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Image-guided targeted biopsy is currently the mainstream method of prostate cancer puncture biopsy, while risk stratification based on imaging and biochemical markers may become the new standard. This paper comprehensively reviews the latest advancements in various imaging techniques and strategies of targeted prostate biopsy. Ultrasound-assisted prostate biopsy mainly includes transrectal ultrasound (TRUS), transrectal-contrast enhanced ultrasound (TR-CEUS), and transrectal real-time elastography (TRTE), which can significantly increase the diagnosis rate of prostate cancer when combined with biopsy. Three-dimensional transrectal ultrasound (3D-TRUS) technology may be used in patients with a negative previous biopsy. At present, micro-ultrasound (Micro-US), the latest ultrasound method, is not inferior to mp-MRI in targeted biopsy of the prostate. Targeted biopsy by mp-MRI has improved the detection rate of clinically significant prostate cancer (csPCa), and the common NMR targeted technologies are magnetic resonance imaging-visual-targeted biopsy (MRI-visual-TB), magnetic resonance imaging-fusion-targeted biopsy (MRI-fusion-TB), and in-bore magnetic resonance imaging-target biopsy (MRI-TB). The fusion of MRI and Micro-US imaging for targeted biopsy has also become a new targeted biopsy method, and MR robot-assisted biopsy is gradually being applied. PET/CT improves localization of tumors and may be valuable for initial staging, re-staging after biochemical recurrence, even in patients with MRI-negative prostate cancer. PET/CT targeted biopsy using tracer has been shown to yield good diagnostic efficacy. PET/MRI technology has the potential to be the imaging test for needle-free biopsies in the future. The development of technology has led to the adaptation and optimization of biopsy strategies in clinical practice.
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Objective @#To evaluate the therapeutic effect of CT/MRI image fusion and usual CT guided percutaneous radiofrequency thermocoagulation of trigeminal semilunar ganglion . @*Methods @#The medical information of 88 patients diagnosed with primary trigeminal neuralgia were assembled . In accordance with different imaging guidance means , they were equally divided into the control group ( trigeminal semilunar ganglion radiofrequency thermo coagulation with CT guidance ) and the fusion group ( trigeminal semilunar ganglion radiofrequency thermocoagula tion with assistance of CT/MRI image fusion technology) at random. The puncture time , intraoperative discomfort rate , preoperative , intraoperative and postoperative visual analogue scale (VAS) score , Barrow neurological insti tute (BNI) pain score and postoperative complication rate were contrasted . @*Results @#The puncture operation time of the fusion group was shorter than that of the control group (P < 0 05) ; the intraoperative and postoperative VAS and BNI scores , occurrence rate of intraoperative discomfort and postoperative complications in the fusion group were lower than those in the control group (P < 0.05) .@*Conclusion @#In respect of improving therapeutic effect and diminishing intraoperative discomfort and postoperative complications , CT/MRI image fusion technique is superior to CT guidance .
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Objective To evaluate the clinical efficacy and safety of CT-guided percutaneous osteoplasty(POP)in the treatment of osteolytic metastases of the pelvis.Methods The clinical data of a total of 40 patients with pelvic osteolytic metastases,who received CT-guided POP at the Affiliated Zhongda Hospital of Southeast University between October 2011 and December 2021,were collected.Visual analogue scale(VAS)score was used to evaluate the clinical pain relief degree at one week,one month,3 months,6 months and 12 months after POP,and the joint function and the used dose of analgesic drugs were recorded.The preoperative and the postoperative 3-month,6-month and 12-month extents of the pelvic tumor destruction were compared.Based on the progression of local lesions within 12 months of follow-up,the patients were divided into controlled group and progression group.The proportion of using systemic anti-tumor therapy,the size of lesion,the amount of bone cement injected,and the cement filling ratio were compared between the two groups.Results Successful surgical procedure was accomplished for 57 lesions in 40 patients.The mean amount of bone cement injected was(4.56±2.25)mUpoint.In the 40 patients,the preoperative and the postoperative one-week,one-month and 3-month VAS score were(8.00±0.85)points,(2.05±0.96)points,(2.08±0.94)points and(2.18±0.84)points respectively,the difference in VAS score between preoperative value and postoperative one-week value was statistically significant(P＜0.01).In 37 patients,the postoperative 6-month VAS score was(2.35±0.54)points;and in 28 patients,the postoperative 12-month VAS score was(2.43±0.79)points.The differences in VAS score between postoperative one-week value and postoperative one-month,3-month,6-month,and 12-month values were not statistically significant(all P＞0.05),while the differences in VAS score between preoperative value and postoperative values were statistically significant(F=316.3,P＜0.01).The postoperative 3-month,6-month,and 12-month local control rates were 96.49％,85.19％,and 78.12％respectively,the differences between each other among the above three values were statistically significant(P=0.026).No statistically significant differences in the proportion of using systemic anti-tumor therapy,the lesion size and the amount of bone cement injected existed between the controlled group and the progression group(all P＞0.05).The cement filling ratio in the controlled group and the progression group was(81.26±9.17)％and(68.40±12.98)％respectively,and the difference between the two groups was statistically significant(P＜0.01).Conclusion For the treatment of pelvic metastases,CT-guided POP is clinically safe and effective.The injected bone cement can control the progression of local lesions for a longer time.(J Intervent Radiol,2023,32:1197-1201)
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Objective To compare the clinical efficacy of CT-guided high-voltage long-duration pulsed radiofrequency(PRF)with that of pudendal nerve block(NB)in the treatment of pudendal neuralgia(PN).Methods A total of 91 patients with confirmed PN were enrolled in this study.The patients were randomly divided into PRF group and NB group.The patients of the PRF group received CT-guided high-voltage long-duration PRF of the pudendal nerve,and the patients of the NB group received CT-guided pudendal nerve block.The visual analogue scale(VAS)score of pain,the time of keeping a sitting position,and the PHQ9-score were determined separately at one day,2 weeks,one month,3 months,and 6 months after treatment,and all procedure-related complications were recorded.Results A 6-month follow-up was accomplished in 87 patients,including 45 in the PRF group and 42 in the NB group.On the first day after operation,the VAS scores became significantly lower in both groups as compared with the preoperative VAS scores(P＜0.01),and the VAS score in the NB group was strikingly lower than that in the PRF group(P=0.039).The postoperative one-month,3-month and 6-month VAS scores in the PRF group were remarkably lower than those in the NB group(P＜0.05).The time of keeping a sitting position and PHQ9-scores at 3 months and 6 months after treatment in the PRF group were obviously better than those in the NB group(P＜0.01).No procedure-related serious adverse reactions were observed in both groups.Conclusion CT-guided high-voltage long-duration PRF is superior to NB in more effectively relieving pain,prolonging the time of keeping a sitting position,and improving the depressed status of the patients with PN.(J Intervent Radiol,2023,32:1216-1220)
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Objective:To study the precision of 3D printing coplanar template (3D-PCT) assisted CT-guided radioactive particle implantation using two types of phantoms, and compare the differences between the phantoms, in order to provide reference for radioactive particle implantation.Methods:The needle inserting path was designed in the brachytherapy treatment planning system (BTPS) and the needle tip coordinates were obtained. Following the needle inserting path, the implant needles were inserted into the custom and the liver phantoms, respectively. Then gold markers were implanted through the needles. Subsequently, the needles were withdrawn by 10 mm, and the cold sources were implanted. The coordinates of needle tips, gold markers, and cold sources were recorded. The precision of implanted needles, first particles, and particles after needle withdrawal were obtained by calculating the distance between two points in the space. Finally, the differences between the two phantoms were compared through independent samples t-test. Results:In the 3D-PCT-assisted CT-guided radioactive particle implantation, the precision of implanted needles, first particles, and particles after needle withdrawal in the custom and the liver phantoms was (1.89±0.72) and (2.14±0.88 ) mm ( P>0.05), (2.03±1.14) and (2.42±1.12) mm ( P>0.05), and (-1.96±1.29) and (-2.82±0.91) mm ( t=2.09, P=0.046), respectively. Conclusions:The 3D-PCT-assisted CT-guided radioactive particle implantation is efficient, stable, and precise, showing slight precision differences between the two phantoms.
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Objective:To study the treatment efficacy of percutaneous radiofrequency thermocoagulation in patients with hyperhidrosis of heads and palms.Methods:Thirty patients with primary hyperhidrosis of heads and palms, admitted to our hospital from June 2017 to May 2019, were chosen in our study. CT-guided percutaneous puncture of T 3 or T 4 and sympathetic ganglion radiofrequency thermocoagulation were given to all patients. The evaluation of curative effects and complications of these patients were summarized during the 12 months of follow up. Results:The symptoms of hyperhidrosis in 24 patients got significant improvement, enjoying postoperative satisfaction rate of 80%. During the surgery, 5 patients suffered thoracic and lung puncture injury, including 4 with pneumothorax and one with hemothorax. Seven patients experienced pain and numbness in the chest, back, armpit or upper arm after surgery; 10 patients developed compensatory hyperhidrosis of the back, and two patients developed compensatory hyperhidrosis of the back and bilateral feet.Conclusion:Percutaneous radiofrequency is an effective treatment for hyperhidrosis that provides excellent immediate and long-term effect, as well as low complication rate.
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Objective To compare the accuracy of 125I seeds longitudinal distance between groups by degradable catheters and hand.Methods The study was divided into two groups (implantation by degradable catheters and that by hand).There were 12 simulated lesions in each group.Seed needle and 125I seeds were implanted by three physicians according to the set longitudinal distance (0.5 and 1.0 cm).Postoperative CT was conducted and the longitudinal distance between seeds was measured,and then the data was analyzed between the actual distance and the designed distance in each group.Results The degree of deviation from the set distance were (0.184 ±0.047) and (0.127 ±0.051) cm in the group by hand,and (0.007 ± 0.006) and (-0.003 ± 0.006) cm in degradable catheters group.The degree of deviation of the seeds in the catheter group was significantly lower than the group by hand (t =3.804,2.499,P ＜0.05).Conclusions The accuracy of the longitudinal distance of the group by catheter is much better than that by hand.
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Objective To compare the dose distribution of postoperative plans with preoperative plans of 3D-printing template (coplanar and non-coplanar) assisted and CT-guided 125I seed implantation for the treatment of soft tissue sarcoma,and to explore the accuracy of treatment at dosimetry level.Methods From December 2015 to July 2017,19 patients with soft tissue sarcoma (a total of 25 lesions)were treated with 3D printing template assisted and CT-guided 125I seed implantation in Peking University Third Hospital.All patients underwent preoperative assessment,CT simulation orientation,preoperative planning,3D-template printing,3D-template reduction,needle and seed implantation,postoperative dosimetry assessment,postoperative care and follow-up.The preoperative and postoperative dosimetric parameters were conpared.Ten cases of soft tissue sarcoma in superficial trunk or limbs were screened.Preoperative planning of coplanar template and non-coplanar template were designed respectively.The dosimetric parameters of preoperative planning guided of two templates were compared.Results Twentyfive 3D-printing templates were designed and constructed,and 25 lesions were totalled.There was no statistical difference between preoperative and postoperative dosimetric parameters.There was no statistical difference of the preoperative plan's dosimetric parameters between coplanar and non-coplanar in soft tissue sarcoma of superficial trunk/limbs.Conclusions The validation of actual dose distribution in postoperative plans assisted by 3D-printing template in 125I seed implantation showed that most of parameters could meet the expectation of preoperative plans,which indicated the improvement in accuracy for this new modality.For soft tissue sarcoma located in the superficial trunk/limbs,it was recommended to select the 3D-printing coplanar template firstly.
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Objective To evaluate the effect of CT-guided percutaneous coaxial needle biopsy combined with microwave ablation (MWA) for the treatment of lung tumors, and to discuss its technique, safety, curative effect and clinical application value. Methods A total of 20 patients with lung tumor, who were admitted to the Department of Interventional Radiology, Shanghai Ruijin Hospital, China, during the period from August 2014 to June 2016, were collected. Among the 20 patients, primary pulmonary cancer was diagnosed in 9 and metastatic tumor in 11. A total of 23 tumor lesions were detected, and CT-guided percutaneous coaxial needle biopsy combined with MWA was performed for all lesions. Based on the size and shape of the tumor, the corresponding ablation power and time of duration were set up. After the treatment, the patients were followed up for 4-26 months, and chest enhanced CT examination was regularly reexamined to assess the curative effect. Results Percutaneous coaxial needle biopsy was carried out for 23 lesions, the tumor diameters ranged from 0.80 cm to 2.40 cm, with a mean of 1.39 cm. MWA was employed for 23 lesions. CT scan performed immediately after MWA showed that the density of tumor lesion became decreased, the diagnostic positive rate of needle biopsy was 83.3％. After the treatment, complete remission was obtained in 15 patients, partial remission in 2 patients, stable disease in one patient, and progression.
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Objective To discuss the safety and curative effect of CT -guided percutaneous argon -helium cryoablation in treating leiomyosarcoma. Methods A total of 25 patients with leiomyosarcoma, who were treated at authors' hospital during the period from January 2012 to January 2016, were included in this study. CT-guided percutaneous argon-helium cryoablation was performed in all patients. The local changes of target lesions, the progression - free survival (PFS) and the survival rate were dynamically checked, and the complications were recorded. Results CT examination performed immediately after argon- helium cryoablation indicated that radical frozen ablation was achieved in 13 patients (52％), significant tumor -reductive frozen ablation in 11 patients (44％), effective tumor-reductive frozen ablation in one patient (4％), and invalid tumor-reductive frozen ablation in 0 patient. Follow - up CT examination performed at 3 months after argon - helium cryoablation showed that, based on solid tumor evaluation criteria, complete remission (CR) was obtained in 14 patients, partial remission (PR) in 8 patients and stable disease (SD) in one patient, the total remission rate (CR+PR) was 88％. The local PFS time was (9. 4±6. 2) months. The one-, 2-and 3-year survival rates were 64％, 48％ and 32％ respectively. In this group of cases, neither serious complications such as haemorrhage or tumor lysis syndrome nor procedure-related death occurred. Postoperative mild and moderate complications included fever, skin frostbite, immediate postoperative local pain exacerbation, nerve damage, etc., all of which disappeared or became relived after symptomatic treatment. Conclusion For the treatment of leiomyosarcoma, CT-guided percutaneous targeted argon-helium cryoablation has certain and definite short-term curative effect. CT-guided argon-helium cryoablation is a safe, reliable and minimally-invasive treatment, this technique is worth popularizing in clinical practice. (J Intervent Radiol, 2018, 27:228-232)
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Objective To discuss the optimalselection of the puncture path in performing CT-guided pericardial drainage,and to evaluate its clinical feasibility and safety.Methods A total of 114 patients with pericardial effusion,who were admitted to authors' hospital during the period from May 2013 to March 2016,were enrolledin this study.The appropriate body position and suitable needle-puncturing route were selected,and CT-guided pericardial drainage with Seldinger'stechnique was performed.Results Successful puncturing and catheter drainage was obtained in all 114 patients,no any serious complication occurred.The time used for manipulation was 18-30 min.Conclusion The use of right puncture path is of great importance for the performance of CT-guided pericardial drainage for pericardial effusion,this technique is highly feasible and safe for relieving the clinical symptoms of pericardial tamponade.
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As an interstitial brachytherapy,radioactive seed implantation could provide high doses in the local site and minimal doses at surrounding normal tissues.It has become one of the best choice for early stage prostate carcinoma.Radioactive seeds were implanted under the guidance by ultrasound,CT and MRI,featured with surgical and interventional treatment.Based on dosimetry for target and organs at risk,radioactive seed implantation is multiple disciplinary.In order to acquire the accurate and high quality seed implantation,it is necessary to set up a team including surgeons,radiation oncologists,interventional doctors and nuclear medicine doctors.The content of the consensus is as follows:radiation physics and dosimetry,indications,side-effects and 3 D-printing template work-follow.Despite the benefit of radioactive seed implantation for solid carcinoma,there still a compelling need for prospective randomized and stage Ⅲ clinical trials from multiple centers,so as to upgrade the evidencebased level,above all confirm the role of radioactive seed implantation in the comprehensive treatment of tumors.
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Objective:To explore the clinical efficacy of microwave ablation under CT-guidance for patients with liver cancer of the first hepatic hilar region at advanced period.Methods: 56 patients with liver cancer of the first hepatic hilar region at advanced period, who had lost the chance of operative treatment, were divided into observation group (28cases) and control group (28cases) as the random number table. The patients of observation group received CT-guidance microwave ablation and other targeted combining therapy while patients of control group underwent routine chemotherapy of arterial embolism. The therapeutic effect and survival situation of the two groups were compared and analyzed.Results: The total effective rate of patients with liver cancer of the observation group(82.14%) was significantly higher than that of control group (46.43%)(x2=7.778,P<0.05). The AFP of both of the two group was obviously reduced, and the improvement degree of observation group was significantly better than that of control group (t=14.662,P<0.05). The survival rate of post-operative 1-2 y of observation group was slightly higher than that of control group, but it was no significant (x2=4.156,x2=0.080,P>0.05).During the process of treatment and post the process of treatment, the occurrence rate of adverse reaction of observation group was significantly lower than that of control group (x2=6.842,P<0.05).Conclusion: The microwave ablation under CT-guidance and other targeted combining therapy has outstanding advantages including simple operation, curative precision and so on. And it has better curative effect for patients with liver cancer of the first hepatic hilar region at advanced period who had lost optimum opportunity of operative treatment. Besides, its adverse reaction is lower and it has obviously preponderance to compare with routine arterial embolism.
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Objective To evaluate the clinical effect of CT-guided radiofrequency thermal coagulation in treating primary trigeminal neuralgia.Methods A total of 165 patients with primary trigeminal neuralgia were selected as research objects.The patients were randomly divided into radiofrequency thermal coagulation group (study group,n=83) and drug damage group (control group,n=82).For the treatment of trigeminal neuralgia,CT-guided radiofrequency thermal coagulation was carried out in the patients of the study group,and CT-guided percutaneous puncturing of oval foramen with epirubicin injection as chemical damage therapy was employed in the patients of the control group.Follow-up check-up was conducted at 3,6,12 and 36 months after the treatment.Visual analog score (VAS),total effective rate and incidence of complications were calculated and the results were compared between the two groups.Results The excellent therapeutic rate of the study group was significantly better than that of the control group,the difference between the two groups was statistically significant (P＜0.05).The incidence of complications in the study group was remarkably lower than that in the control group,the difference between the two groups was statistically significant (P＜0.05).The VAS pain score of the study group was much lower than that of the control group.The total therapeutic effect in the study group was more prominent.Conclusion In treating primary trigeminal neuralgia,CT-guided radiofrequency thermal coagulation has excellent clinical effect.Therefore,this technique is worthy of popularization and application in clinical practice.
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Objective:To explore the clinical efficacy of microwave ablation under CT-guidance for patients with liver cancer of the first hepatic hilar region at advanced period.Methods: 56 patients with liver cancer of the first hepatic hilar region at advanced period, who had lost the chance of operative treatment, were divided into observation group (28cases) and control group (28cases) as the random number table. The patients of observation group received CT-guidance microwave ablation and other targeted combining therapy while patients of control group underwent routine chemotherapy of arterial embolism. The therapeutic effect and survival situation of the two groups were compared and analyzed.Results: The total effective rate of patients with liver cancer of the observation group(82.14%) was significantly higher than that of control group (46.43%)(x2=7.778,P<0.05). The AFP of both of the two group was obviously reduced, and the improvement degree of observation group was significantly better than that of control group (t=14.662,P<0.05). The survival rate of post-operative 1-2 y of observation group was slightly higher than that of control group, but it was no significant (x2=4.156,x2=0.080,P>0.05).During the process of treatment and post the process of treatment, the occurrence rate of adverse reaction of observation group was significantly lower than that of control group (x2=6.842,P<0.05).Conclusion: The microwave ablation under CT-guidance and other targeted combining therapy has outstanding advantages including simple operation, curative precision and so on. And it has better curative effect for patients with liver cancer of the first hepatic hilar region at advanced period who had lost optimum opportunity of operative treatment. Besides, its adverse reaction is lower and it has obviously preponderance to compare with routine arterial embolism.
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Objective To compare the puncturing hit rate,positive rate of pathological diagnosis and the incidence of complications between color Doppler ultrasound-guided and CT-guided percutaneous biopsy for the qualitative diagnosis of ultrasonic-visual chest lesions.Methods A total of 112 patients,who were encountered from January 2015 to June 2016 in authors' hospital and whose imaging materials suggested the presence of ultrasonic-visual chest lesions,were enrolled in this study.There were no bones or lung air between the thoracic skin and chest lesion to hinder imaging observation.Ultrasound-guided puncturing was employed in 52 patients (ultrasound-guided group) and CT-guided puncturing was adopted in 60 patients (CT-guided group).The puncturing hit rate,positive rate of pathological diagnosis and the incidence of complications were compared between the two groups.Results The puncturing hit rate in ultrasound-guided group was 100％ (52/52),which was higher than 91.7％ (55/60) in CT-guided group.The positive rate of pathological diagnosis in ultrasound-guided group was 96.2％ (50/52),which was higher than 80.0％ (48/60)in CT-guided group.The incidence of complications in ultrasound-guided group was 3.8％ (2/52),which was lower than 18.3％(11/60) in CT-guided group.Conclusion For the qualitative diagnosis of ultrasonic-visual chest lesions,ultrasound-guided percutaneous biopsy is more reliable than CT-guided percutaneous biopsy.
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Objective To investigate the risk factors of pneumorrhagia and pneumothorax occurring after CT-guided cutting needle biopsy for pulmonary solid nodules.Methods The clinical data and imaging materials of 320 patients with pulmonary solid nodule (≤3 cm),who received 16 G semi-automatic cutting needle biopsy,were retrospectively analyzed.Both univariate and multivariate logistic regression analysis methods were used to evaluate the risk factors of pneumorrhagia and pneumothorax.Results The incidence of needle track hemorrhage was 33.1％ and the incidence of pneumothorax was 18.1％,the diagnostic accuracy for benign and malignant nodules was 99.6％.Needle track length was an independent risk factor for pneumorrhagia;every increase of 3 cm in needle track length,the risk of pneumorrhagia would increase 3.881 times,besides,the risk of pneumorrhagia had a parallel relationship with the time used for puncturing (P=0.061) as well as with the number of pleural puncturing (P=0.062).The age,lesion's location and needle-pleural angle were independent risk factors for pneumothorax.Each increase of 10 years in age,the risk of pneumothorax would increase 2.102 times.The pneumothorax risk of pulmonary lesion located at upper lung lobe was strikingly lower than that of pulmonary lesion located at lower lung lobe.Each increase of 20 degrees in needle-pleural angle,the risk of pneumothorax would increase 2.413 times.Emphysema was excluded from the equation because it had only a minute difference (P=0.086).Based on the pneumorrhagia and pneumothorax probability values,ROC curves of pneumorrhagia and pneumothorax were drawn,and AUC values of pneumorrhagia and pneumothorax were 0.753 and 0.725 respectively.Conclusion The occurrences of pneumorrhagia and pneumothorax after CT-guided cutting needle biopsy for pulmonary solid nodules are affected by many factors.Careful preoperative evaluation and skilled intraoperative manipulation can effectively reduce the incidence of pneumorrhagia and pneumothorax.
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Objective:To investigate the effect of enteral nutrition support by CT-guided percutaneous gastrostomyon the nutritional status of patients with esophageal cancer complicated with dysphagia during radiotherapy.Methods:Therewere46 cases of esophageal cancer patients with dysphagia treated with CT-guided percutaneousgastrostomy.Others 43 cases of esophageal cancer by oral feeding in patients with dysphagia as control groupduringthe sametimein our hospital radiotherapy center.Patients in the observation group were ingested daily through the gastrostomy,and the nutritional intake of the control group included oral ingestion and intravenous infusion.All patients were measuredthe body height,body weight (BW).body mass index (BMI),Serum levels of serum albumin (ALB),pre-albumin (PA) and hemoglobin (HB) before and after radiotherapy.We also observed the incidence of acute radiation esophagitis and the completion of the treatment plan during radiotherapy in both groups,and to observe the two groups of patients the incidence rate of radiotherapy and treatment plan during the completion of acute radiation esophagitis.Results:There was no significant difference in BW,BMI,ALB,PA,HB before radiotherapy between the two groups (t =0.84,0.63,-1.07,-0.81,1.48,P ＞ 0.05).The BW,BMI,ALB,PA and HB of the observation group were significantly higher than those of the control group at the end of radiotherapy,which werestatistically significant (t=3.30,4.65,6.82,43.56,31.91,P ＜ 0.01).During the radiotherapy,the total incidence of acute radiation esophagitis in the observation group was significantly lower than that in the control group,(x2=3.971,P＜ 0.05).In addition,the completion rate of the observationgroup was significantly higher than that of the control group (x2 =6.811,P ＜ 0.01).Conclusion:To the Patients with dysphagia of esophageal cancer,enteral nutrition byCT guided percutaneous gastrostomy,can improve the malnutrition,the immune function of the patients and reduce the acute radiation esophagitis during radiotherapy and ensure the successful completion of the treatment plan.
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Objective To study the guided interstitial implantation of125I seeds combined with S-1 in the treatment of elderly patients with pancreatic cancer treatment in CT, to evaluate the clinical value of the actual.Methods60 cases of elderly patients with pancreatic cancer in Pujiang People's Hospital from January 2013 to December 2016 were selected as the research object in this study.They were randomly divided into two groups, the control group and the experimental group, each with a total of 30 cases.The control group of patients with S-1 in the treatment.The experimental group with,125I implantation combined with S-1 treatment.Comparative analysis of the control group and the experimental group of patients with treatment effect and toxicity.ResultsAfter different treatment, 30 patients in the experimental group, 9 patients were invalid, the total effective number of cases was 21 cases, the effective rate was 70%.The control group of 30 patients, 19 patients were invalid, the total effective number of cases was 11 cases, the effective rate was 36.7%.Therefore, the effective rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).The disease control rate of the experimental group was 90%, the clinical benefit rate was 50%, the control rate of the patients in the control group was 60%, and the clinical benefit rate was about 23.3%,.The control rate of patientsand the clinical benefit rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05).There was no significant difference between the experimental group and the control group.ConclusionCT guided interstitial implantation of125I seeds combined with S-1 in the treatment of elderly patients with pancreatic cancer can improve the treatment efficiency to a great extent, to help alleviate the suffering of patients, with further clinical promotion and application significance.
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Objective To compare the pre-and post-operative tumor target volume and to examine the consistency in physical dosimetric parameters of organs at risk (OAR) following 3D-printed coplanar template (3D-PCT)-assisted and CT-guided radioactive seed implantation.Methods The 3D-printed coplanar template was designed using a computer software, and the coordinate system was established where the center was used as the basis for setting the x axis and y axis.Crosses defining the center of treatment were drawn on the patient''s body and matched with the corresponding central point, x axis, and y axis of the coplanar template.3D-PCT-assisted and CT-guided radioactive seed implantation was performed based on the pre-operative plan, and the pre-operative, operative, and post-operative plans were designed to evaluate the target tumor volume and the normal dose received by the tissues.In addition, dosimetric parameters, including D90(minimum dose received by 90% of the gross target volume), V100, V150, V200(percentage of GTV that received 100%, 150%, and 200% of the prescribed dose, respectively), minimum peripheral dose (MPD), conformal index (CI), external index (EI), and homogeneity index (HI) in the pre-operative and post-operative plans were also assessed and compared using the Wilcoxon test. Results Fourteen patients treated in our institution from August to October, 2016 were included in this study. The median age of the patients was 61.5 years, and the median Karnofsky Performance Scale score was 80. A total of 14 lesions from the 14 patients were treated by seed implantation in the neck (n=4), chest (n=3), abdomen (n=5), and pelvis (n=2). Of the 14 patients that underwent implantation, 8 had previously received radiation therapy, and 6 had not received radiation therapy. Dosage optimization was performed for all patients during the operation. The median activity of the implanted seeds was 0.625 mCi (0.55-0.75 mCi,1 Ci=3.7×1010 Bq), and the preoperatively planned median number of needling and implanted seeds were 9(4-34) and 45.5(10-162), respectively. However, the actual median number of needling and implanted seeds were 9.5(4-34) and 45.5(10-162), respectively. Dosimetric analysis showed that there were no significant changes in tumor volume (P=0.135), D90(P=0.208), MPD (P=0.104), V100(P=0.542), V150(P=0.754), V200(P=0.583), CI (P=0.426), EI (P=0.326), and HI (P=0.952) after implantation. Conclusions 3D-PCT guidance and dosage optimization can result in good consistency between pre-and post-operative plans for radioactive seed implantation. 3D-PCT is a convenient and cheap technique suitable for large-scale clinical application.