage III was 16.9 months, and the 1-year, 3-year, and 5-year survival rates were 55.7%, 23.5% and 18.2%, respectively, significantly higher than that of the simple operation group ( median survival time 14.3 months, and 1-year, 3-year, 5-year survival rates 42.7%, 22.6% and 16.7%, respectively) (P<0.05). The median survival time of postoperative radiotherapy patients in stage IV, the median survival time was 9.7 months in the postoperative radiotherapy group and 6.3 months in the simple surgery group, and the 1-year survival rates were 14.2% and 9.8%, the 3-year survival rates were 7.2% and 3.9%, the 5-year survival rates were 7.2% and 1.9%, respectively, all showing a statistically significant difference (P<0.05). Among the stage III and IVpatients, all the 1-, 3- and 5-year survival rates of the postoperative radiotherapy group were higher than that of the simple R0 and R1 surgical resection group (all P<0.05), but with a non-significant difference between the stageIandIIpatients (P>0.05). The main side effects in postoperative radiotherapy patients including nausea, vomiting and abdominal pain, all were successfully alleviated by symptomatic and supportive therapy, and the radiotherapy was successfully completed.

CONCLUSIONSWith regard to the gallbladder cancer patients in stage III and IV, the survival rate can be obviously increased by postoperative radiotherapy. However, for patients in stageIand II, whether postoperative radiotherapy significantly improves the survival or not, needs to be further validated in larger scale studies.

Adult ; Aged ; Cholecystectomy ; methods ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; radiotherapy ; surgery ; Humans ; Male ; Middle Aged ; Nausea ; etiology ; Neoplasm Staging ; Radiotherapy, Adjuvant ; adverse effects ; Radiotherapy, Conformal ; adverse effects ; Retrospective Studies ; Survival Rate ; Vomiting ; etiology

OBJECTIVETo explore the clinical and physical factors that might give rise to radiation-induced esophagitis in three-dimensional conformal radiotherapy for non-small cell lung cancer.

METHODSTo collect the clinical and physical records and follow-up information of 106 NSCLC patients without undergoing surgery in our hospital. χ(2) test, linear tendency test and analysis of variance were employed to analyze the relationship between occurrence of radiation-induced esophagitis and clinical and physical treatment. Logistic analysis was also used for multivariate analysis.

RESULTSAmong the 47 cases of radiation-induced esophagitis, 31 cases were of grade I, 11 of grade II, 5 of grade III, and with a total occurrence rate of 44.3% (47/106). Radiation-induced esophagitis was correlated with Karnofsky scores, radiation sensitization and tumor location (χ(2) = 11.30, 8.45, 7.67, P < 0.05). Radiation-induced esophagitis was correlated with the length of irradiated esophagus and average dose of irradiated esophagus (F = 20.82, 83.08, P < 0.001). With the increase of the irradiated volume percentage from V20, V30, V40 up to V50, the occurrence rate of radiation-induced esophagitis was also increased, almost with a linear trend (P < 0.05). Application of all the above factors to logistic model indicated that radiation sensitization,length of irradiated esophagus, average dose and V50 were all statistically significant foactors in the occurrence of radiation-induced esophagitis (OR = 0.321, 2.850, 7.307 and 8.558, P < 0.05).

CONCLUSIONSRadiation sensitization,length of irradiated esophagus, average dose of irradiated esophagus and V50 are independent factors in the occurrence of radiation-induced esophagitis. V50 is of greater importance in the judgement of occurrence of radiation-induced esophagitis.

Aged ; Carcinoma, Non-Small-Cell Lung ; radiotherapy ; Esophagitis ; etiology ; Esophagus ; pathology ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; radiotherapy ; Male ; Middle Aged ; Multivariate Analysis ; Radiation Injuries ; etiology ; Radiation Tolerance ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Retrospective Studies

OBJECTIVETo compare the treatment results of three-dimensional conformal radiotherapy (3D-CRT) and conventional radiotherapy (2D) for patients with locally advanced non-small-cell lung cancer (NSCLC).

METHODSFive hundred and twenty seven patients with stage III NSCLC treated between Jan 2000 and Dec 2006 were included in this study. Among them, 253 cases were treated with 3D-CRT, and 274 with conventional radiotherapy. In the 3D group, 159 (62.8%) patients received chemoradiotherapy, 77 with total radiotherapy dose of > 60 Gy, 49 with 50 - 60 Gy. In the 2D group, 127 (46.4%) patients received chemoradiotherapy, 48 with total radiotherapy dose of > 60 Gy, 75 with 50 - 60 Gy.

RESULTSThe 1-, 3-, 5-year overall survival rates (OS) and median survival time for patients treated with 3D-CRT were 73.3%, 26.1%, 14.4% and 20.1 months, respectively, and that of patients treated with 2D radiotherapy were 61.0%, 13.8%, 8.0% and 15.6 months, respectively (P = 0.002). The 1-, 3-, 5-year cause-specific survival rates (CSS) were 79.0%, 33.3%, and 20.8% for the 3D group and 65.1%, 16.7%, 11.2%, respectively, for the 2D group (P = 0.000). The 1-, 3-, and 5-year locoregional control rates were 71.6%, 34.3% and 31.0% for patients treated with 3D radiotherapy and 57.3%, 22.1% and 19.2%, respectively, for patients treated with 2D treatment (P = 0.002). The results of multivariate analysis showed that 3D-CRT, KPS, clinical tumor response and pretreatment hemoglobin level were independently associated with increased OS and CSS. No statistically significant differences were found between the radiation complications in the two groups.

CONCLUSIONSThe results of our study demonstrate that 3D-conformal radiotherapy improves the survival rate in patients with stage III NSCLC compared with that of 2D radiation therapy.

Aged ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; Chemoradiotherapy ; Female ; Follow-Up Studies ; Hemoglobins ; metabolism ; Humans ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; Male ; Neoplasm Staging ; Radiation Pneumonitis ; etiology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Survival Rate

OBJECTIVETo analyze the magnetic resonance imaging (MRI) findings of radiation-induced liver injury following three-dimensional conformal radiotherapy.

METHODSA retrospective review of the MRI data was conducted in 20 patients treated between September 2000 and October 2005, who suffered liver injuries induced by 1 or 2 three-dimensional conformal radiotherapy sessions for liver neoplasm. The patients underwent MR scans with T2-weighted sequences and T1-weighted sequences in both plain and Gd-DTPA enhanced MRI. Four patients with suspected tumor relapse suggested by MRI were pathologically confirmed to have radiation-induced liver injury.

RESULTSAcute radiation-induced liver injury was represented by large patches of liver edema consistent with the irradiation volume, showing low signal intensity on T1-weighted images (T1WI) and high signal intensity on T2-weighted images (T2WI) without arterial phase enhancement after Gd-DTPA injection. Delayed radiation-induced liver injury was manifested by slightly low-intensity signal on plain T1WI and slightly high-intensity signal on T2WI without obvious arterial phase enhancement following Gd-DTPA injection but with marked enhancement during the portal-venous and delayed phases.

CONCLUSIONRadiation-induced liver injury presents characteristic MRI features, and plain and dynamic enhanced MRI can be of great value for its diagnosis.

Adolescent ; Adult ; Aged ; Female ; Humans ; Liver Diseases ; diagnosis ; etiology ; Liver Neoplasms ; pathology ; radiotherapy ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Radiation Injuries ; diagnosis ; pathology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Sensitivity and Specificity

Breast Neoplasms ; pathology ; radiotherapy ; surgery ; Cone-Beam Computed Tomography ; Dose Fractionation ; Female ; Humans ; Mastectomy, Segmental ; adverse effects ; Neoplasm Staging ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Conformal ; methods ; Respiration ; Seroma ; etiology ; pathology ; Surgical Instruments ; Tumor Burden

Radiation-induced lung injury (RILI) is the most common complication of the radiotherapy for thoracic tumor. It can lower the ratio of local control and seriously affect the patients' quality of life. At present, the clinical management of RILI is not more than the use of glucocorticoid and anti-inflammatory agent for symptomatic treatments. These treatments do not have any preventive effect but cause much side reactions. In this paper, we review the data from the contigency researches on the mechanism of RILI, from the researches on gene therapy and stem cell-therapy, and we dicuss the more safe, more stable and more efficacious treatment of RILI.
Antioxidants ; therapeutic use ; Genetic Therapy ; methods ; Humans ; Lung ; pathology ; radiation effects ; Lung Neoplasms ; radiotherapy ; Mesenchymal Stem Cell Transplantation ; methods ; Radiation Injuries ; etiology ; therapy ; Radiation Pneumonitis ; etiology ; therapy ; Radiation-Protective Agents ; therapeutic use ; Radiotherapy, Conformal ; adverse effects

OBJECTIVETo investigate the association between survival and postoperative three-dimensional conformal radiotherapy (3DCRT) in patients with resected non-small cell lung cancer (NSCLC).

METHODSEighty-four patients were treated with surgery and postoperative 3DCRT for NSCLC. Sixty-five (77.4%) patients received lobectomy, and 19 (22.6%) received pneumonectomy. Fifty-four (64.3%) patients achieved R0 resection and 30 cases (35.8%) received R1/R2 resection. Fifty-two patients were of stage IIIA and 24 patients were of stage IIIB. Photon energy of 6 MV was used for all the patients. The median 3DCRT dose was 60 Gy (40 - 70 Gy) with a fraction size of 2 Gy. Thirty-seven patients received median 3 cycles of adjuvant chemotherapy. The median follow-up was 35.5 months for survivors.

RESULTSThe overall 3-year survival rate was 58.6%, and the 4-year overall survival rate was 43.9%. Of the 43 patients who had treatment failure, only 8 (9.9%) patients showed intrathoracic recurrence, but 38 (46.9%) patients had distant metastasis. The univariate analysis for all patients showed that sex, age, weight loss, tumor size, pathology and stage were not correlated with prognosis. R1/R2 resection was associated with a significantly worse survival. Toxicities were acceptable, with 9 (11.1%) patients appeared higher than NCI CTC grade 2 radiation pneumonitis.

CONCLUSIONIn a population-based cohort, postoperative 3DCRT for NSCLC provides a good prognosis, and the radiation-related pneumonitis is acceptable.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; pathology ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional ; Lung Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pneumonectomy ; methods ; Radiation Pneumonitis ; etiology ; Radiotherapy Dosage ; Radiotherapy, Conformal ; adverse effects ; methods ; Radiotherapy, High-Energy ; adverse effects ; Survival Rate

OBJECTIVETo explore the relationship of dose-volume histogram (DVH) parameters and computed tomography grading of radiation-induced lung injury in patients with non-small cell lung cancer (NSCLC) treated by three-dimensional conformal radiotherapy (3D-CRT).

METHODSOne hundred sixty-nine patients with stage I approximately III NSCLC, treated by 3D-CRT and followed by CT scan for more than six months after 3D-CRT, were divided into grade 0 to grade 4 based on the appearance of radiation-induced lung injury on CT image defined jointly by radiotherapist and radiologist. The patients were divided into CT positive group (grade 2 to grade 4) and CT negative group (grade 0 to grade 1), then the treatment planning shown to the patients were reviewed to compare and analyze the relationship of CT grading of radiation-induced lung injury and the DVH parameter selected.

RESULTSRegardless of whole lung or tumor-bearing lung, there was a statistically significant difference in normal tissue complication probability (NTCP) between the patients grouped with different CT grading of radiation-induced lung injury, and the mean of NTCP increased along with upgrade of CT grading. There was a statistically significant difference of mean lung dose (MLD) regardless of whole lung or tumor-bearing lung between the patients grouped with different CT grading of radiation-induced lung injury, and MLD increased along with upgrade of CT grading. There was a statistically significant difference of the volume received equal or more than 20 Gy (V(20)), 30 Gy (V(30)), 40 Gy (V(40)) of whole lung and tumor-bearing lung between the patients grouped with different CT grading of radiation-induced lung injury, and V(20), V(30), V(40) increased along with upgrade of CT grading. There were not statistically significant differences of the DVH parameters of the contralateral lung in the patients of different groups based on the CT grading. On statistical analysis, the DVH parameters of whole lung and tumor-bearing lung closely correlated with CT grading of radiation-induced injury of the tumor-bearing lung, and there was a relatively strongest relationship between NTCP and CT grading of the tumor-bearing lung (eta = 0.522).

CONCLUSIONDVH parameters such NTCP, MLD, V(20), V(30), and V(40) are statistically correlated closely with CT grading of radiation-induced lung injury after radiotherapy for the patients with NSCLC treated by 3D-CRT. Therefore the parameters can be selected as the reference for evaluation after 3D-CRT for patients with NSCLC.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; radiotherapy ; Dose-Response Relationship, Radiation ; Female ; Follow-Up Studies ; Humans ; Lung ; radiation effects ; Lung Injury ; etiology ; Lung Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Male ; Middle Aged ; Neoplasm Staging ; Radiation Injuries ; etiology ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; adverse effects ; methods ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult