ABSTRACT
Objective:To compare the dosimetric difference between 3D-printed multi-channel applicator and conventional vaginal single-channel applicator for brachytherapy, aiming to provide guidance for patients receiving brachytherapy after cervical cancer surgery.Methods:From January 2019 to November 2020, 25 cervical cancer patients complicated with VAIN Ⅲ receiving 192Ir high-dose-rate brachytherapy after cervical cancer surgery were selected. Each patient was located by CT scanning with 3D-printed multi-channel applicator and conventional vaginal single-channel applicator, and corresponding plan and evaluation were carried out. The dose volume histogram (DVH) was obtained by inverse dose optimization algorithm. The dosimetric differences of high-risk clinical target volume (HRCTV), bladder and rectum during brachytherapy were compared with those of source applicators. The optimal treatment plan was selected. Results:D 90%, D 100%, V 100% and V 150% of the plans designed by 3D-printed individual multi-channel applicator had no significant differences compared with those designed by conventional single-channel applicator (all P>0.05). The bladder and rectal D 2cm 3 designed by 3D-printed multi-channel applicator were significantly lower than those using conventional single-channel applicator, and the differences were statistically significant (both P<0.05). Conclusion:The multi-channel individual applicator target made by 3D-printing technology has good conformal property, properly protects the bladder and rectum and possesses treatment advantages over conventional single-channel applicator.
ABSTRACT
Objective To investigate the efficacy of recombinant activated factor Ⅶ (γFⅦa)in the management or prevention of intraoporative bleeding in general surgery. Methods A retrospective analysis was made to investigate the effect of FⅦa in 56 surgical cases.There were 56 cases including 53 hepatobiliary cases,3 gastrointestinal surgical cflses.γFⅦa was used intraoperatively when bleeding was difficult to control in 12 patients,and in 30 liver transplant cases before a skin incision was made.γFⅦa was used in the other 14 cases postoperatively to control intraabdominal bleeding. Results Massive bleeding stopped in 11 out of 12 cases who used γFⅦa during the operation as a rescue regimen,though two of them eventually died intraoperatively for deteriorating hemedynamics,one died of intraoperative intractable bleeding in spite of the Use of γFⅦa.All the 30 liver transplant cases used γFⅦa in the prevention of intraoperative bleeding had a successful surgery.After γFⅦa was administered in 11 out of the 14 cases of postoperative bleeding,the drainage decreased by 50%.In 3 cases γFⅦa failed and hemodynamic and vital signs were still unstable.In brief,γFⅦa were safely used in bleeding control or prophylaxis.Its Successful rate reached 89% in 56 patients.No thrombus complication was found. Conclusion γFⅦ a controls perioperative hemorrhage complications.
ABSTRACT
Objective To investigate the feasibility, short-term efficacy and adverse effects of 125 I seed implantation guided by ultrasonography or CT in the treatment of recurrent rectal cancers. Methods A total of 15 patients (4 women and 11 men) with recurrent rectal cancer entered the study. Uneer epidural anesthesia, the patients were treated with 125 I seed implantation under the guidance of either transvaginal ultrasonography or CT scans. The prescribed matched peripheral dose (MPD) was 90~110 Gy, with an activity per seed of 0.50~0.70 mCi and the total number of sources implanted of 33~70. Chest and pelvic X-ray examinations were performed within 24~48 hours after implantation to determine whether or not seed misplacement or migration existed. An additional three-dimensional conformal radiation therapy with a 4~6 fields technique was required in 6 patients 4 weeks postoperatively, with 200~300 cGy/fx, 5 fx/week, up to a total dose of 4500~5 000 cGy. Additional chemotherapy with oxaliplatin, 5-fluorouracil and tetrahydrofolic acid for one treatment course was given in 2 patients. The patients were followed for 3~15 months and the tumors were evaluated by CT findings. Results Relief from pain was achieved at a mean of 7 days after procedure, offering a complete relief in 12 patients, a partial relief in 2, and no change in 1, the effective rate being 93%(14/15). Nine patients showed a complete remission, 2 showed a partial remission, 4 showed a progressive disease, the local control rate being 73%(11/15). Two patients died of the dissemination to lungs. In 1 patient 1 seed had migrated to the pelvic side-wall and did not cause any clinical morbidity in a follow-up of 12 months. Conclusion 125 I implantation in recurrence of rectum cancer guided by ultrasonography or CT was safety, minimally invasion, low morbidity and high efficacy, it was worth of development and promotion.