The independent innovation point and clinical effect of whole body-knife

whole body soruplet is a stereotactic radiation therapy device with full independent intellectual property rights integrated and innovative by multi-disciplinary advanced technology in China, which can be used for the treatment of tumorwhole body organsSince October 1998, when the first full-body saber has been applied to the clinic, various different types of equipment have been developed and produced, some of which have been used in clinical practice for many years and some are still in the clinical validation stageAccording to preliminary statistics, China now has nearly 100 different types of systemic sorcine used in clinical treatment of various cancer patients more than 100,000 cases, has become one of China's important three-dimensional orientation radiotherapy meansAir Force GeneralHospitalin the application of THE US-QGD-type systemic sage knife clinical research, treatment of patients more than 4000 cases, put forward a unique dose distribution characteristics and dose segmentation model, developed clinical application and operating norms, in thetumortreatment has obtained a high rate of control, small side effects of better results, and with the equipment research and development units jointly won the 2005 National Science and Technology Progress Award1The main technical content and independent innovation pointthe whole body stool research and development to improve the efficacy of radiation therapy, reduce radiation damage and have independent intellectual property rights for the purpose, based on technology and system integration innovation, through multidisciplinary close cooperation and cross-collaboration, the development of China's characteristics of the gamma-ray stereotactic directional systemic radiation therapy equipment (referred to as systemic radon knife), and through extensive and in-depth clinical application research, so that it can safely and effectively treat a variety oftumorsThe whole body soron uses multi-source dynamic rotational focusing technology to make the gamma ray highly focused on the local region, and its dose distribution is characterized by:1similar to the proton line Bragg peak, which is characterized by high dose concentration, the largest dose at the focal point, the formation of a high-dose platform, and the steep decline of the peripheral dose2Similar to radioactive particle placement, the high-dose focus formed by multi-source dynamic rotation focus is similar to a radioactive particle, in the tumor will be filled with multiple focal points to form a high-dose region, the peripheral high dose range is small, the central dose layer increases, similar to the dose distribution characteristics of radioactive particles placed, can be treated about 1 to 10 cm tumor3The dose distribution of concentric circular layers is increasing, and it is appropriate to use a high-score sub-dose treatment modeIn the case of 50% dose line 5 Gy/t x 10 times (total dose 50 Gy), the dose is converted to a bioequivalent dose (BED) (BED) (BED)," with a alpha/beta value of 10, with a dose distribution of: BED-75 Gy of the Planned Target Area (PTV) (equivalent to 62 Gy of conventional radiotherapy), BED between clinical target area (CTV) and general tumor target area (GTV) is 100 Gy (equivalent to 84 Gy of conventional radiotherapy), and 119 to 131.3 Gy (equivalent to 100 to 110 Gy of conventional radiotherapy) in GTVThis dose distribution not only meets the high dose requirements of The GTV, but also ensures that normal tissueoutside of PTV is below the tolerable dose4Better dose focus ingestion advantage than 3D hoscopic radiotherapy (3D-CRT)The knife uses multi-source multi-beam rotation focus, the number of harnesses up to several hundred bundles or more, the dose distribution is highly concentrated, the range of 30% to 50% dose line is small, can be used as aagentthe range line3D-CRT through a number of wild rays in the tumor superimposed to form a high-dose region, but the field of radiation is limited, the dose focus is not as good as the knife, 30% to 50% dose line range is larger, more than 90% of the dose line as the-side agent5The difference in morpholocation and uneven dose distribution are one of the obvious differences between a systemic stomp and 3D-CRT and a stringent radiotherapy, so its indications should be strictly limited to the tumor of the substantive organ2Clinical application the indication that the whole body knife's adaptation certificate is a substantial organ tumor Clinically, it is mainly used for the treatment of solid organ tumors such as lung cancer, lung metastasis, liver cancer, liver metastasis, pancreatic cancer, abdominal lymph node metastasis, postoperative recurrence of rectal cancer, bile duct cancer, post-peritoneal tumor and pelvic tumor The treatment cases of whole body knife in our hospital are the surrounding lung cancer, lung metastasis cancer, liver cancer, liver metastasis cancer, pancreatic cancer and post-abdominal lymph node metastasis Taboo evidence The use of systemic sororist treatment should be avoided in some of the following cases: (1) the tumor is located in the cavity organ or adjacent to the venture organ, such as esophageal cancer, stomach cancer, septum cancer, colon cancer, etc (except for local recurrence after rectal cancer); The tube has adhesion, etc., these areas of the tumor with a high-dose treatment prone to normal cavity organs radiation damage, such as perforation, stenosis and bleeding, etc ; Treatment With a vacuum forming bag to the patient lying on or down position fixed, CT scan to determine the range of the target area and the relationship between adjacent organs, direct transmission of CT images through the network, according to the requirements of different sites, respectively, sketchggGTV, CTV and PTV, according to the size of the lesions using single-target or multi-target irradiation The lesions are treated with a single target with a suitable aperture of the aperture, and the lesions are irradiated by multiple target combinations with different apertures The amount of is determined according to the size of the target area and the purpose of treatment Root treatment: treatment of lung, liver and other substantial organ tumors: small target area (tumor 3 cm), 50% dose line 5 to 10 Gy / times, 40 to 50 Gy / 4 to 10 times; 14 times; large target area (tumor 6 to 10 cm), 40% to 50% dose line at 3 to 4 Gy / times, 40 Gy after the addition dose of 10 to 20 Gy / times; tumor is located in the substantive organ, but closer to the radioactive sensitive organ (e.g pancreatic cancer and post-peritoneal tumors), should be appropriately reduced sub-dose or total dose Palliative care: According to the patient's overall condition and treatment purposes, the sub-dose and total dose are appropriately reduced on the basis of the root treatment to reduce symptoms and delay tumor growth Clinical phaseing and efficacy evaluation Patients are clinically phased through chest CT, head MRI and bone scan diagnosis, and PET/CT is used for partial case screening Followed every 2 to 3 months in the first year of treatment and once every 6 months thereafter The follow-up period was 12 to 54 months (median time was 27 months), and the follow-up included medical history, physical examination and chest and abdominal CT Ct examination is conducted in the first year after 1, 3, 6 and 12 months after treatment, and subsequent CT examination is carried out in accordance with the judgment of the local doctor Further follow-up visits are available by telephone, letter, or local hospital diagnostic reports to understand the patient's recurrence, toxic side effects and survival The local response of the tumor to complete lysacon (CR, tumor completely disappeared), partial remission (PR, tumor reduction of 50% of the maximum diameter), progression (PD, tumor enlargement of 25% or new lesions) and stabilization (SD, between PR and PD) as the therapeutic judgment criteria , after 3 to 6 months of treatment through CT imaging evaluation Radiation damage was graded by RTOG early and late radiation damage Statistical methods The SSPS 12.0 software package is applied and the survival rate and local control rate are calculated using Kaplan-Meier The follow-up time from the end of treatment to the time of survival or death of the patient at the end of the treatment to the time of the patient's death, the survival rate and the local control rate from the day of treatment 3 Clinical effect non-small cell lung cancer: 123 non-small cell lung cancer in the i-III phase, I/II primary primary cr is 63%, total efficiency is 95%, 1, 2, 3 years tumor control rate is 95%, the total survival rate of I 100%, 91% and 91%, ii-phase is 73%, 64% and 64% II/I/I/I-phase, respectively 88%, 78% and 78%, respectively, the early and late lung reaction is light, the level III radioactive pneumonia only 1 case, accounting for 2%; Primary liver cancer: 123 cases of i- III phase primary liver cancer, primary lesions CR was 25.7%, the total efficiency of 81.1% The median survival of the I/II period was 36 months, with the total survival rates of 1, 2 and 3 years being 81.2%, 79.0% and 49.6%, respectively, and the median survival of phase III cases was 15 months, with the total survival rate of 1 and 2 years was 58.7% and 23.9%, respectively There were significant differences in the total survival rates of 1 and 2 years in the I/II period and III The effect of liver function was significantly related to the pre-treatment liver function status The survival rates of Child-Pugh A-level 1, 2 and 3 were 90.3%, 85.6% and 58.3%, respectively, while Child-Pugh B were 71.3%, 71.3% and 35.7%, respectively, while Child-Pugh C were 50%, 0 and 0, respectively Pancreatic cancer: 111 cases of inoperaclinable stage I-III pancreatic cancer, primary lesions CR was 23.9%, the total efficiency of 84.5% The median survival of I/II was 17 months, and the total survival rate of 1, 2 and 3 years was 69.9%, 35.8% and 30.7% respectively, while the median survival of phase III was 8 months, the total survival rate of 1 and 2 years was 29.6% and 14.8% respectively, and there were significant differences in the total survival rate of 1 and 2 years of I/II and III During treatment, gastrointestinal reaction i - II was 72.9% and Grade III was 3.2%, and the treatment of the disease can be completely alleviated At the same time, the treatment of lung metastasis, liver metastasis and peritoneal metastatic cancer after the 1-year control rate of more than 90% 4 Summary and prospect
China's original whole body knife technology has a large dose focus ingenuity advantage, in the treatment of substantive organ tumors such as lung cancer, liver cancer and pancreatic cancer, etc obtained encouraging results, its control rate and survival rate are much higher than conventional radiotherapy, and the radiation response is relatively light The whole body knife technology is a safe and effective means of stereotactic radiotherapy, which is worthy of further in-depth study and application Full-body knife technology has completely independent intellectual property rights, in line with the requirements of China's "Eleventh Five-Year Plan" of science and technology independent innovation, compared with similar technologies and equipment abroad, low price, simple operation, low treatment costs, easy to promote application, can better meet the current economic conditions in most regions of China's relatively backward actual needs; (Xia Tingyi)