Objective To compare the acute and late adverse events and quality of life (QOL) in patients with nasopharyngeal carcinomas receiving conventional external beam radiation therapy (RT) versus intensity modulated radiation therapy (IMRT).Methods Ninety-one patients with newly diagnosed nasopharyngeal carcinoma treated in our institution between August 2008 and September 2010 were systemically reviewed,including 35 cases administered with conventional RT ( RT group) and 56 cases with IMRT (IMRT group).Conjoint facio-cervical fields plus tangential lower neck-supraclavicular field initially,and then shrinking preauricular portals plus electron beams to the neck were adopted in RT groups,with a total dose of 70 Gy/35 fractions.Nine coplanar fields were conducted in IMRT group with a total dose of 69.96 Gy/33 fractions.Acute and late adverse reactions were observed and compared between RT and IMRT groups,including acute reactions as xerostomia,odynophagia,dermatitis/mucositis and late events as dysphagia,trismus,hypothyroidism,optic/acoustic impairments,skin injury,hypodermal fibrosis,spinal myelitis and brain injury.Results Compared with RT group,IMRT group showed less acute reactions in xerostomia,odynophagia,dysphagia and dermatitis and mucositis(x2 =85.73,56.03,26.58,69.28,55.99,P ＜ 0.05 ),and less late reactions in xerostomia,dysphagia,trismus,taste loss and skin injury (x2 =37.95,7.48,9.49,9.49,11.87,P ＜ 0.05 ),whereas the degree of acoustic/optic impairments and brain injury showed no difference in both groups.Conclusions As compared to conventional RT,IMRT could decrease acute and some late side events,and improve the quality of life in patients with nasopharyngeal carcinoma.

Objective To assess the role of dynamic-enhanced MR angiography (MRA) by comparing with DSA and CT arterial portography (CTAP).Methods Sixteen patients with liver diseases (mainly HCC) were included in the study. All patients underwent dynamic MRI of the liver using SENSE, digital subtraction angiography (DSA) and CTAP within two-week. MRA was reconstructed from raw data. The arterial phase of the modified MRA was compared with DSA for the evaluation of hepatic arteries and the portal phase compared with CTAP. In dynamic MRI, a fixed dosage (20 ml) of contrast medium and scan timing were used. Results The main branches and variations of the hepatic arterial system were well displayed on the dynamic-enhanced MRA, although the distant intrahepatic branches were showed poorly. Portal veins on MRV were showed as well as or even superiorly to CTAP. In addition, the inferior vena cava (IVC) was well demonstrated on MRV in most cases. MRV revealed 1 vascular variation which was not found on DSA and CTAP.Conclusion The dynamic-enhanced MRA using SENSE was a effective modality in demonstrating the hepatic vascular system. It may be a first choice modality in preoperative evaluation of orthotopic liver transplantation.

Objective To evaluate treatment outcomes and quality of life (QOL) in glioma patients treated with postoperative intensity-modulated radiotherapy (IMRT), and to explore the possible clinical factors of affecting QOL. Methods From 2007 to 2009, 37 patients with low or high grade glioma were analyzed retrospectively. All patients were operated by tumor resection below microscopy. IMRT began at 2-4 week postoperstion with 2.0 Gy/fractior, 5 fractions/week and to shrink portal and to add dose to 50-60 Gy/25-30 fractions after 40-50 Gy. The gross tumor volume (GTV) was defined as preoperation T2WI MRI high sign area and postoperation tumor cavity for low grade glioma, and with preoperation T1WI MRI enhanced abnormity area and postoperation tumor cavity for high grade glioma. The clinical target volume ( CTV ) was defined as GTV with a margin of 1.5 cm for low grade glioma and a margin of 2.5 cm for high grade ghoma, the planning target volume (PTV) with CTV plus 0.4 cm margin for setup errors according to the European Organization for Research and Treatment of Cancer ( EORTC ).The treatment outcomes and QOL were assessed. Results The half-year and one-year survival rates for all the patients were 100% and 79.2%, respectively. The median progression-free survival time was 10 months. The main side-responses after postoperative IMRT were fatigue and mild memory decline or cognitive disabilities, which were radiation dose-dependent. Conclusions Postoperative IMRT is an effective and safe modality of therapy for glioma patients.

Objective To assess the outcomes of involved field irradiation (IFI) and elective nodal irradiation (ENI) in patients older than 70 years with esophageal squamous-cell carcinoma(SCC) receiving radical IMRT,and to determine whether IFI is feasible in these patients.Methods Totally 79 patients older than 70 years diagnosed with SCC of esophagus without distant metastases were collected.48 patients were received IFI,and the other 31 patients were treated with ENI.With a median follow-up time of 24 months,disease-free survival,overall survival,patterns of failure,irradiated lung dose and radiation pneumonitis were observed and compared between IFI and ENI groups.Results In IFI and ENI arm,the disease-free survival rates of 1,2,3 years were 60.4％,34.9％,29.7％ and 64.5％,54.0％,35.0％,respectively(P ＞0.05).The 1-,2-,and 3-year survival rates were 72.9％,43.4％,31.5％ for the IFI arm,and 73.0％,53.0％,38.3％ for the ENI arm(P ＞ 0.05).The ENI arm had a tendency to expand survival,but the two arms had no significant difference (P ＞ 0.05).The patterns of failure also had no difference between the two arms.Distant failure,local failure,uninvolved nodal failure in IFI arm were 22.9％,27.0％,4.2％,while in ENI arm were 25.8％,0,19.4％,all of them had no significant difference (P ＞ 0.05).However,the lung V5,V20,mean lung dose in ENI arm were higher than that in IFI and all of them had a significantly difference (t =4.66,29.90,15.63,P ＜ 0.05).The radiation pneumonitis rates were higher in ENI than in IFI arm.The rates of degree 1-2 and degree 3 were 22％,19％,and 13％ and 4％ in the two arms,respectively,with a significantly difference(x2 =4.55,4.77,P ＜ 0.05).Conclusions It is feasible that IFI for definitive IMRT in the elderly patients older than 70 years with SCC,because it got similar disease-free survival and overall survival but with less lung doses along with decreased radio-pulmonary lesion when compared with ENI.

The oligometastasic stage is an intermediate state with mild biological invasion,in which spread may be limited to specific organs and polymetastases do not occour.The number of metastatic tumors is limited less than five.Local therapy such as radiotherapy,surgery and radiofrequency ablation for the relapsed sites could thus improve patients survival.The expression of miR-200 family characterizes oligometastasis(es).Correct understanding and familiarization with treatment of oligometastasis may change the traditional therapeutic strategy of advanced tumors,and some advanced cancer patients may achieve curable results.

Objective To analyze the volumetric and dosimetric variations in radiation treatment planning(RTP) using CT images based on normal and extended reconstructed field-of-view(FOV). Methods Original data of CT scans from 16 cases of nasopharyngeal carcinomas were reconstructed to form 2 sets of CT images with Dermal(45 cm)and EFOV(65 cm),which were then exposed to RTP. Contouring of targets/OAR including GTV(gross tumor volume),CTV(clinical target volume,CTV),brain stem, lens, parotids and cord was made on normsl FOV CT set.A 7-field equi-angular IMRT (intensity modulated radiation Therapy)plan was generated with prescribed GTV dose of 70 Gy.Two sets 0f CT images were fused in DICOM coordinate system and targets/OARs on normal FOV CT were copied to EFOV CT.IMRT plans were then transplanted from normal FOV to EFOV CT,with the same isocenter on DICOM coordinates.Volumetric and dosimetrie variations including GTV,CTV brain stem,lens, parotids and cord were calculated on dose-volume-histogram(DVH).For dosimetric verification,IMRT plans were input into fluence maps of Mapcheck 1175 phantom based on normal FOV and EFOV, and DTA(distance to agreement)was used to analyze the passing rate of calculated/measured absolute doses at 5 cm depth.Paired-t test was used to compare the passing rate of field 1-7 of IMRT plans based on 2 CT sets.Results Volumes of targets and OARs on 2 CT sets of different FOVs were statistically different.with larger calculated volume on norlual FOV in all cases.There was no statistic difference in the maximal(Dmax) doses received by all targets and OARs except the small-volume lens, in which the dose was higher on normal CT than that on EFOV CT(t=-3.14,P<0.007).The mean doses(Dmean)to the CTV(clinical target volume)and GTV(gross tumor volume)were higher on EFOV than normal FOV CT(t=-6.45,-5.65,P<0.001).There was no statistic difference in Dmean received by OARs and the minimal dose (Dmin)by all targets and OARs(P>0.05).There was also no statistic difference in the passing rate of field 1-7 of IMRT plans based on 2 CT sets.Conclusions There were volumetric and dosimetric variations as evaluated on DVH using different reconstructed FOV during CT simulation,though the difference between the passing rates as verified in 2 dimensional fluence map was not significant.

Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in detecting metastatic lymph nodes from nasopharyngeal carcinoma (NPC),and predicting the response of these nodes to concurrent chemoradiation (CRT).Methods Eighteen patients with pathologically proven NPC received conventional magnetic resonance imaging (MRI) and DWI before treatment,weekly during treatment,and one month after treatment.DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values of 0 and 1500 s/mm2.ADC maps were reconstructed for all patients and ADC values were calculated for each lymph node and tongue muscle.Totally fifty-two morphologically abnormal lymph nodes were analyzed.The ADC values of the metastatic lymph nodes before treatment were compared between those with the short axis≥10 mm (n=32) and those with the short axis<10 mm (n=20),and the dynamic changes in ADC values of the lymph nodes before,during,and after therapy were observed and recorded.Results The average ADC of the 32 lymph nodes with the short axis ≥ 10 mm was (0.71±0.12) x 10-3mm/s,not significantly different from that of the 20 lymph nodes with the short axis < 10 mm [(0.73±0.16) x 10-3mm/s,t = 1.11 ,P =0.27].The average ADC values of these lymph nodes before treatment was significantly lower than that of the tongue muscle (t = 19.35,P < 0.0001).During CRT,the ADC values of the lymph nodes increased gradually,with the most evident change in the first two weeks before reaching a relatively flat plateau thereafter.The ADC value of the residual lymph nodes after CRT was significantly higher than that before treatment (t = 12.72,P < 0.0001),however,not statistically significant different from that of the normal tongue muscle (t = 0.34,P = 0.73).Conclusions DWI plays an important role in diagnosing the metastatic lymph nodes from NPC and is feasible for observation of the early response of the lymph nodes to IMRT,thus helping the clinicians make appropriate treatment planning and replanning in the course of radiotherapy.

Objective To compare the dosimetric results of postoperative intensity modulated radiation therapy (IMRT) using single-energy or mixed-energy photons in invasive thymoma patients.Methods Simulation CT images were acquired and clinical target volume (CTV),planning target volume (PTV) and organs at risk (OARs) were defined.Three sets of fixed-field IMRT planning were generated using 6 MV,10 MV and mixed 6/10 MV photons for each case.Monitor Units (MUs) for each plan were recorded after optimization,and parameters of PTV such as conformity index (CI),homogeneity index (HI) and dose to OARs were evaluated on dose-volume histograms.Results Near-Maximal dose (D2％) received by PTV was better in mixed-energy IMRT as compared with 6 MV(t =3.107,P ＜0.05).HI was better in mixed-energy than in 6 MV(t =2.924,P ＜0.05).There were statistically significant differences in CI among three IMRT plans.MU was higher in 6 MV than in both 10 MV and mixed-energy IMRT.The percentages of lung volumes receiving 5 Gy (V5),10 Gy(V10),20 Gy (V20),30 Gy (V30) and the mean lung dose (D) were also significantly different in most plans.V30 and V40 of the heart were comparable between 6 MV and mixed energy plans but better than in 10 MV plan.Conclusions If the reasonable choice of beam angles and number,and capability of energy selection according to beam directions,with combined advantages of low and high energy photons,mixed IMRT plans can improve the quality of IMRT plans in general and has clinical potential for postoperative radiotherapy of invasive thymomas.

Objective　To evaluate the effectiveness of hepatic angiography and embolization in the diagnosis and treatment of hemobilia after hepatobiliary surgery. Methods　Nine patients had upper gastrointestinal bleeding 7 days to 3 months after surgery. They underwent emergency hepatic artery angiography and were treated by embolization using Gelfoam particles only (8 patients) and Gelfoam particles plus microcoils (1 patient). Results　Hepatic artery angiography revealed hepatic artery pseudoaneurysms in 3 patients, diffuse hemorrhage of the hepatic artery branches in 3, right hepatic artery-bile duct fistulas in 2, and hepatic artery-small intestine fistula in 1. Hemobilia was controlled with embolization in 7 patients, of whom 1 had recurrent bleeding 1 day after treatment. During the follow-up, 3 patients died of multiple organ dysfunction syndrome. Two patients whose hemorrhage could not be controlled due to technical reasons died several days later. Conclusion　When hemobilia after hepatobiliary surgery is suspected, patients should receive hepatic angiography as a first diagnostic procedure and be treated with minimally invasive procedure of selective embolization of the involved artery as soon as possible.

Diffusion tensor imaging (DTI) uses the diffusion motion of water molecules to describe the spatial structure of brain.DTI,which can obtain the infiltration of brain tumors into normal physiological structures,makes the diagnosis of diseases change from macroscopic to microscopic,from morphology to both morphology and metabolism,bringing new opportunities for the diagnosis and treatment of brain tumors.In this review,we outlined the theoretical basis and current technical limitations of DTI,and comprehensively discussed its research values in brain tumors radiotherapy treatment and its prognostic value.We believe that DTI can provide important imaging information for radiotherapy planning of brain tumors.