Objective:To explore the dosimetric characteristics of intensity modulated proton therapy (IMPT), intensity modulated radiation therapy (IMRT) and tomotherapy (TOMO) techniques applied in the irradiation of pediatric whole central nervous system tumors.Methods:Taking the target area of a 14-year-old pediatric patient clinically diagnosed with atypical teratoid/rhabdomyoid tumor, meningeal metastasis by Shandong Cancer Hospital and Institute, and undergoing craniospinal irradiation (CSI) as an example, IMPT, IMRT and TOMO plans were designed respectively based on the clinical prescription of the target area and the limit requirements of organs at risk (OARs). The conformal index (CI), homogeneity index (HI) and gradient index (GI) of each planning target volume, as well as the dose volume index of normal tissues, were evaluated to compare the dosimetric characteristics of the three types of plans.Results:The CI (0.71), HI (0.05) and GI (3.13) of the IMPT plan were comparable to those of IMRT plan (0.80, 0.08, 3.14). The HI (0.03) and GI (2.54) of the TOMO plan were excellent, which were all within the clinically acceptable range. The irradiation dose to parallel organs in the IMPT plan was lower than that in the IMRT and TOMO plan. In the IMPT plan, V 5 of lungs was 2.9%, IMRT plan was 37.6%, and TOMO plan was 43.5%. The D mean of liver in the IMPT plan was 0.01 Gy (RBE), IMRT plan was 6.12 Gy, and TOMO plan was 6.39 Gy. In the IMPT plan, none of the bladder, rectum, and femoral head received the dose, while there was low-dose radiation in both IMRT and TOMO plan. For serial organs adjacent to and within the target area, the D max of spinal cord and brainstem in IMPT plan was 39.89 and 39.88 Gy (RBE), respectively; in IMRT plan, they were 39.43 and 38.59 Gy, respectively; and in TOMO plan, they were 38.41 and 37.69 Gy, respectively. The low-dose area in the IMPT plan was significantly better than the photon radiotherapy plans. Among them, the absolute volume IMPT plan occupied by 10% of the prescribed dose area in the patient's body was reduced by 70.10% compared with IMRT plan and 76.96% compared with TOMO plan; the 30% prescribed dose volume IMPT plan was reduced by 53.49% compared with IMRT plan and 62.51% compared with TOMO plan; the 50% prescribed dose volume IMPT plan was reduced by 39.06% compared with IMRT plan and 42.23% compared with TOMO plan. Conclusions:The IMPT plan demonstrated significantly reduced low-dose exposure and lower doses to parallel OARs compared to both IMRT and TOMO plans in pediatric CSI. The CI, HI and GI of the three plans can all meet the clinical requirements. However, for serial organs adjacent to and within the target area, the D max of the IMPT plan may be higher than that of IMRT and TOMO plans.

Objective:To preliminarily explore the correlation between the quantitative parameters of spectral CT before proton radiotherapy and the changes in apparent diffusion coefficient (ADC) of MRI before and after radiotherapy in chordoma patients.Methods:A retrospective analysis was conducted on imaging data from 28 patients with chordoma who underwent proton radiotherapy at Shandong Cancer Hospital and Institute from August 2022 to December 2024. Spectral CT images obtained prior to treatment were used to extract four quantitative parameters of the lesion area: relative iodine concentration (RIC), electron density (ED), effective atomic number (Z eff), and the slope of spectral attenuation curve (λHU). In parallel, MRI-DWI scans before and after treatment were collected to compute the ADC difference (ΔADC). The correlation between spectral CT parameters and ΔADC was assessed using scatter plots, simple linear regression, LOWESS curve fitting, correlation matrix, and bootstrap resampling methods. Results:The ADC of 28 patients was 1 137.05 (921.07, 1 643.91) before treatment, and 1 197.10 (994.75, 1 785.57) after treatment, and the ΔADC was 133.18 (-36.46, 253.04). The RIC was 0.45 (0.12, 0.67), the ED was 38.01±12.72, the Z eff was 8.40±0.64, and the λHU was -2.20±1.05. The scatter plots results indicated a positive distribution trend between RIC and ΔADC, and a negative trend between λHu and ΔADC. Simple linear regression showed that RIC had the highest goodness of fit with ΔADC ( R2=0.75) and the largest regression coefficient ( β=518.34), followed by λHU ( R2=0.64, β=-121.94). The goodness of fit between Z eff and ΔADC was low ( R2=0.25). No correlation was found between ED and ΔADC. LOWESS curve fitting showed a consistent trend with simple linear regression results, without significant deviation. The correlation matrix indicated that RIC was positively correlated with ΔADC ( r=0.88, P<0.001), Z eff was moderately positively correlated with ΔADC ( r=0.51, P=0.006), and λHU was negatively correlated with ΔADC ( r=-0.84, P<0.001). Bootstrap resampling analysis showed that the r values of RIC, Z eff, λHU and ΔADC were 0.87, 0.50, -0.80, respectively. Conclusions:The spectral CT parameter RIC of chordoma patients before proton radiotherapy is positively correlated with ΔADC, while λHU exhibits a negative correlation with ΔADC.

Objective:To explore the dosimetric characteristics of proton and photon radiotherapy in the treatment of breast cancer.Methods:Four female breast cancer patients who needed radiotherapy at Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. The target area ranges of 4 patients were left-sided breast cancer with lymph node involvement, left-sided breast cancer with lymph node involvement and internal mammary node, right-sided breast cancer with lymph node involvement and internal mammary node and synchronous bilateral breast cancer. Intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) plans were designed respectively based on the prescribed dose in the target area and the limits of organs at risk (tomotherapy plan for bilateral breasts). The conformity index (CI), homogeneity index (HI), gradient index (GI) and organs at risk doses were evaluated. The dosimetric characteristics of IMPT and photon radiotherapy were compared.Results:Both IMPT and photon radiotherapy plans of the 4 breast cancer cases met the clinical dose requirements. The HI value of IMPT plans (0.10-0.14) was comparable to that of photon radiotherapy plans (0.10-0.12), and the average CI of the photon radiotherapy plans was 0.10 higher than that of the IMPT plans, and the average GI was 0.55 lower than that of the IMPT plans. The D mean of ipsilateral lung and heart of IMPT was lower, especially in the low-dose area (V 0-3), which was significantly lower than the photon radiotherapy plans, D mean of ipsilateral lung was reduced by 12.2%, 6.1%, 16.1% and 34.8%, respectively, D mean of heart was reduced by 47.2%, 57.0%, 72.4% and 83.0%, respectively. The ipsilateral lung V 20 of IMPT was not lower than photon radiotherapy plans (unilateral breast: IMPT was 30.0%-34.0%, IMRT was 29.0%-35.9%) . Conclusions:IMPT significantly reduces the D mean to the ipsilateral lung and heart while ensuring dose coverage of the target in breast cancer, preventing more volume of surrounding normal tissues from being irradiated. However, IMPT does not show much more advantage than photon radiotherapy plans in the ipsilateral lung V 20.

Objective:To explore the dosimetric characteristics of intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) for typical abdominal and pelvic tumors.Methods:Three patients with abdominal and pelvic tumors (one case each of liver cancer, cervical cancer, and prostate cancer) admitted to Shandong Cancer Hospital and Institute from January to June 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on clinical target volume (CTV) and organs at risk (OARs) constraints. Dosimetric parameters, including conformity index (CI), homogeneity index (HI), and gradient index (GI) for target coverage, as well as OARs dose metrics, were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%, 30%, and 50% of the prescription dose.Results:For all three cases, IMRT plan demonstrated higher CI values (0.82, 0.81, and 0.86) compared to IMPT plan (0.61, 0.62, and 0.43). IMPT plan yielded lower HI values (0.053, 0.075, and 0.020) than IMRT plan (0.060, 0.120, and 0.080) and lower GI values (3.45, 2.63, and 3.80 vs. 7.28, 4.76, and 4.66 for IMRT plan). In liver cancer, IMPT plan reduced the D mean of normal liver tissues and right kidney by 37.8% and 78.5%, respectively, and decreased the D max of spinal cord by 13.2%. For cervical cancer, IMPT plan reduced the V 30 of the small bowel by 22.0%, D mean of the bladder, rectum and bone marrow by 15.7%, 14.3% and 12.6%, and spinal cord D max by 4.8%. In prostate cancer, IMPT plan lowered bladder and rectal D mean by 14.9% and 36.5%, respectively, but resulted in an increase of 35.3% and 6.1% in the D mean and V 40 of the left femoral head, respectively, and an increase of 23.6% and 10.8% in the D mean and V 40 of the right femoral head, respectively. IMPT plan reduced the volumes receiving 10%, 30%, and 50% of the prescription dose by 48.9%-64.8%, 22.0%-47.0%, and 22.0%-57.7%, respectively, compared to IMRT plan. Conclusions:Comparison between IMPT and IMRT plans for abdominopelvic tumors: IMPT plan offers advantages in reducing doses to normal organs such as the liver, kidneys, spinal cord, small intestine, rectum, and bladder. However, its advantage is less pronounced regarding the dose to the femoral heads. IMPT plan notably minimizes additional dose deposition within the body.

Objective:To investigate the dosimetric characteristics of intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) in typical head and neck malignant tumors.Methods:Three types of typical head and neck tumors (nasopharyngeal carcinoma, parotid gland carcinoma, laryngeal carcinoma) treated at Shandong Cancer Hospital and Institute from December 2023 to December 2024 were taken as research subjects. IMPT and VMAT radiotherapy plans were created according to clinical prescription requirements of target and organs at risk limits respectively. The conformity index (CI), homogeneity index (HI) and gradient index (GI) for target coverage of two radiotherapy plans were evaluated for 3 patients, as well as the dosimetric indicators of organs at risk.Results:The CI of IMPT for nasopharyngeal carcinoma, parotid gland carcinoma and laryngeal carcinoma were 0.70, 0.72 and 0.67, respectively. The HI were 0.11, 0.08 and 0.08, respectively. The GI were 3.08, 2.49 and 3.75, respectively. The CI of VMAT plans were 0.77, 0.82 and 0.91, respectively. The HI were 0.12, 0.10 and 0.04, respectively. The GI were 3.67, 2.63 and 3.45, respectively. The results showed that CI of IMPT plan was slightly lower than that of VMAT plan, and HI of IMPT plan was comparable to that of VMAT plan, the GI of the IMPT plan for patients with nasopharyngeal carcinoma and parotid gland carcinoma was lower than that of the VMAT plan, and the GI of the IMPT plan for patient with laryngeal carcinoma was higher than that of the VMAT plan, and all were within the clinically acceptable range. The IMPT plan has demonstrated significant dose advantages in the treatment of nasopharyngeal carcinoma, parotid gland carcinoma and laryngeal carcinoma. For patient with nasopharyngeal carcinoma, the IMPT plan reduced the D max of the left and right crystals by 54.1% and 50.4%, respectively, compared to VMAT plan, and reduced the D mean of the oral and laryngeal tissues by 40.5% and 49.6%, respectively. For patient with parotid gland carcinoma, IMPT plan reduced the D max of the brainstem and spinal cord by 66.2% and 40.5%, respectively, compared to VMAT plan. For patient with laryngeal carcinoma, IMPT reduced spinal cord D max by 77.0%, while thyroid cartilage D mean increased by 8.0% compared to VMAT plan. For the additional dose in the patients' body, taking the absolute volumes occupied by the prescribed dose areas of 10%, 30%, and 50% in the patients' body as examples, IMPT plan of nasopharyngeal carcinoma patient decreased by 29.7%, 29.6%, and 34.9% compared to VMAT plan, respectively. IMPT plan of parotid gland carcinoma patient decreased by 61.0%, 39.7%, and 17.4% compared to VMAT plan, respectively. IMPT plan of laryngeal carcinoma patient decreased by 63.9%, 31.7%, and 4.1% compared to VMAT plan, respectively. Conclusions:Compared with VMAT plan, IMPT plan can effectively reduce the irradiation dose of most organs at risk near the target of head and neck tumors, but the dose of string organs close to the target area may be higher, which needs attention.

Objective:To investigate the dosimetric characteristics of intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) for lung cancers.Methods:Three lung cancer patients (central-lower, central, and peripheral types) admitted to Shandong Cancer Hospital and Institute from January 2024 to May 2024 were selected as the research subjects. IMPT and IMRT plans were designed for each case based on the anatomical location of the clinical target volume and the dose constraints for organs at risk (OARs). Dosimetric parameters, including conformity index (CI), homogeneity index (HI), and gradient index (GI) for target coverage, as well as OARs dosimetric parameters were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%, 30%, and 50% of the prescription dose.Results:For all three cases, IMRT plans demonstrated higher CI values (0.80, 0.60, and 0.79) compared to IMPT plans (0.61, 0.57, and 0.34). IMPT plans yielded lower HI values (0.07, 0.06, and 0.06) than IMRT plans (0.09, 0.15, and 0.09) and lower GI values (2.84, 2.47, and 4.56 vs. 4.91, 3.09, and 4.99 for IMRT plans). Compared with the IMRT plans, the low-dose region in the ipsilateral lung was significantly reduced in IMPT plans (V 5 of the IMPT plans were 20.59%, 46.29%, 10.94%, respectively; V 5 of the IMRT plans were 48.91%, 60.63%, 19.92%, respectively), but there was no significant advantage in the high-dose region compared to IMRT plans (V 20 of the IMPT plans were 12.88%, 34.75%, 5.21%, respectively; V 20 of the IMRT plans were 21.70%, 36.50%, 5.31%, respectively). The dose to the contralateral lung and heart was significantly reduced in IMPT plans [the D mean of the contralateral lung in the IMPT plans were 0.08, 0.04, and 0.00 Gy (RBE), respectively, and those in the IMRT plans were 3.25, 1.18, and 0.55 Gy, respectively; the heart D mean in the IMPT plans were 6.23, 7.04, and 0.00 Gy (RBE), respectively, while those of the IMRT plans were 18.33, 10.27, and 0.08 Gy, respectively). IMPT plans significantly reduced the volumes receiving 10% of the prescription dose by 65.94%, 25.57% and 72.47%, respectively, compared to IMRT plans. The volumes IMPT plans occupied by 30% of the prescription dose area in the body were reduced by 54.97%, 26.47% and 39.04%, respectively, compared to the IMRT plans. The volumes IMPT plans occupied by 50% of the prescription dose area in the body were reduced by 54.49%, 30.43% and 28.89%, respectively, compared to the IMRT plans. Conclusions:IMPT plan significantly reduces the V 5 of the ipsilateral lung, the D mean of the contralateral lung and the heart, while maintaining target coverage compared with IMRT plan for lung cancers. However, IMPT plan does not show much more advantage than IMRT plan in the ipsilateral lung V 20. IMPT can reduce the additional exposure volume within the body.

Objective:To explore the dosimetric characteristics of proton radiotherapy plan and photon radiotherapy plan for esophageal cancer.Methods:Four patients who were admitted to Shandong Cancer Hospital and Institute from January 2024 to April 2024 with esophageal cancer (cervical, middle thoracic and total esophageal tube, as well as the lymphatic drainage areas involved) and required radiotherapy were selected as the research subjects. Intensity modulated proton therapy (IMPT) and intensity modulated radiation therapy (IMRT) plans were designed respectively based on the clinical target volume and the dose constraints for organs at risk (OARs). Dosimetric parameters, including conformity index (CI), homogeneity index (HI), gradient index (GI) for target coverage, as well as OARs dosimetric parameters were evaluated. The volume of additional dose deposition in the body was compared by assessing regions receiving 10%, 30%, and 50% of the prescription dose.Results:For all four cases, IMPT plans yielded lower HI values (0.12, 0.10, 0.06, and 0.08) than IMRT plans (0.15, 0.13, 0.10, and 0.11), and the GI values of IMPT plans (3.11, 3.21, 2.43, and 2.72) was lower than IMRT plans (4.52, 5.14, 3.09, and 3.92). Moreover, the CI of the IMPT plans (0.59, 0.60, 0.77, and 0.72) was inferior to IMRT plans (0.81, 0.77, 0.91, and 0.85). Compared with the IMRT plans, in the whole lung dose indicators of the IMPT plans for the 4 patients, V 5 decreased by 34.1%, 55.0%, 79.7% and 60.3%, respectively; V 20 decreased by 48.3%, 43.9%, 65.8% and 40.8%, respectively, and D mean decreased by 43.4%, 57.2%, 76.2% and 45.4%, respectively. V 30 of the heart decreased by 36.2%, 45.3%, 40.1% and 52.4%, respectively, and D mean of heart decreased by 96.6%, 57.9%, 58.5% and 55.3%, respectively. For the middle and lower thoracic target area, the liver was significantly protected in the IMPT plan (D mean decreased by 76.0% compared with the IMRT plan). In terms of the additional dose deposition in the patient's body, IMPT plans reduced the volumes receiving 10%, 30% and 50% of the prescription dose by 45.0%-61.4%, 41.2%- 61.8% and 34.8%-61.6%, respectively, compared with the IMRT plans. Conclusions:By comparing the dosimetric parameters of IMPT and IMRT plans for 4 cases of esophageal cancer, the IMPT plans have advantages in reducing the doses to lung tissue, heart, and liver, and can also reduce additional dose deposition in the patient's body.

BACKGROUND: Lung cancer is the leading malignancy in China in terms of both incidence and mortality. With increased health awareness and the widespread use of low-dose computed tomography (CT), early diagnosis rates have been steadily improving. Surgical intervention remains the primary treatment option for early-stage lung cancer, and video-assisted thoracoscopic surgery (VATS) has become a common approach due to its minimal invasiveness and rapid recovery. However, post-discharge recovery remains incomplete, underscoring the importance of postoperative care. Traditional follow-up methods, lack standardization, consume significant medical resources, and increase the burden of the patients. Artificial intelligence (AI)-driven disease management platforms offer a novel solution to optimize postoperative follow-up. This study followed 463 lung cancer surgery patients using an AI-based platform, aiming to identify common postoperative issues, propose solutions, improve quality of life, reduce recurrence-related costs, and promote AI integration in healthcare. METHODS: Using the AI disease management platform, this study integrated educational videos, collaboration between healthcare teams and AI assistants, daily health logs, health assessment forms, and personalized interventions to monitor postoperative recovery. The postoperative rehabilitation status of the patients was assessed by the Leicester Cough Questionnaire (LCQ-MC). Two independent t-test and one-way ANOVA were used to analyze the causes of postoperative cough in lung cancer. RESULTS: Most issues occurred within 7 d post-discharge, significantly declined on 14 d post-discharge. Factors such as gender, smoking history, and surgical approaches were found to influence cough recovery. The incidence of cough on 7 d post-discharge in females was higher than that in males (P<0.01), while the incidence of cough on 14 d post-discharge in elderly patients was lower than that in young patients (P=0.03). The AI-based platform effectively addressed cough, pain, and sleep disturbances through phased interventions. CONCLUSIONS The AI-based platform significantly enhanced postoperative management efficiency and the self-care capabilities of the patients, particularly in phased cough management. Future integration with wearable devices could enable more precise and personalized postoperative care, further advancing the application of AI technology across multidisciplinary healthcare domains.
Humans ; Lung Neoplasms/rehabilitation* ; Male ; Female ; Middle Aged ; Aged ; Patient Discharge ; Artificial Intelligence ; Adult ; Postoperative Care ; Postoperative Period ; Disease Management ; Quality of Life

Objective:To analyze the efficacy and safety of standard chemotherapy and immune checkpoint inhibitors (CI) combined with radiotherapy (RT) in driver-gene negative (wild-type) oligometastatic non-small cell lung cancer (NSCLC) patients with central nervous system involvement.Methods:In this multicenter retrospective cohort study, oligometastatic NSCLC patients receiving first-line chemo-immunotherapy-based therapy were analyzed. Between January 2017 and January 2023, a total of 98 eligible patients were enrolled from the National Cancer Center/Cancer Hospital (Beijing/Shenzhen) and Shanxi Province Cancer Hospital. All participants were divided into chemo-immunotherapy (CI) group (28.6%, n=28) and chemo-immuno-radiotherapy (CIR) group (71.4%, n=70) according to whether receiving radiotherapy. Baseline characteristics were well-balanced between two groups, with no statistically significant differences (all P>0.05). The primary endpoint of the study was overall survival (OS), while progression-free survival (PFS) was designated as a key secondary endpoint. Qualitative data were compared by Chi-square test. Survival analysis was conducted using Kaplan-Meier method, and prognostic analysis was performed by multivariate Cox regression models. Results:The median PFS in the CIR and CI groups was 21.8 and 11.5 months, respectively, and the difference was not statistically significant ( P=0.211). The median OS in the CIR group was significantly better ( P=0.036) than 25.3 months in the CI group. The median OS in the CIR group was not reached. The 2-year local regional control rates for the whole brain radiotherapy patients, stereotactic radiotherapy / stereotactic radiosurgery patients and CI groups were 33.3% ,100% and 83.4%, respectively. Multivariate analysis showed that brain radiotherapy was an independent protective factor for OS in patients with oligometastatic brain metastases at baseline ( HR=0.47, 95% CI=0.22-0.99, P=0.047). Subgroup analysis revealed that patients with 1-3 metastatic lesions benefited from radiotherapy (PFS: HR=0.47, 95% CI=0.22-1.03, P=0.060; OS: HR=0.34, 95% CI=0.12-0.98, P=0.046). Conclusions:For central nervous system involved oligometastatic NSCLC patients, the integration of chemo-immunotherapy with radiotherapy is well tolerated and can improve the efficacy, particularly among those with a limited number of metastatic lesions.

Objective:To analyze the efficacy and safety of standard chemotherapy and immune checkpoint inhibitors (CI) combined with radiotherapy (RT) in driver-gene negative (wild-type) oligometastatic non-small cell lung cancer (NSCLC) patients with central nervous system involvement.Methods:In this multicenter retrospective cohort study, oligometastatic NSCLC patients receiving first-line chemo-immunotherapy-based therapy were analyzed. Between January 2017 and January 2023, a total of 98 eligible patients were enrolled from the National Cancer Center/Cancer Hospital (Beijing/Shenzhen) and Shanxi Province Cancer Hospital. All participants were divided into chemo-immunotherapy (CI) group (28.6%, n=28) and chemo-immuno-radiotherapy (CIR) group (71.4%, n=70) according to whether receiving radiotherapy. Baseline characteristics were well-balanced between two groups, with no statistically significant differences (all P>0.05). The primary endpoint of the study was overall survival (OS), while progression-free survival (PFS) was designated as a key secondary endpoint. Qualitative data were compared by Chi-square test. Survival analysis was conducted using Kaplan-Meier method, and prognostic analysis was performed by multivariate Cox regression models. Results:The median PFS in the CIR and CI groups was 21.8 and 11.5 months, respectively, and the difference was not statistically significant ( P=0.211). The median OS in the CIR group was significantly better ( P=0.036) than 25.3 months in the CI group. The median OS in the CIR group was not reached. The 2-year local regional control rates for the whole brain radiotherapy patients, stereotactic radiotherapy / stereotactic radiosurgery patients and CI groups were 33.3% ,100% and 83.4%, respectively. Multivariate analysis showed that brain radiotherapy was an independent protective factor for OS in patients with oligometastatic brain metastases at baseline ( HR=0.47, 95% CI=0.22-0.99, P=0.047). Subgroup analysis revealed that patients with 1-3 metastatic lesions benefited from radiotherapy (PFS: HR=0.47, 95% CI=0.22-1.03, P=0.060; OS: HR=0.34, 95% CI=0.12-0.98, P=0.046). Conclusions:For central nervous system involved oligometastatic NSCLC patients, the integration of chemo-immunotherapy with radiotherapy is well tolerated and can improve the efficacy, particularly among those with a limited number of metastatic lesions.