Objective To evaluate the safety and effectiveness of ultra-hypofractionated stereotactic body radiotherapy in the treatment of prostate cancer.Methods A total of 26 patients with prostate cancer treated with Cyber-Knife from May 2010 to May 2018 were analyzed retrospectively.The median age of the patients was 69 years old (range,57 to 87).Ultra-hypofractionated radiotherapy was delivered in five fractions of 7.0-7.5 Gy for a total dose of 35.0-37.5 Gy.Androgen deprivation therapy (ADT) was administered in combination with the Cyber-Knife.The primary endpoints were radiation toxicity,PSA-response,local control and symptom alleviation,while the secondary endpoints were progression-free survival and overall survival.Results No graded ≥ 3 acute and late radiation toxicities occurred during follow-up.The acute toxicity of Grades 1 and 2 was 38.4％ and 19.2％,while the late toxicity of Grades 1 and 2 was 30.8％ and 3.8％,respectively.At a median follow-up of 22.44 months,for patients with localized stage,PSA level was decreased significantly after radiotherapy (Z =2.900,2.794,2.510,2.090,P＜0.05).However,there was no statistically significant difference for the metastatic group (P＞ 0.05).Conclusions Ultra-hypofractionated stereotactic body radiotherapy is a safe and effective treatment for patients with prostate cancer.

Objective: To investigate the feasibility and application value of toluidine bule-dextran-40 (TB-Dex-40) as the tracer for lymphatic system in head and neck region. Methods: Twenty healthy adult New Zealand white rabbits were equally divided into two groups: the experimental group (TB-Dex-40 group, n=10) and the control group (TB group, n=10). Rabbits in experimental group received submucosal injection of 1.0% (0.14 mOsm/L) TB-Dex-40, and the control group received injection of 1.0% (32.60 mOsm/L) TB.The staining time and fading time of lymphatic vessels and lymphnodes in the neck region were recorded, and the diffusion ranges of the two dyes in the tongue region were measured. Lymph nodespecimen were collected for pathological examination after 10 min, 1 hour and 4 weeks of staining. The experimental animals were sacrificed before and 4 weeks after the experiment. After death, organs of heart, lung, liver and kidney were examined pathologically. Results: TB-Dex-40 reached sentinel lymph node (SLN) and stained lymphatic vessels at an average of (21.67±0.19) s after injection, while in control group was(3.22±0.34) s (P<0.01). The time difference between the two dyes reaching sentinel lymph nodes was statistically significant.The durations from lymphatic staining to marked fading were (19.70±1.34) min in experimental group and (14.30±0.95) min in control group, respectively.The difference was statistically significant (P<0.01). SLN staining by TB-Dex-40 was still evident after 4 weeks, while TB staining has completely faded after 2 d.The average ranges of diffusionin tongue were (10.50±1.08) mm in experimental group and (20.00±1.05) mm in controlgroup, respectively. The difference was statistically significant (P<0.01).No abnormalities were found in blood test and pathological examination of main organs. Conclusions TB-Dex-40 has high specificity forstaining lymphatic vessels and is a good tracer with potential clinical value.

Objective: To compare the dosimetrics of the plan target volume (PTV) and organs at risk (OARs) between two treatment planning approaches for patients with multiple brain metastases from non-small cell lung cancer on CyberKnife. Methods: 20 patients with multiple metastases from lung carcinoma were reviewed and analyzed, who had been treated by CyberKnife from December 2017 to December 2018. The CyberKnife stereotactic radiotherapy plans of the 20 cases were re-planed with single plan for multiple lesions and multiple plans per lesion. The dosimetry differences of PTV and OARs isodose disribution, conformity index (CI), total beam counts and total monitor units (MUs) were compared in the two types of plans. Results: The two types of plans could satisfy over 95% PTV coverage of the prescription dose. The maximum and mean dose of normal brain adjacent to the PTV were reduced in multiple plan approach effectively. Moreover, the maximum and mean dose of OARs (brainstem) dropped by 1.62% and 5.57% (t=1.09, P<0.01) respectively. The number of treatment nodes and total MU declined by 4.63% (t=1.87, P<0.01)and 1.06% in multiple plan approach, which could significantly shorten the clinical treatment time. The differences in CI index between these two types of plans was of no statistical significance. Conclusions For patients with multiple brain metastases of similar diameter and volume from non-small cell lung cancer to be treated on CyberKnife, multiple plans per lesion could not only reduce dose to normal brain tissue and OARs, but also improve the treatment efficiency.

Objective To investigate the feasibility and application value of toluidine bule?dextran?40 (TB?Dex?40) as the tracer for lymphatic system in head and neck region. Methods Twenty healthy adult New Zealand white rabbits were equally divided into two groups: the experimental group (TB?Dex?40 group, n=10) and the control group (TB group, n=10). Rabbits in experimental group received submucosal injection of 1.0% (0.14 mOsm/L) TB?Dex?40, and the control group received injection of 1.0% (32.60 mOsm/L) TB. The staining time and fading time of lymphatic vessels and lymphnodes in the neck region were recorded, and the diffusion ranges of the two dyes in the tongue region were measured. Lymph nodespecimen were collected for pathological examination after 10 min, 1 hour and 4 weeks of staining. The experimental animals were sacrificed before and 4 weeks after the experiment. After death, organs of heart, lung, liver and kidney were examined pathologically. Results TB?Dex?40 reached sentinel lymph node (SLN) and stained lymphatic vessels at an average of (21.67±0.19) s after injection, while in control group was(3.22 ± 0.34) s (P<0.01). The time difference between the two dyes reaching sentinel lymph nodes was statistically significant. The durations from lymphatic staining to marked fading were (19.70 ± 1.34) min in experimental group and (14.30 ± 0.95) min in control group, respectively. The difference was statistically significant (P<0.01). SLN staining by TB?Dex?40 was still evident after 4 weeks, while TB staining has completely faded after 2 d.The average ranges of diffusionin tongue were (10.50±1.08) mm in experimental group and (20.00 ± 1.05) mm in controlgroup, respectively. The difference was statistically significant (P<0.01). No abnormalities were found in blood test and pathological examination of main organs. Conclusions TB?Dex?40 has high specificity forstaining lymphatic vessels and is a good tracer with potential clinical value.

Objective To analyze the radiation dose to the normal lung tissue of patients with early stage of non-small cell lung cancer treated by Cyberknife. Methods A retrospective analysis was conducted by summarizing the treatment plans of 264 patients with early stage non-small cell lung cancer from January 2011 to December 2013 in Tianjin Medical University Cancer Institute and Hospital. Sorted by the tumor volumes and locations, the Cyberknife plans were evaluated by means of dose volume histograms ( DVH) , homogeneity indexes ( HI) , percentage volumes receiving at least x Gy ( Vx ) of dose, i. e. , V5 , V10 , V20 , and V30 of the ipsilateral and contralateral lungs. For the tumors approximate to the hilus, the contralateral lungs were included in the optimization process, and the dose-volume metrics were analyzed for the contralateral and bilateral lungs. Results For the tumors close to the chest wall, V5≥(15. 21 ± 3. 12)％ in ipsilateral lung tissue and V5≥(1. 34 ± 0. 67)％ in contralateral lung tissue were observed. For the tumors near the hilus, V5≥(39. 4 ± 11. 90) ％ in ipsilateral lung tissue and V5≥(1. 48 ± 0. 34) ％ in contralateral lung tissue were observed. The irradiated volume ratios of both ipsilateral and contralateral lung tissue increased with the enlargement of tumor sizes. After including the contralateral lung tissue into the optimization, the irradiated volume ratios of the contralateral and bilateral lung tissue (V5,V10) decreasedsignificantly(t=2.44,4.81,3.53,3.17,P<0.05). Conclusions Higherriskof radiation injury in both ipsilateral and contralateral lung tissue can be expected for tumors near the hilus than near the chest wall. After including contralateral lung tissue into the planning optimization, lower dose to the contralateral and whole lung tissue was achieved, indicating a better protection of normal lung tissue.

Objective To evaluate the response rate and efficacy of Cyberknife in the treatment of iliac lymph node metastases (ILNM).Methods Twenty-two patients with 27 ILNM were treated by Cyberknife from May 2010 to May 2016.Tumor volume range from 0.88 to 125.66 cm3 (median 18.87 cm3).The total doses ranged from 21 to 51 Gy (median 39 Gy) and biological effective doses from 35.7 to 100 Gy (median 72.6 Gy) in 3-8 fractions (median 5).Sixty-four percent to eighty-two percent (median 72％) isodose line covered planning target.The survival rates were calculated by Kaplan-Meier method and compared with Log-rank test.Results Follow-up time ranged from 8 to 97 months (median 33 months).The complete response,partial response,stable disease and progression disease rates were 37％,48％,7.5％,48％,respectively.In addition,effective rate was 92.5％.Overall survival range from 4 to 68 months (median 21 months).The 1-,2-,3-year local control rate was all 90.6％ and the survival rates were 78.8％,60.6％ and 43.3％,respectively.Adverse reactions after treatment were gastrointestinal reactions such as nausea,vomiting,fatigue.The chemotherapy before Cyberknife helped to improve overall survival.The patients with backache or edema of lower extremity got rapid relief after treatment.Conclusion The treatment of ILNM with Cyberknife has provided a high response rate with minimal side effects.Cyberknife is a safe and effective local treatment method for ILNM.

Objective To assess the efficacy and safety of CyberKnife radiotherapy in the treatment of locally advanced pancreatic carcinoma. Methods The data of 59 patients with locally advanced pancreatic carcinoma who were treated with CyberKnife radiotherapy from 2006 to 2014 were retrospectively analyzed. The tumor volume ranged from 13?? 0 cm3 to 125?? 1 cm3 with a median value of 27?? 1 cm3 . A dose of 35?50 Gy (median value= 45 Gy) in 3?8 fractions (median value = 5 fractions) was prescribed. The tumor progression was evaluated based on computed tomography. The overall survival (OS) and local progression?free survival ( LPFS) rates were calculated using the Kaplan?Meier method. Results The 1?and 2?year sample sizes were 26 and 17, respectively. The 1?and 2?year OS rates were 54% and 35%, respectively, while the 1?and 2?year LPFS rates were 91% and 70%, respectively. The median OS and LPFS times were 12?? 5 and 10?? 9 months, respectively. The overall incidence of grade 1?2 acute and late gastrointestinal toxicity was 61%. One patient with grade 3 late gastrointestinal toxicity had incomplete intestinal obstruction. Conclusions CyberKnife radiotherapy can achieve excellent treatment outcomes and mild complications in the treatment of locally advanced pancreatic carcinoma.

OBJECTIVETo study the influences of carbon disulfide (CS2) exposureon fatty acid metabolism in apolipoprotein E (ApoE) knockout mice and C57BL/6J mice.

METHODSTwenty-four male ApoE knockout mice were randomly and equally divided into four groups: a CS2-exposed normal diet group, a CS2-unexposed normal diet group, a CS2-exposed high-fat diet group, and a CS2-unexposed high-fat diet group. Twenty-four C57BL/6J male mice were divided into four groups in the same way. The CS2-exposed groups were exposed to CS2 (1 g/m³) by static inhalation for 5 hours a day, 5 days a week. After two weeks, the whole blood of mice was collected. Methyl ester derivatization of fatty acids was performed using an acid-catalyzed method. Fatty acid contents before and after exposure were compared by gas chromatography-mass spectroscopy.

RESULTSThere were significant differences in fatty acid contents of mice between the four groups. For the C57BL/6J mice, the arachidic acid contents in the CS2-exposed high-fat diet group were significantly lower than those in the CS2-unexposed high-fat diet group (P = 0.0450). For the ApoE knockout mice, the arachidonic acid contents in the CS2-exposed normal diet group were significantly lower than those in the CS2-unexposed control diet group (P = 0.0452). For the ApoE knockout mice, the γ-linolenic acid contents in the CS2-exposed high-fat diet group were significantly higher than those in the unexposed high-fat diet group (P = 0.0447).

CONCLUSIONExposure to CS2 can induce fatty acid metabolism disorder in mice, indicating that CS2 may increase the risk of atherosclerosis and other cardiovascular diseases.

Animals ; Apolipoproteins E ; drug effects ; Atherosclerosis ; Carbon Disulfide ; toxicity ; Diet, High-Fat ; Gas Chromatography-Mass Spectrometry ; Lipid Metabolism ; drug effects ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Risk Factors

BACKGROUNDSpine is the most common site of bone metastases in patients with cancer. Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord. The purpose of this study was to evaluate the safety and efficacy of CyberKnife(®) radiation therapy for spinal metastases.

METHODSSeventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed. Thirteen tumors in 12 patients had received prior radiation. Patients were followed clinically and radiographically for at least 12 months or until death. In all patients, the spinal cord and thecal sac were contoured for dose-volume constraints, and maximum doses to 0.1, 0.5, 1, 2, and 5-ml volumes were analyzed.

RESULTSUsing the CyberKnife System, 20-48 Gy in one to five fractions for unirradiated patients, and 21-38 Gy in one to five fractions for the previously irradiatied patients, were delivered. Median 2-Gy normalized Biological Equvalent Dose (nBED) of unirradiated targets and irradiated targets were 49.6 Gy10/2 (range, 31.25-74.8 Gy10/2) and 46.9 Gy10/2 (range, 29.8-66 Gy10/2), respectively. With a median follow-up of 9.4 months (range, 2.5-45 months), twenty-nine patients (46.7%) were alive, whereas the others died of progressive disease. Fifty-six patients (93.3%) reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up, 17 patients (28.3%) reported some degree of pain relief after first fraction of the treatment course. Two patients experienced local recurrence at fifth and ninth months post-radiotherapy. Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 (range, 8.3-154.5 Gy2/2) and 83.5 Gy2/2 (range, 10.5-180.5 Gy2/2), respectively. Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 (range, 17.7-140 Gy2/2) and 70.5 Gy2/2 (range, 21.7-141.3 Gy2/2), respectively. No patient developed radiation related myelopathy during the follow-up period.

CONCLUSIONCyberknife radiotherapy is clinically effective and safe for spinal metastases, even in previously irradiated patients.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; radiotherapy ; Prospective Studies ; Robotics ; methods ; Spinal Neoplasms ; radiotherapy ; secondary ; Young Adult

Calibration ; Humans ; Poisons ; urine