Objective:To explore the method of developing a canal-shaped implant template using a combined automatic pre-planning and 3D printing technology, and assess its impact on dose and efficacy improvement.Methods:Retrospective analysis of 15 patients with advanced cervical cancer admitted to the Affiliated Cancer Hospital of Guangxi Medical University from September 2020 to September 2022 was performed. Patients had characteristics such as vaginal stump recurrence, tumor eccentric growth, and previous hysterotomy, etc. Three-dimensional images were obtained by CT scan after automatic pre-planning. The PMT 3D software was used to analyze digital imaging and communications in medicine (DICOM) radiotherapy data, capture the coordinates of the pre-planned stay points to establish the implant channel, and generate the size and shape of the canal-shaped implant template based on patients' physiological structure. Dosimetric parameters, such as conformity index (CI), were evaluated. The changes of tumor size before and after treatment were analyzed by paired t-test. Results:Fifteen patients were treated with the canal-shaped implant template. The CI was 0.74±0.26, the total radiation dose (HR-CTV) D 90% (EQD 2, α/β=10) was (85.5±6.8) Gy, and the D 2 cm3 (EQD 2, α/β=3)for bladder, rectum, small intestine, and colon were (72.2±4.2), (65.8±6.1), (65.2±4.4), and (69.8±3.7) Gy, respectively, meeting clinical needs. After the treatment, the tumor volume was significantly decreased. The template had a good fit with the vaginal cavity, and a small amount of air gap on the sidewall did not affect the dose. Non-parallel needle insertion increased the utilization of the cavity space and implant needles. Conclusion:The method of developing the canal-shaped implant template using automatic pre-planning and 3D printing technology is efficient and effective, meets the requirements of modern precise radiotherapy, and has practical clinical value.

Objective To analyze the distribution features of the Bragg peak of carbon ion beams in materials using SRIM software, and to explore the use of computed tomography (CT) number to calculate the incident energy of carbon ion beams. Methods SRIM software was used to study the travel of carbon ion beams (100 to 300 MeV/u) in different equivalent materials, and analyze the effects of the incident energy of carbon ion beams and the type and thickness of equivalent materials on the depth of the Bragg peak of carbon ion beams. Origin 2017 was used to analyze the functional relationship between CT number and water-equivalent Bragg peak depth ratio (Di) through data fitting. Results The ratios of the Bragg peak depths in equivalent materials to that in water almost stayed constant with the increase in the incident energy of carbon ion beams. Through the functional relation between CT number and D_i, the Bragg peak depth of a carbon ion beam of a given energy in an equivalent material could be converted to the equivalent Bragg peak depth in water. Conclusion With the water-equivalent Bragg peak depth ratio D_i and CT number of different volume units of human tissues, the equivalent Bragg peak depth in water required for the Bragg peak to fall in the tumor can be accurately calculated, which can be used to reversely infer the needed incident energy of carbon ion beams.

Cervical cancer is a common female reproductive system malignant in developing countries. Radiotherapy plays a very important role in the treatment of cervical cancer, and brachytherapy is an essential part of cervical cancer radiotherapy. With the rapid development of CT and MRI imaging technology, brachytherapy cervical cancer has gradually developed from the traditional two-dimensional image-guided technology to three-dimensional image-guided technology. There are more and more treatment methods, including intracavitary brachytherapy, interstitial brachytherapy and intracavitary/interstitial brachytherapy. This paper reviews several common techniques of three-dimensional brachytherapy for cervical cancer, and discusses the dosimetric feasibility of internal and external integration irradiation.

Objective    To explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT). Methods    A total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg. Results    In all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period. Conclusion    RVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.

Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.

Objective To evaluate the effect of an inverse planning simulated annealing (IPSA) in the treatment of cervical cancer with combined intracavitary and interstitial three-dimensional brachytherapy.Methods A total of 60 patients with locally advanced cervical cancer who received both external beam radiotherapy and combined intracavitary and interstitial brachytherapy in our hospital from October 2016 to July 2018 were enrolled.Patients were divided into four groups with 15 patients each according to the number of needles applied (1,2,3,and 4 needles,respectively).Dosimetric distributions were optimized with both Graphical optimization (GRO) and IPSA.Paired t-test was applied to compare the dosimetric differences between plans optimized with GRO and IPSA.Results The Dg0 and V100 of IPSA plans were higher than those of GRO (t=-4.742,-4.823,P＜0.05),while the conformity index (CI) and conformal index (COIN) were slightly lower than those of GRO plans (t=9.642,8.783,P＜0.05).No significant difference in the V150,V200,V300 between IPSA and GRO (P＞0.05) was observed.There was also no significant difference in the D2cm3 of bladder and rectum between IPSA and GRO (P＞0.05).The difference of Dg0 between IPSA and GRO was increased as the number of implanted needles increased,which increased from 4 cGy to 14 cGy as the number of needle increased from 1 to 4.The difference of V100 between GRO and IPSA was also increased as the number of needle increased.Conclusions In the treatment of cervical cancer with combined intracavitary and interstitial threedimensional brachytherapy,IPSA plan could improve the target coverage(D90,V100)without increasing the dose to the OARs and high dose region in the target compared with GRO.With the numbers of needles increased,the advantage of IPSA increased in terms of target coverage.

Multiple institutions at home and abroad have established and issued the standards,guidelines,criteria or reports of the quality assurance (QA) and quality control (QC) of radiotherapy.At present,no institutions in China have implemented systematic classification of QA-and QC-related criteria of radiotherapy.Complete standard system of QA and QC of radiotherapy should consist of clinical and physical technologies.Physical technology includes equipment,technological flow and radiation protection.The QA and QC of physical technology play a pivotal role in tumor radiotherapy.This paper introduces relevant criteria of QA and QC of radiotherapy at home and abroad.

Objective To use the fusion image of the end-inhalation holding (EIH) phase and endexhalation holding (EEH) phase to define the target volume of individual patient with liver cancer,and to evaluate the target geometry,feasibility,and clinical significance of the technology.Methods Eighteen patients with liver caucer who were treated in our hospital from 2012 to 2013 were enrolled as subjects.With the same posture and scan range,all patients underwent contrast-enhanced three-dimensional computed tomography (3DCT) scans in the phases of free breathing (FB),EIH,and EEH.Gross tumor volume (GTV),clinical target volume (CTV),and organ of risk (OAR) were delineated on the above images.CTVFB was defined as GTV on the FB phase image (GTVFB) plus a margin of 10 mm,while planning target volume (PTVFB) was defined as CTVFB plus a margin of 10 mm in the right-left and anterior-posterior directions and a margin of 20 mm in the superior-inferior direction.GTVEI and GTVEE were defined as GTV on the EIH and EEH images,respectively.Based on the EEH images,the registered EEH and EIH images were fused to form GTVEI+EI.CTVEI+EE was defined as GTVEI+EI plus a margin of 10 mm,while PTVEI+EE was defined as CTVEI+EE plus a margin of 5 mm in the right-left and anterior-posterior directions and a margin of 10 mm in the superior-inferior direction.The Pinnacle3 v8.0m treatment planning system was used to design two 3D conformal radiotherapy plans for each patient.The volume,degree of inclusion (DI),matching index (MI),and central displacement of CTVFB and CTVEI+EE,as well as PTVFB and PTVEI+EE,were compared between the two plans.Results In the 18 patients,the mean CTVFB was significantly smaller than the mean CTVEI+EE(149.00±87.54 cm3 vs.188.17± 125.72 cm3,P=0.014);there was no significant difference between the mean PTVFB and PTVEI+EE (276.68± 146.41 cm3 vs.253.66± 117.35 cm3,P=0.080).DI of CTVFB to CTVEI+EF,PTVFB to PTVEI+EE,CTVEI+EE to CTVFB,and PTVEI+EE to PTVFB were (99.83±0.09)％,(84.55±8.45) ％,(80.83± 12.31) ％,and (99.78±0.08) ％,respectively.MI of CTVEI+EE to CTVFB and PTVEI+EE to PTVFB were 0.83± 0.07 and 0.87± 0.03,respectively.The central displacements of CTVEI+EE from CTVFB in x,y,and z axes were 0.55± 1.07 cm,0.76±3.02 cm,and-0.26± 1.98 cm,respectively (P =0.432,0.971,0.587).Conclusions In the treatment of liver cancer,the target volume delineation and image fusion using 3DCT images in EIH and EEH phases may avoid target omission due to respiratory movement,making it possible to increase radiation dose to target volume and improve the efficacy of radiotherapy.

Objective To evaluate the effect and mechanism of rt-PA combined with high pressure oxygen (HPO)on cerebral ischemia-reperfusion injury in rats.Methods The model of cerebral ischemia-reperfusion injury was constructed by using middle cerebral artery occlusion.The neurological function score;brain index,water content and infarction volume;SOD;LDH;NOS;MDA;LD;NO and NOS were measured.The protein and mRNA expressions of iNOS,BDNF,p75NTR and TrkB were also detected by RT-PCR and Western blot to evaluate and compare the protective effect of rt-PA combined HPO therapy. Results rt-PA combined HPO could significantly decrease the neurological function score;brain index,water content,and infarction volume;SOD;NOS;MDA;LD;NO and NOS but increase LDH content and the weight of rats,compared with rt-PA.In addition,rt-PA combined HPO could increase BNDF and TrKB expressions and downregulate the expressions of iNOS and p75NTR,compared with rt-PA (P<0.05).Conclusion The rt-PA combined HPO therapy has a greater protective effect than rt-PA therapy and its mechanism might be related to having antioxidant effects, increasing the expressions of BDNF and TrKB,and decreasing the expressions of iNOS and p75NTR.

Objective To investigate the development status of tumor radiotherapy in Guangxi Zhuang autonomous region in order to provide reference for the decision-making of the competent administrative departments for public health.Methods A questionnaire survey was conducted by the aid of on-site inspection and telephone or Email investigation among the medical institutions in Guangxi to know the current status of radiotherapy units and settings,human resources,allocation of radiotherapy facilities,and standardization of medical practices.Results Up to the end of August 2014,radiotherapy was carried out in 39 hospitals,with other 5 hospitals under preparation for construction.Among these 40 hospitals were three-dimensional conformal radiotherapy in 38,intensity modulated radiation therapy (IMRT) in 23,and image guided radiation therapy (IGRT) in 5.There were 48 linear accelerators,15 afterloading therapy apparatus,and 4 γ-knife or X-knife in Guangxi.There were 647 professional personnel (except nurses),including 322 radiation oncologists,100 radiotherapy physicists,213 radiotherapy technologists and 12 professional engineers.There were 2 000 to 2 500 hospital beds and 20 000 cancer patients had received radiotherapy in 2013.1 600 to 2 000 people received treatment on average every day.Conclusions The present radiotherapy resources in Guangxi are insufficient and the input to radiotherapy equipment is deficient,with low proportion of cancer patients treated with radiotherapy.Because of the uneven radiotherapy quality among different hospitals,the reasonable planned development and unified diagnostic and treatment practices are required to improve radiotherapy level in Guangxi.For shortage of medical staff and high-quality physical and technical personnel,the improvements are needed by fostering and introduction of personnel.Compared with developed regions in China,the introduction of new technology is largely needed.