2023 Vol. 47, No. 8
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2023, 47(8): 461-467.
doi: 10.3760/cma.j.cn121381-202212015-00320
Abstract:
Objective To investigate the correlation between epidermal growth factor receptor (EGFR) gene mutation with clinical and high-resolution CT (HRCT) imaging features in patients with stages Ⅰ −ⅢB resectable peripheral non-small cell lung cancer (NSCLC). Methods A total of 164 patients with peripheral NSCLC who underwent lung cancer resection, EGFR genetic testing, and clinical staging of Ⅰ −ⅢB in Huizhou Central People's Hospital from January 2019 to April 2021 were retrospectively analyzed. The cohort included 86 males and 78 females, aged 60.3±9.3 years. According to the results of EGFR genetic testing, the patients were divided into EGFR mutation and wild-type groups. The clinical and HRCT imaging features of the patients were analyzed and statistically analyzed. The measurement data were compared by two-independent-sample t-test, and the counting data were compared by chi-square and Fisher's exact probability tests. Indicators with statistical differences were selected for binary Logistic regression analysis. The area under curve of the receiver operating characteristic (ROC) curve was used in evaluating the diagnostic efficiency of the regression model. Results Among the 164 patients with NSCLC, 114 (69.51%) were confirmed to have EGFR mutations, and 50 (30.49%) had wild-type EGFR. Compared with the wild-type EGFR, EGFR mutations were more frequent in non smoking, female patients aged <60 years with a pathological type of adenocarcinoma. Differences between the groups were statistically significant (χ2=21.91, −4.71, 34.64; Fisher's exact probability method, all P<0.05). As observed in HRCT imaging features, the maximum diameter of EGFR mutation group was smaller than that of the wild-type group ((2.52±1.51) cm vs. (4.12±6.07) cm), and the tumors were mostly located in the right lung, with ground-glass opacity or mixed ground-glass opacity, lobulation sign, bronchial inflation sign, and pleural traction sign, compared with the wild-type group, and the differences were statistically significant (t=2.14, χ2=10.13–19.05, all P<0.05). No significant differences in postoperative clinical stage, carcinoembryonic antigen level, lesions with burr signs, necrosis, vascular convergence sign, vacuole sign, cavity sign and thoracic lymphadenopathy were found between the groups (χ2=0.40–2.33, Fisher's exact probability method, all P>0.05). The results of Logistic regression analysis showed that patients with no smoking history (OR=0.225, 95%CI: 0.066–0.764) and tumor accompanied by lobulation sign (OR=3.344, 95%CI: 1.079–10.360) are the independent predictors of EGFR gene mutation (all P<0.05), and the area under the curve of the regression model was 0.858. Conclusion The clinical and imaging features of resectable peripheral NSCLC in stages Ⅰ −ⅢB are correlated with EGFR gene mutation, which are of great significance to assess the patient's condition.
2023, 47(8): 468-476.
doi: 10.3760/cma.j.cn121381-202206001-00333
Abstract:
Objective To evaluate the dosimetric difference of helical tomotherapy plans for nasopharyngeal carcinoma via Ray Station 7 (V6.99) and Tomotheraphy (TOMO) (Hi-Art@V5.1.3) treatment planning systems. Methods This retrospective analysis involved 15 patients of nasopharyngeal carcinoma who completed the TOMO plan in Sun Yat-sen University Cancer Center from May 2018 to December 2018. Among them, 11 cases were males and 4 cases were females, aged (44.0±17.7) years. Using the same prescription dose requirements and dose constraints in TOMO, the plan was designed on the Ray Station 7 treatment planning system. The dosimetric indexes for plan comparison included the 100% and 95% prescription dose coverage of the target volume (V100, V95), dose covering 1%, 98%, 99% of the volume of the target volume (D1%, D98%, D99%), homogeneity index (HI), conformity index (CI), key dosimetric indexes for organs at risk, planning optimization time and delivery time of treatment plan. Data from the two groups that fit a normal distribution were compared by paired t-test. Results The V100 of planning target volume of the primary lesion of nasopharyngeal carcinoma (PTVnx) ((97.5±2.1)% vs. (94.9±3.9)%); V100, V95 of planning target volume of the primary lesion invasion (PTV1) ((98.5±1.4)% vs. (99.1±0.9)%, (99.3±0.7)% vs. 100.0%); V100, V95, CI of planning target volume of primary lesion invasion clinical target volume (CTV1) and expanded gross tumor volume of bilateral lymph node lesions (GTVnd) and the lymphatic drainage area where GTVnd is located and the negative lymphatic drainage area that needs preventive radiotherapy (PTV2) ((98.6±1.1)% vs. (98.9±0.9)%, (99.1±0.9)% vs. (99.8±0.2)%, (74.8±5.7)% vs. (79.2±8.3)%); the dose corresponding to the isodose line surrounding the volume of 1 ml in planning organ at risk volume of spinal cord (PRV-SC) (D1 ml) , the relative volume of the volume surrounded by the isodose line corresponding to 40 and 30 Gy in PRV-SC and the volume of PRV-SC (V40 Gy, V30 Gy), the mean dose (Dmean) of planning organ at risk target volume of the spinal cord ((3 750.0±250.0) cGy vs. (3 443.6±309.3) cGy, (0.7±0.7)% vs. (0.1±0.1)%, (52.3±29.1)% vs. (44.6±22.9)%, (2 705.5±535.5) cGy vs. (2 619.4±413.9) cGy); and Dmean of the right temporal lobe ((1 639.5±594.5) cGy vs. (2 150.3±735.6) cGy) showed statistically significant differences between Ray Station 7 and TOMO plans (t=−4.96−6.71, all P<0.05). The V95, D1%, D98%, HI, CI of PTVnx((99.7±0.3)% vs. (99.8±0.2)%, (7 008.5±746.5) cGy vs. (6 996.0±767.0) cGy, (6 628.0±577.0) cGy vs. (6 548.8±577.3) cGy, (6.2±2.7)% vs. (6.3±2.6)%, (59.8±26.1)% vs. (64.0±24.3)%); V100, V95, D99% and D1% of planning target volume for bilateral lymph node lesion (PTVnd) ((98.5±1.5)% vs. (98.1±1.9)% and (98.7±1.2)% vs. (96.6±3.4)%, (99.7±0.3)% vs. 100.0% and 100.0% vs.100.0%, (6 511.0±500.9) cGy vs. (6 487.1±483.5）cGy and (6 496.0±484.0) cGy vs. (6 493.3±466.6) cGy, (6 824.0±571.0) cGy vs. (6 815.7±562.6) cGy and (6 815.0±583.0) cGy vs.(6 807.0±587.5) cGy) of the two groups of plans showed that the difference was not statistically significant (t=−1.51−0.90, all P>0.05). The relative volume of the volume surrounded by the isodose line corresponding to 50 Gy in PRV-SC and the volume of PRV-SC (V50 Gy) ((0.03±0.03)% vs. 0); Dmean of planning organ at risk target volume of brainstem (PRV-BS) ((2 511.0±792.0) cGy vs. (2 397.0±310.6) cGy); D1% and relative volume of the volume surrounded by the isodose line corresponding to 60 Gy in PRV-BS and the volume of PRV-BS (V60 Gy) ((4 880.0±1 600.0) cGy vs. (5 254.6±755.1) cGy, (1.6±1.6)% vs. (3.6±3.6)%); Dmean of the bilateral parotid ((3 986.5±836.5) cGy vs. (3 953.1±425.6) cGy and (4 223.0±708.0) cGy vs. (4 205.1±800.2) cGy); Dmean of the left temporal lobe ((1 891.5±845.5) cGy vs. (2 077.1±573.0) cGy; V60 Gy of the bilateral temporal lobe ((6.7±6.7)% vs. (6.5±6.5)% and (4.0±4.0)% vs. (5.8±5.8)%) of the two groups of plans showed that the differences were not statistically significant (t=−1.29−1.96, all P>0.05). The dosages of two treatment planning systems were within the clinical requirements range. The planning optimization time of Ray Station 7 treatment planning systems for nasopharyngeal carcinoma was significantly faster than that of TOMO treatment planning systems ((3.00±0.58) min vs. (120.00±17.00) min), the difference was statistically significant (t=−52.31, P<0.01), but their delivery times were similar to each other ((611.0±94.2) s vs. (612.2±94.3) s), the difference was not statistically significant (t=−0.03, P>0.05). Conclusion Statistical analysis of the quality of helical tomotherapy plans for nasopharyngeal carcinoma designed by the two treatment planning systems showed that the differences were not significant, and both can meet clinical dosimetry requirements. Designing a nasopharyngeal carcinoma plan with the Ray Station 7 treatment planning system can significantly save the optimization time.
2023, 47(8): 477-483.
doi: 10.3760/cma.j.cn121381-202208015-00325
Abstract:
Objective To analyze and compare the dosimetric difference between volumetric intensity modulated arc therapy (VMAT) and conformal intensity-modulated radiation therapy (IMRT) in the extended field radiotherapy plan for locally advanced cervical cancer. Methods Retrospective analysis was carried out on the clinical data of 20 patients with cervical cancer admitted to the Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University from January 2019 to December 2021. Patients aged (56.3±9.1) years and ranging from 39 to 78 years old were included. Each patient underwent CT scanning, and the delineations of the planning target volume (PTV), planning gross target volume for lymph node lesion (PGTVnd), and organs at risk such as bladder, rectum, bilateral femoral heads, liver, kidneys, small intestine, and spinal cord were outlined. All patients were divided into the IMRT and VMAT group by using a random number table method with 10 patients in each group. The IMRT and VMAT radiotherapy plans were conducted separately. The patients in the IMRT group were aged (54.1±7.1) years, while those in the VMAT group were aged (58.1±10.8) years. The relevant dosimetric parameters of the target volume and the organs at risk, total machine hops, and total treatment time were compared between the two groups. The t-test was used for inter-group comparison of measurement data. Results In PTV, the conformity index of VMAT was significantly higher than that of IMRT ((0.81±0.03) vs. (0.79±0.23), t=−2.190, P=0.035). In PGTVnd, the homogeneity index of VMAT was significantly lower than that of IMRT ((0.06±0.01) vs. (0.07±0.01), t=−2.315, P=0.026). In the bladder irradiation dose, the V20 Gy (Vx Gy indicates the percentage of volume irradiated with ≥ x Gy to total volume) in the VMAT plan was significantly lower than that in the IMRT group ((92.64±2.29)% vs. (93.98±1.47)%, t=2.220, P=0.032). In the rectal irradiation dose, the V20 Gy in the VMAT group was significantly lower than that in the IMRT group ((92.20±2.21)% vs. (93.68±1.88)%, t=2.282, P=0.028). In the liver irradiation dose, the V10 Gy and V20 Gy in the VMAT group were (7.73±0.39)% and (5.14±0.68)%, respectively, which were lower than the V10 Gy ((7.93±0.10)% ) and V20 Gy ((5.51±0.16)%) in the IMRT group, and the differences were statistically significant (t=2.372, 2.367, P=0.023, 0.023). In the small intestine irradiation dose, V20 Gy, V30 Gy, V40 Gy, and Dmean in the VMAT group were (77.67±4.64)%, (39.21±1.10)%, (18.35±3.05)%, and (30.36±3.46) Gy, respectively, which were significantly lower than the V20 Gy ((80.24±1.05)%), V30 Gy ((42.34±6.00)%), V40 Gy ((22.34±6.01)%), and Dmean ((34.23±6.71) Gy) in the IMRT group (t=2.228–2.628, all P<0.05). In the spinal cord irradiation dose, the V20 Gy and Dmean in the VMAT group were (38.81±2.33)% and (11.46±4.26) Gy, respectively, which were significantly lower than the V20 Gy ((42.88±6.19)%) and Dmean ((17.97±7.40) Gy) in the IMRT group (t=2.752, 3.410, P=0.009, 0.002). In the left kidney irradiation dose, the V20 Gy and Dmean in the VMAT group were (11.67±2.36)% and (10.02±2.19) Gy, respectively, which were significantly lower than the V20 Gy ((15.56±7.50)% ) and Dmean ((14.06±7.29) Gy) in the IMRT group (t=2.216, 2.375, P=0.033, 0.023). In the right kidney irradiation dose, the V20 Gy and Dmean in the VMAT plan were (11.72±2.31)% and (10.07±2.15) Gy, respectively, which were significantly lower than the V20 Gy ((16.67±6.92)%) and Dmean ((13.92±7.17) Gy) in the IMRT group (t=3.030, 2.295, P=0.004, 0.027). In the left caput femoris irradiation dose, significant differences were observed in the V10 Gy ( (74.77±2.33)% vs. (78.51±7.46)%), V20 Gy ((34.37±2.74)% vs. (38.91±7.20)%), V30 Gy ((14.77±2.33)% vs. (18.51±7.46)%), V40 Gy ((2.99±1.03)% vs. (4.98±3.73)%), V50 Gy ((0.48±0.22)% vs. (0.99%±0.65)%), and Dmean ((34.32±2.79) Gy vs. (38.41±6.67) Gy) in the VMAT plan compared with the IMRT group (t=2.147–3.359, all P<0.05). In the right caput femoris irradiation dose, the V50 Gy in the VMAT group was (0.02±0.01)%, which was significantly lower than the V50 Gy ((0.03±0.01)%) in the IMRT group (t=2.997, P=0.005). The total machine hop of VMAT group was significantly lower than that of the IMRT group ((536.16±42.37) vs. (614.44±59.44), t=−5.362, P<0.001). The effective treatment time of VMAT group was significantly lower than that of the IMRT group ((152.23±0.31) min vs. (453.88±9.94) min, t=−151.708, P<0.001). Conclusion VMAT has good plan conformation and uniformity, can effectively protect the organs at risk, and can reduce the number of machine hops, and can shorten the treatment time.
2023, 47(8): 484-491.
doi: 10.3760/cma.j.cn121381-202210003-00329
Abstract:
Objective To prepare a domestically produced 68Ge-68Ga generator and compare it with an imported 68Ge-68Ga generator (ITG Company, Germany) for preliminary application evaluation. Methods A 68Ge-68Ga generator was prepared, and the radioactivity of its elution product 68Ga3+ was measured at the initial time (0) and 1, 4, and 12 h after elution. The γ-spectra of the elution product 68Ga3+ and its distribution in normal mice were compared with those of an imported 68Ge-68Ga generator. The optimal labeling conditions for prostate-specific membrane antigen (PSMA)-11 labeled by domestic 68Ge-68Ga generator elution product and the radiochemical purity of the labeled product were determined, and the distribution of 68Ga-PSMA-11 labeled by domestic and imported 68Ge-68Ga generator elution products in 22Rv1 prostate cancer tumor model mice was compared. The intergroup comparison of measurement data was conducted using the LSD method. Results The radioactivity values of 68Ga3+ in the elution product of the domestic 68Ge-68Ga generator at the initial time (0), 1, 4, and 12 h after elution were 125.8, 74.0, 118.4, and 111.0 MBq, respectively. The γ-spectra of 68Ga3+ eluted by domestic and imported 68Ge-68Ga generators were highly consistent, and no difference was observed in the distribution of 68Ga3+ in normal mice, and both showed high uptake of radioactivity in the heart. The optimal labeling conditions for PSMA-11 labeled by domestic 68Ge-68Ga generator elution product were pH 4.5, reaction at 85 ℃ for 15 min, and the radiochemical purity of the product 68Ga-PSMA-11 was >95%. The imaging results of 68Ga-PSMA-11 labeled by domestic and imported generator elution products in 22Rv1 prostate cancer model mice showed high uptake of 68Ga-PSMA-11 at the tumor site, while the rest were mainly distributed in the kidneys and bladder. At 30, 60, and 90 min after injection, the radioactive uptake values of 68Ga-PSMA-11 labeled by the domestic 68Ge-68Ga generator were lower than those of the imported 68Ge-68Ga generator ((3.60±0.14) %ID/g vs. (5.30±0.42) %ID/g, (3.40±0.12) %ID/g vs. (5.90±0.36) %ID/g, (2.90±0.28) %ID/g vs. (5.50±0.33) %ID/g). The differences were statistically significant (LSD method, all P<0.05). Conclusion No significant difference was observed in the distribution of 68Ga3+ and its labeled 68Ga-PSMA-11 in normal mice and tumor model mice between the domestic 68Ge-68Ga generator and the imported 68Ge-68Ga generator.
2023, 47(8): 492-495.
doi: 10.3760/cma.j.cn121381-202209020-00332
Abstract:
In recent years, the state has continuously invested in constructing medical institutions and developing the medical industry. With the optimization of the allocation of medical resources and the continuous deepening of the medical and health system reform, China's domestic medical equipment has been innovatively developed and popularized. At the same time, according to the popularity of nuclear medicine and the gradual improvement of clinical demand, domestic nuclear medicine equipment has increased significantly, and has made certain innovation and development in PET/CT, PET/MR and SPECT/CT. The authors review the development and current situation of domestic nuclear medicine imaging equipment.
In recent years, the state has continuously invested in constructing medical institutions and developing the medical industry. With the optimization of the allocation of medical resources and the continuous deepening of the medical and health system reform, China's domestic medical equipment has been innovatively developed and popularized. At the same time, according to the popularity of nuclear medicine and the gradual improvement of clinical demand, domestic nuclear medicine equipment has increased significantly, and has made certain innovation and development in PET/CT, PET/MR and SPECT/CT. The authors review the development and current situation of domestic nuclear medicine imaging equipment.
2023, 47(8): 496-502.
doi: 10.3760/cma.j.cn121381-202204020-00330
Abstract:
Human serum albumin (HSA) is a multi-functional protein, which is able to bind and transport a variety of endogenous and exogenous compounds. HSA can be used as a drug carrier in the targeted delivery of cancer drug therapy. To bind to HSA, a large variety of strategies has been developed through adding functional chemical groups to the drug molecule, thus changing the pharmacokinetics, increasing the circulation time of the drug in the blood without significantly affecting its biological activity. This strategy can increase the concentration and prolong the time of radiotherapeutic drugs at the tumor site and improve the effect of radionuclide targeted therapy. Drugs binding to HSA has been exploited to evaluate cardiac function, vascular permeability, and lymphography. In this review article, the recent developments of various ligands binding to HSA in the diagnosis and treatment of nuclear medicine are reviewed.
Human serum albumin (HSA) is a multi-functional protein, which is able to bind and transport a variety of endogenous and exogenous compounds. HSA can be used as a drug carrier in the targeted delivery of cancer drug therapy. To bind to HSA, a large variety of strategies has been developed through adding functional chemical groups to the drug molecule, thus changing the pharmacokinetics, increasing the circulation time of the drug in the blood without significantly affecting its biological activity. This strategy can increase the concentration and prolong the time of radiotherapeutic drugs at the tumor site and improve the effect of radionuclide targeted therapy. Drugs binding to HSA has been exploited to evaluate cardiac function, vascular permeability, and lymphography. In this review article, the recent developments of various ligands binding to HSA in the diagnosis and treatment of nuclear medicine are reviewed.
2023, 47(8): 503-508.
doi: 10.3760/cma.j.cn121381-202211001-00326
Abstract:
Hyperparathyroidism is a metabolism disorder of calcium and phosphorus caused by excessive parathyroid hormone. Surgery is a conventional and most effective treatment method. Accurate preoperative localization and characterization are very critical for successful parathyroidectomy. Most studies have shown that radionuclide imaging plays an important role in preoperative parathyroid localization diagnosis. In particular, new imaging agents (such as 18F-fluoromethyl choline) have good development prospects. This article summarizes the research progress of parathyroid SPECT and PET imaging and different radioactive imaging tracers in the diagnosis of hyperparathyroidism.
Hyperparathyroidism is a metabolism disorder of calcium and phosphorus caused by excessive parathyroid hormone. Surgery is a conventional and most effective treatment method. Accurate preoperative localization and characterization are very critical for successful parathyroidectomy. Most studies have shown that radionuclide imaging plays an important role in preoperative parathyroid localization diagnosis. In particular, new imaging agents (such as 18F-fluoromethyl choline) have good development prospects. This article summarizes the research progress of parathyroid SPECT and PET imaging and different radioactive imaging tracers in the diagnosis of hyperparathyroidism.
2023, 47(8): 509-514.
doi: 10.3760/cma.j.cn121381-202211011-00327
Abstract:
Autonomously functioning thyroid nodule (AFTN) is a disease that can cause thyrotoxicosis. Nodules can be solitary or multiple, with 99% of them being benign and occurring mostly in the two lateral lobes of the thyroid gland. The isthmus is rare. The treatment methods for AFTN include surgery, 131I therapy, antithyroid drug, and radiofrequency ablation. 131I therapy is an effective treatment for AFTN. Based on domestic and foreign literature reports, the authors review the pathogenesis and diagnosis of AFTN, as well as the principle, clinical application and efficacy of 131I therapy, so as to provide reference for clinical diagnosis and treatment of AFTN.
Autonomously functioning thyroid nodule (AFTN) is a disease that can cause thyrotoxicosis. Nodules can be solitary or multiple, with 99% of them being benign and occurring mostly in the two lateral lobes of the thyroid gland. The isthmus is rare. The treatment methods for AFTN include surgery, 131I therapy, antithyroid drug, and radiofrequency ablation. 131I therapy is an effective treatment for AFTN. Based on domestic and foreign literature reports, the authors review the pathogenesis and diagnosis of AFTN, as well as the principle, clinical application and efficacy of 131I therapy, so as to provide reference for clinical diagnosis and treatment of AFTN.
2023, 47(8): 515-522.
doi: 10.3760/cma.j.cn121381-202306019-00328
Abstract:
The skin is the largest organ of the human body. In tumor radiotherapy or accidental radiation accidents, the skin will receive different doses of radiation, resulting in radiation-induced skin injury (RISI). Clinical treatment of RISI is mainly symptomatic treatment, lack of effective targeted drugs. Therefore, it is very important to study safe and effective drugs for the prevention and treatment of RISI. This paper reviews the research progress of RISI prevention and treatment drugs at home and abroad in recent years, in order to provide reference for the research of RISI prevention and treatment drugs.
The skin is the largest organ of the human body. In tumor radiotherapy or accidental radiation accidents, the skin will receive different doses of radiation, resulting in radiation-induced skin injury (RISI). Clinical treatment of RISI is mainly symptomatic treatment, lack of effective targeted drugs. Therefore, it is very important to study safe and effective drugs for the prevention and treatment of RISI. This paper reviews the research progress of RISI prevention and treatment drugs at home and abroad in recent years, in order to provide reference for the research of RISI prevention and treatment drugs.
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