planning target volume

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  • 文章类型: Case Reports
    自1964年以来,颅骨原发性成釉细胞瘤(AM)或成釉细胞癌(AMCa)的报道病例很少。这种罕见情况在特定解剖部位的临床表现和独特特征仍不清楚。我们报告了一例位于额颞叶顶叶区域的颅骨原发性AM恶性转化的病例,并强调了其与文献中报道的其他病例的相似性。
    一名53岁女性患者,有20天的头痛和10天的双侧下肢无力病史。体格检查显示步态缓慢且不稳定。在颅骨成像上,在颅骨的右额叶-颞叶-顶叶区域观察到占位性病变。行右颅骨肿瘤边缘扩张切除术。手术后患者的运动功能恢复正常。术后影像学检查显示10例肿瘤切除。随访影像学检查显示肿瘤复发。患者接受了复发性肿瘤的切除术。术后病理分析显示AM恶变。随访影像学检查显示肿瘤复发。患者接受立体定向放疗。随访影像学检查显示没有肿瘤复发的证据,随后的胸部CT显示没有转移的迹象。
    颅骨的初级AM或AMCa在文献中越来越多地被描述,但是缺乏有关颅骨原发性AM恶性转化的详细报道。这种情况的发病机制尚不清楚。积极的治疗和密切的随访可能是预防疾病复发和恶变的关键。
    UNASSIGNED: Since 1964, there has been a scarcity of reported cases of primary ameloblastoma (AM) or ameloblastic carcinoma (AMCa) of the skull. The clinical presentation and distinctive features of this uncommon condition at specific anatomical sites remain unclear. We report a case of malignant transformation of a primary AM of the skull situated in the frontal-temporal-parietal region and highlight its similarities to other cases reported in the literature.
    UNASSIGNED: A 53-year-old female patient presented with a 20-day history of headaches and bilateral lower limb weakness for 10 days. Physical examination revealed slow and unsteady gait. An occupying lesion was observed in the right frontal-temporal-parietal region of the skull on the Cranial imaging. A right cranial bone tumor margin expansion resection was performed. The patient\'s motor functions recovered normally after surgery. Postoperative imaging examinations showed10 tumor resection. Follow-up imaging examinations showed tumor recurrence. The patient underwent resection of the recurrent tumor. Postoperative pathological analysis revealed malignant transformation of the AM.Follow-up imaging examinations showed tumor recurrence again. The patient was admitted for stereotactic radiotherapy. Follow-up imaging examinations demonstrated no evidence of tumor recurrence and subsequent chest CT revealed no signs of metastasis.
    UNASSIGNED: Primary AM or AMCa of the skull is increasingly being described in the literature, but detailed reports on the malignant transformation of primary AM of the skull are lacking. The pathogenesis of this condition remains unclear. Aggressive treatment and close follow-up may be crucial for preventing disease recurrence and malignant transformation.
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  • 文章类型: Review
    图像指导方面的最新创新,治疗交付,和自适应放疗(RT)为前列腺癌患者的目标体积(PTV)边缘设计创造了新的范例。我们对有关完整前列腺RT的PTV边缘选择和设计的最新文献进行了回顾,不包括术后RT,近距离放射治疗,和质子治疗。我们的评论描述了前列腺和精囊作为异质变形结构的日益关注,随着前列腺内GTV增强和盆腔淋巴结治疗的进一步出现。为了捕捉最近的创新,我们强调了锥形束CT制导的演变,越来越多地使用MRI来改善目标描绘和图像配准,并支持在线自适应RT。此外,我们总结了新的和不断发展的图像引导治疗平台,以及最近关于新型固定策略和运动跟踪的报道。我们的报告还捕获了人工智能的最新实现,以支持图像指导和自适应RT。通过基于模型的风险估计和临床试验来描述PTV边缘变化的临床影响,我们强调最近的高影响报告。我们的报告侧重于PTV利润背景下的主题,但也展示了试图通过稳健的优化和概率规划方法超越PTV利润配方的研究。尽管存在常规使用基于CT的图像引导的目标边缘指南,需要进一步验证,以了解单独或结合实时运动补偿的在线适应的最佳裕度,以最大程度地减少前列腺癌患者治疗中的系统和随机不确定性.
    Recent innovations in image guidance, treatment delivery, and adaptive radiotherapy (RT) have created a new paradigm for planning target volume (PTV) margin design for patients with prostate cancer. We performed a review of the recent literature on PTV margin selection and design for intact prostate RT, excluding post-operative RT, brachytherapy, and proton therapy. Our review describes the increased focus on prostate and seminal vesicles as heterogenous deforming structures with further emergence of intra-prostatic GTV boost and concurrent pelvic lymph node treatment. To capture recent innovations, we highlight the evolution in cone beam CT guidance, and increasing use of MRI for improved target delineation and image registration and supporting online adaptive RT. Moreover, we summarize new and evolving image-guidance treatment platforms as well as recent reports of novel immobilization strategies and motion tracking. Our report also captures recent implementations of artificial intelligence to support image guidance and adaptive RT. To characterize the clinical impact of PTV margin changes via model-based risk estimates and clinical trials, we highlight recent high impact reports. Our report focusses on topics in the context of PTV margins but also showcase studies attempting to move beyond the PTV margin recipes with robust optimization and probabilistic planning approaches. Although guidelines exist for target margins conventional using CT-based image guidance, further validation is required to understand the optimal margins for online adaptation either alone or combined with real-time motion compensation to minimize systematic and random uncertainties in the treatment of patients with prostate cancer.
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