Objective: To investigate the feasibility of intra-operative radiation therapy (IORT) in hepato-cellular carcinoma (HCC). Methods: Based on the dosage distribution of tumor and adjacent sensitive organs, and dose-volu...Objective: To investigate the feasibility of intra-operative radiation therapy (IORT) in hepato-cellular carcinoma (HCC). Methods: Based on the dosage distribution of tumor and adjacent sensitive organs, and dose-volume histogram (DVH), Topslane three-dimensional therapy plan was used to compare IORT and three-dimensional conformal radiation therapy (3D-CRT) in 12 cases of HCC. Results: Taking the center of tumors as the isodose center, the V90 (volume of 90% dose distribution) of IORT was significantly better than that of 3D-CRT, and median absorbed doses of normal organs in IORT was significantly lower than that in 3D-CRT. Conclusion: The V90 of IORT is better than that of 3D-CRT in HCC, and neighboring sensitive organs were effectively protected by IORT. The tumors absorbed dose and local control rate are improved in IORT.展开更多
Cardiac resynchronization therapy （CRT） is associated with a favorable outcome only in patients with left bundle branch block （LBBB） pattern and in patients with a QRS duration 〉 150 ms, in patients with non-LBBB...Cardiac resynchronization therapy （CRT） is associated with a favorable outcome only in patients with left bundle branch block （LBBB） pattern and in patients with a QRS duration 〉 150 ms, in patients with non-LBBB pattern with a QRS duration of 120-150 ms usually is not beneficial. After adjusting for QRS duration, QRS morphology was no longer a determinant of the clinical response to CRT. In contrast to the mainstream view, we hypothesized that the unfavorable CRT outcome in patients with non-LBBB and a QRS duration of 120-150 ms is not due to the QRS morphology itself, but to less dyssynchrony and unfavorable patient characteristics in this subgroup, such as more ischemic etiology and greater prevalence of male patients compared with patients with LBBB pattern. Further, the current CRT technique is devised to eliminate the dyssynchrony present in patients with LBBB pattern and inappropriate to eliminate the dyssynchrony in patients with non-LBBB pattern. We also hypothesized that electrocardiography may also provide information about the presence of interventricular and left intraventricular dyssynchrony and the approximate location of the latest activated left ventricular （LV） region. To this end, we devised new ECG criteria to estimate interventricular and LV intraventricular dyssynchrony and the approximate location of the latest activated LV region. Our preliminary data demonstrated that the latest activated LV region in patients with nonspecific intraventricular conduction disturbance （NICD） pattern might be at a remote site from that present in patients with LBBB pattern, which might necessitate the invention of a novel CRT technique for patients with NICD pattern. The application of the new interventricular and LV intraventricular dyssynchrony ECG criteria and a potential novel CRT technique might decrease the currently high nonresponder rate in patients with NICD pattern.展开更多
Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyo...Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.展开更多
I have read the article entitled ＂Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？＂ by Olechowski, et al. with great interest, recently published in Journal of Geriatric Cardi...I have read the article entitled ＂Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？＂ by Olechowski, et al. with great interest, recently published in Journal of Geriatric Cardiology. The investigators reported that implantation of cardiac resynchronisation therapy （CRT） is feasible and safe in very elderly despite extensive co-morbidity.展开更多
Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetricall...Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.展开更多
Objective： Radiation therapy is an important component of the multidisciplinary management of esophageal carcinoma. Three-dimensional conformal radiation therapy requires the precise definition of the target volume. ...Objective： Radiation therapy is an important component of the multidisciplinary management of esophageal carcinoma. Three-dimensional conformal radiation therapy requires the precise definition of the target volume. We aimed to compare the treatment results and radiation toxicities between three-dimensional conformal radiotherapy （3D-CRT） and conventional radiotherapy （CR） for patients with cervical and thoracic esophageal carcinoma. Methods： From June 2004 to December 2006, a random study was performed on 106 patients treated with 3D-CRT or CR, 53 patients in each group. The patients in CR group received conventional radiotherapy in 2.0 Gy/f, 5 f/week and total dose was 66-70 Gy in 6.5 or 7 weeks. The patients in 3D-CRT group were treated by 3D-CRT in 2.0 Gy/f, 5 f/week and total dose was 64-70 Gy in 6 weeks. The local control rates, survival rates and radiation toxicities for the two groups were investigated. Results： The 1-year and 3-year local control rates were 83.0% and 60.4% in 3D-CRT group and 64.2% （x^2 = 4.853, P = 0.028） and 32.1% （x^2 = 9.812, P = 0.002） in CR group. The 1-year and 3-year survival rates were 73.6% and 50.9% in 3D-CRT group and 54.7% （x^2 = 4.102, P = 0.043） and 32.1% （x^2 = 3.886, P = 0.049） in CR group. Between the two groups, there was no significant difference in radiation toxicities. Conclusien： The 1-year and 3-year local control rates and survival rates of patients with esophageal carcinoma treated by 3D-CRT is superior to CR. However, longer-term results and radiation toxicity need further study which involves more patients and prolonged follow-up.展开更多
基金Supported by the Science and Technology Research Foundation of Shaanxi Province (2005k09-G5)
文摘Objective: To investigate the feasibility of intra-operative radiation therapy (IORT) in hepato-cellular carcinoma (HCC). Methods: Based on the dosage distribution of tumor and adjacent sensitive organs, and dose-volume histogram (DVH), Topslane three-dimensional therapy plan was used to compare IORT and three-dimensional conformal radiation therapy (3D-CRT) in 12 cases of HCC. Results: Taking the center of tumors as the isodose center, the V90 (volume of 90% dose distribution) of IORT was significantly better than that of 3D-CRT, and median absorbed doses of normal organs in IORT was significantly lower than that in 3D-CRT. Conclusion: The V90 of IORT is better than that of 3D-CRT in HCC, and neighboring sensitive organs were effectively protected by IORT. The tumors absorbed dose and local control rate are improved in IORT.
文摘Cardiac resynchronization therapy （CRT） is associated with a favorable outcome only in patients with left bundle branch block （LBBB） pattern and in patients with a QRS duration 〉 150 ms, in patients with non-LBBB pattern with a QRS duration of 120-150 ms usually is not beneficial. After adjusting for QRS duration, QRS morphology was no longer a determinant of the clinical response to CRT. In contrast to the mainstream view, we hypothesized that the unfavorable CRT outcome in patients with non-LBBB and a QRS duration of 120-150 ms is not due to the QRS morphology itself, but to less dyssynchrony and unfavorable patient characteristics in this subgroup, such as more ischemic etiology and greater prevalence of male patients compared with patients with LBBB pattern. Further, the current CRT technique is devised to eliminate the dyssynchrony present in patients with LBBB pattern and inappropriate to eliminate the dyssynchrony in patients with non-LBBB pattern. We also hypothesized that electrocardiography may also provide information about the presence of interventricular and left intraventricular dyssynchrony and the approximate location of the latest activated left ventricular （LV） region. To this end, we devised new ECG criteria to estimate interventricular and LV intraventricular dyssynchrony and the approximate location of the latest activated LV region. Our preliminary data demonstrated that the latest activated LV region in patients with nonspecific intraventricular conduction disturbance （NICD） pattern might be at a remote site from that present in patients with LBBB pattern, which might necessitate the invention of a novel CRT technique for patients with NICD pattern. The application of the new interventricular and LV intraventricular dyssynchrony ECG criteria and a potential novel CRT technique might decrease the currently high nonresponder rate in patients with NICD pattern.
文摘Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.
文摘I have read the article entitled ＂Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？＂ by Olechowski, et al. with great interest, recently published in Journal of Geriatric Cardiology. The investigators reported that implantation of cardiac resynchronisation therapy （CRT） is feasible and safe in very elderly despite extensive co-morbidity.
文摘Objective: The study is a comparative study, the aim of which is to compare 3D conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) in treating nasopharyngeal carcinomas; dosimetrically evaluating and comparing both techniques as regard target coverage and doses to organs at risk (OAR). Methods: Twenty patients with nasopharyngeal carcinoma were treated by 3D-CRT technique and another 20 patients were treated by IMRT. A dosimetric comparison was done by performing two plans for the same patient using Eclipse planning system (version 8.6). Results: IMRT had a better tumor coverage and conformity index compared to 3D-CRT plans (P value of 0.001 and 0.004), respectively. As for the dose homogeneity it was also better in the IMRT plans and the reason for this was attributed to the dose inhomogeneity at the photon/electron junction in the 3D-CRT plans (P value 0.032). Also, doses received by the risk structures, particularly parotids, was significantly less in the IMRT plans than those of 3D-CRT (P value 0.001). Conclusion: IMRT technique was clearly able to increase the dose delivery to the target volume, improve conformity and homogeneity index and spare the parotid glands in comparison to 3D-CRT technique.
文摘Objective： Radiation therapy is an important component of the multidisciplinary management of esophageal carcinoma. Three-dimensional conformal radiation therapy requires the precise definition of the target volume. We aimed to compare the treatment results and radiation toxicities between three-dimensional conformal radiotherapy （3D-CRT） and conventional radiotherapy （CR） for patients with cervical and thoracic esophageal carcinoma. Methods： From June 2004 to December 2006, a random study was performed on 106 patients treated with 3D-CRT or CR, 53 patients in each group. The patients in CR group received conventional radiotherapy in 2.0 Gy/f, 5 f/week and total dose was 66-70 Gy in 6.5 or 7 weeks. The patients in 3D-CRT group were treated by 3D-CRT in 2.0 Gy/f, 5 f/week and total dose was 64-70 Gy in 6 weeks. The local control rates, survival rates and radiation toxicities for the two groups were investigated. Results： The 1-year and 3-year local control rates were 83.0% and 60.4% in 3D-CRT group and 64.2% （x^2 = 4.853, P = 0.028） and 32.1% （x^2 = 9.812, P = 0.002） in CR group. The 1-year and 3-year survival rates were 73.6% and 50.9% in 3D-CRT group and 54.7% （x^2 = 4.102, P = 0.043） and 32.1% （x^2 = 3.886, P = 0.049） in CR group. Between the two groups, there was no significant difference in radiation toxicities. Conclusien： The 1-year and 3-year local control rates and survival rates of patients with esophageal carcinoma treated by 3D-CRT is superior to CR. However, longer-term results and radiation toxicity need further study which involves more patients and prolonged follow-up.
