Tumors In Thorax Research Articles

Application of Patient-Reported Outcome Measurements in Adult Tumor Clinical Trials in China: Cross-Sectional Study.

International health policies and researchers have emphasized the value of evaluating patient-reported outcomes (PROs) in clinical studies. However, the characteristics of PROs in adult tumor clinical trials in China remain insufficiently elucidated. This study aims to assess the application and characteristics of PRO instruments as primary or secondary outcomes in adult randomized clinical trials related to tumors in China. This cross-sectional study identified tumor-focused randomized clinical trials conducted in China between January 1, 2010, and June 30, 2022. The ClinicalTrials.gov database and the Chinese Clinical Trial Registry were selected as the databases. Trials were classified into four groups based on the use of PRO instruments: (1) trials listing PRO instruments as primary outcomes, (2) trials listing PRO instruments as secondary outcomes, (3) trials listing PRO instruments as coprimary outcomes, and (4) trials without any mention of PRO instruments. Pertinent data, including study phase, settings, geographic regions, centers, participant demographics (age and sex), funding sources, intervention types, target diseases, and the names of PRO instruments, were extracted from these trials. The target diseases involved in the trials were grouped according to the American Joint Committee on Cancer Staging Manual, 8th Edition. Among the 6445 trials examined, 2390 (37.08%) incorporated PRO instruments as part of their outcomes. Within this subset, 26.82% (641/2390) listed PRO instruments as primary outcomes, 52.72% (1260/2390) as secondary outcomes, and 20.46% (489/2390) as coprimary outcomes. Among the 2,155,306 participants included in these trials, PRO instruments were used to collect data from 613,648 (28.47%) patients as primary or secondary outcomes and from 74,287 (3.45%) patients as coprimary outcomes. The most common conditions explicitly using specified PRO instruments included thorax tumors (217/1280, 16.95%), breast tumors (176/1280, 13.75%), and lower gastrointestinal tract tumors (173/1280, 13.52%). Frequently used PRO instruments included the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire-30, the visual analog scale, the numeric rating scale, the Traditional Chinese Medicine Symptom Scale, and the Pittsburgh Sleep Quality Index. Over recent years, the incorporation of PROs has demonstrated an upward trajectory in adult randomized clinical trials on tumors in China. Nonetheless, the infrequent measurement of the patient's voice remains noteworthy. Disease-specific PRO instruments should be more effectively incorporated into various tumor disease categories in clinical trials, and there is room for improvement in the inclusion of PRO instruments as clinical trial end points.

Efficacy of the collapsed cone algorithm calculated radiotherapy plans in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT): A comparative dosimetric study in tumors of thorax.

In this study, efficacy of collapsed cone algorithm-generated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) were evaluated for treatment of thoracic esophageal cancer. Ten previously treated patients with VMAT were considered for evaluation. The planning parameters were evaluated in terms of max dose, mean dose, Homogeneity Index, Conformity Index for planning target volume, and organ at risk doses. Total monitor unit, treatment time, and gamma passing index were also reported. The target dose coverage of the VMAT and IMRT plans achieved the clinical dosimetric criteria for all ten patients in the evaluation. Under the condition of equivalent target dose distribution, the VMAT plan's Conformity Index, monitor unit, treatment time, and gamma passing index rate were superior than in the IMRT plan, and the result was statistically significant. Collapsed cone algorithm-based VMAT can have a more effective and better approach for esophageal cancer than IMRT.

P2.22-02 Long-term Survival in Patients with Primitive Neuroectodermal Tumors of Thorax: Does Size Matter?

P2.22-02 Long-term Survival in Patients with Primitive Neuroectodermal Tumors of Thorax: Does Size Matter?

Radiobiological modeling of acute esophagitis after radiation therapy of head, neck, and thorax tumors: The influence of chemo-radiation.

The aim of this study was to evaluate the performance of various radiobiological models in predicting the occurrence of acute esophagitis (AE) during radiation therapy (RT) of head, neck, and thoracic tumors with concurrent and sequential chemotherapy. According to recent studies, the probability of AE following RT by normal tissue complication probability models is predictable. A total of 100 patients with nasopharynx, larynx, Hodgkin's lymphoma, spinal metastases, and oral cavity and lung tumors were included in the study. Half of these patients were treated by concurrent chemo-radiotherapy (Con. CRT) and the other half were treated by radiotherapy alone or sequential chemo-radiotherapy (RT + seq. CRT). Radiobiological models of several types were used as follows,: Lyman-generalized equivalent uniform dose (gEUD), Lyman-MED, log-logistic, logit, and logistic. Parameters were estimated using maximum likelihood estimation, and models were compared using Akaike information criteria. Based on follow-up data, the behavior of dose-response curves differed markedly between the Con. CRT and RT + seq. CRT groups. The best fit with clinical results was offered by the Lyman-MED model for the Con. CRT group and the Lyman-gEUD model for the RT + seq. CRT group. Depending on the model used, the parameter of D50 was considerably lower (up to three times) in the Con. CRT group compared to the RT + seq. CRT group. The incidence of AE significantly differed between the two treatment groups in all the models. New parameter estimates could be used for predicting the probability of acute esophagitis after chemo-RT.

Investigation the Efficacy of Fuzzy Logic Implementation at Image-Guided Radiotherapy.

At image-guided radiotherapy, technique, different imaging, and monitoring systems are utilized for (i) organs border detection and tumor delineation during the treatment planning process and (ii) patient setup and tumor localization at pretreatment step and (iii) real-time tumor motion tracking for dynamic thorax tumors during the treatment. In this study, the effect of fuzzy logic is quantitatively investigated at different steps of image-guided radiotherapy. Fuzzy logic-based models and algorithms have been implemented at three steps, and the obtained results are compared with commonly available strategies. Required data are (i) real patients treated with Synchrony Cyberknife system at Georgetown University Hospital for real-time tumor motion prediction, (ii) computed tomography images taken from real patients for geometrical setup, and also (iii) tomography images of an anthropomorphic phantom for tumor delineation process. In real-time tumor tracking, the targeting error averages of the fuzzy correlation model in comparison with the Cyberknife modeler are 4.57 mm and 8.97 mm, respectively, for a given patient that shows remarkable error reduction. In the case of patient geometrical setup, the fuzzy logic-based algorithm has better influence in comparing with the artificial neural network, while the setup error averages is reduced from 1.47 to 0.4432 mm using the fuzzy logic-based method, for a given patient.Finally, the obtained results show that the fuzzy logic based image processing algorithm exhibits much better performance for edge detection compared to four conventional operators. This study is an effort to show that fuzzy logic based algorithms are also highly applicable at image-guided radiotherapy as one of the important treatment modalities for tumor delineation, patient setup error reduction, and intrafractional motion error compensation due to their inherent properties.

Nhân một trường hợp bướu rất hiếm gặp ở lồng ngực sarcôm hoạt dịch nguyên phát ở phổi

A CASE VERY RARE TUMOR IN THORAX PRIMARY PULMONARY SYNOVIAL SARCOMA: CASE REPORT Background:Primary synovial sarcoma of lung is an extremely rare tumor. The etiology and pathogenesis of sarcomas lung are not well understood. A definitive diagnosis requires detailed connecting clinical symptoms, radiological imaging, immunohistochemical staining and may be molecular genetics techniques. Case Report:A male patient, 46 years old, history disease about 5 days with dry cough, dyspnea and right chest pain. Image manifestations: right pleural effusion and lung collapse. He had been taken the right pleural drainage and then the right lung surgery to remove the tumor. Right lung tumors are associated with right pleura, pericardium and mediastinal invasions. The diagnosis is confirmed with immunohistochemical staining of positive specific markers: PanCK, CD 5/6, CD99, Bcl-2, Calretinin, WT-1, Podoplanin. Conclusions: Primary Pulmonary Synovial Sarcom is a mesenchymal malignant disease in the lungs, very rare. The disease progresses rapidly, involving the parenchyma of the lungs, pleura, or pericardium, the lymph nodes or nearby tissues. The diagnosis have determined by immunohistochemistry. Key word: Primary Pulmonary Synovial Sarcoma; Immunohistochemistry; SSX SYT-SSX Fusion Gene.

Management of thoracoabdominal neuroblastoma: a 13-year experience

BackgroundThoracoabdominal neuroblastoma is a unique surgical challenge. We reviewed our experience focusing on disease patterns and corresponding surgical approaches.MethodsAmong 310 patients in our neuroblastoma database, 30 (9.7%) had thoracoabdominal neuroblastoma....

Bone metastasis pattern of cancer patients with bone metastasis but no visceral metastasis

BackgroundBone metastasis of cancer can be a result from systemic blood spreading or vertebral venous plexus spreading. Systemic blood pathway induced bone metastasis can happen in any bone in the body since the spreading is considered to be random. However, it remains unknown whether there is any pattern of vertebral venous plexus related bone metastasis. In this study, we explored bone metastasis patterns in patients whose primary tumors had been well identified. MethodsWe included 290 consecutive cancer patients with bone metastases but no visceral metastases, out of 2559 patients whose bone metastases were diagnosed by positron emission tomography/computed tomography, between Jan 2015 and Oct 2017 at the Fudan University Shanghai Cancer Center. We excluded those with visceral metastasis to ensure that our study focused on metastasis through the vertebral venous plexus. And we analyzed the distribution and pattern of skeletal metastases. ResultsOf the 290 patients, 28 had head and neck tumors, 178 had thorax tumors, 49 had abdominal tumors and 35 had pelvic tumors; 102 (35%) had only one bone containing a metastasis and 188 (65%) had multiple bones containing metastases. Overall, metastases to the thoracic skeleton were more common in patients with thorax tumors than in other patients (81% vs. 67%, P = 0.007); metastases to the cervical spine or thoracic bones were more common in patients with primary tumors above the diaphragm than those below the diaphragm (82% vs. 66%, P = 0.002). Among those with only one bone containing a metastasis (n = 102), patients with head and neck tumors had a higher incidence of cervical spine metastasis than other patients (25% vs. 2%, P = 0.03), those with thorax tumors had a higher incidence of thoracic bone metastasis than other patients (56% vs. 35%, P = 0.035), and those with pelvic tumors had a higher incidence of pelvis bone metastasis than other patients (78% vs. 27%, P = 0.000054). ConclusionsIn patients with only one bone containing a metastasis but no visceral metastasis, bones near the primary were more likely to be first metastasized. This may be a valuable clue to primary tumor sites in patients with cancers of unknown primaries.

In Silico Trial of MR-Guided Midtreatment Adaptive Planning for Hypofractionated Stereotactic Radiation Therapy in Centrally Located Thoracic Tumors

Hypofractionated (>5 fraction) stereotactic radiation therapy (HSRT) may allow for ablative biologically equivalent dose to tumors with a lower risk of organ-at-risk (OAR) toxicity in central thoracic tumors. Adaptive planning may further improve OAR sparing while maintaining planning target volume (PTV) coverage. We hypothesized that midtreatment adaptive replanning would offer dosimetric advantages during HSRT for central thorax malignancies using magnetic resonance imaging (MRI)-guided radiation therapy. Twelve patients with central thorax tumors received HSRT using MRI-guided radiation therapy. Clinically delivered regimens were 60Gy in 12 fractions or 62.5Gy in 10 fractions, with low-field magnetic resonance (0.35T) volumetric setup imaging acquired at each fraction. Daily gross tumor volume (GTV) and OARs were retrospectively redefined on fraction 1, 6, and 10 MRIs, and GTV response was recorded. Simulated initial plans prescribed a dose of 60Gy in 12 fractions based on fraction 1 MRI. Midtreatment adaptive plans were created based on fraction 6 anatomy-of-the-day. All plans were created using an isotoxicity approach with a goal of 95% PTV coverage, subject to hard OAR constraints, to represent clinically ideal OAR sparing. Plans were then compared for projected OAR sparing and PTV coverage. Patients demonstrated significant on-treatment MRI-defined GTV reduction (median 41.8%; range 16.7%-65.7%). At fraction 6, median reduction was 26.7%. All initial plans met OAR constraints. Initial plan application to fraction 6 and fraction 10 anatomy resulted in 8 OAR violations (5 of 13 patients) and 10 OAR violations (6 of 13 patients). All fraction 6 violations persisted at fraction 10. Midpoint adaptive planning reversed 100% of midpoint OAR violations and tended to reduce the magnitude of OAR violations incurred at fraction 10. In 40% of fractions (2 of 5) in which OAR violation resulted from initial plan application to fraction 6 anatomy, PTV coverage was increased concomitant with violation reversal. Midtreatment adaptive planning based on tumor response may be dosimetrically advantageous for sparing of surrounding critical structures in HSRT for central thorax malignancies and could be applied using either an online or offline paradigm.

Development of Monitoring Method of Respiratory Waveform in Thoracicoabdominal Part Using Web Camera

Countermeasures against respiratory movement are important for tumors of thorax and abdomen in stereotactic body radiation therapy. In the present paper, a web-camera-based-respiratory monitoring method without contact with patient's body was proposed for respiratory study. Thoracic and abdominal motion images were taken by a web camera, and were analyzed using simple image-processing techniques for obtaining respiratory waveforms. Four motion images with different respiration rate were obtained from resusci anne simulator. Respiration waveforms were estimated from the moving images by the proposed method, and were compared with respiration waveforms obtained by the conventional respiratory monitoring device. That was found to have a strong correlation. In addition, the two waveforms were similar in Bland-Altman method comparison. The proposed method can provide non-contact, non-invasive, simple, and realistic respiratory monitoring system for radiotherapy.

Setup in a Clinical Workflow and Results of In Vivo Dosimetry Procedure in an Overload Radiation Therapy Department

High conformal techniques, as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are widely used in overloaded radiotherapy departments. In vivo dosimetric screening appears to be essential in this environment to avoid important dosimetric errors. The work reports the results of the assessment of an in vivo dosimetry (IVD) procedure in a surcharged clinical workflow, analyses the causes that could be responsible of dosimetric disagreements between the delivered and planned treatments and evaluates the added workload needed for the whole procedure. An IVD method based on the results of an electronic portal imaging device (EPID) was used. A total of 3484 IVD tests were performed for 150 patients treated for head and neck, abdomen, pelvis, breast and thorax tumors with IMRT and VMAT techniques. Two types of tests were considered: the ratio R between the reconstructed and planned isocenter doses and a transit dosimetry based on the γ-analysis of the electronic portal images. The tests were considered in tolerance if R is within 5%, γ% >90% (i.e. the percentage of points with γ <1 is greater than 90%) and if γ mean ≤ 0.4. Therefore, within the EPID irradiated area, a maximum of 10% of the points in disagreement were accepted, while the weight of the discrepancy was supplied by the distribution of the γ values, characterized by a mean value lower than 0.4. If even only one of these indices was outside the tolerance level, the reason was investigated and corrected prior to the next fraction and the IVD test was repeated. The time needed for each step of the IVD procedure was registered. IMRT and VMAT treatments for pelvis, abdomen and head and neck presented 10% of the tests out of the tolerance level, while IMRT treatments for the breast and thorax regions accounted for up to 25%. Of the off-tolerance tests, 90% were due to inadequate standard quality controls that can lead to errors in the patient setup. The remaining 10% of the tests out of the tolerance level, were mainly ascribable to patient morphological changes as different filling of bladder and rectum for pelvis treatments, tumor shrinkage for head and neck, but also loss of weight. For breast and thorax treatments, the patient positioning was the main cause of the out of tolerance of the γ analysis. Once corrected the cause of the errors, the percentage of patients ending the treatment with each mean index within the tolerance level tends towards 100% for every region treated and technique used. An average time of 42 minutes/day was sufficient to monitor a daily workload of 60 patients in treatment. IVD performed with an electronic portal imaging device is feasible in an overloaded department. Its use enables the timely realignment of the treatment quality indices within the tolerance level in order to achieve 100% of patient’s final treatment compliant with the one prescribed.

Ectopic parathyroid tumor in thorax – case report

Cilj: Prikazati pacijenticu s primarnim hiperparatireoidizmom zbog ektopicnog smjestenog tumora dostitne žlijezde u toraksu. Prikaz slucaja: 64-godisnja pacijentica s od ranije poznatom hipotireozom i hipertenzijom manifestirala se slikom normocitne anemije, bubrežne insuficijencije i smetnjama gutanja. Zbog navedenih simptoma ucinjena je viseslojna kompjutorizirana tomografija (MSCT) toraksa koja je pokazala tvorbu u stražnjem gornjem medijastinumu, uz promjene na kostima i sumnju na sekundarizme. U sklopu nefroloske obrade uocene su izrazito visoke vrijednosti serumskog kalcija (> 3 mmol/L) i paratireoidnog hormona (PTH) (200 pmol/L), sto je ukazalo da se najvjerojatnije radi o primarnom hiperparatireoidizmu. Ucinjena je dodatna obrada: scintigrafija dostitnih žlijezda, punkcija navedene tvorbe i citoloska analiza. Navedene dijagnosticke metode potvrdile su da se radi o primarnom hiperparatireoidizmu najvjerojatnije adenoma ektopicno smjestene dostitne žlijezde. Pacijentica je podvrgnuta operativnom zahvatu, torakotomiji te odstranjenju navedene tvorbe. Postoperativni kirurski tijek bio je uredan. U laboratorijskim nalazima javila se ocekivana hipokalcemija, zbog sindroma „gladne kosti” koja je medikamentozno tretirana. Naknadno prispjeli patohistoloski nalaz ukazao je na to da se radi o novotvorini dostitne žlijezde nesigurnog malignog potencijala. S obzirom na to da je jedini potpuno pouzdani pokazatelj zlocudne prirode bolesti nalaz metastaza, dijagnoza karcinoma nije se mogla postaviti. Vrijednosti PTH-a postoperativno su bile unutar referentnih vrijednosti. Tijekom pracenja pacijentice u razdoblju od pola godine nakon operativnog zahvata nije doslo do povrata bolesti. Zakljucak: Primarni hiperparatireoidizam cest je endokrinoloski poremecaj i o njemu treba razmisljati u svakodnevnom radu. Osim povecanih dostitnih žlijezda na tipicnom mjestu u vratu, moguc je razvoj i ektopcno smjestenih dostitnih žlijezda.

Method of intra-arterial chemotherapy of esophageal cancer

Esophagus it is an organ that takes blood from the different sources. Anatomic features of nourishment of esophageal tumors did not allow study them with the help of angiography like the tumors of other organs. In this connection intra-arterial way of chemotherapy drug administration for treating esophageal tumors is practically not studied.Methodology. For creating the maximal concentration of chemotherapy drug in esophageal tumor in the scientific department of the thorax tumors was elaborated the methodology of intra-arterial chemotherapy of esophageal cancer. Patients with cancer of the upper third of esophagus underwent catheterization of the clypeate cervical trunk or lower clypeate artery, middle third – left lower diaphragmatic artery, lower third – left gastric artery. Catheterization of the own esophageal arteries was not realized in any case.Results. At randomized research 34 patients underwent catheterization of esophageal arteries. Locally spread esophageal tumors have the dominant source of the blood supply and several secondary branches. The tumors growth results in hypertrophy of afferent preexisting vessels and development of neovascularization in the injury nidus. Conclusion. The use of intra-arterial chemotherapy in patients with esophageal cancer combined with the radiotherapy can be the method of choice for non-adjunctive and conservative treatment

SU-E-J-76: Clinical Use of a Real-Time Surface Image-Guided Positioning and Tracking System in Proton Therapy.

To position patients and track the intra-fractional movements, the AlignRT system was implemented in proton incline-beam-line (IBL) at Procure Oklahoma-City center. The AlignRT3c system was configured near perpendicular to the gantry rotation for accommodating the X-ray IGPS. To evaluate positioning accuracy, more than 10 surfaces of each patient for ten patients with intracranial tumors were acquired after patients positioned by X-ray IGPS. Displacements between acquired surfaces and the reference surface taken at 1st day of treatment were examined. Intra-fractional movements with respiratory was studied with gated surface that allows setting the reference surface for patient at exhale during breathing. Intra-fractional movements due to respiratory were monitored on 10 sections of each patient for three patients with thoracic tumors. Accuracy of positioning patient is 2.0 mm at both anterior-posterior and lateral directions, and is 3.5 mm in superior-inferior (SI) direction by aligning the surfaces of masks. Observed larger displacements along SI direction can be due to patient's movements within the mask. Periodical displacements within 5 mm compared to its reference were seen for the three patients with thorax tumors. However, 10 mm sharp displacements with a few seconds were observed when patient moved the body. We have implemented the first AlignRT3c IGPS for proton therapy for positioning patients within 2.0 mm, and successfully tracked intra-fractional respiratory motion during treatment after positioning patient.

THE EXPERIENCE OF DECOMPRESSION-AND-STABILIZING SURGERIES IN PATIENTS WITH MULTIPLE MALIGNANT TUMORS OF THORACIC AND LUMBAR SPINE

The authors have analyzed the surgical treatment of 34 patients with multiple malignant, mainly metastases tumors of thorax and lumbar spine, using spinal implants. The results of the estimation of life quality, neurological status and survival after the surgery have shown the effectiveness of decompress and stabilization technologies at any variants of malignant tumor spine injuries, especially involving specific therapy. 27 patients were observed during the period from 10 months to 5 years.

Chronic inhalation exposure of hamsters to nickel-enriched fly ash

Hamsters were chronically exposed to ∼70 μg/liter respirable nickel-enriched fly ash (NEFA) aerosol, ∼17 μg/liter NEFA, or ∼70 μg/liter fly ash (FA) for up to 20 months. A control group received sham exposures. The NEFA particles of respirable size contained approximately 6% nickel, compared to about 0.3% for FA. Five hamsters/group were sacrificed after 4, 8, 12, or 16 months of exposure. An additional five hamsters/group were withdrawn from exposure at the same intervals for lifelong observations. Exposures to NEFA had no significant effect on body weight and life span of the animals although heavy deposits of NEFA in the lungs were demonstrated. However, lung weights of the high NEFA- and of the FA-exposed animals were significantly higher than those of the low-NEFA group and the controls, and mean lung volumes were significantly larger for the high-NEFA group and the FA group than for the low-NEFA group and the controls. Dust was deposited (anthracosis) in the lungs of all exposed hamsters. Incidence and severity of interstitial reaction and bronchiolization were significantly higher in the dust-exposed groups than in the sham-exposed controls. The severity of anthracosis, interstitial reaction, and bronchiolization was significantly lower in the low-NEFA group than in the high-NEFA and FA groups. While two malignant primary thorax tumors were found in two hamsters of the high-NEFA group, no statistically significant carcinogenesis was observed. Of the exposure-related changes, only anthracosis decreased after withdrawal from exposure. Pulmonary nickel burdens after 20 months of exposure suggest that the pulmonary clearance rate was slower in the high-NEFA group than in the low-NEFA group.