Objective:To investigate the skin positioning error in total breast radiotherapy after breast cancer surgery through image analysis.Methods:The study period was from January 2019 to June 2019. A total of 80 patients who received breast-conserving breast cancer surgery and adjuvant radiotherapy during this period in Zhejiang Cancer Hospital were selected. The CT positioning image for each patient in the treatment plan was created and the relevant cone beam computed tomography verification film after the patient positioning setting was obtained during radiotherapy, and the positioning map and the verification film to each patient through image processing software skin surface location were overlapped. The isocenter deviation of the nipple-lung ( X) and cranial tail ( Y) directions and the deviation of the X and Y axis rotation angle of the superimposed image were measured. Results:In the 80 patients, the system error ( μ, Σ) and random error ( σ) were calculated based on the X-axis and Y-axis deviation and the rotation angle deviation. The μ value of X-axis, Y-axis and rotation angle were (0.01 ± 0.01) mm, (-1.35 ± 0.14) mm and (0.06 ± 0.01)°. The Σ value of X-axis, Y-axis and rotation angle were (1.76 ± 0.72) mm, (1.49 ± 0.58)mm and (0.90 ± 0.12)°. The σ value of X-axis, Y-axis and rotation angle were (1.34 ± 0.96) mm, (1.93 ± 1.02) mm and (1.0 ± 0.2)°. The average value of the total vector error in the left and right patients were (3.02 ± 1.26), (2.88 ± 1.03) and (3.25 ± 1.38) mm, which had no clinical significance. Conclusions:In the routine breast radiotherapy after breast-conserving surgery, the smallest position error of the skin can be obtained by using the skin surface position combined with image processing software.

Objective:To explore a three-dimensional dose distribution prediction method for the left breast cancer radiotherapy planning based on full convolution network (FCN), and to evaluate the accuracy of the prediction model.Methods:FCN was utilized to achieve three-dimensional dose distribution prediction. First, a volumetric modulated arc therapy (VMAT) plan dataset with 60 cases of left breast cancer was built. Ten cases were randomly chosen from the dataset as the test set, and the remaining 50 cases were used as the training set. Then, a U-Net model was built with the organ structure matrix as inputs and dose distribution matrix as outputs. Finally, the model was adopted to predict the dose distribution of the cases in the test set, and the predicted 3D doses were compared with actual planned results.Results:The mean absolute differences of PTV, ipsilateral lung, heart, whole lung and spinal cord for 10 cases were (119.95±9.04) cGy, (214.02±9.04) cGy, (116.23±30.96) cGy, (127.67±69.19) cGy, and (37.28±18.66) cGy, respectively. The Dice similarity coefficient (DSC) of the prediction dose and the planned dose in the 80% and 100% prescription dose range were 0.92±0.01 and 0.92±0.01. The γ rate of 3 mm/3% in the area of 80% and 10% prescription dose range were 0.85±0.03 and 0.84±0.02. Conclusion:FCN can be used to predict the three-dimensional dose distribution of left breast cancer patients undergoing VMAT.

Objective To evaluate the effect of different methods of deformable image registration on the dose evaluation in adaptive radiotherapy for lung cancer. Methods By using Raystation Ver4. 5 treatment planning system platform, two algorithms ( Hybrid-and Biomechanics-based deformable image registration) and two orders (CT images before and during radiotherapy as reference images) were adopted. Four deformable image registration methods were utilized to calculate the accumulative dose. Eleven patients of lung cancer received adaptive radiotherapy for 35. 0-61. 6 Gy were recruited. The mean doses of lung,heart and GTV and the D98 and D2 of GTV were statistically compared using four methods. Results With the four deformable image registration methods, the standard deviation of the mean lung dose of 11 lung cancer patients was ranged from 0. 07 to 0. 70 Gy,0. 01 to 0. 79 Gy for the mean heart dose,0. 01 to 2. 23 Gy for the mean GTV dose,0. 02 to 6. 51 Gy for the D98 of GTV and 0. 01 to 0. 97 Gy for the D2 of GTV,respectively. Conclusion The selection of deformable image registration method causes uncertainty to the calculation of accumulative dose during adaptive radiotherapy for lung cancer.

Objective To analyze the risk factors of post-ERCP pancreatitis (PEP) and to evaluate the relationship between cannulation time and PEP.Methods The data of cannulation time in 1 625 patients who underwent ERCP from 2010 to 2012 were retrospectively studied.The risk factors associated with PEP were analyzed by univariate and multivariate Logistic regression analysis.The effect of different cannulation time on PEP was evaluated.Results The incidence of overall PEP was 4.6％ (75/1 625) including 4.1％ (67/1 625)of mild and 0.5％ (8/1 625)of moderate-to-severe.Univariate analysis revealed that diabetes mellitus (P =0.02),choledocholithiasis (P =0.02),malignant biliary stenosis (P =0.007),duodenal stenosis (P =0.029),precut (P＜0.01),cannulation time ≥ 8 min (P＜0.01),blood platelet count ≥ 180× 109/L(P =0.089),alkaline phosphatase ≥ 120 U/L (P =0.083) and total bilirubin ≥ 17.1 μmol/L (P =0.094)were associated with PEP.Multivariate analysis revealed that precut (OR=1.93,95％CI:1.10-3.39,P=0.022),cannulation time ≥8 min (OR =3.50,95％CI:2.00-6.13,P＜0.01) and duodenum stenosis (OR=2.92,95％CI:1.08-7.86,P=0.034) were independent risk factors of PEP.Within 30 min of cannulation,longer cannulation time was accompanied with higher PEP rate.Conclusion The cannulation time is an independent risk factor of PEP.Overall PEP is increased when cannulation time is more than 8 min.

Objective: To investigate the value of detecting circulating tumor cells (CTCs) in patients with local advanced head and neck squamous cell carcinoma (LAHNSCC). Methods: Twenty cases of LAHNSCC and eight healthy cases as the negative control were collected. The clinicopathological factors were evaluated. The LAHNSCC CTCs were enriched by specific antibody nanofluidic chip immunoassay using CytoSorter CTCs sorting system. LAHNSCC CTCs were identified by immunofluorescence staining. The relationships between CTCs and the clinicopathological features of LAHNSCC were analyzed. The numbers of CTCs were monitored and compared two weeks after inductive chemotherapy and at the end of the treatment. Results: CTCs were detect in 15 (75%) 20 patients with LASHNCC, with an average number of 22.4 CTCs. There was a correlation between the numbers of CTCs and age or N staging (P<0.05). Among the 15 cases with CTCs, 13 cases received inductive chemotherapy, for whom CTCs were detected again after inductive chemotherapy in all of these 13 patients, with an average number of 9.5 CTCs. Ten of the fourteen cases (71.4%) were still CTCs detected After whole treatments CTCs were detected in 14 patients, of them, 10 (71.4%) patients showed positive CTCs, with an average 1.6 CTCs. The numbers of CTCs decreased after either inductive chemotherapy or the whole treatment. The number of detected CTCs after whole treatment decreased nearly to background levels. Conclusions CTCs have a high detection rate in the peripheral blood of patients with LAHNSCC, especially in patients ≥60 years old and with ≥ N2 stage before treatment. Real-time detection of dynamic change of CTCs may assist to evaluate therapeutic effect.

Objective To apply Nutritional Risk Screening-2002(NRS-2002) to perform primary screening for nutritional risk in patients with esophageal cancer who undergo radiotherapy, and assess their nutritional status, and to investigate the value of NRS-2002 in such patients.Methods A total of 97 patients who were diagnosed with esophageal cancer and underwent radiotherapy in Zhejiang Cancer Hospital from January 2010 to April 2014 were analyzed retrospectively.The Kaplan-Meier method was applied to analyze the difference in survival, and the chi-square test and the Pearson correlation analysis were applied to analyze the correlation between NRS-2002 score and blood parameters.Results Of all patients, 26.8%had nutritional risk before radiotherapy, which gradually increased with the progress of radiotherapy.The 1-year overall survival rates of the patients with NRS-2002scores of ≤3 and ≥4 on admission were 91.1%and 61.9%, respectively (P=0.010).As for the patients with the highest NRS-2002 scores of ≤2 and ≥3 during treatment, the 1-year overall survival rates were 94.2% and 77.5%, respectively (P=0.012).As for the patients with the lowest NRS-2002 scores of ≤3 and ≥4 during treatment, the 1-year overall survival rates were 91.3% and 54.5%, respectively ( P=0.018).The NRS-2002 score was correlated with prealbumin on admission and at week 1 of radiotherapy (P=0.000 and 0.002), and the NRS-2002 score was correlated with albumin at week 3 of radiotherapy (P=0.036).The multivariate analysis showed that the TNM stage of esophageal cancer and the highest NRS-2002 score during treatment were the independent prognostic factors in esophageal cancer (P=0.001 and 0.005).Conclusions The patients with esophageal cancer undergoing radiotherapy have high nutritional risk, and NRS-2002 score is the independent prognostic factor in these patients and can be used as a tool for primary screening for nutritional risk.

Objective To investigate the surgical procedures and prognosis for neck recurrence or residue of nasopharyngeal carcinoma(NPC) after primary radiotherapy.Methods A total of 153 cases with neck recurrence or residue after radiotherapy in NPC who received salvage neck surgery between January 2001 and December 2011 were retrospectively analyzed.There were rN1 109 cases,rN2 17 cases and rN3 27 cases.Of them 17 cases received bilateral neck dissection(ND) simultaneously.The surgical procedures included the modified radical neck dissection (MRND) in 66 cases,radical neck dissection (RND) in 48 cases,selective neck dissection (SND) in 28 cases,enlarged radical neck dissection (ERND) in 16 cases,local excision in 9 cases,and parotidectomy in 3 cases.The Kaplan-Meier method was used to calculate survival curves,and the differences between groups were calculated by x2 tests.Results There were 20 cases(13.1％)with lymph node(LN) metastasis in level Ⅰ and 7 cases (4.6％) with parotid gland LN metastasis.The 3-year and 5-year overall survival rates were 57.2％ and 40.6％ respectively,and the median survival time was 49 months.Cox regression analysis revealed that rN staging,size of LN and age were the main prognosis factors for survival.Conclusions Salvage surgery was effective for neck recurrence or residue of NPC after primary treatment,and MRND and SND are reasonable options so as to improve functionality.Dissection of LN in level Ⅰ and parotid gland should be selective.Patients with stage rN3 or LN ＞ 6 cm or age ＞ 50 years had poor prognosis.

Objective To analyze the clinical features and prognosis of radiotherapy associated sarcoma (RAS) in the head and neck following radiotherapy for nasopharyngeal carcinoma (NPC).Methods The clinicopathologic data,diagnosis,treatment and follow-up results of 11 patients with RAS diagnosed between January 1995 and December 2011 at Zhejiang Cancer Hospital were analyzed retrospectively.Among these patients,6 were males and 5 were females.Patients' ages ranged from 33 to 66 years (median 50 years).The latency period for development of the RAS was between 3 years and 23 years (median 7 years) after irradiation.Overall survival rate was calculated using the Kaplan-Meier method and Log rank test.Results All cases underwent surgery,of them 6 casesachieved radical resection3 cases left with microscopic positive resection margins and 2 caseshad palliative surgery.Among 11 patients,4 had resurgery after recurrence,including 1 case had repeated surgeries followed by chemotherapy and radioactive seed implantation.Follow-up time ranged from 2 to 102 months,andeight patients died The 2-year,3-year and 5-year cumulative survival rateswere 45.5％,30.3％ and 15.2％,respectively.The median survival time was 15 months.Surgical resection with clear margins achieved significantly better prognosis (P =0.04).Conclusions The incidence of RAS after radiation of NPC is generally low,but the treatment of RAS is very difficult,with poor prognosis.

Objective To evaluate the prognostic factors of brain metastasis from non-small cell lung cancer and suggest a individualized treatment method proposal with prognostic estimation. Methods From Dec. 2003 to Jan.2007, 183 patients received whole brain radiation therapy (WBRT) were retrospectively analyzed. Kaplan-Meier method was used to analyze the survival. Logrank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. Results The overall l-, 2- and 3-year survival rate was 40.6%, 16.6% and 11.3%, respectively, but with a median survival time of 10.0 months (95% CI 8.6-11.4 months). In multivariate analysis, RAP grouping, weight loss, LDH in blood serum and treatment method were independent prognostic factors. The median survival time of WBRT alone, WBRT with chemotherapy, surgery with chemoradiotherapy and WBRT with Gefitinib was 9.0, 9.0, 22.0 and 13.0 months, respectively, but their difference were statistical significant (X2 = 10.37, P = 0.016). Conclusions The main prognostic factors of brain metastasis from non-small cell lung cancer are RAP grouping, weight loss, LDH in blood serum and treatment method. The survival time is prolonged by proper multidiseiplinary management than WBRT alone. The effect of combined treatment of surgery with chemoradiotherapy is favorable for the patients operated with single region of metastasis.

Objective To determine long-term survival of 214 patients of lung cancer with brain metastases and to detect the potential prognostic factors.Methods A retrospective review was pedormed evaluating patients diagnosed as lung cancer with brain metastasis from Jan 1992 to Dec 2001 at Zhejiang Cancer Hospital.Two hundred and fourteen cases were enrolled.All hospital records were thoroughly reviewed in a retrospective manner.The management of the brain metastases were as follows: 8 patients underwent surgical resection and postoperative whole brain radiotherapy (WBRT); 2 cases received resection and chemotherapy; 10 had resection alone; 10 underwent WBRT alone,36 had chemotherapy alone; 15 received the combination of resection,chemotherapy and WBRT; 104 were performed with chemotherapy combined with WBRT; 29 had only supportive care.Survival time was measured from the date of the first treatment for malignancy to the date of death or the last follow-up.Seven further potential prognostic factors were investigated for survival including age,gender,T or N status,number of extra cranial metastases,pathological type and treatment modality.Statistical analysis was performed using the Kaplan-Meier method and Cox-regression analysis.Results The overall median survival time was 10 months (95% CI9.06--10.94) and the 1,3,5 year survival rates were 7.46%,1.14% and 0,respectively.In the univariate model,none of the following variables had effect on survival: age,gender,T stage of the tumor,nodal status,number of extra cranial metastases and histological type.Univariate analysis showed a better survival for the combination of surgical resection,chemotherapy and radiation (P=0.00).Based on Cox-regression analysis,treatment modality was the only independent predictor of survival Conclusions Aggressive combined therapy of brain metastases may achieve a survival advantage.Excellent overall survival of lung cancer with brain metastases has been achieved with a combination of WBRT with surgical resection and chemotherapy.