RESUMEN
Objective:To establish a radiotherapy treatment planning process of high ventilation functional lung avoided (HVFLA) for thoracic tumors based on 4D-CT lung ventilation functional images and determine the treatment planning strategy of HVFLA radiotherapy, and so as to provide support for the clinical trials of HVFLA radiotherapy in thoracic cancer patients.Methods:A deep learning-based 4D-CT lung ventilation functional imaging model was established and integrated into the radiotherapy treatment planning process. Furthermore, ten thoracic cancer patients with 4D-CT simulation positioning were retrospectively enrolled in this study. The established model was used to obtain the 4D-CT lung ventilation functional imaging for each patient. According to the relative value of lung ventilation, the lung ventilation areas are equally segmented into high, medium and low lung ventilation and then imported them into Pinnacle 3 treatment planning system. According to the prescription dose of target and dose constraints of organ at risks (OARs), the clinical and HVFLA treatment plans were designed for each patient using volumetric modulated radiotherapy technique, and each plan should meet the clinical requirements and adding dose constraints of high ventilation functional lung for HVFLA plan. The dosimetric indexes of the target, OARs (lungs, heart and cord) and high functional lung (HFL) were used to evaluated the plan quality. The dosimetric indexes included D2, D98 and mean dose of target, V5, V10, V20, V30 and mean dose of lungs and HFL, V30, V40 and mean dose of heart, and D1 cm 3 of cord. Paired samples t-test was used for statistical analysis of the two groups of plans. Results:The target and OARs of the clinical plan and HVFLA plan meet the clinical requirements. The HVFLA plan resulted in a statistically significant reduction in the mean dose, V5, V10, V20, and V30 of the high functional lung by 1.2 Gy, 5.9%, 4.2%, 2.6%, and 2.3%, respectively ( t=-8.07, 4.02, -6.02, -7.06, -6.77, P<0.05). There was no statistical difference in the dosimetric indexes of lungs, heart and cord. Conclusions:We established the treatment planning process of HVFLA radiotherapy based on 4D-CT lung ventilation functional images. The HVFLA plan can effectively reduce the dose of HFL, while the doses of lungs, heart and cord had no significant difference compared with the clinical plan. The strategy of HVFLA radiotherapy planning is feasible to provide support for the implementation of HVFLA radiotherapy in thoracic cancer patients.
RESUMEN
Objective:To investigate the correlation between chronic periodontitis and pulmonary ventilation function.Methods:A total of 135 patients with chronic periodontitis who received treatment in Yuyao People's Hospital of Zhejiang Province between June 2014 and December 2019 were included in this study. They were divided into group A (stage I, initial lesion, n = 45), group B (stage II, early lesion, n = 45), group C (stage III, confirmed lesion, n = 45) according to the severity of periodontal lesion. Lung ventilation function indexes and serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) were compared among the three groups. The correlation between periodontal condition and lung ventilation function indexes was analyzed. Results:Probing depth (PD), clinical attachment loss (CAL), number of missing teeth, alveolar bone resorption level were (1.67 ± 0.65) mm, (2.48 ± 0.44) mm, 0 pieces, and (1.38 ± 0.23) mm in group A, (2.05 ± 0.30) mm, (4.04 ± 0.97) mm, 1 piece, (3.37± 0.73) mm in group B, and (2.23 ± 0.47) mm, (5.17 ± 0.75) mm, 3 pieces, (6.48 ± 0.62) mm in group C. With the worsening of the disease, PD, CAL, number of missing teeth, and alveolar bone resorption level were gradually increased. PD, CAL and alveolar bone resorption level in group C were significantly higher than those in group A ( t = 4.68, 20.75, 51.74, all P < 0.001) and group B ( t = 2.17, 6.18, 21.78, P = 0.033, < 0.001, < 0.001). PD, CAL and alveolar bone resorption level in group B were significantly higher than those in group A ( t = 3.56, 9.82, 17.44, all P < 0.001). There was no significant difference in the number of missing teeth ( P > 0.05). Serum IL-6, IL-8 and TNF-α levels were (11.28 ± 4.26) ng/L, (7.48 ± 1.97) ng/L, (14.59 ± 2.11) ng/L in group A, (17.09 ± 4.91) ng/L, (10.82 ± 2.10) ng/L, (19.95 ± 4.48) ng/L in group B, and (26.47 ± 5.86) ng/L, (15.06 ± 2.75) ng/L, (33.76 ± 6.30) ng/L] in group C. With the worsening of the disease, serum IL-6, IL-8 and TNF-α levels were gradually increased. Serum IL-6, IL-8 and TNF-α levels in group C were significantly higher than those in group A ( t = 14.06, 15.03, 19.36, P < 0.001) and group B ( t = 8.23, 8.22, 11.98, all P < 0.001). Serum IL-6, IL-8 and TNF-α levels in group B were significantly higher than those in group A ( t = 6.00, 7.78, 7.26, P < 0.001). The percentage of the maximum expiratory volume in the first second to the predicted value (FEV 1%pre) and the ratio of the maximum expiratory volume in the first second to the forced vital capacity (FEV 1/FVC) were (81.53 ± 6.30)% and (68.73 ± 4.65)% in group A, (70.47 ± 5.25)% and (60.86 ± 3.42)% in group B, and (59.02 ± 3.41)% and (56.93 ± 4.21)% in group C. With the worsening of the disease, FEV 1%pre and FEV 1/FVC were gradually decreased. FEV 1%pre and FEV 1/FVC in group C were significantly lower than those in group A ( t = 21.08, 12.62, both P < 0.001) and group B ( t = 12.27, 4.86, both P < 0.001). FEV 1%pre and FEV 1/FVC in group B were significantly lower than those in group A ( t = 9.05, 9.25, both P < 0.001). Spearman correlation analysis showed that serum IL-6, IL-8 and TNF-α levels were negatively correlated with FEV1%pre and FEV 1/FVC ( r = -0.50, -0.28, -0.42, -0.61, -0.34, -0.51, all P < 0.05). Conclusion:There is a correlation between chronic periodontitis and pulmonary ventilation function. Inflammatory mediators may be involved in chronic periodontitis as internal systemic factors.