Equity Portfolio Management Using Option Price Information

DEFF Research Database (Denmark)

Christoffersen, Peter; Pan, Xuhui (Nick)

We survey the recent academic literature that uses option-implied information to construct equity portfolios. Studies show that equity managers can earn a positive alpha by using information in individual equity options, by using stocks' exposure to information in market index options, and by using...... stocks' exposure to crude oil option information. Option-implied information can also help construct better mean-variance portfolios and better estimates of market beta....

Equity Portfolio Management Using Option Price Information

DEFF Research Database (Denmark)

Christoffersen, Peter; Pan, Xuhui (Nick)

We survey the recent academic literature that uses option-implied information to construct equity portfolios. Studies show that equity managers can earn a positive alpha by using information in individual equity options, by using stocks' exposure to information in market index options, and by usi...

Stereotactic body radiotherapy: a promising treatment option for the boost of oropharyngeal cancers not suitable for brachytherapy: a single-institutional experience.

NARCIS (Netherlands)

Al-Mamgani, A.; Tans, L.; Teguh, D.N.; Rooij, P. van; Zwijnenburg, E.M.; Levendag, P.C.

2012-01-01

PURPOSE: To prospectively assess the outcome and toxicity of frameless stereotactic body radiotherapy (SBRT) as a treatment option for boosting primary oropharyngeal cancers (OPC) in patients who not suitable for the standard brachytherapy boost (BTB). METHODS AND MATERIALS: Between 2005 and 2010,

Image-guided radiotherapy and motion management in lung cancer

DEFF Research Database (Denmark)

Korreman, Stine

2015-01-01

In this review, image guidance and motion management in radiotherapy for lung cancer is discussed. Motion characteristics of lung tumours and image guidance techniques to obtain motion information are elaborated. Possibilities for management of image guidance and motion in the various steps...

Proceedings of the Management options information seminar

International Nuclear Information System (INIS)

2002-01-01

This seminar was held in order to provide an opportunity to participants to broaden their knowledge concerning the numerous management options that are available when dealing with emissions generated by the electric power sector. It also represented an opportunity to gather information with regard to a host of different options to support the Electricity Project Team. The presentations centred on topics such as assessment, design and development of management options for the emissions of the electric power industry in Alberta. The legal, economic, social and environmental aspects were considered by the speakers for the options, and the perspectives included experience gained from hands on projects and initiatives. The reasons underlying the selection of options were revealed and lessons learned examined. Of the 14 presentations and the closing remarks speech, two presentations were included in this database. refs., tabs., figs

Low dose preoperative radiotherapy for carcinoma of the oesophagus

International Nuclear Information System (INIS)

Arnott, S.J.; Duncan, W.; Kerr, G.R.; Jack, W.J.L.; Mackillop, W.J.; Walbaum, P.R.; Cameron, E.

1992-01-01

Patients (176) with potentially operable squamous cell carcinoma or adenocarcinoma of middle or lower thirds of oesophagus were randomly assigned to preoperative radiotherapy or surgery alone. Patients assigned to the radiotherapy arm received 20 Gy in 10 treatments over 2 weeks, using parallel opposed 4 MV beams. The preoperative radiotherapy was not associated with any significant acute morbidity or any increase in operative complications. The median survival of the overall group of 176 patients was 8 moths, and the 5-year survival was 13%. There was no significant difference in the survival of the 90 patients who received preoperative radiotherapy and the 86 who were managed by surgery alone. Proportional hazards analysis identified lymph node involvement, high tumor grade and male sex as significant adverse prognostic features, but the treatment option assigned had no prognostic significance. It was concluded that low dose preoperative radiotherapy offered no advantage over surgery alone. (author). 9 refs.; 3 figs.; 6 tabs

Radiotherapy in the management of Graves' ophthalmopathy

International Nuclear Information System (INIS)

Sakata, Koh-ichi; Hareyama, Masato; Oouchi, Atsushi; Shidou, Mitsuo; Nagakura, Hisayasu; Morita, Kazuo; Osanai, Hajime; Ohtsuka, Kenji; Hinoda, Yuji

1998-01-01

To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. Fourteen female and six male patients with Graves' ophthalmopathy were treated with radiotherapy between 1989 and 1996. Prior to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of 24-28 Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. Treatment was well tolerated. There have been no late complications. All 12 patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves' disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles. (author)

Hazardous landfill management, control options

International Nuclear Information System (INIS)

Corbin, M.H.; Lederman, P.B.

1982-01-01

The land disposal of hazardous wastes has been a common practice over the last half century. The industrial and environmental communities, as well as the public, have an immediate challenge to control the contaminants that may be released from waste land disposal facilities. At the same time, land disposal continues to be, in many cases, the only available disposal technique that can be utilized in the next five years. Thus, it is extremely important that environmentally sound landfill management and control techniques be utilized, both for inactive and active sites. There are a number of key steps in developing a sound management and control plan. These include problem definition, personnel safety, characterization, evaluation of control options, cost-effectiveness analysis and development of an integrated control plan. A number of control options, including diversion, regrading, sealing, and leachate treatment are available and more cost effective in most cases than waste removal. These and other options, as well as the methodology to develop an integrated control plan, are discussed, together with examples. (Auth.)

Review of options for managing iodine-125 wastes

International Nuclear Information System (INIS)

Lock, P.J.; Wakerley, M.W.

1991-01-01

Data on the nature, radioactive content and management options used for I-125 wastes that are produced in England and Wales and fall within the provisions of the Radioactive Substances Act 1960 have been collated. The options for, and impacts of the disposal of these wastes have been reviewed and discussed. In addition storage for decay has been reviewed. The necessary storage requirements and methods of storage for the various waste forms have been examined. Conclusions are drawn with respect to the potential/suitability of the various waste management options. (author)

Dosimetric Study of Current Treatment Options for Radiotherapy in Retinoblastoma

Energy Technology Data Exchange (ETDEWEB)

Eldebawy, Eman [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada); Department of Radiation Oncology, Children' s Cancer Hospital, Cairo (Egypt); Parker, William, E-mail: william.parker@mcgill.ca [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Abdel Rahman, Wamied [Department of Medical Physics, McGill University Health Centre, Montreal, Quebec (Canada); Freeman, Carolyn R. [Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec (Canada)

2012-03-01

Purpose: To determine the best treatment technique for patients with retinoblastoma requiring radiotherapy to the whole eye. Methods and Materials: Treatment plans for 3 patients with retinoblastoma were developed using 10 radiotherapy techniques including electron beams, photon beam wedge pair (WP), photon beam three-dimensional conformal radiotherapy (3D-CRT), fixed gantry intensity-modulated radiotherapy (IMRT), photon volumetric arc therapy (VMAT), fractionated stereotactic radiotherapy, and helical tomotherapy (HT). Dose-volume analyses were carried out for each technique. Results: All techniques provided similar target coverage; conformity was highest for VMAT, nine-field (9F) IMRT, and HT (conformity index [CI] = 1.3) and lowest for the WP and two electron techniques (CI = 1.8). The electron techniques had the highest planning target volume dose gradient (131% of maximum dose received [D{sub max}]), and the CRT techniques had the lowest (103% D{sub max}) gradient. The volume receiving at least 20 Gy (V{sub 20Gy}) for the ipsilateral bony orbit was lowest for the VMAT and HT techniques (56%) and highest for the CRT techniques (90%). Generally, the electron beam techniques were superior in terms of brain sparing and delivered approximately one-third of the integral dose of the photon techniques. Conclusions: Inverse planned image-guided radiotherapy delivered using HT or VMAT gives better conformity index, improved orbital bone and brain sparing, and a lower integral dose than other techniques.

From technical quality assurance of radiotherapy to a comprehensive quality of service management system

International Nuclear Information System (INIS)

Kehoe, T.; Rugg, L.

1999-01-01

A hierarchy of dosimetry, planning and machine performance checks and evaluations of clinical outcomes have been widely used in radiotherapy for decades. Procedures, codes of practice and guidance are readily available on the technical aspects of radiotherapy treatments, maintenance of which is achieved by quality control checks within a quality assurance approach to radiotherapy. Recently a series of high profile, well-publicised treatment accidents resulting in damage to patients have focused the attention of both professionals and the public. There is now pressure to introduce formal quality management systems. Patients and their relatives/carers are having their expectations raised but their definition of a quality service differs from that generally considered by the oncology professionals. Most departmental managers and staff have wide experience of quality control checks. They understand the philosophy of quality assurance. However the idea of formal quality systems/quality management is alien to them. What is a professional/departmental manager to do? This paper addresses that question by discussing the underlying principles of quality management covering service provision as well as technical radiotherapy treatment delivery and by providing some guidance based on experience in the practical implementation of quality management through three stages of development: a QA programme incorporating checks on essential parts of the technical treatment delivery, a formal documented certified QA system focusing on technical treatment delivery, a comprehensive quality management system covering all parts of a service. One possible action plan is provided indicating progress through the three stages of development based on experience in one large Radiation Oncology Department. With planning, resources and commitment. a comprehensive quality of service management system is achievable in radiotherapy. (author.)

Options analysis of managed care contracting and regulation: theory and evidence.

Science.gov (United States)

McLean, R A; Magiera, F T

2000-08-01

Managed care contracts can be represented as bundles of options. In particular, the managed care provider is short a call option. To hedge the risk involved in such contracts, managed care contractors can construct several types of virtual put options, among them the ownership of facilities. Agency theory and options theory suggest that for-profit managed care plans, in the presence of debt, will engage in less hedging activity than will other managed care plans. Here, the authors test that hypothesis, using data for Florida HMOs in 1995, and they reject the null hypothesis. That managed care organizations act as if they are short a call option raises interesting regulatory issues, including the possibility of using a hedge-based regulatory scheme in place of a net-worth-based scheme.

Radiotherapy

International Nuclear Information System (INIS)

Prosnitz, L.R.; Kapp, D.S.; Weissberg, J.B.

1983-01-01

This review highlights developments over the past decade in radiotherapy and attempts to summarize the state of the art in the management of the major diseases in which radiotherapy has a meaningful role. The equipment, radiobiology of radiotherapy and carcinoma of the lung, breast and intestines are highlighted

Mixed Waste Management Options: 1995 Update. National Low-Level Waste Management Program

Energy Technology Data Exchange (ETDEWEB)

Kirner, N.; Kelly, J.; Faison, G.; Johnson, D. [Foster Wheeler Environmental Corp. (United States)

1995-05-01

In the original mixed Waste Management Options (DOE/LLW-134) issued in December 1991, the question was posed, ``Can mixed waste be managed out of existence?`` That study found that most, but not all, of the Nation`s mixed waste can theoretically be managed out of existence. Four years later, the Nation is still faced with a lack of disposal options for commercially generated mixed waste. However, since publication of the original Mixed Waste Management Options report in 1991, limited disposal capacity and new technologies to treat mixed waste have become available. A more detailed estimate of the Nation`s mixed waste also became available when the US Environmental Protection Agency (EPA) and the US Nuclear Regulatory Commission (NRC) published their comprehensive assessment, titled National Profile on Commercially Generated Low-Level Radioactive Mixed Waste (National Profile). These advancements in our knowledge about mixed waste inventories and generation, coupled with greater treatment and disposal options, lead to a more applied question posed for this updated report: ``Which mixed waste has no treatment option?`` Beyond estimating the volume of mixed waste requiring jointly regulated disposal, this report also provides a general background on the Atomic Energy Act (AEA) and the Resource Conservation and Recovery Act (RCRA). It also presents a methodical approach for generators to use when deciding how to manage their mixed waste. The volume of mixed waste that may require land disposal in a jointly regulated facility each year was estimated through the application of this methodology.

Mixed Waste Management Options: 1995 Update. National Low-Level Waste Management Program

International Nuclear Information System (INIS)

Kirner, N.; Kelly, J.; Faison, G.; Johnson, D.

1995-05-01

In the original mixed Waste Management Options (DOE/LLW-134) issued in December 1991, the question was posed, ''Can mixed waste be managed out of existence?'' That study found that most, but not all, of the Nation's mixed waste can theoretically be managed out of existence. Four years later, the Nation is still faced with a lack of disposal options for commercially generated mixed waste. However, since publication of the original Mixed Waste Management Options report in 1991, limited disposal capacity and new technologies to treat mixed waste have become available. A more detailed estimate of the Nation's mixed waste also became available when the US Environmental Protection Agency (EPA) and the US Nuclear Regulatory Commission (NRC) published their comprehensive assessment, titled National Profile on Commercially Generated Low-Level Radioactive Mixed Waste (National Profile). These advancements in our knowledge about mixed waste inventories and generation, coupled with greater treatment and disposal options, lead to a more applied question posed for this updated report: ''Which mixed waste has no treatment option?'' Beyond estimating the volume of mixed waste requiring jointly regulated disposal, this report also provides a general background on the Atomic Energy Act (AEA) and the Resource Conservation and Recovery Act (RCRA). It also presents a methodical approach for generators to use when deciding how to manage their mixed waste. The volume of mixed waste that may require land disposal in a jointly regulated facility each year was estimated through the application of this methodology

A multi-criteria decision analysis assessment of waste paper management options

Energy Technology Data Exchange (ETDEWEB)

Hanan, Deirdre [Department of Design, Development, Environment and Materials, The Open University, Walton Hall, Milton Keynes, MK7 6AA (United Kingdom); Burnley, Stephen, E-mail: s.j.burnley@open.ac.uk [Department of Design, Development, Environment and Materials, The Open University, Walton Hall, Milton Keynes, MK7 6AA (United Kingdom); Cooke, David [Department of Design, Development, Environment and Materials, The Open University, Walton Hall, Milton Keynes, MK7 6AA (United Kingdom)

2013-03-15

Highlights: ► Isolated communities have particular problems in terms of waste management. ► An MCDA tool allowed a group of non-experts to evaluate waste management options. ► The group preferred local waste management solutions to export to the mainland. ► Gasification of paper was the preferred option followed by recycling. ► The group concluded that they could be involved in the decision making process. - Abstract: The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making.

A multi-criteria decision analysis assessment of waste paper management options

International Nuclear Information System (INIS)

Hanan, Deirdre; Burnley, Stephen; Cooke, David

2013-01-01

Highlights: ► Isolated communities have particular problems in terms of waste management. ► An MCDA tool allowed a group of non-experts to evaluate waste management options. ► The group preferred local waste management solutions to export to the mainland. ► Gasification of paper was the preferred option followed by recycling. ► The group concluded that they could be involved in the decision making process. - Abstract: The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making

[Radiotherapy in node-positive prostate cancer].

Science.gov (United States)

Bottke, D; Bartkowiak, D; Bolenz, C; Wiegel, T

2016-03-01

There are numerous randomized trials to guide the management of patients with localized (and metastatic) prostate cancer, but only a few (mostly retrospective) studies have specifically addressed node-positive patients. Therefore, there is uncertainty regarding optimal treatment in this situation. Current guidelines recommend long-term androgen deprivation therapy (ADT) alone or radiotherapy plus long-term ADT as treatment options. This overview summarizes the existing literature on the use of radiotherapy for node-positive prostate cancer as definitive treatment and as adjuvant or salvage therapy after radical prostatectomy. In this context, we also discuss several PET tracers in the imaging evaluation of patients with biochemical recurrence of prostate cancer after radical prostatectomy. As for definitive treatment, retrospective studies suggest that ADT plus radiotherapy improves overall survival compared with ADT alone. These studies also consistently demonstrated that many patients with node-positive prostate cancer can achieve long-term survival - and are likely curable - with aggressive therapy. The beneficial impact of adjuvant radiotherapy on survival in patients with pN1 prostate cancer seems to be highly influenced by tumor characteristics. Men with ≤ 2 positive lymph nodes in the presence of intermediate- to high-grade disease, or positive margins, and those with 3 or 4 positive lymph nodes are the ideal candidates for adjuvant radiotherapy (plus long-term ADT) after surgery. There is a need for randomized trials to further examine the potential role of radiotherapy as either definitive or adjuvant treatment, for patients with node-positive prostate cancer.

Radiotherapy in fascial fibromatosis: a case series, literature review and considerations for treatment of early-stage disease

International Nuclear Information System (INIS)

Grenfell, Solveig; Borg, Martin

2014-01-01

Palmar and plantar fascial fibromatoses are benign hyperproliferative disorders of the deep fascia of the palm and sole. This study seeks to examine the role of radiotherapy in the management of fascial fibromatosis. Six consecutive cases of early-stage fascial fibromatosis treated with radiotherapy at the Adelaide Radiotherapy Centre between July 2008 and May 2011 were analysed. The results of the case series were compared with a systematic review of the literature. All six cases regressed or showed a reduction of symptoms following radiotherapy. Treatment was well tolerated with minor toxicities. Median follow-up for the case series was 38.5 months. The systematic review identified seven studies describing the use of radiotherapy as primary treatment for fascial fibromatosis between 1946 and 2013. The literature indicates that radiotherapy can prevent disease progression and improve symptoms for early-stage disease, with low likelihood of significant toxicities. Early results from our case series are consistent with the literature, showing that radiotherapy can provide an effective management option for patients with early-stage fascial fibromatosis, and justify consideration of radiotherapy as a primary treatment for early-stage disease.

The role of radiotherapy in the management of POEMS syndrome.

Science.gov (United States)

Suh, Yang-Gun; Kim, Young-Suk; Suh, Chang-Ok; Kim, Yu Ri; Cheong, June-Won; Kim, Jin Seok; Cho, Jaeho

2014-11-28

POEMS syndrome is a paraneoplastic syndrome caused by an underlying plasma cell proliferative disease. In this study, we examined the treatment outcomes and role of radiotherapy in the management of POEMS syndrome. In total, 33 patients diagnosed with POEMS syndrome were analyzed. These patients presented with osteosclerotic myeloma (OSM, n = 13), Castleman's disease (CD, n = 4), OSM with CD (n = 10), and vascular endothelial growth factor elevation without gross lesions (VEGFe, n = 6), respectively. The patients were treated by radiotherapy alone (n = 4), chemotherapy alone (n = 16), or a combination thereof (n = 9). The clinical response rates of radiotherapy, chemotherapy, and radiotherapy plus chemotherapy were 75%, 69%, and 89%, respectively. In addition, the hematologic response rates were 50%, 69%, and 71%, respectively. Among the six patients with limited multiple lesions who underwent radiotherapy, the clinical symptoms were improved in five patients after radiotherapy. The median progression-free survival (PFS) was 51 months, and the median overall survival (OS) was 65 months. In univariate analysis, the administration of chemotherapy was significantly associated with better PFS (p = 0.007) and OS (p = 0.020). In contrast, underlying VEGFe was a significant factor worsening PFS (p = 0.035) and OS (p = 0.008). Radiotherapy produces a reliable clinical response and is effective in improving POEMS-associated symptoms that are refractory to chemotherapy in selected patients with clustered or limited multiple lesions that can be covered by single radiation field.

The role of radiotherapy in the management of POEMS syndrome

International Nuclear Information System (INIS)

Suh, Yang-Gun; Kim, Young-Suk; Suh, Chang-Ok; Kim, Yu Ri; Cheong, June-Won; Kim, Jin Seok; Cho, Jaeho

2014-01-01

POEMS syndrome is a paraneoplastic syndrome caused by an underlying plasma cell proliferative disease. In this study, we examined the treatment outcomes and role of radiotherapy in the management of POEMS syndrome. In total, 33 patients diagnosed with POEMS syndrome were analyzed. These patients presented with osteosclerotic myeloma (OSM, n = 13), Castleman’s disease (CD, n = 4), OSM with CD (n = 10), and vascular endothelial growth factor elevation without gross lesions (VEGFe, n = 6), respectively. The patients were treated by radiotherapy alone (n = 4), chemotherapy alone (n = 16), or a combination thereof (n = 9). The clinical response rates of radiotherapy, chemotherapy, and radiotherapy plus chemotherapy were 75%, 69%, and 89%, respectively. In addition, the hematologic response rates were 50%, 69%, and 71%, respectively. Among the six patients with limited multiple lesions who underwent radiotherapy, the clinical symptoms were improved in five patients after radiotherapy. The median progression-free survival (PFS) was 51 months, and the median overall survival (OS) was 65 months. In univariate analysis, the administration of chemotherapy was significantly associated with better PFS (p = 0.007) and OS (p = 0.020). In contrast, underlying VEGFe was a significant factor worsening PFS (p = 0.035) and OS (p = 0.008). Radiotherapy produces a reliable clinical response and is effective in improving POEMS-associated symptoms that are refractory to chemotherapy in selected patients with clustered or limited multiple lesions that can be covered by single radiation field

Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease.

Science.gov (United States)

Crook, Juanita

2016-11-01

Squamous cell cancer of the penis is a radiocurable malignancy all too often managed solely by partial or total penectomy. Effective management of the primary tumor while preserving penile morphology and function is a priority. External radiotherapy and brachytherapy have a role to play in the definitive management of the primary tumor. Surgical nodal staging remains a cornerstone of management because it is the strongest predictor of survival, and inguinal status determines pelvic management. Postoperative radiotherapy of the regional nodes for high-risk pathology is indicated. Chemoradiotherapy should be considered as neoadjuvant treatment for unresectable nodes or as definitive management. Copyright © 2016 Elsevier Inc. All rights reserved.

Stereotactic body radiotherapy for primary renal cell carcinoma and adrenal metastases.

Science.gov (United States)

Kothari, Gargi; Louie, Alexander V; Pryor, David; Vela, Ian; Lo, Simon S; Teh, Bin S; Siva, Shankar

2017-09-01

The incidence of renal cell carcinoma (RCC) and metastatic adrenal lesions continues to rise and present evolving complexities in terms of management. Technical challenges in treatment delivery are compounded by the setting of an ageing patient population with multiple medical co-morbidities. While the standard of care treatment for both primary RCC and oligometastatic adrenal lesions has typically been surgery, a number of patients may be medically or surgically inoperable, and for whom alternative options require consideration. Additionally, in metastatic disease, surgery presents an invasive option, sometimes with unacceptable risks of perioperative morbidity and therefore is considered a less desirable option to some. Stereotactic body radiotherapy (SBRT) is an established radiotherapy technique that is rapidly being incorporated into many radiotherapy departments, particu-larly with the increasing availability and capabilities of modern linear accelerators to deliver precise image guided treatment. There are considerable advantages of SBRT including its ability to provide a non-invasive ablative treatment with very few treatment sessions, with emerging evidence showing promising rates of local control (LC) and low associated mor-bidity. This review details the use of SBRT for primary RCC as well as adrenal metastases, focusing on issues including patient selection, technical considerations, and patient out-comes. Furthermore, this review explores some recent insights into the radiobiology of RCC, the immunomodulatory effects of SBRT, and the use of systemic agents with SBRT.

Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy

International Nuclear Information System (INIS)

Shah, Chirag; Badiyan, Shahed; Berry, Sameer; Khan, Atif J.; Goyal, Sharad; Schulte, Kevin; Nanavati, Anish; Lynch, Melanie; Vicini, Frank A.

2014-01-01

Breast cancer radiotherapy represents an essential component in the overall management of both early stage and locally advanced breast cancer. As the number of breast cancer survivors has increased, chronic sequelae of breast cancer radiotherapy become more important. While recently published data suggest a potential for an increase in cardiac events with radiotherapy, these studies do not consider the impact of newer radiotherapy techniques commonly utilized. Therefore, the purpose of this review is to evaluate cardiac dose sparing techniques in breast cancer radiotherapy. Current options for cardiac protection/avoidance include (1) maneuvers that displace the heart from the field such as coordinating the breathing cycle or through prone patient positioning, (2) technological advances such as intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT), and (3) techniques that treat a smaller volume around the lumpectomy cavity such as accelerated partial breast irradiation (APBI), or intraoperative radiotherapy (IORT). While these techniques have shown promise dosimetrically, limited data on late cardiac events exist due to the difficulties of long-term follow up. Future studies are required to validate the efficacy of cardiac dose sparing techniques and may use surrogates for cardiac events such as biomarkers or perfusion imaging

Contact radiotherapy. Report of technological assessment

International Nuclear Information System (INIS)

Ortholan, Cecile; Melin, Nicole; Lee-Robin, Sun Hae; David, Denis Jean; Pages, Frederique; Devaud, Christine; Noel, Georges; Biga, Julie; Moty-Monnereau, Celine; Canet, Philippe; Lascols, Sylvie; Lamas, Muriel; Ramdine, Jessica; Tuil, Louise

2008-10-01

This report aims at assessing safety, indications, the role in therapeutic strategy, and efficiency of contact radiotherapy. It also aims at answering questions like: is the contact radiotherapy technique validated? What are the indications for contact radiotherapy? What about the efficiency and safety of contact radiotherapy? After a presentation of preliminary notions on radiotherapy (radiation types, dose, and irradiation techniques), the report presents this specific technique of contact radiotherapy: definition, devices, use recommendations, issues of radiation protection, modalities of performance of a contact radiotherapy session, and concerned pathologies. Then, based on a literature survey, this report addresses the various concerned tumours (skin, rectum, brain, breast), indicates some general information about these tumours (epidemiological data, anatomy and classification, therapeutic options, radiotherapy), and proposes an assessment of the efficiency and safety of contact radiotherapy

Economic analysis of emerald ash borer (Coleoptera: Buprestidae) management options.

Science.gov (United States)

Vannatta, A R; Hauer, R H; Schuettpelz, N M

2012-02-01

Emerald ash borer, Agrilus planipennis (Fairmaire) (Coleoptera: Buprestidae), plays a significant role in the health and extent of management of native North American ash species in urban forests. An economic analysis of management options was performed to aid decision makers in preparing for likely future infestations. Separate ash tree population valuations were derived from the i-Tree Streets program and the Council of Tree and Landscape Appraisers (CTLA) methodology. A relative economic analysis was used to compare a control option (do-nothing approach, only removing ash trees as they die) to three distinct management options: 1) preemptive removal of all ash trees over a 5 yr period, 2) preemptive removal of all ash trees and replacement with comparable nonash trees, or 3) treating the entire population of ash trees with insecticides to minimize mortality. For each valuation and management option, an annual analysis was performed for both the remaining ash tree population and those lost to emerald ash borer. Retention of ash trees using insecticide treatments typically retained greater urban forest value, followed by doing nothing (control), which was better than preemptive removal and replacement. Preemptive removal without tree replacement, which was the least expensive management option, also provided the lowest net urban forest value over the 20-yr simulation. A "no emerald ash borer" scenario was modeled to further serve as a benchmark for each management option and provide a level of economic justification for regulatory programs aimed at slowing the movement of emerald ash borer.

The effect of dental management for maintaining dental health in patients with head and neck cancer after radiotherapy

International Nuclear Information System (INIS)

Katsura, Kouji; Sasai, Keisuke; Sato, Katsuro; Hayashi, Takafumi; Goto, Sanae; Tomita, Masahiko; Matsuyama, Hiroshi

2009-01-01

The purpose of this study was to evaluate the significance of our dental management protocol by observing the chronological change of dental health of head and neck radiotherapy patients. Fifty-two head and neck radiotherapy patients who had received dental management to prevent and/or alleviate their oral complications were enrolled in this study. They were followed for three or more years after radiotherapy. We divided them into three groups according to the timing of the start of dental management; Pre, Mid and Post. The chronological changes of dental status (DMFT and the number of tooth extractions) and osteoradionecrosis were investigated for three to five years. The increase in the DMFT index of the Pre and Mid groups was reduced to less than 2 by introducing our dental management protocol. On the contrary, the number of unavoidable tooth extractions following radiotherapy was the least in the Pre group. The incidence rates of osteoradionecrosis of the mandible in the Pre, Mid and Post groups were 6.5%, 18.0% and 20.0% respectively. Our dental management protocol was proved to be effective in maintaining dental health and helpful in controlling osteoradionecrosis following head and neck radiotherapy. For a more effective outcome, we advocate that dental management should commence before the start of head and neck radiotherapy. (author)

Radiotherapy in the management of orbital lymphoma

International Nuclear Information System (INIS)

Bolek, Timothy W.; Moyses, H. Michael; Marcus, Robert B.; Gorden, Lemuel; Maiese, Russell L.; Almasri, Nidal M.; Mendenhall, Nancy Price

1999-01-01

Purpose: This retrospective study reviews the treatment technique, disease outcome, and complications of radiotherapy used in the management of lymphoma involving the orbits. Patients and Methods: Thirty-eight patients were treated between May 1969 and January 1995, with a median follow-up of 8.3 years. All patients had biopsy-proven orbital lymphoma. Twenty patients who had limited disease were treated with curative intent, and 18 patients who had known systemic disease were treated with palliative intent. Of the 20 patients treated with curative intent, 14 had low-grade and 6 had intermediate- or high-grade disease. None received chemotherapy. Most patients received treatment with 250 kVP or 60 Co radiation, using either an en face anterior field or wedged anterior and lateral fields. Median treatment dose was 25 Gy. Lens shielding was performed if possible. For patients treated for cure, cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method. Results: Control of disease in the orbit was achieved in all but 1 patient, who developed an out-of-field recurrence after irradiation of a lacrimal tumor and was salvaged with further radiotherapy. In the patients treated curatively, the 5-year rate of actuarial freedom from distant relapse was 61% for those with low-grade and 33% for those with intermediate/high-grade disease (p = 0.08). Cause-specific survival at 5 years was 89% for patients with low-grade and 33% for those with intermediate/high-grade disease (p = 0.005). Two patients with low-grade disease had contralateral orbital failures; both were salvaged with further irradiation. Acute toxicity was minimal. Cataracts developed in 7 of 21 patients treated without lens shielding and 0 of 17 patients treated with lens shielding. No patient developed significant late lacrimal toxicity. Conclusion: Radiotherapy is a safe and effective local treatment in the management of orbital lymphoma

Management of hilar bile duct carcinoma with high-dose radiotherapy and expandable metallic stent placement

International Nuclear Information System (INIS)

Saito, Hiroya; Takamura, Akio

2000-01-01

This article describes our experience with high-dose radiotherapy in combination with the placement of expandable metallic stents (EMS) in the management of hilar bile duct carcinoma. Between 1988 and 1999, 107 consecutive patients with hilar bile duct carcinoma were treated with EMS placement either alone or in combination with high-dose radiotherapy. External beam radiotherapy (EBRT) was indicated in 101 patients, and in 86 this was combined with intraluminal 192 Ir irradiation (ILRT, 59-98 Gy) EMS were placed after the completion of radiotherapy. The 1-, 2-, 3-, and 5-year actuarial survival rates for the radiotherapy group were 66.4%, 23.4%, 15.6%, 7.8%, respectively, and the 1- and 2-year actuarial survival rates for the nonradiotherapy group were 66.4% and 0%, respectively. The placement of EMS was useful for the early establishment of an internal bile passage in radically irradiated patients and the 1-, 2-, 3-, and 5-year actuarial patency rates for the radiotherapy group were 56.3%, 45.3%, 35.2%, and 23.4%, respectively, and the 1- and 2-year actuarial patency rates for the non radiotherapy group were 50.0% and 0% respectively. High-dose radiotherapy, consisting of ILRT and EBRT, appears to be feasible in the management of hilar bile duct carcinoma, and it offers a survival advantage for patients no suited for surgical resection. The placement of EMS assists the internal bile flow and lengthens survival after high-dose radiotherapy. (author)

Is argon plasma coagulation an effective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy?

Directory of Open Access Journals (Sweden)

Eduardo Hortelano

Full Text Available Introduction: In severe cases refractory to medical treatment, APC appears to be the preferred alternative to control persistent rectal bleeding of patients with chronic radiation proctitis. Although successful outcomes have been demonstrated in patients previously treated with moderate doses of radiotherapy, there is reluctance towards its indication due to the concern of severe adverse events in patients treated with high doses of radiation. Objectives: The aim of this study was to assess the efficacy and toxicity of APC in the management of bleeding radiation-induced proctitis in patients treated with high doses of radiation for prostate cancer. Methods and materials: Data from 30 patients were treated with APC due to chronic radiation proctitis, were reviewed retrospectively. All cases had prostate cancer and 9 of them (30 % underwent previous radical prostatectomy. The median dose of conformal 3D External Beam Radiotherapy (EBRT delivered was 74 Gy (range 46-76. Median rectal D1cc and D2cc was 72.5 and 72.4 Gy respectively. Median rectal V70, V60 and V40 was 12, 39.5 and 80 %. Cardiovascular and digestive disease, diabetes, smoking behaviour, lowest haemoglobin and transfusion requirements were recorded. Indications for treatment with APC were anemia and persistent bleeding despite medical treatment. Argon gas flow was set at 1.8 l/min with an electrical power setting of 50 W. Results: Median age of all patients was 69.6 years. The median lowest haemoglobin level was 9.6 g/dL. Median time between completion of radiotherapy and first session of APC was 13 months. Ninety-four therapeutic sessions were performed (median 3 sessions. Median time follow-up was 14.5 months (range 2-61. Complete response with resolved rectal bleeding was achieved in 23 patients (77 %, partial response in 5 (16 % and no control in 2 (6 %. No patients required transfusion following therapy. Two patients developed long-term (> 6 weeks grade 2 rectal ulceration and

Erectile dysfunction management options in Nigeria.

Science.gov (United States)

Afolayan, Anthony Jide; Yakubu, Musa Toyin

2009-04-01

In Nigeria, the prevalence of erectile dysfunction (ED) among patients attending primary care clinics, age-standardized to the U.S. population in 2000 is 57.4%. This is considered high enough to warrant the attention of scientist for critical studies and analysis. The high ED prevalence is associated with etiologies such as psychosexual factors, chronic medical conditions, and some lifestyles. ED constitutes a major public health problem, influencing the patient's well-being and quality of life. It also leads to broken homes and marriages, psychological, social, and physical morbidity. To give an account of various ED management options in Nigeria. Review of peer-reviewed literature, questionnaire, and ethnobotanical survey to some indigenous herb sellers and herbalists. Cross cultural perspectives of ED management in Nigeria. The review suggests that traditional (phytotherapy, zootherapy, and occultism) and nontraditional, orthodox practice (drug therapy, psychological, and behavioral counseling) are applicable to ED management in Nigeria. This review should help in creating awareness into various options available for managing ED in the country, but does not recommend self medication of any form, be it the use of orthodox or herbal remedy.

A multi-criteria decision analysis assessment of waste paper management options.

Science.gov (United States)

Hanan, Deirdre; Burnley, Stephen; Cooke, David

2013-03-01

The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

Comparative evaluation of radioactive waste management options. Final report

International Nuclear Information System (INIS)

Appel, D.; Kreusch, J.; Neumann, W.

2001-05-01

A comprehensive presentation of the various radioactive waste options under debate has not been made so far, let alone a comparative evaluation of the options with respect to their substantiated or assumed advantages or drawbacks. However, any appropriate discussion about the pros and cons of the specific options for final decision making has to be based on a comprehensive knowledge base drawn from profound comparative evaluation of essential options. Therefore, the study reported in this publication was to serve three major purposes: Presentation of the conditions and waste management policies and approaches in selected countries, in order to compile information about the various policy goals and the full scope of argumentation, as well as the range of individual arguments used for or against specific options. - Derivation of a methodology for evaluation, including development of criteria for a comparative and qualitative evaluation of options. - Identification of possible implications for a waste management strategy for Germany, derived from the results of the comparative evaluation and the examination of the reasonings and argumentation used in the various countries. (orig./CB) [de

Mammary radiotherapy and patients-risks management with continue evaluation of clinical indicators

International Nuclear Information System (INIS)

Untereiner, M.; Frederick, B.; Burie, D.; Cavuto, C.; Rob, L.; Coiffier, N.; Colet, M.

2009-01-01

Purpose: The breast irradiation represents 25% of radiotherapy indication in the radiotherapy centers. The modeling of the management of complications risks and recurrences in relation with mammary irradiation constitutes a methodological base allowing to develop a general concept for any other indication of radiotherapy. The objective of the study was a continuous evaluation of clinical risks to get indicators of the therapy results: for the institution, to get an auto-evaluation tool of the functioning (continuous evaluation of clinical results, identification of sentinel events); for the patients to get precise and detailed information on the risks linked to their treatment (communication of clinical results, comparison with the literature, benchmarking). (N.C.)

Low-level radioactive waste management options

International Nuclear Information System (INIS)

Schmalz, R.F.

1989-01-01

This paper discusses the non-technical problems associated with the social and political obstacles to the secure disposal of low level radioactive waste. The author reviews thirty years' experience managing non-military wastes. The merits of available options are considered

Economic assumptions for evaluating reactor-related options for managing plutonium

International Nuclear Information System (INIS)

Rothwell, G.

1996-01-01

This paper discusses the economic assumptions in the U.S. National Academy of Sciences' report, Management and Disposition of Excess Weapons Plutonium: Reactor-Related Options (1995). It reviews the Net Present Value approach for discounting and comparing the costs and benefits of reactor-related options. It argues that because risks associated with the returns to plutonium management are unlikely to be constant over time, it is preferable to use a real risk-free rate to discount cash flows and explicitly describe the probability distributions for costs and benefits, allowing decision makers to determine the risk premium of each option. As a baseline for comparison, it assumes that one economic benefit of changing the current plutonium management system is a reduction in on-going Surveillance and Maintenance (S and M) costs. This reduction in the present value of S and M costs can be compared with the discounted costs of each option. These costs include direct construction costs, indirect costs, operating costs minus revenues, and decontamination and decommissioning expenses. The paper also discusses how to conduct an uncertainty analysis. It finishes by summarizing conclusions and recommendations and discusses how these recommendations might apply to the evaluation of Russian plutonium management options. (author)

Cartography and risk management in radiotherapy: a collaborative work of the department of radiotherapy and the department of quality and risk management Institute Jean-Godinot

International Nuclear Information System (INIS)

Nguyen, T.D.; Loiseau, M.; Devie, I.; Heusghem, M.; Gaillot-Petit, N.

2010-01-01

Purpose To deploy an inductive process for radiotherapy risk management in a regional cancer centre and to infer the actions required to solve the situations of criticality. Methods Close collaboration between the department of radiation oncology-biophysics and the department of quality and risk management in the same institution allowed to create a multi professional and multidisciplinary task force and to make the experience feedback easier. A preliminary risk analysis method was used to identify the generic dangers, the mapping of risks and the specification of the scales of criticality. This method helped to evaluate and to rate each apprehended event. Four scales have been defined: seriousness scale in five levels, likelihood scale in five classes, endeavour scale in four levels and criticality scale in three categories: acceptable (criticality 1) tolerable under control (criticality 2) and unacceptable (criticality 3). Results Fifty-seven level 1 dangerous situations linked to 78 scenarios of criticality acceptable, tolerable and unacceptable in 24, 44 and 10 cases respectively have been identified in the department of radiotherapy leading to carry out 28 risk reduction actions. Conclusions The performed risk analysis offered an original frame for a collective thinking among the care providers and contributed to modify their mode of conceiving both security and radioprotection. The study allowed us to give a relevant answer to the High Authority of Health and the Authority of Nuclear Security demands either in terms of efficient management of the risks in radiotherapy or regarding the daily concerns of the care-givers. (authors)

The Role of Postoperative Radiotherapy in the Management of Intracranial Meningiomas

International Nuclear Information System (INIS)

Chang, Sei Kyung; Suh, Chang Ok; Shin, Hyun Soo; Kim, Gwi Eon

1994-01-01

Purpose: To evaluate the role of postoperative radiotherapy in the management of primary or recurrent intracranial meningiomas. Methods and Materials: A retrospective review of 34 intracranial meningioma patients referred to the Yonsei Cancer Center for postoperative radiotherapy between 1981 and 1990 was undertaken. Of the 34 patients, 24 patients received elective postoperative radiotherapy after total or subtotal resection(Group 1), and 10 patients received postoperative radiotherapy as a salvage treatment for recurrent tumors(Group 2). Ten patients received postoperative radiotherapy after total resection, and twenty-four after subtotal resection. Ten patients who had total tumor resection were referred for radiotherapy either because of angioblastic or malignant histologic type (4 patients in Group 1) or because of recurrent disease after initial surgery(6 patients in Group 2). Radiation dose of 50-56Gy was delivered over a period of 5-5.5 weeks using 4MV LINAC or Co-60 teletherapy unit. Results: Overall actuarial progression free survival (PFS) at 5 years was 80%. Survival was most likely affected by histologic subtypes. Five year PFS rate was 52% for benign angioblastic histology, as compared with 100% for classic benign histology. For malignant meningiomas, 5 year PFS rate was 44%. The recurrence rates of classic, angioblastic, and malignant type were 5%(1/21), 80%(4/5), and 50%(4/8), respectively. The duration between salvage post-operative radiotherapy and recurrence was longer than the duration between initial surgery and recurrence in the patients of group 2 with angioblastic or malignant histology. Conclusion: Postoperative radiotherapy of primary or recurrent intracranial meningiomas appears to be effective modality, especially in the patients with classic meningiomas. In angioblastic or malignant histologies, a more effective approach seems to be needed for decreasing recurrence rate

What determines how top managers value their stock options?

NARCIS (Netherlands)

Sautner, Z.; Weber, M.

2008-01-01

What determines how top managers value their executive stock options? We explore this question empirically by using a unique survey data set which combines subjective option valuation data with a wide set of individual-level variables. Inconsistent with the predictions of theory, individuals in our

41 CFR 102-194.5 - What is the Standard and Optional Forms Management Program?

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the Standard and Optional Forms Management Program? 102-194.5 Section 102-194.5 Public Contracts and Property Management... PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.5 What is the Standard and Optional...

Therapeutic challenge in brain metastases: chemotherapy, surgery or radiotherapy

International Nuclear Information System (INIS)

Mena, Ivan; Contreras, Manuel; Ceballos Francisco

1998-01-01

Metastases to the brain occur in 25 to 35% of patients with systemic cancer. Cerebral metastatic is the most common intracranial tumor in adults and occur up to 10 times more frequently than primary tumors in the central nervous system. Significant advances have occurred in the diagnosis and treatment of metastases to the brain, and the therapeutic nihilism of the past is now no longer warranted for most patients. With the currently available treatments, most patients do not die of their brain metastases and usually experience effective palliation of neurologic symptoms and meaning full extension of life. As a trial to limit the cerebral metastatic disease, many and diverse therapy options have been developed such as: chemotherapy, surgery plus whole-brain radiotherapy, only radiation therapy, therapy with neutron, intersticial brachytherapy and stereotactic radiosurgery. In selected cases, surgery plus whole-brain radiotherapy is the conventional treatment for single metastases. However, recurrence usually limits the quality of life and greatly decrease the patients time life, and the therapy options are scarce. This piece of writing also includes a review of the available therapy forms to manage this kind of lesions. (The author)

Management options in the food chain for accidental radionuclide deposition

International Nuclear Information System (INIS)

Rantavaara, A.

2005-12-01

Finland with four other countries participated in the European Union's network project FARMING in 2000 - 2004. The aim of the project was to invite participants from each country representing the food supply chain in a stakeholder group and advance with the groups the networking in building preparedness for accidental contamination of the food production systems. The task of the groups was to evaluate the practicability of management options suggested for reduction of radiation exposure through foodstuffs, and for disposal of waste generated in implementation of these options. The criteria for practicability were effectiveness in reduction of radiation exposure through foodstuffs, technical feasibility, capacity, costs for implementation, secondary costs for waste disposal, socio-economic impact, and acceptability concerning ecology and protection of environment and landscape. Practicable management options aimed at sustainable restoration of food production systems after accidental contamination. The Finnish stakeholder group represented farm production, processing industry, food marketing, catering, advisor organisations for households and agriculture, consumers, nature conservation, the media, experts on environmental impact and authorities responsible for production, safety and security of foodstuffs, food supply and feedstuffs. The group was expected to examine the effect of the Finnish, and, also more generally, northern production conditions on the practicability of the suggested management options. The stakeholder group members first familiarized themselves with intervention after accidental contamination of a large milk production area and thereafter with practicability of individual management options. The evaluation was based on the group members' complementary expertise that very well covered the chain 'from field to fork' whether the issue was related to legislation, production methods, logistics, environmental impacts, or the issues of consumers and

Surgery and radiotherapy in the treatment of cutaneous melanoma

DEFF Research Database (Denmark)

Testori, A; Rutkowski, P; Marsden, J

2009-01-01

on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases....

Calcific tendinitis of the rotator cuff: management options.

Science.gov (United States)

Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options

International Nuclear Information System (INIS)

Moreno, Antonio José Conde; Albiach, Carlos Ferrer; Soria, Rodrigo Muelas; Vidal, Verónica González; Gómez, Raquel García; Antequera, María Albert

2014-01-01

There are various subgroups of patients with metastatic prostate cancer: polymetastatic, oligometastatic, or oligo-recurrent cancers whose progression follows different courses and for whom there are different treatment options. Knowledge of tumor dissemination pathways and different genetic and epigenetic tumor profiles, as well as their evolution during disease progression, along with new diagnostic and therapeutic advances has allowed us to address these situations with local ablative treatments such as stereotactic body radiation therapy or stereotactic radiosurgery. These treatments provide high rates of local control with low toxicity in metastatic spread for primary cancers including those of pulmonary, digestive, and renal origin, while these types of treatments are still emerging for cancers of prostatic origin. There are several retrospective studies showing the effectiveness of such treatments in prostate cancer metastases, which has led to the emergence of prospective studies on the issue and even some phase II studies intended to prevent or delay systemic treatments such as chemotherapy. Here we collect together and review these past experiences and the studies currently underway. These types of radiotherapy treatments redefine how we approach extracranial metastatic disease and open up new possibilities for combination therapy with new systemic treatment agents

Quo vadis radiotherapy? Technological advances and the rising problems in cancer management.

Science.gov (United States)

Allen, Barry J; Bezak, Eva; Marcu, Loredana G

2013-01-01

Despite the latest technological advances in radiotherapy, cancer control is still challenging for several tumour sites. The survival rates for the most deadly cancers, such as ovarian and pancreatic, have not changed over the last decades. The solution to the problem lies in the change of focus: from local treatment to systemic therapy. The aim of this paper is to present the current status as well as the gaps in radiotherapy and, at the same time, to look into potential solutions to improve cancer control and survival. The currently available advanced radiotherapy treatment techniques have been analysed and their cost-effectiveness discussed. The problem of systemic disease management was specifically targeted. Clinical studies show limited benefit in cancer control from hadron therapy. However, targeted therapies together with molecular imaging could improve treatment outcome for several tumour sites while controlling the systemic disease. The advances in photon therapy continue to be competitive with the much more expensive hadron therapy. To justify the cost effectiveness of proton/heavy ion therapy, there is a need for phase III randomised clinical trials. Furthermore, the success of systemic disease management lies in the fusion between radiation oncology technology and microbiology.

A multicentre 'end to end' dosimetry audit of motion management (4DCT-defined motion envelope) in radiotherapy.

Science.gov (United States)

Palmer, Antony L; Nash, David; Kearton, John R; Jafari, Shakardokht M; Muscat, Sarah

2017-12-01

External dosimetry audit is valuable for the assurance of radiotherapy quality. However, motion management has not been rigorously audited, despite its complexity and importance for accuracy. We describe the first end-to-end dosimetry audit for non-SABR (stereotactic ablative body radiotherapy) lung treatments, measuring dose accumulation in a moving target, and assessing adequacy of target dose coverage. A respiratory motion lung-phantom with custom-designed insert was used. Dose was measured with radiochromic film, employing triple-channel dosimetry and uncertainty reduction. The host's 4DCT scan, outlining and planning techniques were used. Measurements with the phantom static and then moving at treatment delivery separated inherent treatment uncertainties from motion effects. Calculated and measured dose distributions were compared by isodose overlay, gamma analysis, and we introduce the concept of 'dose plane histograms' for clinically relevant interpretation of film dosimetry. 12 radiotherapy centres and 19 plans were audited: conformal, IMRT (intensity modulated radiotherapy) and VMAT (volumetric modulated radiotherapy). Excellent agreement between planned and static-phantom results were seen (mean gamma pass 98.7% at 3% 2 mm). Dose blurring was evident in the moving-phantom measurements (mean gamma pass 88.2% at 3% 2 mm). Planning techniques for motion management were adequate to deliver the intended moving-target dose coverage. A novel, clinically-relevant, end-to-end dosimetry audit of motion management strategies in radiotherapy is reported. Copyright © 2017 Elsevier B.V. All rights reserved.

The role of radiotherapy in the management of extrahepatic bile duct cancer: an analysis of 145 consecutive patients treated with intraluminal and/or external beam radiotherapy

International Nuclear Information System (INIS)

Kamada, Tadashi; Saitou, Hiroya; Takamura, Akio; Nojima, Takayuki; Okushiba, Shun-Ichi

1996-01-01

Purpose: To determine the feasibility of high dose radiotherapy and to evaluate its role in the management of extrahepatic bile duct (EHBD) cancer. Methods and Materials: Between 1983 and 1991, 145 consecutive patients with EHBD cancer were treated by low dose rate intraluminal 192 Ir irradiation (ILRT) either alone or in combination with external beam radiotherapy (EBRT). Among the primarily irradiated, 77 patients unsuitable for surgical resection, 54 were enrolled in radical radiotherapy, and 23 received palliative radiotherapy. Fifty-nine received postoperative radiotherapy, and the remaining 9 preoperative radiotherapy. The mean radiation dose was 67.8 Gy, ranging from 10 to 135 Gy. Intraluminal 192 Ir irradiation was indicated in 103 patients, and 85 of them were combined with EBRT. Expandable metallic biliary endoprosthesis (EMBE) was used in 32 primarily irradiated patients (31 radical and 1 palliative radiotherapy) after the completion of radiotherapy. Results: The 1-, 3-, and 5-year actuarial survival rates for all 145 patients were 55%, 18%, and 10%, for the 54 patients treated by radical radiotherapy (mean 83.1 Gy), 56%, 13%, and 6% [median survival time (MST) 12.4 months], and for the 59 patients receiving postoperative radiotherapy (mean 61.6 Gy), 73%, 31%, and 18% (MST 21.5 months), respectively. Expandable metallic biliary endoprosthesis was useful for the early establishment of an internal bile passage in radically irradiated patients and MST of 14.9 months in these 31 patients was significantly longer than that of 9.3 months in the remaining 23 patients without EMBE placement (p < 0.05). Eighteen patients whose surgical margins were positive in the hepatic side bile duct(s) showed significantly better survival compared with 15 patients whose surgical margins were positive in the adjacent structure(s) (44% vs. 0% survival at 3 years, p < 0.001). No survival benefit was obtained in patients given palliative or preoperative radiotherapy

Department and patient management in radiotherapy. The Freiburg model

International Nuclear Information System (INIS)

Heinemann, Felix; Frommhold, Hermann; Roehner, Fred; Bruggmoser, Gregor; Schmucker, Marianne; Henne, Karl; Grosu, Anca-Ligia

2009-01-01

Background and Purpose: The activities in radiotherapy are mainly affected by numerous partly very complex operational procedures which have to be completed while high safety requirements have to be fulfilled. This fact and steadily increasing economic pressure are forcing us to develop new strategies which help us to optimize our operational procedures and assure their reliability. As there are not so many radiotherapeutic institutions and the main focus, up to now, was mainly stressed on the acceleration systems (radiation planning, acceleration control), only few industrial systems are available which could also support the economic, organizational and administrative needs of radiotherapy. Methods: During the building operations for the 'new clinic for radiotherapy' at the University Hospital Freiburg, Germany, the staff of the clinical and administrative information and the medical physicists developed, in close cooperation with the physicians, a comprehensive concept to control and organize a radiotherapeutic institution. This concept was examined during the construction phase of the new clinic and the adjoined HBFG ('Hochschulbaufoerderungsgesetz') process by the 'Deutsche Forschungsgemeinschaft' and financed totally by federal funds. Results and Conclusion: The precondition for the goal to operate a homogeneous and comprehensive management of a clinic for radiotherapy was the direct connection of the acceleration area with the organizational/administrative surrounding. The thus developed common basic dates and consistence created transparency and allowed us for the first time to control all operational procedures by EDV-technical means. After 2 years full-time operation and implementation of numerous particular projects we are now ready for film- and paperless digital work. (orig.)

Malignant gliomas of the brain managed by radiotherapy after surgery

Energy Technology Data Exchange (ETDEWEB)

Fichardt, T.; Sandison, A.G. (Pretoria Univ. (South Africa). Dept. of Radiotherapy)

The article reviews the literature and gives an account of the authors' experience during a 20-year period (1960-1980) of the value of radiotherapy after surgery in the management of 76 patients suffering from brain gliomas classified into 3 grades according to the degree of anaplasia present in the histological sections, viz. grades II, III and IV. Radiotherapy was not given to grade I malignant gliomas as they are treated by surgery only. The period is divided into 2 subperiods. The first is from 1960-1972 when part-brain, high-dose irradiation following surgery was used on 33 patients in various age groups. The second period covers whole-brain, low-dose irradiation following surgery and was used on 43 patients in various age groups.

Radioiodine and radiotherapy in the management of thyroid cancers

International Nuclear Information System (INIS)

Simpson, W.J.

1990-01-01

Radioiodine is an important adjuvant treatment in the management of resectable papillary and follicular thyroid cancers in all patients except those with the best prognostic features. External radiation is also an important adjuvant therapy in these patients, especially those with tumors that extend beyond the thyroid gland and invade the trachea, esophagus, nerves, and blood vessels; it is especially important in treating patients whose tumors do not concentrate radioiodine. Radioiodine may be curative in patients with microscopic distant metastases demonstrated by radioiodine scanning. Even unresectable primary papillary and follicular cancers may be eradicated by combined therapy with radioiodine and radiotherapy. Radioiodine plays no significant role in the treatment of medullary or anaplastic thyroid cancers, but external radiation may eradicate microscopic thyroid bed or nodal disease when persistent disease is indicated by elevated calcitonin levels in medullary thyroid cancer patients. Anaplastic thyroid cancers are usually unresectable and are not eradicated by conventional radiotherapy or by any of the novel radiation techniques, with or without chemotherapy. In all types of thyroid cancer, external radiotherapy may produce beneficial palliative results in patients with distant metastases, but the use of radioiodine should always be explored in papillary and follicular thyroid cancer patients. 30 references

Radiotherapy in Cancer Management

International Nuclear Information System (INIS)

Abdel-Wahab, M.

2015-01-01

Radiotherapy has been used for curative or palliative treatment of cancer, either alone or increasingly as part of a multimodality approach in conjunction with chemotherapy, immunotherapy or surgery. Radiation must be delivered in the safest and most effective way. The use of radiologic and nuclear medicine diagnostic techniques, e.g., the use of CT (Computerized Tomography) and PET/CT allow better detection and staging of diseases by displaying both morphological and functional abnormalities within the affected organs and are essential in the process of radiotherapy planning. Technical advances in radiotherapy have allowed better targeting of tumors, sparing of normal tissue and, in the case of radiosurgery, a decrease in the number of treatments. The IAEA Programme in Human Health aims to enhance the capabilities in Member States to address needs related to the treatment of diseases, including cancer, through the application of nuclear techniques. The Programme supports quality assurance in radiation medicine; DIRAC, the only radiation oncology-specific resource database world-wide; significant, innovative education and training programmes through telemedicine and e-learning accessible via the human health campus website. Technical expertise for country– and region–specific technical cooperation radiation-medicine projects is provided to establish or enhance radiation medicine worldwide. (author)

13 CFR 107.250 - Exclusion of stock options issued by Licensee from Management Expenses.

Science.gov (United States)

2010-01-01

... Sbic § 107.250 Exclusion of stock options issued by Licensee from Management Expenses. Stock options... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Exclusion of stock options issued by Licensee from Management Expenses. 107.250 Section 107.250 Business Credit and Assistance SMALL...

[From quality management to dynamic management through quality: Deployment within a radiotherapy group].

Science.gov (United States)

Guerrier, B; Halm, É; Craman, M; Dujols, J-P; Norkowski, J-L; Meynard, K

2017-10-01

In 2015, the quality group of the radiotherapy clinic Groupement de Radiothérapie et d'Oncologie des Pyrénées (GROP, Pau, France) decided to review the deployment of its quality approach in order to optimize it continuously. For this, two improvements were proposed: an involvement of process drivers and a material and financial investment in document management software. The implementation of these organizational and managerial provisions enabled us to better cover the requirements of the ISO 9001 standard, the international reference in quality management. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Management of Men with Prostate-specific Antigen Failure After Prostate Radiotherapy: The Case Against Early Androgen Deprivation.

Science.gov (United States)

Brand, Douglas; Parker, Chris

2018-04-01

In men with prostate-specific antigen failure after radical radiotherapy, androgen deprivation therapy should be delayed until the site of recurrence is known to allow consideration of curative treatment options, to delay androgen deprivation therapy-related morbidity, and to enable earlier access to abiraterone and docetaxel. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Option managing for radioactive metallic waste from the decommissioning of Kori Unit 1

Energy Technology Data Exchange (ETDEWEB)

Kessel, David S.; Kim, Chagn Lak [KEPCO International Nuclear Graduate School (KINGS), Ulsan (Korea, Republic of)

2017-06-15

The purpose of this paper is to evaluate several leading options for the management of radioactive metallic waste against a set of general criteria including safety, cost effectiveness, radiological dose to workers and volume reduction. Several options for managing metallic waste generated from decommissioning are evaluated in this paper. These options include free release, controlled reuse, and direct disposal of radioactive metallic waste. Each of these options may involve treatment of the metal waste for volume reduction by physical cutting or melting. A multi-criteria decision analysis was performed using the Analytic Hierarchy Process (AHP) to rank the options. Melting radioactive metallic waste to produce metal ingots with controlled reuse or free release is found to be the most effective option.

French programs for advanced waste management options

Energy Technology Data Exchange (ETDEWEB)

Salvatores, M [CEA-DRN (France); Schapira, J P [CNRS-IN2P3 (France); Mouney, H [EDF-DE (France)

1997-11-01

Several organisms (CEA, CNRS, EdF, etc.) are cooperating in France on Accelerator-Driven Systems (ADS). The major motivation is the investigation of innovative options for the radioactive waste management. The paper describes the ongoing activities and future directions of this cooperative effort in the field of ADS. 11 refs, 3 figs.

Using real options analysis to support strategic management decisions

Science.gov (United States)

Kabaivanov, Stanimir; Markovska, Veneta; Milev, Mariyan

2013-12-01

Decision making is a complex process that requires taking into consideration multiple heterogeneous sources of uncertainty. Standard valuation and financial analysis techniques often fail to properly account for all these sources of risk as well as for all sources of additional flexibility. In this paper we explore applications of a modified binomial tree method for real options analysis (ROA) in an effort to improve decision making process. Usual cases of use of real options are analyzed with elaborate study on the applications and advantages that company management can derive from their application. A numeric results based on extending simple binomial tree approach for multiple sources of uncertainty are provided to demonstrate the improvement effects on management decisions.

Municipal solid waste options : integrating organics management and residual disposal treatment : executive summary

Energy Technology Data Exchange (ETDEWEB)

Cant, M. (comp.) [Totten Sims Hubicki Associates Ltd., Calgary, AB (Canada); Van der Werf, P. [2cg Inc., Edmonton, AB (Canada); Kelleher, M. [Kelleher Environmental, Toronto, ON (Canada); Merriman, D. [MacViro Consultants, Markham, ON (Canada); Fitcher, K. [Gartner Lee Ltd., Toronto, ON (Canada); MacDonald, N. [CH2M Hill Engineering Ltd., Calgary, AB (Canada)

2006-04-15

The Municipal Solid Waste (MSW) Options Report explored different MSW management options for 3 community sizes: 20,000, 80,000 and 200,0000 people. It was released at a time when many communities were developing waste management plans to cost-effectively reduce environmental impacts and conserve landfill capacity. The purpose of this report was to provide a greater understanding on the environmental, social, economic, energy recovery/utilization and greenhouse gas (GHG) considerations of MSW management. The report also demonstrated the interrelationships between the management of organics and residuals. It was based on information from existing waste diversion and organics management options and emerging residual treatment technology options. The following organics management and residual treatment disposal options were evaluated: composting; anaerobic digestion; sanitary landfills; bioreactor landfills; and thermal treatment. Composting was examined with reference to both source separated organics (SSO) and mixed waste composting. SSO refers to the separation of materials suitable for composting solid waste from households, while mixed waste composting refers to the manual or mechanical removal of recyclable material from the waste, including compost. The composting process was reviewed along with available technologies such as non-reactor windrow; aerated static pile; reactor enclosed channel; and, container tunnel. An evaluation of SSO and mixed waste composting was then presented in terms of environmental, social, financial and GHG impacts. refs., tabs., figs.

2001 updated standard options and recommendations for radiotherapy in non metastatic breast cancer patients

International Nuclear Information System (INIS)

Fourquet, A.; Sigal-Zafrani, B.; Cutuli, B.; Luporsi, E.; Lesur, A.

2002-01-01

Context. - The 'Standards, Options an Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of french cancer centers (FNCLCC), the 20 french cancer centers, and specialists from french public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives. -To develop clinical practice guidelines for non metastatic breast cancer patients according to the definitions of the Standards, Options and Recommendations project. Methods. -Data were identified by searching Medline, web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 148 independent reviewers. Results. - This article presents the chapter radiotherapy resulting from the 2001 update of the version first published in 1996. The modified 2001 version of the standards, options and recommendations takes into account new information published. The main recommendations are (1) Breast irradiation after conservative surgery significatively decrease the risk of local recurrence (level of evidence A) and the decrease in the risk of local recidivation after chest wall irradiation is greater as the number of risk factors for local recurrence increases (level of evidence A). (2) After conservative surgery, a whole breast irradiation should be performed at a minimum dose of 50 Gy in 25 fractions (standard, level of evidence A). (3) A boost in the tumour bed should be performed in women under 50 years, even if the surgical margins are free (standard, level of evidence B). (4) Internal mammary chain irradiation is indicated for internal or central tumours in the absence of axillary

Radiotherapy in the management of orbital lymphoma

International Nuclear Information System (INIS)

Bolek, Timothy W.; Moyses, H. Michael; Marcus, Robert B.; Mendenhall, Nancy Price

1996-01-01

Purpose/Objective: This retrospective study reviews the treatment technique, disease outcome and complications of radiotherapy used in the management of lymphoma involving the orbits. Materials and Methods: Thirty-eight patients were treated between May 1969 and January 1995 with a median follow-up of 8.3 years. All patients had biopsy-proven orbital lymphoma. Therapy was delivered with curative intent in 20 patients and with palliative intent in 18 patients who had known systemic disease. Of the 20 patients treated with curative intent, 14 had low-grade and 6 had intermediate or high-grade disease. None received chemotherapy. Most patients received treatment with 250 kVP or 60 Co X rays, using either an en face anterior field or wedged anterior and lateral fields. Treatment dose ranged from 5 to 53 Gy with a median of 25 Gy. Lens shielding was performed using either a lead contact lens or a hanging brass shield. For patients treated for cure, cause-specific survival and freedom from distant relapse were calculated using the Kaplan-Meier method. Results: Control of disease in the orbit was achieved in all but 1 patient, who developed an out-of-field recurrence after irradiation of a lacrimal tumor. This patient was salvaged with further radiotherapy. In the patients treated curatively, 5 year actuarial freedom from distant relapse was 61% for those with low-grade and 33% for those with intermediate/high-grade disease (p = 0.08). Cause-specific survival at 5 years was 89% for patients with low-grade and 33% for those with intermediate/high grade disease (p = 0.005). There were 2 contralateral orbital failures, both in patients with low-grade disease, and both patients were salvaged with further irradiation. Treatment failed in nodal sites alone in 4 patients, and none were salvaged. Relapses occurred in both nodal and extra nodal sites in 3 patients, and 2 of them were treated successfully with chemotherapy. Acute toxicity was minimal. Cataracts developed in 7 of 21

Quality Management in Radiotherapy. Chapter 19

International Nuclear Information System (INIS)

Scalliet, P.

2017-01-01

Soon after the discovery of X rays and natural radioactivity, the therapeutic use of ionizing radiation grew into what has today become an important oncological specialty, with unmatched cost–benefit features. Radiotherapy is an inexpensive solution to many cancers; it is a reproducible technique with fundamentals that rely both on a large set of evidence based medical data and on high technology equipment that has benefited from the digital revolution in the second half of the twentieth century. One characteristic of radiotherapy is its narrow therapeutic window, with cure being never very far from injury. Therefore, radiotherapy administration requires great accuracy in target volume definition and dose control. Modest underdosage leads to the recurrence of cancer, while overdosage leads to unacceptable toxicity. While more sophisticated treatment techniques have emerged recently (intensity modulation, image guidance, hadrons), equally sophisticated means to control the actual delivery of radiotherapy have been developed. Better control of dose delivery allows for better delineation between target tissue exposed to high doses and normal tissue shielded to the maximum, with steep dose gradients sometimes over a few millimetres. This, in turn, requires better volume definition and better control of patient positioning.

A PC-based software package for modeling DOE mixed-waste management options

International Nuclear Information System (INIS)

Abashian, M.S.; Carney, C.; Schum, K.

1995-02-01

The U.S. Department of Energy (DOE) Headquarters and associated contractors have developed an IBM PC-based software package that estimates costs, schedules, and public and occupational health risks for a range of mixed-waste management options. A key application of the software package is the comparison of various waste-treatment options documented in the draft Site Treatment Plans prepared in accordance with the requirements of the Federal Facility Compliance Act of 1992. This automated Systems Analysis Methodology consists of a user interface for configuring complexwide or site-specific waste-management options; calculational algorithms for cost, schedule and risk; and user-selected graphical or tabular output of results. The mixed-waste management activities modeled in the automated Systems Analysis Methodology include waste storage, characterization, handling, transportation, treatment, and disposal. Analyses of treatment options identified in the draft Site Treatment Plans suggest potential cost and schedule savings from consolidation of proposed treatment facilities. This paper presents an overview of the automated Systems Analysis Methodology

Evaluating Nitrogen Management Options for Reducing Nitrate Leaching from Northeast U.S. Pastures

Directory of Open Access Journals (Sweden)

William L. Stout

2001-01-01

Full Text Available Substantial amounts of nitrate nitrogen NO3-N can leach from intensively grazed pasture in the northeast U.S. where there is about 30 cm of groundwater recharge, annually. Management options for reducing NO3-N leaching were evaluated for this environment using the Cornell Net Carbohydrate and Protein System Model and a recently developed nitrogen leaching index. Management options utilizing energy supplementation of grazing dairy cows could improve nitrogen efficiency within the cow, but would not necessarily reduce NO3-N leaching at the pasture scale if stocking rate was not controlled. The management option of using white clover to supply nitrogen to the pasture decreased NO3-N leaching, but produced less dry matter yield, which in turn reduced stocking rate. The economic returns of reducing NO3-N with these options need to be evaluated in light of milk prices and commodity and fertilizer nitrogen costs. At current prices and costs, the economic benefit from the energy supplementation options is substantial.

Contemporary management of stage i testicular seminoma: a survey of Canadian radiation oncologists

Science.gov (United States)

Samant, R.; Alomary, I.; Genest, P.; Eapen, L.

2008-01-01

Recently published studies clearly indicate that there are now several acceptable options for managing stage i testicular seminoma patients after orchiectomy. We therefore decided to survey Canadian radiation oncologists to determine how they currently manage such patients and to compare the results with previous surveys. Our results demonstrate that adjuvant single-agent chemotherapy is being considered as an option by an increasing proportion of radiation oncologists (although it is not considered the preferred option), the routine use of radiotherapy is declining, and surveillance is becoming increasingly popular and is recommended most often. PMID:18769613

Energy options

International Nuclear Information System (INIS)

Hampton, Michael

1999-01-01

This chapter focuses on energy options as a means of managing exposure to energy prices. An intuitive approach to energy options is presented, and traditional definitions of call and put options are given. The relationship between options and swaps, option value and option exercises, commodity options, and option pricing are described. An end-user's guide to energy option strategy is outlined, and straight options, collars, participating swaps and collars, bull and bear spreads, and swaption are examined. Panels explaining the defining of basis risk, and discussing option pricing and the Greeks, delta hedging, managing oil options using the Black-Scholes model, caps, floors and collars, and guidelines on hedging versus speculation with options are included in the paper

Radiotherapy and wound healing: principles, management and prospects (review).

Science.gov (United States)

Gieringer, Matthias; Gosepath, Jan; Naim, Ramin

2011-08-01

Radiation therapy is a major therapeutic modality in the management of cancer patients. Over 60% of these patients receive radiotherapy at some point during their course of treatment and over 90% will develop skin reactions after therapy. Problematic wound healing in radiation-damaged tissue constitutes a major surgical difficulty and despite all efforts, irradiated skin remains a therapeutic challenge. This review provides an overview of the fundamental principles of radiation therapy with regards to the wound healing in normal and irradiated skin. Furthermore, it presents techniques that describe how to prevent and manage skin side effects as well as prospects that may improve cutaneous wound repair in general and in irradiated skin.

Market based generation: A promising market management option

International Nuclear Information System (INIS)

Siddiqi, R.

1992-01-01

It is proposed to ease the tension between demand management and supply side management at electric utilities through the introduction of a concept called market management. Market management provides a framework for developing and evaluating the attractiveness of new products and services such as dispersed generation hardware, implementation services, and complementary pricing structures. A market management strategy is the definition of market segments, creating products for those segments, evaluation of the profitability of the product-segment combinations, commitment of resources to those segments, and development of product and marketing plans for those segments. A brief analysis of backup generation is presented as an example of market management. In this example, the customer that is backed up shares some portion of the capital and maintenance costs of the backup unit through priority service rates; the utility and customers that are not backed up can obtain the use of the generating resource but pay only a portion of its costs. Backup generation programs have been found to provide utilities with the ability to meet peak load requirements more cheaply than by investing in peaking capacity. Other benefits for utilities include protection of market share, more efficient rates, and a new source of revenues. With the advances in the technology of small-scale generation, utilities can examine bundling various pricing options with market based generation to offer alternative value-added service options to customer segments with demand characteristics that make these technologies attractive. 3 figs

A national survey of current practices of preparation and management of radical prostate radiotherapy patients during treatment

International Nuclear Information System (INIS)

Nightingale, H.; Conroy, R.; Elliott, T.; Coyle, C.; Wylie, J.P.; Choudhury, A.

2017-01-01

Aims: Radiotherapy is an important radical treatment for prostate cancer patients with services continually evolving. This survey aims to gain an insight in to the variation of radiotherapy practices in the UK, focussing on pre-treatment preparations, on-treatment review and management of radical prostate cancer patients undergoing radiotherapy. To our knowledge this is the first survey reported focussing on prostate radiotherapy practices with responses from a mix of health professionals. Materials and methods: A national survey was designed based on current known practices in supportive care and management of prostate cancer patients. The survey was distributed to lead radiotherapy personnel in radiotherapy services across the UK with a 77% response rate (n = 54). Results: Pre-treatment protocols were mandated in the majority of departments. Use of bladder filling (98%) and bowel emptying (66%) were frequently deployed. Bowel preparation varied between use of laxatives (13%) or enemas (41%) to achieve consistency. On-treatment reviews were carried out by a mix of health professionals; most commonly shared between oncologists and radiographers (20%). Radiographers reviewing patients were independent prescribers in 22% of departments. Toxicity grading tools were not used by almost half of departments (47%) either at baseline and/or on-treatment reviews. Written information about follow-up was given to patients towards the end of their radiotherapy; however, fewer departments included the length of hormone duration (13%). Conclusion: This survey has demonstrated variations in practice exist across the UK. These variations suggest that important questions about the best methods for treatment accuracy and patient management need to be established through further research. - Highlights: • Results of a national survey demonstrate wide variations in UK practice. • Lack of a clear evidence base could be a contributing factor to such variation. • Practices are

Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

LENUS (Irish Health Repository)

Joyce, M

2012-02-01

BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.

How PET is changing the management of cancer with radiotherapy

International Nuclear Information System (INIS)

Mac Manus, M.

2005-01-01

Information from PET scanning is transforming the management of many malignancies and the impact of PET is likely to increase further as new indications are recognised. PET is of particular value in patients treated with radiotherapy (RT) with curative intent. These patients rarely undergo invasive surgical staging and therefore imaging is crucial in determining the extent of disease before treatment. More accurate staging with PET means that futile aggressive RT or chcmoRT can be avoided in patients with incurable extensive disease. FDG-PET is of proven value in the staging of common metabolically-active malignancies treated with radiotherapy. These include lung cancer, head and neck cancer, lymphomas and oesophageal carcinoma. It has been shown that PET can improve the selection of patients for radical surgery or radiotherapy in lung cancer and that PET-based staging more accurately predicts survival than conventional staging. For those patients that remain eligible for definitive RT after PET. treatment can be more accurately targeted at the tumour and involved regional nodes. The value of PET for treatment planning is enhanced significantly when PET and CT scans are acquired on a combined PET/CT scanner. Fused PET-CT images can be imported into the radiotherapy planning computer and used to accurately target tumour with the best beam arrangement. After treatment, response may be hard to assess with structural imaging. PET-rcsponse to chemotherapy or radiotherapy in non-small cell lung cancer (NSCLC) predicts survival in NSCLC more accurately than CT response. However, PET has much more potential than imaging with FDG alone can realise. Markers such as FLT can be used to image proliferation in tumours, misonidazole or FAZA can be used to image hypoxia and labeled metabolites of anti-cancer drugs such as 5-FU can be used to study pharmacokinetics. New combinations of radiation and drugs may emerge that can be selected based on biological characteristics of

Risk management with options and futures under liquidity risk

OpenAIRE

Adam-Müller, A F A; Panaretou, A

2009-01-01

Futures hedging creates liquidity risk through marking to market. Liquidity risk matters if interim losses on a futures position have to be financed at a markup over the risk-free rate. This study analyzes the optimal risk management and production decisions of a firm facing joint price and liquidity risk. It provides a rationale for the use of options on futures in imperfect capital markets. If liquidity risk materializes, the firm sells options on futures in order to partly cover this liqui...

The role of radiotherapy in the management of POEMS syndrome

OpenAIRE

Suh, Yang-Gun; Kim, Young-Suk; Suh, Chang-Ok; Kim, Yu Ri; Cheong, June-Won; Kim, Jin Seok; Cho, Jaeho

2014-01-01

Background POEMS syndrome is a paraneoplastic syndrome caused by an underlying plasma cell proliferative disease. In this study, we examined the treatment outcomes and role of radiotherapy in the management of POEMS syndrome. Methods In total, 33 patients diagnosed with POEMS syndrome were analyzed. These patients presented with osteosclerotic myeloma (OSM, n = 13), Castleman’s disease (CD, n = 4), OSM with CD (n = 10), and vascular endothelial growth factor elevation without gross lesions (V...

Forest managment options for sequestering carbon in Mexico

International Nuclear Information System (INIS)

Masera, O.R.; Bellon, M.R.; Segura, G.

1995-01-01

This paper identifies and examines economic response options to avoid carbon emissions and increase carbon sequestration in Mexican forests. A ''Policy'' scenario covering the years 2000, 2010 and 2030 and a ''Technical Potential'' scenario (year 2030) are developed to examine the potential carbon sequestration and costs of each response option. Benefit-cost analyses for three case studies, including management of a pulpwood plantation, a native temperate forest and a native tropical evergreen forest are presented and discussed. The study suggests that a large potential for reducing carbon emissions and increasing carbon sequestration exists in Mexican forests. However, the achievement of this potential will require important reforms to the current institutional setting of the forest sector. The management of native temperate and tropical forests offers the most promising alternatives for carbon sequestration. The cost effectiveness of commercial plantations critically depends on very high site productivity. Restoration of degraded forest lands; particularly through the establishment of energy plantations, also shows a large carbon sequestration potential. (Author)

Radiotherapy Technical Considerations in the Management of Locally Advanced Pancreatic Cancer: American-French Consensus Recommendations

International Nuclear Information System (INIS)

Huguet, Florence; Goodman, Karyn A.; Azria, David; Racadot, Severine; Abrams, Ross A.

2012-01-01

Summary: Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose

Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations.

Science.gov (United States)

Huguet, Florence; Goodman, Karyn A; Azria, David; Racadot, Severine; Abrams, Ross A

2012-08-01

Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose intensity

Evaluation of dairy effluent management options using multiple criteria analysis.

Science.gov (United States)

Hajkowicz, Stefan A; Wheeler, Sarah A

2008-04-01

This article describes how options for managing dairy effluent on the Lower Murray River in South Australia were evaluated using multiple criteria analysis (MCA). Multiple criteria analysis is a framework for combining multiple environmental, social, and economic objectives in policy decisions. At the time of the study, dairy irrigation in the region was based on flood irrigation which involved returning effluent to the river. The returned water contained nutrients, salts, and microbial contaminants leading to environmental, human health, and tourism impacts. In this study MCA was used to evaluate 11 options against 6 criteria for managing dairy effluent problems. Of the 11 options, the MCA model selected partial rehabilitation of dairy paddocks with the conversion of remaining land to other agriculture. Soon after, the South Australian Government adopted this course of action and is now providing incentives for dairy farmers in the region to upgrade irrigation infrastructure and/or enter alternative industries.

Development of integrated waste management options for irradiated graphite

Energy Technology Data Exchange (ETDEWEB)

Wareing, Alan; Abrahamsen-Mills, Liam; Fowler, Linda; Jarvis, Richard; Banford, Anthony William [National Nuclear Laboratory, Warrington (United Kingdom); Grave, Michael [Doosan Babcock, Gateshead (United Kingdom); Metcalfe, Martin [National Nuclear Laboratory, Gloucestershire (United Kingdom); Norris, Simon [Radioactive Waste Management Limited, Oxon (United Kingdom)

2017-08-15

The European Treatment and Disposal of Irradiated Graphite and other Carbonaceous Waste project sought to develop best practices in the retrieval, treatment, and disposal of irradiated graphite including other irradiated carbonaceous waste such as structural material made of graphite, nongraphitized carbon bricks, and fuel coatings. Emphasis was given on legacy irradiated graphite, as this represents a significant inventory in respective national waste management programs. This paper provides an overview of the characteristics of graphite irradiated during its use, primarily as a moderator material, within nuclear reactors. It describes the potential techniques applicable to the retrieval, treatment, recycling/reuse, and disposal of these graphite wastes. Considering the lifecycle of nuclear graphite, from manufacture to final disposal, a number of waste management options have been developed. These options consider the techniques and technologies required to address each stage of the lifecycle, such as segregation, treatment, recycle, and ultimate disposal in a radioactive waste repository, providing a toolbox to aid operators and regulators to determine the most appropriate management strategy. It is noted that national waste management programs currently have, or are in the process of developing, respective approaches to irradiated graphite management. The output of the Treatment and Disposal of Irradiated Graphite and other Carbonaceous Waste project is intended to aid these considerations, rather than dictate them.

Socia preferences to Mopane woodland management options: A ...

African Journals Online (AJOL)

Socia preferences to Mopane woodland management options: A case study from Southern Zimbabwe. TA Gondo, C Musvoto, T Mujawo. Abstract. No Abstract. Discovery and Innovation Vol. 19 (1&2) 2007: pp.4-14. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

Quality management system in radiotherapy in the light of regulations applicable in Poland

Science.gov (United States)

2012-01-01

The need to establish conditions for safe irradiation was noted in Poland back in 1986 in the Atomic Law, but for over 16 years no regulations regarding this aspect were passed. The radiological incident in Bialystok (Poland) in 2001 undeniably accelerated the implementation of new legal regulations. Nevertheless, in the absence of national guidelines until 2002, most health care institutions resorted to the quality management system (QMS) model proposed by the ISO norm 9001:2000. Eventually, practice proved the theory and the aforementioned model was also implemented into Polish acts of law defining basic requirements for QMS in radiotherapy. The aim of this work is to review current national regulations regarding QMS in radiotherapy, in particular those referring to standard procedures, the establishment of a commission for procedures and performance of external and internal clinical audits in oncological radiotherapy, as well as to present the process of their implementation into the practice of health care institutions. PMID:23788867

A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult's recurrent craniopharyngioma.

Science.gov (United States)

Preece, David; Allan, Alfred; Becerra, Rodrigo

2016-01-01

To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning. JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy. JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy. Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD's IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained. These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.

Conventional megavoltage radiotherapy in the management of malignant epithelial tumours of the parotid gland

International Nuclear Information System (INIS)

Piedbois, P.; Bataini, J.P.; Colin, P.; Jaulerry, C.; Brunin, F.; Pontvert, D.; Durand, J.C.

1989-01-01

This is an evaluation of definitive conventional megavoltage radiotherapy in a consecutive series of 35 patients presenting malignant epithelial tumours of the parotid gland. In this series, the 5-year actuarial locoregional control rate was 41% with a 5-year crude survival rate of 36%. The results are analyzed according to tumour presentation and tumour doses. Six of 15 patients with tumours larger than 6 cm have had a lasting locoregional control. During the same period 43 other patients received radiotherapy as a post-operative modality. Results obtained in this group confirm the previously published data. While recent studies tend to demonstrate the specific efficacy of high LET radiation in the management of locally advanced salivary gland tumours, radical conventional radiotherapy can still be employed with a curative intent when neutron facilities are not available. (author). 34 refs.; 1 fig.; 5 tabs

Expanding options in radiation oncology: neutron beam therapy

International Nuclear Information System (INIS)

Cohen, L.

1982-01-01

Twelve years experience with neutron beam therapy in Britain, the USA, Europe and Japan shows that local control is achievable in late-stage epidermoid cancer somewhat more frequently than with conventional radiotherapy. Tumours reputed to be radioresistant (salivary gland, bladder, rectosigmoid, melanoma, bone and soft-tissue sarcomas) have proved to be particularly responsive to neutrons. Pilot studies in brain and pancreatic tumours suggest promising new approaches to management of cancer in these sites. The availability of neutron therapy in the clinical environment opens new prospects for irradiation of 'radioresistant' tumours, permits more conservative cancer surgery, expands the use of elective chemotherapy and provides a wider range of options for cancer patients. (author)

Bee diseases: Examining options for their management in Africa ...

African Journals Online (AJOL)

Bee diseases: Examining options for their management in Africa. ... In Europe and Asia, the problem of damage to bees by Varroa-Mites has ... has become more complicated, more work-intensive and more cost-intensive. ... from 32 Countries:.

Stereotactic body radiotherapy in lung cancer: an update

Energy Technology Data Exchange (ETDEWEB)

Abreu, Carlos Eduardo Cintra Vita; Ferreira, Paula Pratti Rodrigues; Moraes, Fabio Ynoe de; Neves Junior, Wellington Furtado Pimenta; Carvalho, Heloisa de Andrade, E-mail: heloisa.carvalho@hc.fm.usp.br [Hospital Sirio-Libanes, Sao Paulo, SP (Brazil). Departamento de Radioterapia; Gadia, Rafael [Hospital Sirio-Libanes, Brasilia, DF (Brazil). Departamento de Radioterapia; Universidade de Sao Paulo (USP), Sao Paulo, SP (Brazil). Departamento de Radiologia e Oncologia. Servico de Radioterapia

2015-07-15

For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique. (author)

Assessment of contrast enhanced respiration managed cone-beam CT for image guided radiotherapy of intrahepatic tumors

International Nuclear Information System (INIS)

Jensen, Nikolaj K. G.; Stewart, Errol; Lock, Michael; Fisher, Barbara; Kozak, Roman; Chen, Jeff; Lee, Ting-Yim; Wong, Eugene

2014-01-01

Purpose: Contrast enhancement and respiration management are widely used during image acquisition for radiotherapy treatment planning of liver tumors along with respiration management at the treatment unit. However, neither respiration management nor intravenous contrast is commonly used during cone-beam CT (CBCT) image acquisition for alignment prior to radiotherapy. In this study, the authors investigate the potential gains of injecting an iodinated contrast agent in combination with respiration management during CBCT acquisition for liver tumor radiotherapy. Methods: Five rabbits with implanted liver tumors were subjected to CBCT with and without motion management and contrast injection. The acquired CBCT images were registered to the planning CT to determine alignment accuracy and dosimetric impact. The authors developed a simulation tool for simulating contrast-enhanced CBCT images from dynamic contrast enhanced CT imaging (DCE-CT) to determine optimal contrast injection protocols. The tool was validated against contrast-enhanced CBCT of the rabbit subjects and was used for five human patients diagnosed with hepatocellular carcinoma. Results: In the rabbit experiment, when neither motion management nor contrast was used, tumor centroid misalignment between planning image and CBCT was 9.2 mm. This was reduced to 2.8 mm when both techniques were employed. Tumors were not visualized in clinical CBCT images of human subjects. Simulated contrast-enhanced CBCT was found to improve tumor contrast in all subjects. Different patients were found to require different contrast injections to maximize tumor contrast. Conclusions: Based on the authors’ animal study, respiration managed contrast enhanced CBCT improves IGRT significantly. Contrast enhanced CBCT benefits from patient specific tracer kinetics determined from DCE-CT

Assessment of contrast enhanced respiration managed cone-beam CT for image guided radiotherapy of intrahepatic tumors

Energy Technology Data Exchange (ETDEWEB)

Jensen, Nikolaj K. G., E-mail: nkyj@regionsjaelland.dk [Physics and Engineering, London Regional Cancer Program, London, Ontario N6A3K7 (Canada); Stewart, Errol [Radiology, St. Joseph' s Health Care, London, Ontario N6A 4V2 (Canada); Imaging Research Lab, Robarts Research Institute, London, Ontario N6A 5B7 (Canada); Imaging Program, Lawson Health Research Institute, London, Ontario N6C 2R5 (Canada); Lock, Michael; Fisher, Barbara [Radiation Oncology, London Regional Cancer Program, London, Ontario N6A3K7 (Canada); Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6 (Canada); Kozak, Roman [Radiology, St. Joseph' s Health Care, London, Ontario N6A 4V2 (Canada); Chen, Jeff [Physics and Engineering, London Regional Cancer Program, London, Ontario N6A3K7 (Canada); Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6 (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 5C1 (Canada); Lee, Ting-Yim [Radiology, St. Joseph' s Health Care, London, Ontario N6A 4V2 (Canada); Imaging Research Lab, Robarts Research Institute, London, Ontario N6A 5B7 (Canada); Imaging Program, Lawson Health Research Institute, London, Ontario N6C 2R5 (Canada); Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6 (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 5C1 (Canada); Wong, Eugene [Physics and Engineering, London Regional Cancer Program, London, Ontario N6A3K7 (Canada); Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6 (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 5C1 (Canada); Department of Physics and Astronomy, University of Western Ontario, London, Ontario N6A 3K7 (Canada)

2014-05-15

Purpose: Contrast enhancement and respiration management are widely used during image acquisition for radiotherapy treatment planning of liver tumors along with respiration management at the treatment unit. However, neither respiration management nor intravenous contrast is commonly used during cone-beam CT (CBCT) image acquisition for alignment prior to radiotherapy. In this study, the authors investigate the potential gains of injecting an iodinated contrast agent in combination with respiration management during CBCT acquisition for liver tumor radiotherapy. Methods: Five rabbits with implanted liver tumors were subjected to CBCT with and without motion management and contrast injection. The acquired CBCT images were registered to the planning CT to determine alignment accuracy and dosimetric impact. The authors developed a simulation tool for simulating contrast-enhanced CBCT images from dynamic contrast enhanced CT imaging (DCE-CT) to determine optimal contrast injection protocols. The tool was validated against contrast-enhanced CBCT of the rabbit subjects and was used for five human patients diagnosed with hepatocellular carcinoma. Results: In the rabbit experiment, when neither motion management nor contrast was used, tumor centroid misalignment between planning image and CBCT was 9.2 mm. This was reduced to 2.8 mm when both techniques were employed. Tumors were not visualized in clinical CBCT images of human subjects. Simulated contrast-enhanced CBCT was found to improve tumor contrast in all subjects. Different patients were found to require different contrast injections to maximize tumor contrast. Conclusions: Based on the authors’ animal study, respiration managed contrast enhanced CBCT improves IGRT significantly. Contrast enhanced CBCT benefits from patient specific tracer kinetics determined from DCE-CT.

Standards, options and recommends for the external radiotherapy of patients reached by prostate carcinoma: evaluation of dose effect

International Nuclear Information System (INIS)

Pommier, P.; Fervers, B.; Villers, A.; Bataillard, A.

2002-01-01

The 'Standards, Options and Recommendations' (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres (FNCCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by critical appraisal by a multidisciplinary group of experts. Draft guidelines for the radiotherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. The FNCLCC and the French Urology Association (AFU) designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group A first draft of the guidelines was written, they validated by independent reviewers. The main recommendations are: a minimal dose of 70 Gy; patients with intermediate prognosis are the ones who benefit most from the dose escalation effect over 74 Gy, provided they receive exclusive radiation therapy; whenever possible, patients should be included in controlled trials designed to assess the effects of dose escalation and hormonotherapy. (author)

Usage of Option Contracts for Foreign Exchange Risk Management

Directory of Open Access Journals (Sweden)

Daniel Armeanu

2007-06-01

Full Text Available Today in Romania, in the context of the liberalization of the capital account and under a floating exchange rate (official is a managed floating currency regime established by National Bank of Romania the foreign exchange rate is very volatile. In consequence the financial institutions, corporations and, especially, the importers and exporters have to deal with a big exposition of currency risk related with their activities. Financial institutions and corporations today must adopt new roles in order to compete successfully in the explosively evolving foreign exchange markets. The methods, instruments and techniques used to manage foreign exchange risk are more complex than ever before. The objective of our paper is to provide the techniques and insights needed to pinpoint opportunities and control risks. We will present the most modern practical methods for managing the currency risk: option strategies (spread, strangle, straddle, etc. Also we will present the advantage, the disadvantage and our opinions related with the use of currency derivatives instruments (especially currency strategies options, making a comparative analysis.

The role and principles of radiotherapy in prostate cancer in the elderly subject

International Nuclear Information System (INIS)

Richaud, P.; Salomon, L.; Mongiat-Artus, P.; Gaschignard, N.; Beuzeboc, P.; Peyromaure, M.; Bastide, C.; Cornud, F.; Molinie, V.; Rozet, F.; Staerman, F.; Soulie, M.

2009-01-01

The aging of the population has resulted in an increase in the number of elderly patients with prostate cancer. Among the curative treatment options in the elderly subject, external radiotherapy is the most frequently chosen option. Combined treatment including radiotherapy and hormone therapy should be preferred to hormonal therapy alone, including in elderly patients, whenever life expectancy surpasses 4-5 years. The indications for this radiotherapy should be defined in an attempt to prevent excessive or insufficient treatment, to adapt the treatment modalities to the patient's age by assessing its potential toxicity, and to discuss the possible alternatives. In cases of localized prostate cancer in men who are aging well, a standard treatment should be proposed, preferring radiotherapy possibly associated with hormone therapy in cases with negative prognostic factors. Patients with a reversible health problems can also receive standard treatment, notably in cases with aggressive prognostic factors. (authors)

Radiotherapy in stage 1 testicular seminoma: retrospective study and review of literature; Radiotherapie des seminomes testiculaires de stade 1: etude retrospective et revue de la litterature

Energy Technology Data Exchange (ETDEWEB)

Bauduceau, O.; Le-Moulec, S.; Bernard, O. [Hopital des Armees du Val-de-Grace, Service de Radiotherapie et Oncologie, 75 - Paris (France); Souleau, B. [Hopital des Armees Percy, Service d' Hematologie, 92 - Clamart (France); Houlgatte, A. [Hopital des Armees du Val-de-Grace, Service d' Urologie, 75 - Paris (France)

2003-12-01

Introduction. - Seminoma accounts for about 40% of germ cell tumours of the testicle. In this retrospective analysis, we review literature concerning management of stage I seminoma. Materials and methods. - Between March 1987 and April 2001, 65 patients with stage I pure testicular seminoma received adjuvant radiotherapy with a 25 MV linear accelerator. Results. - Median age was 33 years. Testicular tumour has been found on the right testis in 39 patients and on the left one in 24 patients. Patients have been treated using an anterior-posterior parallel pair and have received 20-25 Gy in 10-14 fractions. The target volume consisted of paraaortic, and paraaortic + homolateral iliac lymph nodes in 17 and 46 patients, respectively. Acute toxicity was mainly digestive, 38% of patients presenting nausea and vomiting. Median follow-up time was 37 months. All patients are alive in complete remission. Discussion. - Because of good radio-sensitivity of seminoma, radiotherapy is regarded as standard adjuvant treatment (5 years relapse rate: 3-5%). Acute toxicity is dominated by moderate gastro-intestinal side effects. Secondary neoplasia represents one of the worst possible long-term complications of therapy. Waiting for ongoing randomized trials, the modern literature for seminoma reflects a trend toward lower radiation doses (20-25 Gy) and smaller treatment volumes (paraaortic field). Adjuvant chemotherapy with two courses of carbo-platin, might be equivalent to radiotherapy but must be investigated in randomized trials. A surveillance policy is one of the other management options less recommended. (author)

How to use PET/CT in the evaluation of response to radiotherapy.

Science.gov (United States)

Decazes, Pierre; Thureau, Sébastien; Dubray, Bernard; Vera, Pierre

2017-11-28

Radiotherapy is a major treatment modality for many cancers. Tumor response after radiotherapy determines the subsequent steps of the patient's management (surveillance, adjuvant or salvage treatment and palliative care). Tumor response assessed during radiotherapy offers a promising opportunity to adapt the treatment plan to reduced / increased target volume, to specifically target sub-volumes with relevant biological characteristics (metabolism, hypoxia, proliferation ...) and to further spare the organs at risk. In addition to its role in the diagnosis and the initial staging, Positron Emission Tomography combined with a Computed Tomography (PET/CT) provides functional information and is therefore attractive to evaluate tumor response. To review the published data addressing PET/CT as an evaluation tool in irradiated tumors. Reports on PET/CT acquired at various times (during radiotherapy, after initial (chemo-)radiotherapy, after definitive radiotherapy and during posttreatment follow-up) in solid tumors (lung, head-and-neck, cervix, esophagus, prostate and rectum) were collected and reviewed. Various tracers and technical are also discussed. 18F-FDG PET/CT has a well-established role in clinical routine after definitive chemo-radiotherapy for locally advanced head-and-neck cancers. 18F-choline PET/CT is indicated in prostate cancer patients with biochemical failure. 18F-FDG PET/CT is optional in many others circumstances and the clinical benefits of assessing tumor response with PET/CT remain a field of very active research. The combination of PET with Magnetic Resonance Imaging (PET/MRI) may prove to be valuable in irradiated rectal and cervix cancers. Tumor response can be evaluated by PET/CT with clinical consequences in multiple situations, notably in head and neck and prostate cancers, after radiotherapy. Further clinical evaluation for most cancers is still needed, possibly in association to MRI.

Development of integrated waste management options for irradiated graphite

Directory of Open Access Journals (Sweden)

Alan Wareing

2017-08-01

Full Text Available The European Treatment and Disposal of Irradiated Graphite and other Carbonaceous Waste project sought to develop best practices in the retrieval, treatment, and disposal of irradiated graphite including other irradiated carbonaceous waste such as structural material made of graphite, nongraphitized carbon bricks, and fuel coatings. Emphasis was given on legacy irradiated graphite, as this represents a significant inventory in respective national waste management programs. This paper provides an overview of the characteristics of graphite irradiated during its use, primarily as a moderator material, within nuclear reactors. It describes the potential techniques applicable to the retrieval, treatment, recycling/reuse, and disposal of these graphite wastes. Considering the lifecycle of nuclear graphite, from manufacture to final disposal, a number of waste management options have been developed. These options consider the techniques and technologies required to address each stage of the lifecycle, such as segregation, treatment, recycle, and ultimate disposal in a radioactive waste repository, providing a toolbox to aid operators and regulators to determine the most appropriate management strategy. It is noted that national waste management programs currently have, or are in the process of developing, respective approaches to irradiated graphite management. The output of the Treatment and Disposal of Irradiated Graphite and other Carbonaceous Waste project is intended to aid these considerations, rather than dictate them.

Therapeutic options and postoperative wound complications after extremity soft tissue sarcoma resection and postoperative external beam radiotherapy.

Science.gov (United States)

Abouarab, Mohamed H; Salem, Iman L; Degheidy, Magdy M; Henn, Dominic; Hirche, Christoph; Eweida, Ahmad; Uhl, Matthias; Kneser, Ulrich; Kremer, Thomas

2018-02-01

Soft tissue sarcomas occur most commonly in the lower and upper extremities. The standard treatment is limb salvage surgery combined with radiotherapy. Postoperative radiotherapy is associated with wound complications. This systematic review aims to summarise the available evidence and review the literature of the last 10 years regarding postoperative wound complications in patients who had limb salvage surgical excision followed by direct closure vs flap coverage together with postoperative radiotherapy and to define the optimal timeframe for adjuvant radiotherapy after soft tissue sarcomas resection and flap reconstruction. A literature search was performed using PubMed. The following keywords were searched: limb salvage, limb-sparing, flaps, radiation therapy, radiation, irradiation, adjuvant radiotherapy, postoperative radiotherapy, radiation effects, wound healing, surgical wound infection, surgical wound dehiscence, wound healing, soft tissue sarcoma and neoplasms. In total, 1045 papers were retrieved. Thirty-seven articles were finally selected after screening of abstracts and applying dates and language filters and inclusion and exclusion criteria. Plastic surgery provides a vast number of reconstructive flap procedures that are directly linked to decreasing wound complications, especially with the expectant postoperative radiotherapy. This adjuvant radiotherapy is better administered in the first 3-6 weeks after reconstruction to allow timely wound healing and avoid local recurrence. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Nuclear spent fuel management. Experience and options

International Nuclear Information System (INIS)

1986-01-01

Spent nuclear fuel can be stored safely for long periods at relatively low cost, but some form of permanent disposal will eventually be necessary. This report examines the options for spent fuel management, explores the future prospects for each stage of the back-end of the fuel cycle and provides a thorough review of past experience and the technical status of the alternatives. Current policies and practices in twelve OECD countries are surveyed

New options in the management of tendinopathy

Science.gov (United States)

Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Spiezia, Filippo; Denaro, Vincenzo

2010-01-01

Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy. PMID:24198540

Considerations Regarding ROK Spent Nuclear Fuel Management Options

International Nuclear Information System (INIS)

Braun, Chaim; Forrest, Robert

2013-01-01

In this paper we discuss spent fuel management options in the Republic of Korea (ROK) from two interrelated perspectives: Centralized dry cask storage and spent fuel pyroprocessing and burning in sodium fast reactors (SFRs). We argue that the ROK will run out of space for at-reactors spent fuel storage by about the year 2030 and will thus need to transition centralized dry cask storage. Pyroprocessing plant capacity, even if approved and successfully licensed and constructed by that time, will not suffice to handle all the spent fuel discharged annually. Hence centralized dry cask storage will be required even if the pyroprocessing option is successfully developed by 2030. Pyroprocessing is but an enabling technology on the path leading to fissile material recycling and burning in future SFRs. In this regard we discuss two SFR options under development in the U. S.: the Super Prism and the Travelling Wave Reactor (TWR). We note that the U. S. is further along in reactor development than the ROK. The ROK though has acquired more experience, recently in investigating fuel recycling options for SFRs. We thus call for two complementary joint R and D project to be conducted by U. S. and ROK scientists. One leading to the development of a demonstration centralized away-from-reactors spent fuel storage facility. The other involve further R and D on a combined SFR-fuel cycle complex based on the reactor and fuel cycle options discussed in the paper

Radiotherapy Learning in Medical Undergraduate Courses.

Science.gov (United States)

de la Peña, L; Garcia-Linares, A

2016-12-01

Approximately 60 % of all cancer patients receive radiotherapy as a component of their treatment. Radiation Oncology concepts, specifically, are not formally introduced to students in most traditional school curricula until their clinical rotations or may only be included as an optional elective during the core clinical clerkships. The aim of this study is to determine whether the teaching of Radiation Oncology by radiation oncologists, in the third year, in block diagnostic and therapeutic procedures, is helpful for student training and changes their attitude towards the specialty. We administered a pre-test and post-test examination of the concepts in general radiation oncology, radiation physics, radiobiology, breast cancer and their opinion to the third year medical students. The 10-question, multiple choice tests were administered before starting the lessons and when they finished the course. Of the 130 third year students, 95 (73.07 %) participated in the pre-test and post-test analysis. For the entire cohort, improvement was seen in all questions except one regarding physics. A statistically significant improvement (p < 0.005) was seen in the question regarding the aspects of general radiotherapy, radiobiology, acute and after-effects of radiation and the management of early-stage breast cancer. With an adequate methodology, third year students can learn aspects of Radiation Oncology.

Treatment options for carcinoma in situ testis

DEFF Research Database (Denmark)

Mortensen, M S; Gundgaard, M.G.; Daugaard, G

2011-01-01

countries only offer this to high-risk patients. The treatment options range from orchidectomy and chemotherapy to radiotherapy and in rare cases surveillance. Results of the different treatment strategies are presented in this review. The optimal radiation dose is still not clarified. Most patients have...

DIRECTIONS FOR FUTURE CONSTRUCTION SUPPLY CHAIN MANAGEMENT RESEARCH IN NEW ZEALAND: A REAL OPTIONS PERSPECTIVE

Directory of Open Access Journals (Sweden)

Tran, Van

2012-04-01

Full Text Available Real Options (RO has been a universally accepted concept in a number of major industries. However, its use in the construction supply chain management (CSCM sector has been limited. Some rare supply chain management RO studies have shown a number of limitations. First, there is a lack of a rigorous theoretical RO framework pertaining specifically to CSCM. All such supply chain management RO studies are based off RO theories or models developed for other sectors (engineering, infrastructure, natural resources. And second, attempts to extend real option to wider uses in CSCM seem premature at the present. This paper reviews all recent literature pertaining to real options and real options applied specifically to the construction supply chain management area. The study proposes a research programme pertaining to CSCM in New Zealand in order to enhance the current understanding of RO in this area and in the process develop a comprehensive theory for the RO application in New Zealand CSCM.

Albedo and vegetation demand-side management options for warm climates

International Nuclear Information System (INIS)

Hall, Darwin C.

1997-01-01

For electric utilities, demand-side management (DSM) can reduce electric load and shift load from peak to off-peak periods. In general, the investor in DSM collects the reward with lower electric bills, excepting a positive externality because of reduced tropospheric and stratospheric air pollution from fossil fuel power plants. In warm climates, DSM options include increasing albedo and vegetation, respectively, by painting surfaces white and planting trees; these DSM options are distinguished from all other DSM options because of ecosystem effects. Ambient temperature falls, mitigating the urban 'heat island', which reduces electric load and ozone formation. The investor in albedo and vegetation DSM options does not collect all of the reward from lower electric bills, since the lower ambient temperature provides savings to all customers who use electricity for air conditioning and refrigeration. Similar to other DSM options, air pollution is also reduced as a result of lower power plant emissions. Complex airshed models and electric utility system dispatch models are applied in this paper to account for some of these ecosystem effects. Unaccounted ecosystem effects remain, stymieing cost effectiveness analysis

TU-E-BRB-02: DIR QA Options and Research Development

International Nuclear Information System (INIS)

Kirby, N.

2015-01-01

Deformable image registration (DIR) is developing rapidly and is poised to substantially improve dose fusion accuracy for adaptive and retreatment planning and motion management and PET fusion to enhance contour delineation for treatment planning. However, DIR dose warping accuracy is difficult to quantify, in general, and particularly difficult to do so on a patient-specific basis. As clinical DIR options become more widely available, there is an increased need to understand the implications of incorporating DIR into clinical workflow. Several groups have assessed DIR accuracy in clinically relevant scenarios, but no comprehensive review material is yet available. This session will also discuss aspects of the AAPM Task Group 132 on the Use of Image Registration and Data Fusion Algorithms and Techniques in Radiotherapy Treatment Planning official report, which provides recommendations for DIR clinical use. We will summarize and compare various commercial DIR software options, outline successful clinical techniques, show specific examples with discussion of appropriate and inappropriate applications of DIR, discuss the clinical implications of DIR, provide an overview of current DIR error analysis research, review QA options and research phantom development and present TG-132 recommendations. Learning Objectives: Compare/contrast commercial DIR software and QA options Overview clinical DIR workflow for retreatment To understand uncertainties introduced by DIR Review TG-132 proposed recommendations

TU-E-BRB-02: DIR QA Options and Research Development

Energy Technology Data Exchange (ETDEWEB)

Kirby, N. [University of Texas HSC SA (United States)

2015-06-15

Deformable image registration (DIR) is developing rapidly and is poised to substantially improve dose fusion accuracy for adaptive and retreatment planning and motion management and PET fusion to enhance contour delineation for treatment planning. However, DIR dose warping accuracy is difficult to quantify, in general, and particularly difficult to do so on a patient-specific basis. As clinical DIR options become more widely available, there is an increased need to understand the implications of incorporating DIR into clinical workflow. Several groups have assessed DIR accuracy in clinically relevant scenarios, but no comprehensive review material is yet available. This session will also discuss aspects of the AAPM Task Group 132 on the Use of Image Registration and Data Fusion Algorithms and Techniques in Radiotherapy Treatment Planning official report, which provides recommendations for DIR clinical use. We will summarize and compare various commercial DIR software options, outline successful clinical techniques, show specific examples with discussion of appropriate and inappropriate applications of DIR, discuss the clinical implications of DIR, provide an overview of current DIR error analysis research, review QA options and research phantom development and present TG-132 recommendations. Learning Objectives: Compare/contrast commercial DIR software and QA options Overview clinical DIR workflow for retreatment To understand uncertainties introduced by DIR Review TG-132 proposed recommendations.

Cerebral function estimation using electro-encephalography for the patients with brain tumor managed by radiotherapy

International Nuclear Information System (INIS)

Mariya, Yasushi; Saito, Fumio; Kimura, Tamaki

1999-01-01

Cerebral function of 12 patients accompanied with brain tumor, managed by radiotherapy, were serially estimated using electroencephalography (EEG), and the results were compared with tumor responses, analyzed by magnetic resonance imaging (MRI), and clinical courses. After radiotherapy, EEG findings were improved in 7 patients, unchanged in 3, and worsened in 1. Clinical courses were generally correlated with serial changes in EEG findings and tumor responses. However, in 3 patients, clinical courses were explained better with EEG findings than tumor responses. It is suggested that the combination of EEG and image analysis is clinically useful for comprehensive estimation of radiotherapeutic effects. (author)

A cooperative building up of care security: patient participation to risk management in radiotherapy

International Nuclear Information System (INIS)

Pernet, A.; Mollo, V.; Giraud, P.

2010-01-01

Based on observations of radiotherapy consultations, interviews of professionals (physicians and operators), of ex-patients and patients under treatment, and on analysis of questionnaires sent to patients, this study aimed at understanding how, and to which levels, participation of patients can optimize risk management. It outlines the major role of therapeutic information and education of patients, but also of health professionals, in order to reach a shared cooperative management of cares. Short communication

Real options analysis for land use management: Methods, application, and implications for policy.

Science.gov (United States)

Regan, Courtney M; Bryan, Brett A; Connor, Jeffery D; Meyer, Wayne S; Ostendorf, Bertram; Zhu, Zili; Bao, Chenming

2015-09-15

Discounted cash flow analysis, including net present value is an established way to value land use and management investments which accounts for the time-value of money. However, it provides a static view and assumes passive commitment to an investment strategy when real world land use and management investment decisions are characterised by uncertainty, irreversibility, change, and adaptation. Real options analysis has been proposed as a better valuation method under uncertainty and where the opportunity exists to delay investment decisions, pending more information. We briefly review the use of discounted cash flow methods in land use and management and discuss their benefits and limitations. We then provide an overview of real options analysis, describe the main analytical methods, and summarize its application to land use investment decisions. Real options analysis is largely underutilized in evaluating land use decisions, despite uncertainty in policy and economic drivers, the irreversibility and sunk costs involved. New simulation methods offer the potential for overcoming current technical challenges to implementation as demonstrated with a real options simulation model used to evaluate an agricultural land use decision in South Australia. We conclude that considering option values in future policy design will provide a more realistic assessment of landholder investment decision making and provide insights for improved policy performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Radiotherapy in stage 1 testicular seminoma: retrospective study and review of literature

International Nuclear Information System (INIS)

Bauduceau, O.; Le-Moulec, S.; Bernard, O.; Souleau, B.; Houlgatte, A.

2003-01-01

Introduction. - Seminoma accounts for about 40% of germ cell tumours of the testicle. In this retrospective analysis, we review literature concerning management of stage I seminoma. Materials and methods. - Between March 1987 and April 2001, 65 patients with stage I pure testicular seminoma received adjuvant radiotherapy with a 25 MV linear accelerator. Results. - Median age was 33 years. Testicular tumour has been found on the right testis in 39 patients and on the left one in 24 patients. Patients have been treated using an anterior-posterior parallel pair and have received 20-25 Gy in 10-14 fractions. The target volume consisted of paraaortic, and paraaortic + homolateral iliac lymph nodes in 17 and 46 patients, respectively. Acute toxicity was mainly digestive, 38% of patients presenting nausea and vomiting. Median follow-up time was 37 months. All patients are alive in complete remission. Discussion. - Because of good radio-sensitivity of seminoma, radiotherapy is regarded as standard adjuvant treatment (5 years relapse rate: 3-5%). Acute toxicity is dominated by moderate gastro-intestinal side effects. Secondary neoplasia represents one of the worst possible long-term complications of therapy. Waiting for ongoing randomized trials, the modern literature for seminoma reflects a trend toward lower radiation doses (20-25 Gy) and smaller treatment volumes (paraaortic field). Adjuvant chemotherapy with two courses of carbo-platin, might be equivalent to radiotherapy but must be investigated in randomized trials. A surveillance policy is one of the other management options less recommended. (author)

Single-centre experience of stereotactic radiosurgery and fractionated stereotactic radiotherapy for prolactinomas with the linear accelerator.

Science.gov (United States)

Wilson, Peter J; Williams, Janet Rosemary; Smee, Robert Ian

2015-06-01

Primary management of prolactinomas is usually medical, with surgery a secondary option where necessary. This study is a review of a single centre's experience with focused radiotherapy where benefit was not gained by medical or surgical approaches. Radiotherapy as an alternative and adjuvant treatment for prolactinomas has been performed at our institution with the linear accelerator since 1990. We present a retrospective review of 13 patients managed with stereotactic radiosurgery (SRS) and 5 managed with fractionated stereotactic radiotherapy (FSRT), as well as 5 managed with conventional radiotherapy, at the Prince of Wales Hospital. Patients with a histopathologically diagnosed prolactinoma were eligible. Those patients who had a confirmed pathological diagnosis of prolactinoma following surgical intervention, a prolactin level elevated above 500 μg/L, or a prolactin level persistently elevated above 200 μg/L with exclusion of other causes were represented in this review. At the end of documented follow-up (SRS median 6 years, FSRT median 2 years), no SRS patients showed an increase in tumour volume. After FSRT, 1 patient showed an increase in size, 2 showed a decrease in size and 2 patients showed no change. Prolactin levels trended towards improvement after SRS and FSRT, but no patients achieved the remission level of <20 μg/L. Seven of 13 patients in the SRS group achieved a level of <500 μg/L, whereas no patients reached this target after FSRT. A reduction in prolactin level is frequent after SRS and FSRT for prolactinomas; however, true biochemical remission is uncommon. Tumour volume control in this series was excellent, but this may be related to the natural history of the disease. Morbidity and mortality after stereotactic radiation were very low in this series. © 2014 The Royal Australian and New Zealand College of Radiologists.

Strategies to tackle the challenges of external beam radiotherapy for liver tumors.

Science.gov (United States)

Lock, Michael I; Klein, Jonathan; Chung, Hans T; Herman, Joseph M; Kim, Edward Y; Small, William; Mayr, Nina A; Lo, Simon S

2017-05-18

Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity. Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis. However, the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment, management of motion and appropriate selection of dose regimen. This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines. Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation. Indeed, certain sub-populations, such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization, have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration. Implementing a liver radiation program requires three primary challenges to be addressed: (1) immobilization and motion management; (2) localization; and (3) dose regimen and constraint selection. Strategies to deal with motion include simple internal target volume (ITV) expansions, non-gated ITV reduction strategies, breath hold methods, and surrogate marker methods to enable gating or tracking. Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy, imaging modalities, and margin management. Finally, a dose response has been demonstrated and dose regimens appear to be converging. A more uniform approach to treatment in terms of technique, dose selection and patient selection will allow us to study liver radiation in larger and, hopefully, multicenter randomized

Technological options for management of hazardous wastes from US Department of Energy facilities

Energy Technology Data Exchange (ETDEWEB)

Chiu, S.; Newsom, D.; Barisas, S.; Humphrey, J.; Fradkin, L.; Surles, T.

1982-08-01

This report provides comprehensive information on the technological options for management of hazardous wastes generated at facilities owned or operated by the US Department of Energy (DOE). These facilities annually generate a large quantity of wastes that could be deemed hazardous under the Resource Conservation and Recovery Act (RCRA). Included in these wastes are liquids or solids containing polychlorinated biphenyls, pesticides, heavy metals, waste oils, spent solvents, acids, bases, carcinogens, and numerous other pollutants. Some of these wastes consist of nonnuclear hazardous chemicals; others are mixed wastes containing radioactive materials and hazardous chemicals. Nearly 20 unit processes and disposal methods are presented in this report. They were selected on the basis of their proven utility in waste management and potential applicability at DOE sites. These technological options fall into five categories: physical processes, chemical processes, waste exchange, fixation, and ultimate disposal. The options can be employed for either resource recovery, waste detoxification, volume reduction, or perpetual storage. Detailed descriptions of each technological option are presented, including information on process performance, cost, energy and environmental considerations, waste management of applications, and potential applications at DOE sites. 131 references, 25 figures, 23 tables.

Technological options for management of hazardous wastes from US Department of Energy facilities

International Nuclear Information System (INIS)

Chiu, S.; Newsom, D.; Barisas, S.; Humphrey, J.; Fradkin, L.; Surles, T.

1982-08-01

This report provides comprehensive information on the technological options for management of hazardous wastes generated at facilities owned or operated by the US Department of Energy (DOE). These facilities annually generate a large quantity of wastes that could be deemed hazardous under the Resource Conservation and Recovery Act (RCRA). Included in these wastes are liquids or solids containing polychlorinated biphenyls, pesticides, heavy metals, waste oils, spent solvents, acids, bases, carcinogens, and numerous other pollutants. Some of these wastes consist of nonnuclear hazardous chemicals; others are mixed wastes containing radioactive materials and hazardous chemicals. Nearly 20 unit processes and disposal methods are presented in this report. They were selected on the basis of their proven utility in waste management and potential applicability at DOE sites. These technological options fall into five categories: physical processes, chemical processes, waste exchange, fixation, and ultimate disposal. The options can be employed for either resource recovery, waste detoxification, volume reduction, or perpetual storage. Detailed descriptions of each technological option are presented, including information on process performance, cost, energy and environmental considerations, waste management of applications, and potential applications at DOE sites. 131 references, 25 figures, 23 tables

Radiotherapy Plus Transarterial Chemoembolization for Hepatocellular Carcinoma Invading the Portal Vein: Long-Term Patient Outcomes

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Yoon, Sang Min [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lim, Young-Suk [Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Won, Hyung Jin [Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Jong Hoon, E-mail: jhkim2@amc.seoul.kr [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Kang Mo; Lee, Han Chu; Chung, Young-Hwa; Lee, Yung Sang [Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Lee, Sung Gyu [Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Park, Jin-hong [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Suh, Dong Jin [Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2012-04-01

Purpose: We have evaluated the clinical outcomes of patients after transarterial chemoembolization (TACE) and 3-dimensional conformal radiotherapy for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods and Materials: A registry database of 412 patients treated with TACE and three-dimensional conformal radiotherapy for HCC with PVTT between August 2002 and August 2008 were analyzed retrospectively. The radiotherapy volume included the PVTT, with a 2- to 3-cm margin to cover adjacent HCC. Intrahepatic primary HCC was managed by TACE before or after radiotherapy. Results: Median patient age was 52 years old, and 88.1% of patients were male. Main or bilateral PVTT was observed in 200 (48.5%) patients. Median radiation dose was 40 Gy (range, 21-60 Gy) delivered in 2- to 5-Gy fractions. We found that 3.6% of patients achieved a complete response and that 24.3% of patients achieved a partial response. The response and progression-free rates of PVTT were 39.6% and 85.6%, respectively. Median patient survival was 10.6 months, and the 1- and 2-year survival rates were 42.5% and 22.8%, respectively. Significant independent variables associated with overall survival included advanced tumor stage, alpha-fetoprotein level, degree of PVTT, and response to radiotherapy. Forty-one patients (10.0%) showed grade 3-4 hepatic toxicity during or 3 months after completion of radiotherapy. Grades 2-3 gastroduodenal complications were observed in 15 patients (3.6%). Conclusions: Radiotherapy is a safe and effective treatment for PVTT in patients with HCC. These results suggested that the combination of TACE and radiotherapy is a treatment option for relieving and/or stabilizing PVTT in patients with advanced HCC.

Experience with an Internet information system about radiotherapy

International Nuclear Information System (INIS)

Cecilio, Paulo J.; Carvalho, Heloisa A.; Sartoris, Carla E.; Fonseca, Ismael B.; Neviani, Cristiano B.

2001-01-01

An independent web site with information about cancer treatment with radiation was created: 'www.iradioterapia.com'. Information is based on scientific data and different treatment guidelines. Always in an ethical way, health professionals, students, patients and their relatives, and others, can obtain theoretical information about therapeutic options, management of the disease, up-to-date on treatments worldwide, and on-line responses to several questions. They can also participate in group discussion among themselves. On the web since August 2000, 4000 accesses had already been registered, with many questions answered for patients and group discussions. The main questions are about medical treatment policies, patient care, and prognosis of the disease. There are very few information available for patients and relatives about radiotherapy. Free access to this kind of information allows improvement of treatment techniques, patient-physician relationship, and confidence of the patient during treatment. Internet access permitted more participation of patients and their relatives in their own treatment, allowing higher comfort and tranquility. Patients collaborate in medical appointments, searching for the best technique and treatment options. (author)

Radiological impacts of spent nuclear fuel management options

International Nuclear Information System (INIS)

Riotte, H.; Lazo, T.; Mundigl, S.

2000-01-01

An important technical study on radiological impacts of spent nuclear fuel management options, recently completed by the NEA, is intended to facilitate informed international discussions on the nuclear fuel cycle. The study compares the radiological impacts on the public and on nuclear workers resulting from two approaches to handling spent fuel from nuclear power plants: - the reprocessing option, that includes the recycling of spent uranium fuel, the reuse of the separated plutonium in MOX fuel, and the direct disposal of spent MOX fuel; and the once-through option, with no reprocessing of spent fuel, and its direct disposal. Based on the detailed research of a group of 18 internationally recognised experts, under NEA sponsorship, the report concludes that: The radiological impacts of both the reprocessing and the non-reprocessing fuel cycles studied are small, well below any regulatory dose limits for the public and for workers, and insignificantly low as compared with exposures caused by natural radiation. The difference in the radiological impacts of the two fuel cycles studied does not provide a compelling argument in favour of one option or the other. The study also points out that other factors, such as resource utilisation efficiency, energy security, and social and economic considerations would tend to carry more weight than radiological impacts in decision-making processes. (authors)

Electricity market risk management using forward contracts with bilateral options

International Nuclear Information System (INIS)

Chung, T.S.; Yu, C.W.; Wong, K.P.; Zhang, S.H.

2003-01-01

Extreme short-term price volatility in competitive electricity markets creates the need for risk management arrangements. A new electricity forward contract with bilateral financial options is introduced, which allows both seller and buyer to take advantage of flexibility in generation and consumption to obtain monetary benefits while simultaneously removing the risk of market price fluctuations. The option theory is incorporated to formulate the contract price. The strike prices of options are derived from solving an equilibrium model in which both the buyer and the seller aim to maximise their own profit. Theoretical analysis shows that the proposed optional forward contract presents a more equitable and reasonable payoff structure that allows the buyer and seller to earn a larger overall expected benefit, and the contractual arrangement supports efficiency in economic dispatch of electricity production and consumption. The insights obtained from these results will be helpful to participants in the contractual decision-making process. (Author)

Imaging and concomitant dose in radiotherapy

International Nuclear Information System (INIS)

Negi, P.S.

2008-01-01

Image guidance in radiotherapy now involves multiple imaging procedures for planning, simulation, set-up inter and intrafraction monitoring. Presently ALARA (i.e. as low as reasonable achievable) is the principle of management of dose to radiation workers and patients in any diagnostic imaging procedures including image guided surgery. The situation is different in repeated radiographic/fluoroscopic imaging performed for simulation, dose planning, patient positioning and set-up corrections during preparation/execution of Image guided radiotherapy (IGRT) as well as for Intensity Modulated Radiotherapy (IMRT). Reported imaging and concomitant doses will be highlighted and discussed for the management and optimization of imaging techniques in IMRT and IGRT

Cartography and risk management in radiotherapy: a collaborative work of the department of radiotherapy and the department of quality and risk management Institute Jean-Godinot; Cartographie et gestion des risques en radiotherapie: un travail commun du departement de radiotherapie et du departement de la qualite et de la gestion des risques de l'institut Jean-Godinot

Energy Technology Data Exchange (ETDEWEB)

Nguyen, T.D.; Loiseau, M. [Institut Jean-Godinot, Dept. de radiotherapie, 51 - Reims (France); Devie, I.; Heusghem, M. [Institut Jean-Godinot, Dept. de la qualite et de la gestion des risques, 51 - Reims (France); Gaillot-Petit, N. [Institut Jean-Godinot, Unite de radiophysique medicale, 51 - Reims (France)

2010-01-15

Purpose To deploy an inductive process for radiotherapy risk management in a regional cancer centre and to infer the actions required to solve the situations of criticality. Methods Close collaboration between the department of radiation oncology-biophysics and the department of quality and risk management in the same institution allowed to create a multi professional and multidisciplinary task force and to make the experience feedback easier. A preliminary risk analysis method was used to identify the generic dangers, the mapping of risks and the specification of the scales of criticality. This method helped to evaluate and to rate each apprehended event. Four scales have been defined: seriousness scale in five levels, likelihood scale in five classes, endeavour scale in four levels and criticality scale in three categories: acceptable (criticality 1) tolerable under control (criticality 2) and unacceptable (criticality 3). Results Fifty-seven level 1 dangerous situations linked to 78 scenarios of criticality acceptable, tolerable and unacceptable in 24, 44 and 10 cases respectively have been identified in the department of radiotherapy leading to carry out 28 risk reduction actions. Conclusions The performed risk analysis offered an original frame for a collective thinking among the care providers and contributed to modify their mode of conceiving both security and radioprotection. The study allowed us to give a relevant answer to the High Authority of Health and the Authority of Nuclear Security demands either in terms of efficient management of the risks in radiotherapy or regarding the daily concerns of the care-givers. (authors)

Bone Health and Pelvic Radiotherapy.

Science.gov (United States)

Higham, C E; Faithfull, S

2015-11-01

Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

The role of radiotherapy in the management of desmoid tumors

International Nuclear Information System (INIS)

Kirschner, M.J.; Sauer, R.

1993-01-01

698 published cases are reviewed and analysed with respect to the previous surgery and the therapeutic impact of postoperative radiotherapy. After an R1 surgical resection radiotherapy significantly decreases the risk for loco-regional relapse in about 40%. Radiotherapy is also recommended after an R0 surgical resection with safety margins less than 2 cm. A total radiotherapy dose of 50 Gy seems to be sufficient, whereas radiotherapy doses beyond 60 Gy provide no additional control. Following an R2 resection up to 28% of these tumors may not progress or even show a complete remission. A wait-and-see policy is justified for R1-2-resected lesions in the abdominal wall, especially if severe treatment sequelae have to be expected. The role of chemotherapy still remains questionable. (orig./MM) [de

Biomarkers of Tumour Radiosensitivity and Predicting Benefit from Radiotherapy.

Science.gov (United States)

Forker, L J; Choudhury, A; Kiltie, A E

2015-10-01

Radiotherapy is an essential component of treatment for more than half of newly diagnosed cancer patients. The response to radiotherapy varies widely between individuals and although advances in technology have allowed the adaptation of radiotherapy fields to tumour anatomy, it is still not possible to tailor radiotherapy based on tumour biology. A biomarker of intrinsic radiosensitivity would be extremely valuable for individual dosing, aiding decision making between radical treatment options and avoiding toxicity of neoadjuvant or adjuvant radiotherapy in those unlikely to benefit. This systematic review summarises the current evidence for biomarkers under investigation as predictors of radiotherapy benefit. Only 10 biomarkers were identified as having been evaluated for their radiotherapy-specific predictive value in over 100 patients in a clinical setting, highlighting that despite a rich literature there were few high-quality studies for inclusion. The most extensively studied radiotherapy predictive biomarkers were the radiosensitivity index and MRE11; however, neither has been evaluated in a randomised controlled trial. Although these biomarkers show promise, there is not enough evidence to justify their use in routine practice. Further validation is needed before biomarkers can fulfil their potential and predict treatment outcomes for large numbers of patients. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

New options in the management of tendinopathy

Directory of Open Access Journals (Sweden)

Nicola Maffulli

2010-03-01

Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Mattia Loppini2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, ItalyAbstract: Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic

Options for including nitrogen management in climate policy

International Nuclear Information System (INIS)

Erisman, J.W.

2010-12-01

The outline of the presentation is as follows: Climate change and nitrogen; Nitrogen and climate interlinkages; Options for nitrogen management; Report, workshop and IPCC; and Conclusions. The concluding remarks are: Fertilizing the biosphere with reactive nitrogen compounds lead to ecosystem, health, water and climate impacts; Nitrogen deposition can lead to additional carbon sequestration and to impacts on biodiversity and ecosystem services; Nitrogen addition to the biosphere might have a net cooling effect of 1 W/m 2 ; Life Cycle Analysis is needed to show the full impact; and Nitrogen management is essential for the environment and can have a positive effect on the net GHG exchange.

Radiotherapy and Brachytherapy : Proceedings of the NATO Advanced Study Institute on Physics of Modern Radiotherapy & Brachytherapy

CERN Document Server

Lemoigne, Yves

2009-01-01

This volume collects a series of lectures presented at the tenth ESI School held at Archamps (FR) in November 2007 and dedicated to radiotherapy and brachytherapy. The lectures focus on the multiple facets of radiotherapy in general, including external radiotherapy (often called teletherapy) as well as internal radiotherapy (called brachytherapy). Radiotherapy strategy and dose management as well as the decisive role of digital imaging in the associated clinical practice are developed in several articles. Grouped under the discipline of Conformal Radiotherapy (CRT), numerous modern techniques, from Multi-Leaf Collimators (MLC) to Intensity Modulated RadioTherapy (IMRT), are explained in detail. The importance of treatment planning based upon patient data from digital imaging (Computed Tomography) is also underlined. Finally, despite the quasi- totality of patients being presently treated with gamma and X-rays, novel powerful tools are emerging using proton and light ions (like carbon ions) beams, bound to bec...

Radiotherapy for calcaneodynia. Results of a single center prospective randomized dose optimization trial

Energy Technology Data Exchange (ETDEWEB)

Ott, O.J.; Jeremias, C.; Gaipl, U.S.; Frey, B.; Schmidt, M.; Fietkau, R. [University Hospital Erlangen (Germany). Dept. of Radiation Oncology

2013-04-15

The aim of this work was to compare the efficacy of two different dose fractionation schedules for radiotherapy of patients with calcaneodynia. Between February 2006 and April 2010, 457 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received radiotherapy using the orthovoltage technique. One radiotherapy series consisted of 6 single fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, immediately after, and 6 weeks after radiotherapy using a visual analogue scale (VAS) and a comprehensive pain score (CPS). The overall response rate for all patients was 87 % directly after and 88 % 6 weeks after radiotherapy. The mean VAS values before, immediately after, and 6 weeks after treatment for the 0.5 and 1.0 Gy groups were 65.5 {+-} 22.1 and 64.0 {+-} 20.5 (p = 0.188), 34.8 {+-} 24.7 and 39.0 {+-} 26.3 (p = 0.122), and 25.1 {+-} 26.8 and 28.9 {+-} 26.8 (p = 0.156), respectively. The mean CPS before, immediately after, and 6 weeks after treatment was 10.1 {+-} 2.7 and 10.0 {+-} 3.0 (p = 0.783), 5.6 {+-} 3.7 and 6.0 {+-} 3.9 (p = 0.336), 4.0 {+-} 4.1 and 4.3 {+-} 3.6 (p = 0.257), respectively. No statistically significant differences between the two single dose trial arms for early (p = 0.216) and delayed response (p = 0.080) were found. Radiotherapy is an effective treatment option for the management of calcaneodynia. For radiation protection reasons, the dose for a radiotherapy series is recommended not to exceed 3-6 Gy. (orig.)

Tumor motion in lung cancers: An overview of four-dimensional radiotherapy treatment of lung cancers

Directory of Open Access Journals (Sweden)

Anusheel Munshi

2017-01-01

Full Text Available Most modern radiotherapy centers have adopted contouring based treatment. Sparing of the normal structures has been made more achievable than ever before by use of technologies such as Intensity Modulated Radiotherapy (IMRT and Image guided radiotherapy (IGRT. However, unlike, sites such as brain or head neck, thorax is a site in active motion, mostly contributed by patient's respiratory movement. 4 D radiotherapy, that addresses the issues of motion in thoracic tumours answers this critical question. The present article outlines the scope of need for 4 D radiotherapy and discusses the options available for 4 D treatments of cancer patients.

Intraoperative radiotherapy in breast cancer: literature review

International Nuclear Information System (INIS)

Alfaro Hidalgo, Sabrina A.

2013-01-01

A literature review was performed on intraoperative radiotherapy of breast cancer. The strength and attractiveness is established of techniques of partial irradiation in the treatment of breast cancer. The benefit is originated to restrict the area immediate of radiotherapy to the tumor bed or quadrant index and identifying the benefit of being applied during the radiotherapy while surgical lumpectomy. The impact of local recurrence has been established using intraoperative radiotherapy. The advantages of intraoperative radiotherapy was compared in the management of the conservative surgery in early stages of breast cancer with external radiotherapy. Different methods of intraoperative radiotherapy have been compared and individual impact on local recurrence ranges. Intraoperative radiotherapy has had many advantages: radiobiological, technical, clinical, psychological and economical in the handling of conservative surgery in early stages of breast cancer, compared with external radiotherapy [es

Multileaf collimator in radiotherapy

International Nuclear Information System (INIS)

Jeraj, M.; Robar, V.

2004-01-01

Background. Basic goal of radiotherapy treatment is the irradiation of a target volume while minimizing the amount of radiation absorbed in healthy tissue. Shaping the beam is an important way of minimizing the absorbed dose in healthy tissue and critical structures. Conventional collimator jaws are used for shaping a rectangular treatment field; but, as usually treatment volume is not rectangular, additional shaping is required. On a linear accelerator, lead blocks or individually made Cerroben TM blocks are attached onto the treatment head under standard collimating system. Another option is the use of multileaf collimator (MLC). Conclusions. Multileaf collimator is becoming the main tool for beam shaping on the linear accelerator. It is a simple and useful system in the preparation and performance of radiotherapy treatment. Multileaf collimators are reliable, as their manufacturers developed various mechanisms for their precision, control and reliability, together with reduction of leakage and transmission of radiation between and through the leaves. Multileaf collimator is known today as a very useful clinical system for simple field shaping, but its use is getting even more important in dynamic radiotherapy, with the leaves moving during irradiation. This enables a precise dose delivery on any part of a treated volume. Intensity modulated radiotherapy (IMRT), the therapy of the future, is based on the dynamic use of MLC. (author)

National Forest management options in response to climate change

Science.gov (United States)

Forest Service U.S. Department of Agriculture

2009-01-01

The effect of climate change on ecosystem structure, function, and services will depend on the ecosystem's degree of sensitivity to climate change, the natural ability of plants and animals to adapt, and the availability of effective management options. Sensitivity to climate change is a function of ecosystem health and environmental stresses such as air pollution...

Radiotherapy management of brain metastases using conventional linear accelerator.

Science.gov (United States)

Matzenauer, Marcel; Vrana, David; Vlachova, Zuzana; Cwiertka, Karel; Kalita, Ondrej; Melichar, Bohuslav

2016-09-01

As treatments for primary cancers continue to improve life expectancy, unfortunately, brain metastases also appear to be constantly increasing and life expectancy for patients with brain metastases is low. Longer survival and improved quality of life may be achieved using localised radiological and surgical approaches in addition to low dose corticosteroids. Stereotactic brain radiotherapy is one rapidly evolving localized radiation treatment. This article describes our experience with stereotactic radiotherapy using a linear accelerator. We reviewed patients treated with stereotactic radiotherapy, from the time of its introduction into daily practice in our Department of Oncology in 2014. We collected the data on patient treatment and predicted survival based on prognostic indices and actual patient outcome. A total of 10 patients were treated by stereotactic radiotherapy, in one case in combination with whole brain radiotherapy and hippocampal sparing. There was no significant treatment related toxicity during the treatment or follow-up and due to the small number of fractions, the overall tolerance of the treatment was excellent. The patient intrafractional movement in all cases was under 1 mm suggesting that 1 mm margin around the CTV to create the PTV is sufficient and also that patient immobilization using the thermoplastic mask compared with invasive techniques, is feasible. We also found that prognostic indices such as the Graded Prognostic Assessment provide accurate predictions of patient survival. Based on our current evidence, patients with brain metastases fit enough, should be considered for stereotactic radiotherapy treatment.

Low-dose radiotherapy as treatment for benign lymphoepitelial lesion in HIV-patients

International Nuclear Information System (INIS)

Gonzalez Patino, E.; Lopez Vazquez, M.D.; Cascallar Caneda, L.; Antinez Lopez, J.; Victoria Fernandez, C.; Salvador Garrido, N.; Ares Banobre, M.; Porto vazquez, M.C.

1995-01-01

Standard treatments for benign lymphoepitelial lesion of the parotid gland in patients infected with the human immunodeficiency virus (HIV) are unsatisfactory. Recently, low-dose radiotherapy has been proposed as a noninvasive treatment option. We describe a case of bilateral benign lymphoepitelial lesion parotid gland in a HIV-positive paint, treated by radiotherapy. Low-dose radiotherapy, appears as a alternative in the treatment for benign lymphoepitelial lesion in HIV-patients, and preliminary evaluations have indicated that this treatment is effective from both the clinical and cosmetic points of view

PP22. PROGRESSING RADIOTHERAPY-DRUG COMBINATIONS TOWARDS EARLY PHASE CLINICAL TRIALS

Science.gov (United States)

Jones, Dr Hazel; Stock, Dr Julie; Chalmers, Prof Anthony

2017-01-01

Abstract The Radiotherapy-Drug Combinations consortium (RaDCom) works with UK-based investigators to design and deliver high quality preclinical projects evaluating specific radiotherapy-drug combinations. We have several collaborations with industry, from in vitro projects to understand the novel agent in the context of radiobiology, through to preclinical studies that will generate data to support the development of radiotherapy combination trials. RaDCom facilitates the coordination of industry interactions, triage new proposals, monitor active projects, and engages with the radiotherapy community to promote collaboration and networking (via a capability map). The CRUK New Agents Committee Preclinical Combination Grant scheme provides one of the funding options for these studies, with the potential to feed into early phase clinical trials via the ECMC Combinations Alliance. RaDCom also supports broader radiotherapy research initiatives, by working to improve preclinical quality assurance and identifying a route to registration for radiotherapy-drug treatments. These activities will place the UK at the forefront of radiotherapy-drug preclinical research and provide a significant incentive for pharmaceutical companies to invest in this area and utilise the RaDCom network. Further information can be found on our webpage: http://ctrad.ncri.org.uk/research-support/radiation-drug-combinations-radcom Successful projects from RaDCom can then move into early phase combinations trials within the Combinations Alliance. The Combinations Alliance supports early phase combination studies in the UK via the ECMC (Experimental Cancer Medicine Centres) network. It focuses on translational research, and enables clinical project teams to work with disease experts to set up investigator led trials. The CRUK Centre of Drug Development (CDD) supports these studies with further management and coordination ensuring more robust timelines and delivery. The Combinations Alliance framework

Taking Action Against Ocean Acidification: A Review of Management and Policy Options

Science.gov (United States)

Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

2013-10-01

Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

Taking action against ocean acidification: a review of management and policy options.

Science.gov (United States)

Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

2013-10-01

Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

Radiotherapy as a conservative treatment in breast cancer

International Nuclear Information System (INIS)

Pfuhl, O.R. von; Miola, U.J.; Campos, J.C.F. de

1977-01-01

The review of 545 cases of cancer of the breast, 10% of which were treated by exclusive radiotherapy, emphasized the trend towards conservative treatment, because 29,8% of mastectomized women died within two years from the operation with distant metastases. As it is possible with radiotherapy to cause fibrosis or keep inactive breast tumors up to 5 cm diameter for two years or longer, one must consider irradiation as a good option for young women with small tumors. A combination was used of tangencial radiotherapy up to 5.000 rads to the whole breast with a boost dose two weeks later of 3.000 to 4.000 rads by means of intersticial radiotherapy given only to the palpable tumor. This was fulfilled by the afterloading method according to a system described as geometrization of the breast by parallel plates where holes were drilled for the needles. No recurrence was seen in 4 years in the selected group of 12 patients submitted to the mentioned treatment [pt

Radiotherapy in the treament of gastrointestinal stromal tumors

Directory of Open Access Journals (Sweden)

Rebecca C. Heintzelman

2011-10-01

Full Text Available Gastrointestinal stromal tumors (GIST are uncommon mesenchymal tumors of the gastrointestinal tract. Up to one-third of GISTs are malignant with a high rate of metastasis. Surgical resection is the mainstay of care for patients with resectable disease. Imatinib mesylate, a selective tyrosine kinase inhibitor, is the current standard of care for GISTs that cannot be completely resected or in cases of metastatic GIST. Although often overlooked, radiation therapy is a viable option for select patients with GIST. We report the case of a patient with unresectable GIST who was treated with local radiotherapy and achieved longterm response. We also present a review of the literature regarding the use of radiotherapy in the treatment of GIST. GIST has been shown to be a radiosensitive tumor. Radiotherapy can offer long-term local control and should be considered in the adjuvant or palliative setting. The role of radiotherapy delivered concurrently with imatinib in the treatment of GIST may warrant further investigation.

Options for the management of Chernobyl-restricted areas in England and Wales

International Nuclear Information System (INIS)

Nisbet, A.; Woodman, R.

1999-01-01

Areas in England and Wales are still subject to restrictions on tile movement, sale and slaughter of sheep because concentrations of radiocaesium in sheep meat may exceed the 1000 Bq kg -1 limit imposed after the Chernobyl nuclear power plant accident. Various monitoring programmes have been implemented to enable lamb production to be sustained in these restricted areas, although no alternative management strategies have been considered to date. Current management practices have been reviewed and costed. An assessment has also been undertaken to establish the practicability and cost effectiveness of five alternative management options. The practicability of each option, which encompasses technical feasibility, capacity, cost, impact and acceptability, was assessed through a series of case studies carried out on farms in the restricted area of north Wales, and through consultation with a range of organisations with interests in farming and/or the environment. Recommendations are made for the future management of the restricted areas in England and Wales. (author)

A dose-response analysis for classical Kaposi's sarcoma management by radiotherapy

International Nuclear Information System (INIS)

Oysul, K.; Beyzadeoglu, M.; Surenkok, S.; Ozyigit, G.; Dirican, B.

2008-01-01

Objective was to evaluate the dose-response relationship in classical Kaposi's sarcoma CKS patients treated with external beam radiotherapy. Between 1993 and 2004, patients with CKS treated at the Department of Radiation Oncology, Gulhane Military Medical School, Ankara, Turkey were evaluated in this retrospective study. The median age at initial presentation was 60 years. First we analyzed the overall response rates for normalized total dose2Gy NTD2Gy of 20Gy. Secondly we searched for whether better response rates could be obtained with the NTD2Gy of >/=20Gy compared to the NTD2Gy of /20Gy and 64% and 24%for NDT2Gyof 20< Gy and these were statistically different p=0.001. Late side effects of radiation therapy were acceptable in all but 4 patients with fibrosis and edema. This retrospective analysis showed that radiotherapy schedules with an NDT2Gy of 20 Gy and above by using local irradiation fields are effective in terms of complete response rates in the management of CKS compared to NDT2Gy of < 20 Gy. (author)

Management of tritium-contaminated wastes a survey of alternative options

International Nuclear Information System (INIS)

Mannone, F.

1990-01-01

The European Tritium Handling Experimental Laboratory (ETHEL) under construction on the site of Ispra Joint Research Centre of the Commission of European Communities has been commissioned to experimentally develop operational and environmental safety aspects related to the tritium technology in fusion, i.e. dealing with the behaviour and reliability of materials, equipment and containment systems under tritium impact. For this reason a part of the experimental activities to be performed in ETHEL will be devoted to laboratory research on tritiated waste management. However, since all experimental activities planned for the execution in ETHEL will by itselves generate tritiated wastes, current strategies and practices to be applied for the routine management of these wastes need also to be defined. To attain this target an adequate background information must be provided, which is the intent of this report. Through an exhaustive literature survey tritiated waste management options till now investigated or currently applied in several countries have been assessed. A particular importance has been attached to the tritium leach test programmes, whose results enable to assess the tritium retention efficiency of the various waste immobilization options. The conclusions resulting from the overall assessment are presented

Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma.

Science.gov (United States)

Li, Qi-Wen; Niu, Shao-Qing; Wang, Han-Yu; Wen, Ge; Li, Yi-Yang; Xia, Yun-Fei; Zhang, Yu-Jing

2015-01-01

A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP), but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities in the management of SP. Data from 38 consecutive patients with solitary plasmacytoma, including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed. 15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiation dose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) were calculated and outcomes of different therapies were compared. The median follow-up time was 55 months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariate analysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher 5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) and OS (100% vs 70%, p=0.041). Radiotherapy alone can be considered as a more effective treatment for SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires further study.

Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer.

Science.gov (United States)

Oldenburg, J; Aparicio, J; Beyer, J; Cohn-Cedermark, G; Cullen, M; Gilligan, T; De Giorgi, U; De Santis, M; de Wit, R; Fosså, S D; Germà-Lluch, J R; Gillessen, S; Haugnes, H S; Honecker, F; Horwich, A; Lorch, A; Ondruš, D; Rosti, G; Stephenson, A J; Tandstad, T

2015-05-01

Testicular cancer (TC) is the most common neoplasm in males aged 15-40 years. The majority of patients have no evidence of metastases at diagnosis and thus have clinical stage I (CSI) disease [Oldenburg J, Fossa SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(Suppl 6): vi125-vi132; de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006; 24: 5482-5492.]. Management of CSI TC is controversial and options include surveillance and active treatment. Different forms of adjuvant therapy exist, including either one or two cycles of carboplatin chemotherapy or radiotherapy for seminoma and either one or two cycles of cisplatin-based chemotherapy or retroperitoneal lymph node dissection for non-seminoma. Long-term disease-specific survival is ∼99% with any of these approaches, including surveillance. While surveillance allows most patients to avoid additional treatment, adjuvant therapy markedly lowers the relapse rate. Weighing the net benefits of surveillance against those of adjuvant treatment depends on prioritizing competing aims such as avoiding unnecessary treatment, avoiding more burdensome treatment with salvage chemotherapy and minimizing the anxiety, stress and life disruption associated with relapse. Unbiased information about the advantages and disadvantages of surveillance and adjuvant treatment is a prerequisite for informed consent by the patient. In a clinical scenario like CSI TC, where different disease-management options produce indistinguishable long-term survival rates, patient values, priorities and preferences should be taken into account. In this review, we provide an overview about risk factors for relapse, potential benefits and harms of adjuvant chemotherapy and active surveillance and a rationale for involving patients in individualized decision making about their treatment rather than adopting

Hypofractionated radiotherapy as local hemostatic agent in advanced cancer

Directory of Open Access Journals (Sweden)

Malik Tariq Rasool

2011-01-01

Full Text Available Purpose : Tumor bleeding continues to remain a challenge in an oncological setting, and radiotherapy has been studied as a local hemostatic agent. We studied the role of local radiotherapy in controlling bleeding at our center. Materials and Methods : We reviewed 25 treated cases (cancer urinary bladder: 12, lung cancer: 5, cervical cancer: 4, uterine cancer: 1, rectal cancer: 2, schwanoma: 1 at our center from March 2008 to December 2010. All patients had either an advanced or recurrent disease. Radiotherapy schedule was either 20 Gray in 5 fractions or 15 Gray in 5 fractions and was delivered with Cobalt 60. Results and Conclusion : Of 25 patients, 22 (88% responded, and there was complete cessation of bleeding. Both 15 Gray and 20 Gray dose schedule had equal efficacy. Treatment was well tolerated without any intermission. Radiotherapy is a safe and effective option in controlling tumor bleeding.

Acceptability of child adoption as management option for infertility in ...

African Journals Online (AJOL)

Infertility remains a global health challenge with devastating psycho-social consequences in many African communities. Adoption that may serve as an alternative strategy for the affected couples is not widely practiced. This study was conceptualized to assess the acceptability of child adoption as a management option by ...

Primary radiotherapy of prolactinomas. Eight- to 15-year follow-up

Energy Technology Data Exchange (ETDEWEB)

Mehta, A.E.; Reyes, F.I.; Faiman, C.

1987-07-01

Eight women with amenorrhea, galactorrhea, and hyperprolactinemia, of whom six had macroadenomas and two had microadenomas, were treated with conventional (cobalt-60) external radiotherapy, and their progress was monitored for eight to 15 years. Normoprolactinemia was established in five of these patients after two to 13 years (median, nine years). A recurrence was treated surgically in one patient, and stable prolactin values and roentgenographic features have been maintained in two patients. Hypopituitarism has developed in only one patient to date, and no other complications of radiotherapy have been observed. These findings, together with the few previous reports on the long-term effects of radiotherapy on macroprolactinomas, have been compared with the long-term results following surgery or dopamine agonist therapy. The normalization of prolactin values is considerably delayed following radiotherapy compared with the other two therapeutic modalities. However, radiotherapy affords permanent normalization without recurrence in a larger percentage of patients than does surgery and avoids the considerable ongoing cost and inconvenience of daily drug ingestion. The long-term development of hypopituitarism appears to be an acceptably small risk of radiotherapy. Thus, conventional radiotherapy is an attractive treatment option, particularly for macroprolactinomas; adjunctive bromocriptine can be used while awaiting the longer-term benefits of radiotherapy.

Primary radiotherapy of prolactinomas. Eight- to 15-year follow-up

International Nuclear Information System (INIS)

Mehta, A.E.; Reyes, F.I.; Faiman, C.

1987-01-01

Eight women with amenorrhea, galactorrhea, and hyperprolactinemia, of whom six had macroadenomas and two had microadenomas, were treated with conventional (cobalt-60) external radiotherapy, and their progress was monitored for eight to 15 years. Normoprolactinemia was established in five of these patients after two to 13 years (median, nine years). A recurrence was treated surgically in one patient, and stable prolactin values and roentgenographic features have been maintained in two patients. Hypopituitarism has developed in only one patient to date, and no other complications of radiotherapy have been observed. These findings, together with the few previous reports on the long-term effects of radiotherapy on macroprolactinomas, have been compared with the long-term results following surgery or dopamine agonist therapy. The normalization of prolactin values is considerably delayed following radiotherapy compared with the other two therapeutic modalities. However, radiotherapy affords permanent normalization without recurrence in a larger percentage of patients than does surgery and avoids the considerable ongoing cost and inconvenience of daily drug ingestion. The long-term development of hypopituitarism appears to be an acceptably small risk of radiotherapy. Thus, conventional radiotherapy is an attractive treatment option, particularly for macroprolactinomas; adjunctive bromocriptine can be used while awaiting the longer-term benefits of radiotherapy

Chest wall desmoid tumours treated with definitive radiotherapy: a plan comparison of 3D conformal radiotherapy, intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy

International Nuclear Information System (INIS)

Liu, Jia; Ng, Diana; Lee, James; Stalley, Paul; Hong, Angela

2016-01-01

Definitive radiotherapy is often used for chest wall desmoid tumours due to size or anatomical location. The delivery of radiotherapy is challenging due to the large size and constraints of normal surrounding structures. We compared the dosimetry of 3D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy (VMAT) to evaluate the best treatment option. Ten consecutive patients with inoperable chest wall desmoid tumours (PTV range 416–4549 cm 3 ) were selected. For each patient, 3DCRT, IMRT and VMAT plans were generated and the Conformity Index (CI), organ at risk (OAR) doses and monitor unit (MU) were evaluated. The Wilcoxon signed-rank test was used to compare dose delivered to both target and OARs. The mean number of fields for 3DCRT and IMRT were 6.3 ± 2.1, 7.2 ± 1.8. The mean number of arcs for VMAT was 3.7 ± 1.1. The mean conformity index of VMAT (0.98 ± 0.14) was similar to that of IMRT (1.03 ± 0.13), both of which were significantly better than 3DCRT (1.35 ± 0.20; p = 0.005). The mean dose to lung was significantly higher for 3DCRT (11.9Gy ± 7.9) compared to IMRT (9.4Gy ± 5.4, p = 0.014) and VMAT (8.9Gy ± 4.5, p = 0.017). For the 3 females, the low dose regions in the ipsilateral breast for VMAT were generally less with VMAT. IMRT plans required 1427 ± 532 MU per fraction which was almost 4-fold higher than 3DCRT (313 ± 112, P = 0.005). Compared to IMRT, VMAT plans required 60 % less MU (570 ± 285, P = 0.005). For inoperable chest wall desmoid tumours, VMAT delivered equivalent target coverage when compared to IMRT but required 60 % less MU. Both VMAT and IMRT were superior to 3DCRT in terms of better PTV coverage and sparing of lung tissue

Knowledge, attitudes and behaviour regarding waste management options in Romania: results from a school questionnaire

OpenAIRE

Karin KOLBE

2014-01-01

This study analyses knowledge, attitudes and behaviour in the area of different waste management approaches of pupils in Romania. Examining school students' knowledge about waste management options and finding out the reasons that prevent them from participating in environmentally sound disposal options is essential for teachers and legislators. For this purpose, questionnaires were designed and distributed in two schools in Romania. The analysis revealed that knowledge is highly developed in...

EGFR-inhibitors, radiotherapy and normal tissue toxicity

DEFF Research Database (Denmark)

Eriksen, J. G.

2015-01-01

will be explained with references to the current knowledge of the biology of skin toxicity. Treatment options for acute side-effects in skin and mucosa after bio-radiotherapy is rarely causal. A few attempts have been done; some of them aiming to rephosphorylate the EGFreceptor in the skin with vitamin K3. The talk...

Multidisciplinary Management of Laryngeal Carcinoma

International Nuclear Information System (INIS)

Mendenhall, William M.; Mancuso, Anthony A.; Hinerman, Russell W.; Malyapa, Robert S.; Werning, John W.; Amdur, Robert J.; Villaret, Douglas B.

2007-01-01

The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor

Sucralfate cream in the management of moist desquamation during radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Delaney, G. [Liverpool Hospital, Liverpool, NSW, (Australia). Department of Radiation Oncology, Cancer Therapy Centre; Fisher, R.; Hook, C. [Prince of Wales Hospital, Randwick, NSW, (Australia). Department of Radiation Oncology; Barton, M. [Westmead Hospital, Westmead, NSW (Australia). Department of Radiation Oncology

1997-08-01

Randomized trials have shown that sucralfate is effective in the management of acute radiation reactions such as oesophagitis, mucositis and proctitis. However, at the time of commencement of the present trial, it had never been used in the management of moist desquamation of the skin. The purpose of the present study was to assess the value of sucralfate cream in the management of moist desquamation during radiotherapy. Patients who developed moist desquamation during radiation were eligible. Patients were stratified by site of radiotherapy into three groups: (i) the head and neck; (ii) the breast; and (iii) other sites. Patients were randomized to receive 10% sucralfate in sorbolene cream or sorbolene alone. Patients` pain and skin healing were assessed by using linear analogue self-assessment (LASA) scales and by serial measurement of the desquamated area. Due to poor patient accrual, the trial was terminated after 2 years and 39 patients. No statistically significant difference was found between the two arms in either time from randomization to healing or improvement in pain score. Twenty patients in the sucralfate arm took a geometric mean of 14.8 days to heal whereas 19 patients receiving sorbolene alone took a geometric mean of 14.2 days. The ratio of mean times to healing, 1.043, is not statistically different from 1 (P= 0.86; 95% Cl = 0.65,1.67). A total of 75% of the patients reported pain relief on application of either cream. Mean LASA scores for pain for each day after randomization were compared by treatment arm and there was no statistically significant difference (P = 0.32). The present trial was unable to show a difference in terms of time to healing or pain relief in the treatment of moist desquamation. The small number of patients in the trial gave a wide confidence interval for treatment difference, implying that an important effect of sucralfate has not been excluded. Given the poor accrual in the present, single-institution study, future

Sucralfate cream in the management of moist desquamation during radiotherapy

International Nuclear Information System (INIS)

Delaney, G.; Fisher, R.; Hook, C.; Barton, M.

1997-01-01

Randomized trials have shown that sucralfate is effective in the management of acute radiation reactions such as oesophagitis, mucositis and proctitis. However, at the time of commencement of the present trial, it had never been used in the management of moist desquamation of the skin. The purpose of the present study was to assess the value of sucralfate cream in the management of moist desquamation during radiotherapy. Patients who developed moist desquamation during radiation were eligible. Patients were stratified by site of radiotherapy into three groups: (i) the head and neck; (ii) the breast; and (iii) other sites. Patients were randomized to receive 10% sucralfate in sorbolene cream or sorbolene alone. Patients' pain and skin healing were assessed by using linear analogue self-assessment (LASA) scales and by serial measurement of the desquamated area. Due to poor patient accrual, the trial was terminated after 2 years and 39 patients. No statistically significant difference was found between the two arms in either time from randomization to healing or improvement in pain score. Twenty patients in the sucralfate arm took a geometric mean of 14.8 days to heal whereas 19 patients receiving sorbolene alone took a geometric mean of 14.2 days. The ratio of mean times to healing, 1.043, is not statistically different from 1 (P= 0.86; 95% Cl = 0.65,1.67). A total of 75% of the patients reported pain relief on application of either cream. Mean LASA scores for pain for each day after randomization were compared by treatment arm and there was no statistically significant difference (P = 0.32). The present trial was unable to show a difference in terms of time to healing or pain relief in the treatment of moist desquamation. The small number of patients in the trial gave a wide confidence interval for treatment difference, implying that an important effect of sucralfate has not been excluded. Given the poor accrual in the present, single-institution study, future

Stereotactic body radiotherapy for liver tumors. Principles and practical guidelines of the DEGRO Working Group on Stereotactic Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Sterzing, Florian [Deutsches Krebsforschungszentrum (DKFZ), Klinische Kooperationseinheit Strahlentherapie, Heidelberg (Germany); Radiologische Universitaetsklinik, Abteilung fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Brunner, Thomas B. [Universitaetsklinikum Freiburg, Klinik fuer Strahlenheilkunde, Radiologische Klinik, Freiburg (Germany); Ernst, Iris; Greve, Burkhard [Universitaetsklinikum Muenster, Klinik fuer Strahlentherapie - Radioonkologie, Muenster (Germany); Baus, Wolfgang W. [Universitaetsklinikum Koeln, Klinik und Poliklinik fuer Strahlentherapie, Koeln (Germany); Herfarth, Klaus [Radiologische Universitaetsklinik, Abteilung fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Guckenberger, Matthias [UniversitaetsSpital Zuerich, Klinik fuer Radio-Onkologie, Zuerich (Switzerland)

2014-10-15

This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a practical guideline for safe and effective stereotactic body radiotherapy (SBRT) of liver tumors. The literature on the clinical evidence of SBRT for both primary liver tumors and liver metastases was reviewed and analyzed focusing on both physical requirements and special biological characteristics. Recommendations were developed for patient selection, imaging, planning, treatment delivery, motion management, dose reporting, and follow-up. Radiation dose constraints to critical organs at risk are provided. SBRT is a well-established treatment option for primary and secondary liver tumors associated with low morbidity. (orig.) [German] Die Arbeitsgruppe Stereotaxie der Deutschen Gesellschaft fuer Radioonkologie (DEGRO) legt hier eine Empfehlung zur sicheren und effektiven Durchfuehrung der SBRT von Lebertumoren vor. Eine Literaturrecherche zur Untersuchung der Evidenz der SBRT sowohl fuer primaere Lebertumore als auch fuer Lebermetastasen wurde durchgefuehrt. Auf dieser Basis werden Empfehlungen fuer technisch-physikalische Voraussetzungen wie auch fuer die taegliche Praxis der Leber-SBRT gegeben. Weiterhin werden radiobiologische Besonderheiten dieses Verfahrens dargestellt. Praktische Vorgaben werden fuer Patientenselektion, Bildgebung, Planung, Applikation, Bewegungsmanagement, Dosisdokumentation und Follow-up gegeben. Dosisempfehlungen fuer die kritischen Risikoorgane werden dargestellt. Die SBRT stellt eine etablierte Behandlungsmethode fuer primaere und sekundaere Lebertumore dar und ist mit niedriger Morbiditaet assoziiert. (orig.)

An evaluation of the utilisation of the virtual environment for radiotherapy training (VERT) in clinical radiotherapy centres across the UK

International Nuclear Information System (INIS)

James, Sarah; Dumbleton, Claire

2013-01-01

Aim: The purpose of the survey was to evaluate the utilisation of the Virtual Environment for Radiotherapy Training (VERT) in clinical radiotherapy centres across the UK. Methods: A survey questionnaire was constructed using the Survey Monkey™ tool to evaluate the utilisation of the Virtual Environment for Radiotherapy Training. Once constructed, an online link to the survey questionnaire was emailed to all radiotherapy centre managers in the UK (n = 67) who were invited to provide one response per centre. The survey comprised forty-five questions which were grouped into eleven sections. Key results: The results indicate that 61% of UK radiotherapy centres have VERT installed, twenty centres are currently without a VERT installation and only 1 centre is intending to install a system in the near future. The results also indicate that the use of VERT varies considerably in differing radiotherapy centres with the most frequent use of VERT being for the training of staff, specifically for the training of pre-registration therapeutic radiographers and preparation time for trainers. The majority of centres using VERT for any of the purposes investigated feel it provides benefits. Conclusions and recommendations: The survey highlighted the varied use of VERT in radiotherapy centres across the UK and indicated that when VERT is used in clinical radiotherapy centres, a wide variety of benefits are experienced. Because of the variation in use, it is concluded that the benefits of the VERT installations in radiotherapy centres across the UK are not being fully realised. It is recommended that all radiotherapy service managers commit adequate resources to develop and implement VERT fully and effectively so that its full potential is realised in all radiotherapy centres across the UK

Real Options in Capital Budgeting. Pricing the Option to Delay and the Option to Abandon a Project

Directory of Open Access Journals (Sweden)

Nicoleta Vintila

2007-07-01

Full Text Available Traditional discounted cash-flows method for assessing projects assumes that investment decision is an irreversible one, which is not correct. Managers can and must reconsider their initial decision as the new information arises during the project life. This is managerial flexibility and it creates strategic value for a project, only if management takes advantage of the opportunities associated with an analyzed project. Real options represent a new approach in capital budgeting, using the theory of pricing financial options for investments in real assets. In this paper, we emphasize the characteristics and valuation methodologies of real options. The objective in the last section is pricing the option to delay and the option to abandon a project in construction materials field.

Guide of external radiotherapy procedures 2007

International Nuclear Information System (INIS)

Anon.

2008-01-01

This work aims at participating in the permanent optimization of the returned medical service and the ratio profit-risk. This first version of the guide of external radiotherapy procedures 2007 processes only techniques of external radiotherapy, by opposition to the techniques of brachytherapy which use radioactive sources (iridium 192 , iodine 125 , cesium 137 ) placed in the contact of the tumor to be irradiated. Only, also, will be considered the irradiations of the most frequent cunning(malignant) tumors with the exception of the radiotherapy of the mild pathologies and the re-irradiations after a first radiotherapy. The first part is shared in eight chapters as follow: introduction, the steps of a treatment by radiotherapy, infrastructure, equipment and human resources, radiobiology mechanism of action of ionising radiations in radiotherapy, dose in radiotherapy, quality of treatment and radiation protection of patients in radiotherapy, prevention and risk management in radiotherapy, quality assurance and radiation protection for the pediatrics cancers and the case of pregnant women. The second part gives the tumoral localizations and the procedures; the third part is a glossary and different annexes such regulations and legislative texts. (N.C.)

Life cycle assessment of bagasse waste management options

International Nuclear Information System (INIS)

Kiatkittipong, Worapon; Wongsuchoto, Porntip; Pavasant, Prasert

2009-01-01

Bagasse is mostly utilized for steam and power production for domestic sugar mills. There have been a number of alternatives that could well be applied to manage bagasse, such as pulp production, conversion to biogas and electricity production. The selection of proper alternatives depends significantly on the appropriateness of the technology both from the technical and the environmental points of view. This work proposes a simple model based on the application of life cycle assessment (LCA) to evaluate the environmental impacts of various alternatives for dealing with bagasse waste. The environmental aspects of concern included global warming potential, acidification potential, eutrophication potential and photochemical oxidant creation. Four waste management scenarios for bagasse were evaluated: landfilling with utilization of landfill gas, anaerobic digestion with biogas production, incineration for power generation, and pulp production. In landfills, environmental impacts depended significantly on the biogas collection efficiency, whereas incineration of bagasse to electricity in the power plant showed better environmental performance than that of conventional low biogas collection efficiency landfills. Anaerobic digestion of bagasse in a control biogas reactor was superior to the other two energy generation options in all environmental aspects. Although the use of bagasse in pulp mills created relatively high environmental burdens, the results from the LCA revealed that other stages of the life cycle produced relatively small impacts and that this option might be the most environmentally benign alternative

Aftereffect of radiotherapy of upper aero-digestive tracts in odontological care

International Nuclear Information System (INIS)

Schiochet, Luc

2010-01-01

In its first part, this thesis proposes a detailed presentation of the upper aero-digestive tract cancer. The author defines the cancerous process, describes anatomic aspects, and discusses epidemiological aspects (occurrence, mortality, survival, and epidemiological data in different countries). In the second part, the author discusses the role of radiotherapy and of dental surgery in taking a cancerous patient into care (general principles of radiotherapy, therapeutic options and choices, association of radiotherapy, chemotherapy and surgery). Principles of radiotherapy are then more precisely addressed: physical principles (X rays, gamma rays, electrons, neutrons, and protons), radioactivity doses, radiotherapy effect, main equipment, radiotherapy techniques (conformational or intensity-modulated radiotherapy, computed tomography, Cyberknife, external radiotherapy, brachytherapy). The third part addresses early oral-facial complications induced by radiotherapy: factors favouring these complications, nervous effects, effects on the blood system and on the skin, hyposialia and xerostomia, radio-induced mucositis of upper aero-digestive tracts. The next part addresses late effects: late cutaneous after-effects, late radio-mucositis, limitation of mouth opening, tooth decays, osteoradionecrosis. The last part addresses the role of the dental surgeon in taking into care a patient whose head and neck have been irradiated: role before irradiation, during irradiation, and after irradiation [fr

Forward, Forward Option and No Hedging Which One is the Best for Managing Currency Risk?

Directory of Open Access Journals (Sweden)

Riko Hendrawan

2017-07-01

Full Text Available Bank Indonesia Regulation No.18/18/PBI/2016 concerning foreign exchange transactions against rupiah between banks and domestic parties, indicates that the importance of hedging for business actors in Indonesia. Based on the data of the rupiah exchange rate movement against the dollar from January 2006 to December 2016 shows that the fluctuation of the rupiah against the US dollar tends to weaken, although at some point the observation shows the strengthening of the rupiah against the US dollar. The purpose of this research is to assess impact of Forward, Forward Option and No Hedging Strategy for managing currency exposure between IDR to USD. Using data from January 2006–December 2016 taken from website of Bank Indonesia and Federal Reserve. Total 396 simulations,consists of 132 using Forward simulations, 132 using Forward Option simulations and 132 using No Hedging simulations. Findings from this research show that Forward Option was has no positive contribution in managing currency exposure, No Hedging Strategy has 36,36 percent positive contribution and forward contract has 72,73 percent positive contribution in managing currency exposure. Its means Forward Contract was better than Forward Option and No Hedging Strategies in managing currency exposure.

Transition from 2-D radiotherapy to 3-D conformal and intensity modulated radiotherapy

International Nuclear Information System (INIS)

2008-05-01

Cancer is one of the leading causes of death globally and radiotherapy is currently an essential component in the management of cancer patients, either alone or in combination with surgery or chemotherapy, both for cure or palliation. It is now recognized that safe and effective radiotherapy service needs not only substantial capital investment in radiotherapy equipment and specially designed facilities but also continuous investment in maintenance and upgrading of the equipment to comply with the technical progress, but also in training the staff. The recent IAEA-TECDOC publication 'Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects' provides general guidelines for designing and implementing radiotherapy services in Member States. Advances in computer technology have enabled the possibility of transitioning from basic 2- dimensional treatment planning and delivery (2-D radiotherapy) to a more sophisticated approach with 3-dimensional conformal radiotherapy (3-D CRT). Whereas 2-D radiotherapy can be applied with simple equipment, infrastructure and training, transfer to 3-D conformal treatments requires more resources in technology, equipment, staff and training. A novel radiation treatment approach using Intensity Modulated Radiation Therapy (IMRT) that optimizes the delivery of radiation to irregularly shaped tumour volumes demands even more sophisticated equipment and seamless teamwork, and consequentially more resources, advanced training and more time for treatment planning and verification of dose delivery than 3-D CRT. Whereas 3-D CRT can be considered as a standard, IMRT is still evolving. Due to the increased interest of Member States to the modern application of radiotherapy the IAEA has received a number of requests for guidance coming from radiotherapy departments that wish to upgrade their facilities to 3-D CRT and IMRT through Technical Cooperation programme. These requests are expected to increase

Nasopharyngeal juvenile angiofibroma: updating of radiotherapy results

International Nuclear Information System (INIS)

Alert Silva, Jose; Caballero Aguirrechu, Iraida; Reno Cespedes, Jesus; Perez Penna, Lourdes

2010-01-01

The nasopharyngeal juvenile angiofibroma is a uncommon benign tumor composed of fibrous connective tissue and many vascular spaces covered by endothelium. It is almost exclusive of male sex and of adolescents. Choice treatment is the exeresis without obviate other possibilities as the radiotherapy. The aim of present study was to show the results of this latter as therapeutical option

Radiotherapy-induced hypopituitarism: a review.

Science.gov (United States)

Sathyapalan, Thozhukat; Dixit, Sanjay

2012-05-01

Hypopituitarism is a disorder caused by impaired hormonal secretions from the hypothalamic-pituitary axis. Radiotherapy is the most common cause of iatrogenic hypopituitarism. The hypothalamic-pituitary axis inadvertently gets irradiated in patients receiving prophylactic cranial radiotherapy for leukemia, total body irradiation and radiotherapy for intracranial, base skull, sinonasal and nasopharyngeal tumors. Radiation-induced hypopituitarism (RIH) is insidious, progressive and largely nonreversible. Mostly, RIH involves one hypothalamic-pituitary axis; however, multiple hormonal axes deficiency starts developing at higher doses. Although the clinical effects of the hypopituitarism are more profound in children and young adults, its implications in older adults are being increasingly recognized. The risk continues to persist or increase up to 10 years following radiation exposure. The clinical management of hypopituitarism is challenging both for the patients and healthcare providers. Here we have reviewed the scale of the problem, the risk factors and the management of RIH.

Life cycle analysis of management options for organic waste collected in an urban area.

Science.gov (United States)

Di Maria, Francesco; Micale, Caterina

2015-01-01

Different options for managing the organic fraction (OF) of municipal solid waste generated in a given urban area were analyzed by life cycle assessment (LCA) for different source segregation (SS) intensities ranging from 0 to 52%. The best management option for processing the OF remaining in the residual organic fraction (ROF) for the different SS intensities was by incineration. Landfilling and mechanical biological treatment (MBT) of ROF gave higher impacts. Aerobic treatment alone or combined with anaerobic digestion (AD) for processing the source-segregated organic fraction (SSOF) led to relevant environmental impact reduction even if the difference between the two options was quite negligible. The weighted impact showed that scenarios using incineration always gave environmental gains, whereas there was a higher environmental burden with the scenarios using MBT.

Current treatment options for meningioma.

Science.gov (United States)

Apra, Caroline; Peyre, Matthieu; Kalamarides, Michel

2018-03-01

With an annual incidence of 5/100,000, meningioma is the most frequent primary tumor of the central nervous system. Risk factors are radiotherapy and hormone intake. Most meningiomas are grade I benign tumors, but up to 15% are atypical and 2% anaplastic according to the WHO 2016 histological criteria. Areas covered: This review details the current standard therapy based on international guidelines and recent literature, and describes new approaches developed to treat refractory cases. First-line treatments are observation and surgery, but adjuvant radiotherapy/radiosurgery is discussed for atypical and indicated for anaplastic meningiomas. The most problematic cases include skull base meningiomas that enclose vasculo-nervous structures and surgery- and radiation-refractory tumors that present with significant morbidity and mortality. The treatment of recurrent tumors is based on radiotherapy and repeated surgery. Systematic therapies are not effective in general but several clinical trials are ongoing. Expert commentary: Molecular characterization of the tumors, based on genetic mutations such as NF2, SMO, TERT, TRAF7, and on the methylation profile are developing, completing the histological classification and giving new insights into prognosis and treatment options.

Land Management Restrictions and Options for Change in Perpetual Conservation Easements

Science.gov (United States)

Rissman, Adena; Bihari, Menka; Hamilton, Christopher; Locke, Christina; Lowenstein, David; Motew, Melissa; Price, Jessica; Smail, Robert

2013-07-01

Conservation organizations rely on conservation easements for diverse purposes, including protection of species and natural communities, working forests, and open space. This research investigated how perpetual conservation easements incorporated property rights, responsibilities, and options for change over time in land management. We compared 34 conservation easements held by one federal, three state, and four nonprofit organizations in Wisconsin. They incorporated six mechanisms for ongoing land management decision-making: management plans (74 %), modifications to permitted landowner uses with discretionary consent (65 %), amendment clauses (53 %), easement holder rights to conduct land management (50 %), reference to laws or policies as compliance terms (47 %), and conditional use permits (12 %). Easements with purposes to protect species and natural communities had more ecological monitoring rights, organizational control over land management, and mechanisms for change than easements with general open space purposes. Forestry purposes were associated with mechanisms for change but not necessarily with ecological monitoring rights or organizational control over land management. The Natural Resources Conservation Service-Wetland Reserve Program had a particularly consistent approach with high control over land use and some discretion to modify uses through permits. Conservation staff perceived a need to respond to changing social and ecological conditions but were divided on whether climate change was likely to negatively impact their conservation easements. Many conservation easements involved significant constraints on easement holders' options for altering land management to achieve conservation purposes over time. This study suggests the need for greater attention to easement drafting, monitoring, and ongoing decision processes to ensure the public benefits of land conservation in changing landscapes.

Options for Healthcare Waste Management and Treatment in China

Institute of Scientific and Technical Information of China (English)

无

2006-01-01

Healthcare waste management and treatment is one of the national priority tasks of China's Tenth Five-Year Plan.Numerous installations disposing medical waste have already operated the project or under construction to the operation in 2006. This paper focuses on the assessment of existing and fu~re options to handle medical waste (MW). Internationally available and so far in China applied technologies and management practice are analysed, including the problems how to materials. Non-hazardous MW can be managed and treated in analogue to municipal solid waste (MSW). In most of the European countries decentralised hospital incinerators have been, because of high operation costs and pollution problems,widely banned and replaced by pre-treatment technologies at the source and centralised incineration plants for hazardous MW.Information for adapting and further developing MW management solutions and treatment technologies in China and applying the most appropriate MWM practice is provided.

An instrument dedicated for modelling of pulmonary radiotherapy

International Nuclear Information System (INIS)

Niezink, Anne G.H.; Dollekamp, Nienke J.; Elzinga, Harriet J.; Borger, Denise; Boer, Eduard J.H.; Ubbels, Jan F.; Woltman-van Iersel, Marleen; Leest, Annija H.D. van der; Beijert, Max; Groen, Harry J.M.; Kraan, Jan; Hiltermann, Thijo J.N.; Wekken, Anthonie J. van der; Putten, John W.G. van; Rutgers, Steven R.; Pieterman, Remge M.; Hosson, Sander M. de; Roenhorst, Anke W.J.; Langendijk, Johannes A.; Widder, Joachim

2015-01-01

Background and purpose: Radiotherapy plays a pivotal role in lung cancer treatment. Selection of patients for new (radio)therapeutic options aiming at improving outcomes requires reliable and validated prediction models. We present the implementation of a prospective platform for evaluation and development of lung radiotherapy (proPED-LUNG) as an instrument enabling multidimensional predictive modelling. Materials and methods: ProPED-LUNG was designed to comprise relevant baseline and follow up data of patients receiving pulmonary radiotherapy with curative intent. Patient characteristics, diagnostic and staging information, treatment parameters including full dose–volume-histograms, tumour control, survival, and toxicity are scored. Besides physician-rated data, a range of patient-rated data regarding symptoms and health-related quality-of-life are collected. Results: After 18 months of accrual, 315 patients have been included (accrual rate, 18 per month). Of the first hundred patients included, 70 received conformal (chemo)radiotherapy and 30 underwent stereotactic radiotherapy. Compliance at 3 and 6 months follow-up was 96–100% for patient-rated, and 81–94% for physician-rated assessments. For data collection, 0.4 FTE were allocated in a 183 FTE department (0.2%). Conclusions: ProPED-LUNG is feasible with high compliance rates and yields a large amount of high quality prospective disease-related, treatment-related, patient- and physician-rated data which can be used to evaluate new developments in pulmonary radiotherapy

Prevention and treatment of the orofacial complications of radiotherapy

International Nuclear Information System (INIS)

Rothwell, B.R.

1987-01-01

Radiotherapy of malignant head and neck tumors often causes extensive, permanent changes in salivary glands, peridental alveolar bone, and mucosal structures. Dental neglect and inappropriate dental management can cause complications. The potential orofacial side effects of radiotherapy are reviewed, as are preventive strategies for the dental treatment of patients scheduled to undergo radiotherapy

Safety and quality management for radiotherapy treatments - ASN guide nr 5 - Index 1 - Release of the 10/04/2009

International Nuclear Information System (INIS)

2009-01-01

This guide aims at proposing a framework for the safety and quality management for radiotherapy treatments. It addresses the general requirements for the quality management system (general requirements and requirements related to documentation), the management responsibility, the resource management (human and hardware resources), the preparation and performance of activities allowing the taking into care of a patient from his first consultation to the post-treatment follow-up, the assessment, analysis and improvement of the quality management system

Time Charters with Purchase Options in Shipping: Valuation and Risk Management

DEFF Research Database (Denmark)

Jørgensen, Peter Løchte; De Giovanni, Domenico

The paper studies the valuation and optimal management of Time Charters with Purchase Options (T/C-POPs) which is a specific type of asset lease with embedded options that is common in shipping markets. T/C-POPs are economically significant and sometimes account for more than half of the stock...... market value of listed shipping companies. The main source of risk in markets for maritime transportation is the freight rate, and we therefore specify a single-factor continuous time model for the dynamic evolution of freight rates which allows us to price a wide variety of freight rate related...

Time Charters with Purchase Options in Shipping: Valuation and Risk Management

DEFF Research Database (Denmark)

Jørgensen, Peter Løchte; De Giovanni, Domenico

2010-01-01

The article studies the valuation and optimal management of Time Charters with Purchase Options (T/C-POPs), which is a specific type of asset lease with embedded options that is common in shipping markets. T/C-POPs are economically significant and sometimes account for more than half of the stock...... market value of listed shipping companies. The main source of risk in markets for maritime transportation is the freight rate, and we therefore specify a single-factor continuous time model for the dynamic evolution of freight rates that allows us to price a wide variety of freight rate...

The role of quantitative optimization techniques in assessment of best practicable environmental options for radioactive waste management

International Nuclear Information System (INIS)

Johnston, P.D.

1987-01-01

The interpretation of the Best Practicable Environmental Option (BPEO) and ALARA concepts in radioactive waste management is given. The quantitative analysis of the financial and radiological impacts of different options for waste management is discussed. Finally, the role of quantitative multi-attribute analysis in the DOE's assessment of BPEOs for radioactive waste is described. (UK)

Stereotactic Body Radiotherapy for Localized Ureter Transitional Cell Carcinoma: Three Case Reports

Directory of Open Access Journals (Sweden)

Yoshiyasu Maehata

2015-01-01

Full Text Available The gold standard management for ureter transitional cell carcinoma (UTCC is radical nephroureterectomy with excision of the bladder cuff. However, some patients cannot undergo this procedure for several reasons. In the case reports described herein, we performed stereotactic body radiotherapy (SBRT on three patients with inoperable or surgery-rejected localized UTCC. Two out of the three patients did not develop local recurrence or distant metastasis during the observation period. However, recurrence was detected in the bladder of one patient 22 months after the treatment. No acute or late adverse events occurred in any of the three patients. SBRT may become one of the treatment options for inoperable or surgery-rejected UTCC patients.

Radiation caries - an evil eye of radiotherapy

International Nuclear Information System (INIS)

Lakshman, Anusha Rangare

2013-01-01

Although radiotherapy plays an important role in the management of patients with head and neck cancer, it is also associated with several undesired side effects such as radiation caries which is a common, yet serious, complication. The radiotherapy field of exposure frequently includes the salivary glands, oral mucosa, and jaws, thus, leading to various side effects including hyposalivation, mucositis, and taste loss. Irradiated patients are also at increased risk for the development of a rapid, rampant carious process known as radiation caries. Lesions tend to develop four weeks after completion of radiotherapy and affect atypical areas of teeth, such as the lingual surface, incisal edges, and cusp tips. The aim of this paper is to review the clinical features, prevention and management of radiation caries. (author)

Inoperable metastatic giant basal cell trunk carcinoma: radiotherapy can be useful; Carcinome basocellulaire geant du tronc metastatique inoperable: la radiotherapie peut etre utile

Energy Technology Data Exchange (ETDEWEB)

Mania, A.; Durando, X.; Lapeyre, M. [Centre Jean-Perrin, Clermont-Ferrand (France); Barthelemy, I. [CHU Estaing, Clermont-Ferrand (France)

2011-10-15

The authors evoke some characteristics of the basal cell carcinoma (slow evolution, local morbidity) and report and discuss the case of a giant basal cell trunk carcinoma, associated with several symptoms (pain, bleeding, anaemia), already metastatic at the moment of diagnosis, and locally treated by irradiation. Due to its size and expansion, this carcinoma was considered as inoperable. An external radiotherapy has been performed and resulted in a significant clinical tumour reduction. But the metastatic risk is high in such cases. Radiotherapy is then a therapeutic option for a local treatment with a durable efficiency. Short communication

Towards phronetic knowledge for strategic planning in corporate real estate management: A real options approach

NARCIS (Netherlands)

van Reedt Dortland, Maartje; Voordijk, Johannes T.; Dewulf, Geert P.M.R.

2014-01-01

Purpose – The objective of this paper is to provide insights about the potential of real option thinking for corporate real estate management (CREM) from the owner-user perspective. A promising approach to classifying and evaluating flexibility in real estate is the real options approach. Most

41 CFR 102-194.30 - What role does my agency play in the Standard and Optional Forms Management Program?

Science.gov (United States)

2010-07-01

... What role does my agency play in the Standard and Optional Forms Management Program? Your agency head... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What role does my agency play in the Standard and Optional Forms Management Program? 102-194.30 Section 102-194.30 Public...

Advice concerning radiotherapy

International Nuclear Information System (INIS)

1984-01-01

Dutch National cancer incidence figures were calculated by using the reliable data on cancer incidence in the Eindhoven area and population forecasts and information obtained from the Central Bureau of Statistics. Several radiotherapy departments suffer from under capacity (a lack of resources and understaffing). Data have also shown that 35% of cancer patients receive radiotherapy, instead of 50%. Calculations have been made by the committee on the present and future needs with regard to equipment and staff. In 1983, the number of megavoltage therapy units amounted to 38, but should have been 65. It should be 80 in 1990 and 90 in 2000. Since building and installing such equipment is a lengthy process a considerable effort is needed to make up for the arrears. The committee advocates the extension of the system of regional cooperation in cancer care (comprehensive cancer centres), in which radiotherapy departments play a crucial role. Working parties from the committee provided a comprehensive description of current radiotherapy practice with reference to physical, technical, clinical and management aspects. Another working party assessed the results of cancer treatment with regard to many different tumour sites. Recent and expected developments were analysed or indicated. The Radiotherapy Committee commissioned an external team to conduct a project to achieve a picture of future developments using methods different to those of the committee's. An interim advice has been added on this subject. (Auth.)

Stereotactic intracranial radiotherapy: Dose prescription

International Nuclear Information System (INIS)

Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

2012-01-01

The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

Cystectomy and Urinary Diversion for the Management of a Devastated Lower Urinary Tract Following Prostatic Cryotherapy and/or Radiotherapy.

Science.gov (United States)

Sack, Bryan S; Langenstroer, Peter; Guralnick, Michael L; Jacobsohn, Kenneth M; O'Connor, R Corey

2016-04-01

We investigated the outcomes and quality of life measures in men who underwent cystectomy and urinary diversion for devastating lower urinary tract toxicity after prostatic radiotherapy and/or cryotherapy for the treatment of prostate cancer. Records of patients who underwent cystectomy and urinary diversion for the management of a devastated lower urinary tract following prostatic radiotherapy or cryotherapy were reviewed retrospectively. A postoperative, retrospective quality of life (QOL) survey was designed specific to this patient subset and obtained by telephone interview. Extirpative surgery with urinary diversion for management of a devastated lower urinary tract was performed on 15 patients with a mean age of 72 years (range 63-82). Toxicities leading to bladder removal included bladder neck contractures, prostatic necrosis, incontinence, osteomyelitis, bladder calculi, fistulae, urethral strictures, abscesses, necrotizing fasciitis, and radiation/hemorrhagic cystitis. The mean number of failed conservative, minimally invasive interventions per patients prior to cystectomy was 3.7 (range 1-12). The average time period from major complication following radiotherapy/cryotherapy to cystectomy was 29.1 months (range 5-65). The QOL survey showed all of the patients who completed the survey (n = 13) would undergo the procedure again and 11 (85%) would have undergone the procedure an average of 13.2 months sooner (range 5-36). Toxicities secondary to prostatic radiotherapy or cryotherapy may be debilitating. Our results demonstrate that cystectomy with urinary diversion can improve QOL in patients with a devastated lower urinary tract.

The role of radiotherapy in the management of supratentorial low grade astrocytoma

International Nuclear Information System (INIS)

Song, M. H.; Chang, H. S.; Lee, K. J.

1997-01-01

To evaluate the role of radiotherapy in the management of incompletely resected supratentorial low grade astrocytoma with the analysis of the survival, the pattern of failure, and the prognostic variables affecting survival. Between January 1990 and December 1995, fifty-one patients with supratentorial low grade astrocytoma received radiotherapy after subtotal resection (16 patients) or stereotactic biopsy(35 patients)at Asan Medical Center. External radiotherapy was done by conventional fractionation with the total dose of 4820cGy to 6000cGy(median 5580cGy) and partial brain volume. The follow-up was done from 6 to 79 months(median 48 months). Overall actuarial survival rate at 2 and 5 years were 83.4% and 54.8T, respectively. Progression free survival at 2 and 5 years were 67.4% and 48.7%, respectively. The significant prognostic factors affecting overall survival rate were the performance status, T stage, histologic subtype, radiation field and radiation response. The major pattern of failure was local failure, such as progressive disease and primary site recurrence in 23 patients (45.1%). Progression free survivors excluding 2 patients were physically and intellectually intact without major neurologic deficit. Although the follow-up period of this study was relatively short, overall actuarial and progression free survival rate were encouraging. Patients with good performance status, lower T stage, pilocytic subtype, patients treated with small radiation field and radiation responder showed better survival. As the local failure was the major pattern of failure, the various efforts to decrease the local failure is necessary. (author)

Otologic disorders following radiotherapy for nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Wakisaka, Hiroyuki; Hyodo, Masamitsu; Motoyoshi, Kazumi; Yamada, Hiroyuki

2007-01-01

Radiotherapy is widely accepted as the first choice for nasopharyngeal carcinoma. Delayed otitis of both external and middle ears is sometimes seen as a complication after radiotherapy for head and neck cancer, especially for nasopharyngeal carcinoma. They are usually hard to manage and some produces cochlear damages, finally resulting in a sensorineural hearing loss. However, these otologic disorders are tends to be overlooked, because physicians pay less attention to them than the concerning for cancer recurrence. Therefore, studies on the otologic disorders following radiotherapy are lacking. In this study, we analyzed 24 nasopharyngeal carcinoma cases retrospectively to clarify the incidence of otologic disorders induced by radiotherapy. (author)

Exotic Options: a Chooser Option and its Pricing

Directory of Open Access Journals (Sweden)

Raimonda Martinkutė-Kaulienė

2012-12-01

Full Text Available Financial instruments traded in the markets and investors’ situation in such markets are getting more and more complex. This leads to more complex derivative structures used for hedging that are harder to analyze and which risk is harder managed. Because of the complexity of these instruments, the basic characteristics of many exotic options may sometimes be not clearly understood. Most scientific studies have been focused on developing models for pricing various types of exotic options, but it is important to study their unique characteristics and to understand them correctly in order to use them in proper market situations. The paper examines main aspects of options, emphasizing the variety of exotic options and their place in financial markets and risk management process. As the exact valuation of exotic options is quite difficult, the article deals with the theoretical and practical aspects of pricing of chooser options that suggest a broad range of usage and application in different market conditions. The calculations made in the article showed that the price of the chooser is closely correlated with the choice time and low correlated with its strike price. So the first mentioned factor should be taken into consideration when making appropriate hedging and investing decisions.

Treatment of late sequelae after radiotherapy for head and neck cancer.

Science.gov (United States)

Strojan, Primož; Hutcheson, Katherine A; Eisbruch, Avraham; Beitler, Jonathan J; Langendijk, Johannes A; Lee, Anne W M; Corry, June; Mendenhall, William M; Smee, Robert; Rinaldo, Alessandra; Ferlito, Alfio

2017-09-01

Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss. Copyright © 2017 Elsevier Ltd. All rights reserved.

Paragangliomas: Presentation and management by radiotherapy at the Prince of Wales Hospital

International Nuclear Information System (INIS)

Smee, Robert I.; Jayasekara, Jayana; Williams, Janet R.; Hanna, Claire

2015-01-01

Paragangliomas are commonly treated with surgery, while radiotherapy is reserved for those that are inoperable or have relapsed. However, this retrospective study aims to determine whether radiotherapy is a viable initial treatment for paragangliomas. Of 73 tumours researched, 44 were diagnosed and treated from January 1967 to December 2012 at the Radiation Oncology Department at the Prince of Wales Hospital and thus were eligible for analysis. Median follow-up time was 3.5 years with a range of 1 to 40 years. Thirty-four tumours were treated with radiotherapy only, and 10 tumours were treated with both surgical resection and radiotherapy. Local control and cause-specific survival were the primary end points measured. Five-year local control rate for the population of 44 lesions was 89%; it was 100% in the group treated by radiotherapy alone, but only 50% in the group treated by surgery followed by radiotherapy, with radiation used for salvage. The difference in control rates between these two subset groups was found to be statistically significant (P < 0.001). Cause-specific survival rates for this eligible population at 5 and 10 years were 98% and 90%, respectively. After initial radiotherapy, 4 patients had improved cranial nerve function, there was clinical improvement in tinnitus, and one new cranial nerve deficit developed where a high dose was used. Radiotherapy has high local control rates and few complications. The local control and complication rates compare favourably to surgery.

Managing Reputational Risk through Environmental Management and Reporting: An Options Theory Approach

Directory of Open Access Journals (Sweden)

Juan Pineiro-Chousa

2017-03-01

Full Text Available Reputation is a complex and multidimensional concept that may be organized in downside and upside reputational risk. In this article, we present a formal modelling for the management capabilities of environmental management and reporting over reputational risk, considering that reputational risk is becoming increasingly important for organizations and it directly depends on the information available about companies’ environmental performances. As long as the effectiveness of communication and disclosure plays a key role in the process, the usefulness of environmental management and reporting as a hedging instrument for reputational risk is addressed through different levels of information transparency. When considering a scenario of voluntary reporting, we show that environmentally concerned companies can reduce the cost of environmental management as a reputational risk strategy, as well as reducing the potential loss of reputational value from reputational threats and increasing the potential profit from reputational opportunities. In the context of mandatory reporting, we highlight the role of assurance companies as bearers of the risk of bad reputations for non-concerned companies. As a result, this novel approach applies theoretical oriented research from options theory to reputational risk management literature, so that it benefits from the option’s well known theory, robustness, and conclusions.

Clinical quality standards for radiotherapy

Science.gov (United States)

2012-01-01

Aim of the study The technological progress that is currently being witnessed in the areas of diagnostic imaging, treatment planning systems and therapeutic equipment has caused radiotherapy to become a high-tech and interdisciplinary domain involving staff of various backgrounds. This allows steady improvement in therapy results, but at the same time makes the diagnostic, imaging and therapeutic processes more complex and complicated, requiring every stage of those processes to be planned, organized, controlled and improved so as to assure high quality of services provided. The aim of this paper is to present clinical quality standards for radiotherapy as developed by the author. Material and methods In order to develop the quality standards, a comparative analysis was performed between European and Polish legal acts adopted in the period of 1980-2006 and the universal industrial ISO 9001:2008 standard, defining requirements for quality management systems, and relevant articles published in 1984-2009 were reviewed, including applicable guidelines and recommendations of American, international, European and Polish bodies, such as the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy & Oncology (ESTRO), the International Atomic Energy Agency (IAEA), and the Organisation of European Cancer Institutes (OECI) on quality assurance and management in radiotherapy. Results As a result, 352 quality standards for radiotherapy were developed and categorized into the following three groups: 1 – organizational standards; 2 – physico-technical standards and 3 – clinical standards. Conclusion Proposed clinical quality standards for radiotherapy can be used by any institution using ionizing radiation for medical purposes. However, standards are of value only if they are implemented, reviewed, audited and improved, and if there is a clear mechanism in place to monitor and address failure to meet agreed standards. PMID:23788854

Feasibility of carbon-ion radiotherapy for re-irradiation of locoregionally recurrent, metastatic, or secondary lung tumors.

Science.gov (United States)

Hayashi, Kazuhiko; Yamamoto, Naoyoshi; Karube, Masataka; Nakajima, Mio; Tsuji, Hiroshi; Ogawa, Kazuhiko; Kamada, Tadashi

2018-03-02

Intrathoracic recurrence after carbon-ion radiotherapy for primary or metastatic lung tumors remains a major cause of cancer-related deaths. However, treatment options are limited. Herein, we report on the toxicity and efficacy of re-irradiation with carbon-ion radiotherapy for locoregionally recurrent, metastatic, or secondary lung tumors. Data of 95 patients with prior intrathoracic carbon-ion radiotherapy who were treated with re-irradiation with carbon-ion radiotherapy at our institution between 2006 and 2016 were retrospectively analyzed. Seventy-three patients (76.8%) had primary lung tumors and 22 patients (23.2%) had metastatic lung tumors. The median dose of initial carbon-ion radiotherapy was 52.8 Gy (relative biological effectiveness) and the median dose of re-irradiation was 66.0 Gy (relative biological effectiveness). None of the patients received concurrent chemotherapy. The median follow-up period after re-irradiation was 18 months. In terms of grade ≥3 toxicities, one patient experienced each of the following: grade 5 bronchopleural fistula, grade 4 radiation pneumonitis, grade 3 chest pain, and grade 3 radiation pneumonitis. The 2-year local control and overall survival rates were 54.0% and 61.9%, respectively. In conclusion, re-irradiation with carbon-ion radiotherapy was associated with relatively low toxicity and moderate efficacy. Re-irradiation with carbon-ion radiotherapy might be an effective treatment option for patients with locoregionally recurrent, metastatic, or secondary lung tumors. © 2018 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

5 CFR 870.705 - Amount and election of Option B and Option C.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Amount and election of Option B and Option C. 870.705 Section 870.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED... Compensationers § 870.705 Amount and election of Option B and Option C. (a) The number of multiples of Option B...

[Bladder-conserving treatment for bladder cancer: potential of and developments in radiotherapy].

Science.gov (United States)

Hulshof, Maarten C C M; Pieters, Bradley R; Koning, Caro C E

2013-01-01

The standard treatment for muscle-invasive bladder cancer is surgical removal of the bladder and construction of a neobladder. Recently, important improvements have been made in the potential for bladder-conserving treatment using radiotherapy. External beam radiotherapy has undergone technological improvements, as a result of which it is possible to radiate the tumour more precisely while decreasing radiation to healthy tissue. Radiochemotherapy improves local recurrence-free and overall survival compared with radiotherapy alone. The results of this combined treatment are comparable with those of surgery. Additionally, Dutch radiotherapy departments have collected data in a national database of 1040 selected patients with confined bladder cancer. These patients were treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%. Bladder conserving treatment options for muscle-invasive bladder cancer should be discussed during the multidisciplinary meeting.

Carbon footprint and energy use of food waste management options for fresh fruit and vegetables from supermarkets.

Science.gov (United States)

Eriksson, Mattias; Spångberg, Johanna

2017-02-01

Food waste is a problem with economic, environmental and social implications, making it both important and complex. Previous studies have addressed food waste management options at the less prioritised end of the waste hierarchy, but information on more prioritised levels is also needed when selecting the best available waste management options. Investigating the global warming potential and primary energy use of different waste management options offers a limited perspective, but is still important for validating impacts from the waste hierarchy in a local context. This study compared the effect on greenhouse gas emissions and primary energy use of different food waste management scenarios in the city of Växjö, Sweden. A life cycle assessment was performed for four waste management scenarios (incineration, anaerobic digestion, conversion and donation), using five food products (bananas, tomatoes, apples, oranges and sweet peppers) from the fresh fruit and vegetables department in two supermarkets as examples when treated as individual waste streams. For all five waste streams, the established waste hierarchy was a useful tool for prioritising the various options, since the re-use options (conversion and donation) reduced the greenhouse gas emissions and the primary energy use to a significantly higher degree than the energy recovery options (incineration and anaerobic digestion). The substitution of other products and services had a major impact on the results in all scenarios. Re-use scenarios where food was replaced therefore had much higher potential to reduce environmental impact than the energy recovery scenarios where fossil fuel was replaced. This is due to the high level of resources needed to produce food compared with production of fossil fuels, but also to fresh fruit and vegetables having a high water content, making them inefficient as energy carriers. Waste valorisation measures should therefore focus on directing each type of food to the waste

How do managers behave in stock option plans? Clinical evidence from exercise and survey data

NARCIS (Netherlands)

Sautner, Z.; Weber, M.

2009-01-01

We use unique case study data to analyze the behavior of top managers in an executive stock option plan. We gather questionnaire data on the managers' traits and combine it with exercise data. Managers in our sample expect low volatilities (compared to historical estimates) and are well diversified

Paragangliomas: presentation and management by radiotherapy at the Prince of Wales Hospital.

Science.gov (United States)

Smee, Robert I; Jayasekara, Jayana; Williams, Janet R; Hanna, Claire

2015-04-01

Paragangliomas are commonly treated with surgery, while radiotherapy is reserved for those that are inoperable or have relapsed. However, this retrospective study aims to determine whether radiotherapy is a viable initial treatment for paragangliomas. Of 73 tumours researched, 44 were diagnosed and treated from January 1967 to December 2012 at the Radiation Oncology Department at the Prince of Wales Hospital and thus were eligible for analysis. Median follow-up time was 3.5 years with a range of 1 to 40 years. Thirty-four tumours were treated with radiotherapy only, and 10 tumours were treated with both surgical resection and radiotherapy. Local control and cause-specific survival were the primary end points measured. Five-year local control rate for the population of 44 lesions was 89%; it was 100% in the group treated by radiotherapy alone, but only 50% in the group treated by surgery followed by radiotherapy, with radiation used for salvage. The difference in control rates between these two subset groups was found to be statistically significant (P < 0.001). Cause-specific survival rates for this eligible population at 5 and 10 years were 98% and 90%, respectively. After initial radiotherapy, 4 patients had improved cranial nerve function, there was clinical improvement in tinnitus, and one new cranial nerve deficit developed where a high dose was used. Radiotherapy has high local control rates and few complications. The local control and complication rates compare favourably to surgery. © 2014 The Royal Australian and New Zealand College of Radiologists.

Management of Spinal Metastases From Renal Cell Carcinoma Using Stereotactic Body Radiotherapy

International Nuclear Information System (INIS)

Nguyen, Quynh-Nhu; Shiu, Almon S.; Rhines, Laurence D.; Wang He; Allen, Pamela K.; Wang, Xin Shelley; Chang, Eric L.

2010-01-01

Purpose: To evaluate the outcomes associated with stereotactic body radiotherapy (SBRT) in the management of spinal metastases from renal cell carcinoma (RCC). Methods and Materials: SBRT was used in the treatment of patients with spinal metastases from RCC. Patients received either 24 Gy in a single fraction, 27 Gy in three fractions, or 30 Gy delivered in five fractions. Effectiveness of SBRT with respect to tumor control and palliation of pain was assessed using patient-reported outcomes. Results: A total of 48 patients with 55 spinal metastases were treated with SBRT with a median follow-up time of 13.1 months (range, 3.3-54.5 months). The actuarial 1-year spine tumor progression free survival was 82.1%. At pretreatment baseline, 23% patients were pain free; at 1 month and 12 months post-SBRT, 44% and 52% patients were pain free, respectively. No Grade 3-4 neurologic toxicity was observed. Conclusions: The data support SBRT as a safe and effective treatment modality that can be used to achieve good tumor control and palliation of pain associated with RCC spinal metastases. Further evaluation with randomized trials comparing SBRT to conventional radiotherapy may be warranted.

A decision methodology for the evaluation of mixed low-level radioactive waste management options for DOE sites

Energy Technology Data Exchange (ETDEWEB)

Bassi, J. [Dept. of Energy, Washington, DC (United States); Abashian, M.S.; Chakraborti, S.; Devarakonda, M.; Djordjevic, S.M. [IT Corp., Albuquerque, NM (United States)

1993-03-01

Currently, many DOE sites are developing site-specific solutions to manage their mixed low-level wastes. These site-specific MLLW programs often result in duplication of efforts between the different sites, and consequently, inefficient use of DOE system resources. A nationally integrated program for MLLW eliminates unnecessary duplication of effort, but requires a comprehensive analysis of waste management options to ensure that all site issues are addressed. A methodology for comprehensive analysis of the complete DOE MLLW system is being developed by DOE-HQ to establish an integrated and standardized solution for managing MLLW. To be effective, the comprehensive systems analysis must consider all aspects of MLLW management from cradle-to-grave (i.e. from MLLW generation to disposal). The results of the analysis will include recommendations for alternative management options for the complete DOE MLLW system based on various components such as effectiveness, cost, health and safety risks, and the probability of regulatory acceptance for an option. Because of the diverse nature of these various components and the associated difficulties in comparing between them, a decision methodology is being developed that will integrate the above components into a single evaluation scheme for performing relative comparisons between different MLLW management options. The remainder of this paper provides an overview of the roles and responsibilities of the various participants of the DOE MLLW Program, and discusses in detail the components involved in the development of the decision methodology for a comprehensive systems analysis.

Polish Toxic Currency Options

Directory of Open Access Journals (Sweden)

Waldemar Gontarski

2009-06-01

Full Text Available Toxic currency options are defined on the basis of the opposition to the nature (essence of an option contract, which is justified in terms of norms founded on the general law clause of characteristics (nature of a relation (which represents an independent premise for imposing restrictions on the freedom of contracts. So-understood toxic currency options are unlawful. Indeed they contravene iuris cogentis regulations. These include for instance option contracts, which are concluded with a bank, if the bank has not informed about option risk before concluding the contract; or the barrier options, which focus only on the protection of bank’s interests. Therefore, such options may appear to be invalid. Therefore, performing contracts for toxic currency options may be qualified as a criminal mismanagement. For the sake of security, the manager should then take into consideration filing a claim for stating invalidity (which can be made in a court verdict. At the same time, if the supervisory board member in a commercial company, who can also be a subject to mismanagement offences, commits an omission involving lack of reaction (for example, if he/she fails to notify of the suspected offence committed by the management board members acting to the company’s detriment when the management board makes the company conclude option contracts which are charged with absolute invalidity the supervisory board member so acting may be considered to act to the company’s detriment. In the most recent Polish jurisprudence and judicature the standard of a “good host” is treated to be the last resort for determining whether the manager’s powers resulting from criminal regulations were performed. The manager of the exporter should not, as a rule, issue any options. Issuing options always means assuming an obligation. In the case of currency put options it is an absolute obligation to purchase a given amount in euro at exchange rate set in advance. On the

New algorithm for risk analysis in radiotherapy

International Nuclear Information System (INIS)

Torres, Antonio; Montes de Oca, Joe

2015-01-01

Risk analyses applied to radiotherapy treatments have become an undeniable necessity, considering the dangers generated by the combination of using powerful radiation fields on patients and the occurrence of human errors and equipment failures during these treatments. The technique par excellence to execute these analyses has been the risk matrix. This paper presents the development of a new algorithm to execute the task with wide graphic and analytic potentialities, thus transforming it into a very useful option for risk monitoring and the optimization of quality assurance. The system SECURE- MR, which is the basic software of this algorithm, has been successfully used in risk analysis regarding different kinds of radiotherapies. Compared to previous methods, It offers new possibilities of analysis considering risk controlling factors as the robustness of reducers of initiators frequency and its consequences. Their analytic capacities and graphs allow novel developments to classify risk contributing factors, to represent information processes as well as accidental sequences. The paper shows the application of the proposed system to a generic process of radiotherapy treatment using a lineal accelerator. (author)

The effectiveness of radiotherapy for Merkel cell carcinoma

International Nuclear Information System (INIS)

Wakisaka, Masaki; Mori, Hiromu; Monzen, Yoshio; Aikawa, Hisayuki; Miyake, Hidetoshi; Ashizawa, Akira; Okamoto, Osamu; Yoshiyama, Masako; Takayasu, Susumu

1992-01-01

Merkel cell carcinoma is a high-grade malignant tumor of the skin that tends to extend locally and metastasize to regional lymph nodes. Surgical resection is the treatment of choice, and the effectiveness of radiotherapy for this disease has not yet been established. We report two cases of biopsy-proven Merkel cell carcinoma effectively treated with radiotherapy. Histopathological examination of the resected specimens after radiotherapy of 50 Gy and 38 Gy, respectively, using 6∼15 MeV electrons showed no malignant cells in either case. No evidence of recurrence or metastasis has been noted in 11 to 21 months after radiotherapy. To our knowledge, no case of Merkel cell carcinoma in which complete cure was obtained by radiotherapy alone has been reported previously. It is considered that preoperative radiotherapy would contribute to the management of this locally invasive but radiosensitive tumor. (author)

Template for assessing climate change impacts and management options: TACCIMO user guide version 2.2

Science.gov (United States)

Emrys Treasure; Steven McNulty; Jennifer Moore Myers; Lisa Nicole Jennings

2014-01-01

The Template for Assessing Climate Change Impacts and Management Options (TACCIMO) is a Web-based tool developed by the Forest Service, U.S. Department of Agriculture to assist Federal, State, and private land managers and planners with evaluation of climate change science implications for sustainable natural resource management. TACCIMO is a dynamic information...

Impact of immunotherapy among patients with melanoma brain metastases managed with radiotherapy.

Science.gov (United States)

Stokes, William A; Binder, David C; Jones, Bernard L; Oweida, Ayman J; Liu, Arthur K; Rusthoven, Chad G; Karam, Sana D

2017-12-15

Patients with melanoma brain metastases (MBM) have been excluded from trials evaluating immunotherapy in melanoma. As such, immunotherapy's role in MBM is poorly understood, particularly in combination with radiotherapy. The National Cancer Database was queried for patients with MBM receiving brain radiotherapy. They were classified according to immunotherapy receipt. Multivariate Cox regression was performed to identify factors associated with survival. Among 1287 patients, 185 received immunotherapy. Factors associated with improved survival included younger age, academic facility, lower extracranial disease burden, stereotactic radiotherapy, chemotherapy, and immunotherapy. Adding immunotherapy to radiotherapy for MBM is associated with improved survival. Copyright © 2017 Elsevier B.V. All rights reserved.

Assessment of stormwater management options in urban contexts using Multiple Attribute Decision-Making

DEFF Research Database (Denmark)

Gogate, Nivedita G.; Kalbar, Pradip; Raval, Pratap M.

2017-01-01

This paper addresses the problem of selecting the most sustainable stormwater management alternative in developing countries in a dense urban context. Firstly, suitable Low Impact Development (LID) stormwater management measures for dense urban areas in developing countries were identified based...... sustainable stormwater management options in densely populated areas of developing countries....... on critical review of literature. Alternatives have been formulated as varying percentages (degree of adoption) of these suitable measures to manage the stormwater sustainably. Further, a novel decision-making framework is developed which generates the hierarchy for selection of the most sustainable...

Long-term results of ipsilateral radiotherapy for tonsil cancer

Energy Technology Data Exchange (ETDEWEB)

Koo, Tae Ryoolk; Wu, Hong Gyun [Dept. of Seoul National University College of Medicine, Seoul (Korea, Republic of)

2013-06-15

We evaluated the effectiveness and safety of ipsilateral radiotherapy for the patient with well lateralized tonsil cancer: not cross midline and <1 cm of tumor invasion into the soft palate or base of tongue. From 2003 to 2011, twenty patients with well lateralized tonsil cancer underwent ipsilateral radiotherapy. Nineteen patients had T1-T2 tumors, and one patient had T3 tumor; twelve patients had N0-N2a disease and eight patients had N2b disease. Primary surgery followed by radiotherapy was performed in fourteen patients: four of these patients received chemotherapy. Four patients underwent induction chemotherapy followed by concurrent chemoradiotherapy (CCRT). The remaining two patients received induction chemotherapy followed by radiotherapy and definitive CCRT, respectively. No patient underwent radiotherapy alone. We analyzed the pattern of failure and complications. The median follow-up time was 64 months (range, 11 to 106 months) for surviving patients. One patient had local failure at tumor bed. There was no regional failure in contralateral neck, even in N2b disease. At five-year, local progression-free survival, distant metastasis-free survival, and progression-free survival rates were 95%, 100%, and 95%, respectively. One patient with treatment failure died, and the five-year overall survival rate was 95%. Radiation Therapy Oncology Group grade 2 xerostomia was found in one patient at least 6 months after the completion of radiotherapy. Ipsilateral radiotherapy is a reasonable treatment option for well lateralized tonsil cancer. Low rate of chronic xerostomia can be expected by sparing contralateral major salivary glands.

Women's experiences of three early miscarriage management options: a qualitative study.

Science.gov (United States)

Smith, Lindsay F; Frost, Julia; Levitas, Ruth; Bradley, Harriet; Garcia, Jo

2006-03-01

Miscarriage affects around one in six pregnancies. Much research has taken place identifying the consequences of this for parents but is mainly quantitative. Of the limited qualitative studies, none have explored women's experiences of the methods of miscarriage management received. To assess the social and personal impact of different management methods (expectant, medical and surgical) on women's experience of first trimester miscarriage. Qualitative interviews using a topic guide with a purposive cohort of four categories of women (each management method plus non-participants) 6 months to 1 year after first trimester miscarriage. Focus groups with both research participants and health workers. Women from three hospitals in the South West of England that participated in the Miscarriage Treatment (MIST) trial. Seventy-two interviews were undertaken between September 1999 and June 2000. There were also five focus groups (47 participants) and two feedback sessions (8 participants) with written feedback from 12 women. Interviews lasted 0.5-2.5 hours generating over 2000 A4 pages of transcripts. The transcripts were analysed for common themes, using standard proformas, which were filled in by individual team members and then discussed by the whole research team. Iterative readings in the light of new emerging issues ensured that new themes could be identified throughout the analytical process. All transcripts were then encoded for the identified themes using NUDIST. Common themes emerged across all management options although some were specific to just one or two management options. The five major themes arising out of the data analysis were: intervention; experiences of care; finality; the 'baby'; and pain and bleeding. Women's experiences and beliefs vary widely and their preferences need to be considered in their early miscarriage management. The three methods have different benefits and problems from the women's point of view. Competence and caring from

The Results of Combined External Radiotherapy and Chemotherapy in the Management of Esophageal Cancer

International Nuclear Information System (INIS)

Lee, Hyun Joo; Suh, Hyun Suk; Kim, Jun Hee; Kim, Chul Soo; Kim, Sung Rok; Kim, Re Hwe

1996-01-01

Purpose : To evaluate the role of combination therapy of external radiotherapy and chemotherapy in the management of advanced esophageal cancer as a primary treatment compared with radiation therapy alone. Methods and Materials : A retrospective review of evaluable 55 esophageal cancer patients referred to the Department of Therapeutic Radiology, Paik Hospital for the external radiotherapy between Jul. 1983 and Dec.1994 was undertaken. Combined therapy patients (A group) were 30 and radiation alone patients (B group) were 25. Median age was 60 years old in A group(ranges : 42-81) and 65 years old in B group (ranges : 50-81). The male patients were 53. The fifty patients had squamous cell carcinomas. Radiation doses of 2520-6480c Gy were delivered over a period of 4-7 weeks. using 4MV LIVAC. Chemotherapy was administered in bolus injection before, after, or during the course of external radiotherapy. The local control rate and patterns of failure according to both treatment modalities and 1,2 year survival rates according to prognostic factors (stage, tumor length, radiation dose etc.) were analysed. Results : Median follow up period was 7 months (range : 2-73 months). Median survival was 7.5 months (20 days-29 months) in A group and 5 months(20 days-73 months) in B group. The 1,2 YSRs were 26.7%, 8.9% in A group. 12.7%, 4.3% in B group (p>0.05), respectively. The 1,2 YSRs according to stage(II/III), tumor length (5cm more or less). radiation dose(5000c Gy more or less) of A and B group were analyzed and the differences of survival rates of both treatments were not statistically significant. But among group B, patients who received 5000c Gy or more showed significant survival benefits (p<0.05). The treatment response rates of A and B group were 43.8%, 25.0%, respectively. Complete response rate of 25.0% in A and 8.3% in B were achieved. The local failure and distant metastasis were 52.4%, 23.8% in A group. 64.3%, 14.3% in B group, respectively. The combination

Radiotherapy of splenomegaly. A palliative treatment option for a benign phenomenon in malignant diseases

International Nuclear Information System (INIS)

Kriz, Jan; Mueller, Rolf-Peter; Eich, Hans Theodor

2011-01-01

Purpose: Since the 20 th century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT. Material and Methods: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects. Results: From 1989-2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with 60 Co gamma rays or 5-15MV photons. The fraction size ranged from 10-200 cGy and the total dose per treatment course from 30-1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II . Conclusion: The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten. (orig.)

Radiotherapy of splenomegaly. A palliative treatment option for a benign phenomenon in malignant diseases

Energy Technology Data Exchange (ETDEWEB)

Kriz, Jan; Mueller, Rolf-Peter; Eich, Hans Theodor [Koeln Univ. (Germany). Dept. of Radiation Oncology; Micke, Oliver [St. Franziskus Hospital, Bielefeld (Germany). Dept. of Radiation Oncology; Bruns, Frank [Medical School Hannover (Germany). Dept. of Radiation Oncology; Haverkamp, Uwe [Clemens Hospital, Muenster (Germany). Dept. of Radiation and Radiation Oncology; Muecke, Ralph; Schaefer, Ulrich [Hospital Lippe (Germany). Dept. of Radiation Oncology; Seegenschmiedt, Heinrich [Center of Radiotherapy, Hamburg (Germany)

2011-04-15

Purpose: Since the 20{sup th} century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT. Material and Methods: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects. Results: From 1989-2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with {sup 60}Co gamma rays or 5-15MV photons. The fraction size ranged from 10-200 cGy and the total dose per treatment course from 30-1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II . Conclusion: The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten. (orig.)

Xerostomia induced by radiotherapy

Directory of Open Access Journals (Sweden)

Alimi D

2015-08-01

Full Text Available David Alimi Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAWe read with great interest the excellent review on xerostomia induced by radiotherapy, by Pinna et al.1 The authors should be congratulated for a very detailed review of the physiopathology, clinical symptoms, and therapeutic management of an extremely difficult condition. Although we agree that the use of anticholinergic medication represents treatment, it requires the patient to have residual salivary gland function. Unfortunately, it is well established that in most cases radiotherapy destroys most of the salivary gland and associated salivary secretions.     

Intravesical Glycosaminoglycan Replacement with Chondroitin Sulphate (Gepan? instill) in Patients with Chronic Radiotherapy- or Chemotherapy-Associated Cystitis

OpenAIRE

Schwalenberg, Thilo; Berger, Frank Peter; Horn, Lars Christian; Thi, Phuc Ho; Stolzenburg, Jens?Uwe; Neuhaus, Jochen

2015-01-01

Background and Objective Intravesical instillation of glycosaminoglycans is a promising option for the treatment of chronic cystitis, as it supports the regeneration of the damaged urothelial layer. We investigated the efficacy of short-term intravesical chondroitin sulphate treatment (six courses of instillation) in patients with chronic radiotherapy- or chemotherapy-associated cystitis. Methods This prospective, observational study included patients with chronic radiotherapy- or chemotherap...

Managing AVN following internal fixation: treatment options and clinical results.

Science.gov (United States)

Hoskinson, Simon; Morison, Zachary; Shahrokhi, Shahram; Schemitsch, Emil H

2015-03-01

Avascular necrosis (AVN) after internal fixation of intracapsular hip fractures is a progressive multifactorial disease that ultimately results in local ischemia with ensuing osteocyte necrosis and structural compromise. This disease can cause significant clinical morbidity and affects patients of any age, including young and active patients. Effective treatment of this condition among young adults is challenging due to their high functional demands. The aim of managing AVN is to relieve pain, preserve range of movement and improve function. Treatment methods vary depending on the stage of the disease and can be broadly categorised into two options, hip preserving surgery and hip arthroplasty. Although, hip preserving techniques are attractive in the young adult, they may alter the morphology of the proximal femur and make subsequent arthroplasty more challenging. Conversely, arthroplasty in the young adult may require repeat revision procedures throughout the patient's life. Current evidence suggests that modifications of prevailing treatments, in addition to new technologies, have led to the development of management strategies that may be able to alter the course of femoral head osteonecrosis. This review aims to summarise the options available for treatment of AVN in the young adult and review the clinical results. Copyright © 2014 Elsevier Ltd. All rights reserved.

Targeted intraoperative radiotherapy in oncology

CERN Document Server

Keshtgar, Mohammed; Wenz, Frederik

2014-01-01

Targeted intraoperative radiotherapy is a major advance in the management of cancer patients. With an emphasis on practical aspects, this book offers an ideal introduction to this innovative  technology for clinicians.

Economic Screening of Geologic Sequestration Options in the United States with a Carbon Management Geographic Information System

Energy Technology Data Exchange (ETDEWEB)

Dahowski, Robert T.(BATTELLE (PACIFIC NW LAB)); Dooley, James J.(BATTELLE (PACIFIC NW LAB)); Brown, Daryl R.(BATTELLE (PACIFIC NW LAB)); Stephan, Alex J.(BATTELLE (PACIFIC NW LAB)); Badie I. Morsi

2001-10-19

Developing a carbon management strategy is a formidable task for nations as well as individual companies. It is often difficult to understand what options are available, let alone determine which may be optimal. In response to the need for a better understanding of complex carbon management options, Battelle has developed a state-of-the-art Geographic Information System (GIS) model with economic screening capability focused on carbon capture and geologic sequestration opportunities in the United States. This paper describes the development of this GIS-based economic screening model and demonstrates its use for carbon management analysis.

Radiological aspects of postfission waste management for light-water reactor fuel cycle options

Energy Technology Data Exchange (ETDEWEB)

Shipler, D B; Nelson, I C [Battelle Pacific Northwest Laboratories, Richland, WA (United States)

1978-12-01

A generic environmental impact statement on the management of radioactive postfission wastes from various light-water reactor fuel cycles in the United States has been prepared. The environmental analysis for post-fission waste management includes an examination of radiological impacts related to different waste treatment, storage, transportation, and disposal options at the process level. Effects addressed include effluents from plants, and radiological impacts from facility operation (routine and accidents), and decommissioning. Environmental effects are combined for fuel reprocessing plants, mixed-oxide fuel fabrication plants, and waste repositories. Radiological effects are also aggregated for several fuel cycle options over the period 1980 and 2050. Fuel cycles analyzed are (1) once-through cycle in which spent reactor fuel is cooled in water basins for at least 6-1/2 years and then disposed of in deep geologic repositories; (2) spent fuel reprocessing in which uranium only and uranium and plutonium is recycled and solidified high level waste, fuel residues, and non-high-level transuranic wastes are disposed of in deep geologic repositories; and (3) deferred cycle that calls for storage of spent fuel at Federal spent fuel storage facilities until the year 2000 at which time a decision is made whether to dispose of spent fuel as a waste or to reprocess the fuel to recover uranium and plutonium. Key environmental issues for decision-making related to waste management alternatives and fuel cycle options are highlighted. (author)

Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder

International Nuclear Information System (INIS)

Hindson, Benjamin R.; Turner, Sandra L.; Millar, Jeremy L.

2012-01-01

Curative radiotherapy, with or without concurrent chemotherapy, is recognized as a standard treatment option for muscle-invasive bladder cancer. It is commonly used for two distinct groups of patients: either for those medically unfit for surgery, or as part of a 'bladder preserving' management plan incorporating the possibility of salvage cystectomy. However, in both situations, the approach to radiotherapy varies widely around the world. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recognised a need to develop consistent, evidence-based guidelines for patient selection and radiotherapy technique in the delivery of curative radiotherapy. Following a workshop convened in May 2009, a working party collated opinions and conducted a wide literature appraisal linking each recommendation with the best available evidence. This process was subject to ongoing re-presentation to the Faculty of Radiation Oncology Genito-Urinary Group members prior to final endorsement. These Guidelines include patient selection, radiation target delineation, dose and fractionation schedules, normal tissue constraints and investigational techniques. Particular emphasis is given to the rationale for the target volumes described. These Guidelines provide a consensus-based framework for the delivery of curative radiotherapy for muscle-invasive bladder cancer. Widespread input from radiation oncologists treating bladder cancer ensures that these techniques are feasible in practice. We recommend these Guidelines be adopted widely in order to encourage a uniformly high standard of radiotherapy in this setting, and to allow for better comparison of outcomes.

Contribution of radiotherapy to the treatment of malignant tumors, 3. Combined drugs and radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Niibe, Hideo; Takahashi, Iku; Tamaki, Yoshio (Gunma Univ., Maebashi (Japan). School of Medicine)

1984-09-01

Effects of cytotoxic agent, hormone, hypoxic cell sensitizer, and radiation protector combined with radiation therapy in cancer management were analysed. The results were as follows: 1) An increase in response was seen in 25% or more of tumor nodules given radiotherapy combined with misonidazole, anoxic cell sensitizer, compared with radiotherpy alone. But the drug was also found to be neurotoxic and peripheral neuropathy. 2) Evidence has been given that Amifostine may protect the mucosal damage from radiation when Amifostine prior to irradiation was administrated to patients with tumor in the head and neck or in the pelvis. 3) There were no difference between five year survival of radiotherapy alone and with chemotherapy for patients with stage I Non-Hodgkin lymphoma. Chemotherapy following radiotherapy for patients with stage II was more effective treatment method than radiotherapy alone. 4) Radiotherapy for patients with prostate cancer was performed to control only primary site. The success rates of local control were over 80%. The near future holds extensive promise for a combination of radiation therapy, cytotoxic chemotherapy, hormone therapy, hypoxic cell sensitizer, and radiation protectors. All of these when used in the appropriate circumstances may yield significant improvements in the therapeutic ratio and in the long-tern control of tumors.

Waste Management Options for Long-Duration Space Missions: When to Reject, Reuse, or Recycle

Science.gov (United States)

Linne, Diane L.; Palaszewski, Bryan A.; Gokoglu, Suleyman; Gallo, Christopher A.; Balasubramaniam, Ramaswamy; Hegde, Uday G.

2014-01-01

The amount of waste generated on long-duration space missions away from Earth orbit creates the daunting challenge of how to manage the waste through reuse, rejection, or recycle. The option to merely dispose of the solid waste through an airlock to space was studied for both Earth-moon libration point missions and crewed Mars missions. Although the unique dynamic characteristics of an orbit around L2 might allow some discarded waste to intersect the lunar surface before re-impacting the spacecraft, the large amount of waste needed to be managed and potential hazards associated with volatiles recondensing on the spacecraft surfaces make this option problematic. A second option evaluated is to process the waste into useful gases to be either vented to space or used in various propulsion systems. These propellants could then be used to provide the yearly station-keeping needs at an L2 orbit, or if processed into oxygen and methane propellants, could be used to augment science exploration by enabling lunar mini landers to the far side of the moon.

Estimation of cancer risks from radiotherapy of benign diseases

International Nuclear Information System (INIS)

Trott, K.R.; Kamprad, F.

2006-01-01

Background: The effective-dose method which was proposed by the ICRP (International Commission of Radiation Protection) for the estimation of risk to the general population from occupational or environmental, low-dose radiation exposure is not adequate for estimating the risk of cancer induction by radiotherapy of malignant or nonmalignant diseases. Methods:The risk of cancer induction by radiotherapy of benign diseases should be based on epidemiologic data directly derived from follow-up studies of patients who had been given radiotherapy for nonmalignant diseases in the past. Results: Risk factors were derived from epidemiologic studies of patients treated with irradiation for nonmalignant diseases to be used for selecting treatment options and optimizing treatment procedures. Conclusion: In most cases, cancer risks estimated by the effective-dose method may overestimate the true risks by one order of magnitude, yet in other cases even may underestimate it. The proposed method using organ-specific risk factors may be more suitable for treatment planning. (orig.)

Dealing with uncertainty and pursuing superior technology options in risk management-The inherency risk analysis

International Nuclear Information System (INIS)

Helland, Aasgeir

2009-01-01

Current regulatory systems focus on the state of scientific evidence as the predominant factor for how to handle risks to human health and the environment. However, production and assessment of risk information are costly and time-consuming, and firms have an intrinsic disincentive to produce and distribute information about risks of their products as this could endanger their production opportunities and sales. An emphasis on more or better science may result in insufficient thought and attention going into the exploration of technology alternatives, and that risk management policies miss out on the possible achievement of a more favorable set of consequences. In this article, a method is proposed that combines risk assessment with the search for alternative technological options as a part of the risk management procedure. The method proposed is the inherency risk analysis where the first stage focuses on the original agent subject to investigation, the second stage focuses on identifying technological options whereas the third stage reviews the different alternatives, searching for the most attractive tradeoffs between costs and inherent safety. This is then used as a fundament for deciding which technology option to pursue. This method aims at providing a solution-focused, systematic technology-based approach for addressing and setting priorities for environmental problems. By combining risk assessment with a structured approach to identify superior technology options within a risk management system, the result could very well be a win-win situation for both company and the environment.

Stage report of the national radiotherapy survey committee May 2009; Rapport d'etape du Comite National de suivi de la radiotherapie mai 2009

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-07-01

This report proposes an assessment of the impact of the national radiotherapy measures present in the road map (November 2007 - March 2009) and describes the creation of a national support unit to manage the operating difficulties of 27 radiotherapy centres. It comments how a transition period between 2009 and 2011 must accompany radiotherapy before the implementation of opposable agreement criteria in 2011, notably through an improvement of recruitment, a support to cooperation between radiotherapy centres, the implementation of a radio-vigilance unit. Finally, it briefly discusses how to prepare the 2011-2013 period.

Radiotherapy in the management of cervical cancer in elderly patients

International Nuclear Information System (INIS)

Lindegaard, J.C.; Thranov, I.R.; Engelholm, S.A.

2000-01-01

One hundred and fourteen elderly patients (median 75.5 years, range 70.0-85.9) consecutively referred for curative radiotherapy in the period 1987-1996 were prospectively followed with regard to tumour control and complications. The importance of age, stage (FIGO), tumour size, histology, tumour fixation, haemoglobin, concurrent disease, performance status (WHO) and type of radiotherapy were assessed using univariate and multivariate analyses. Treatment was completed as planned in 68%, delayed in 29% and stopped prematurely in 3%. The frequency of grade 3 late complications was 11% and the actuarial probability at 5 years was 20%. Overall 5-year survival according to FIGO was 61% (I), 34% (II) and 25% (III). Cox multivariate analysis identified tumour size as independent prognostic factor for tumour control, disease-free survival and overall survival. FIGO stage was predictive for late grade 2 complications. We were unable to identify significant factors with respect to grade 3 complications. Age was not a significant parameter for any of the investigated endpoints. Elderly patients in good performance status with advanced cancer of the uterine may tolerate radical radiotherapy with acceptable morbidity and reasonable survival. Radiotherapy may also be a good alternative in early stage disease for surgically unfit elderly patients. (author)

Quality assurance protocol for linear accelerators used in radiotherapy

International Nuclear Information System (INIS)

Petkovska, Sonja

2012-01-01

Radiotherapy is a modality of choice for treatment of malignant diseases. Linear accelerators are the most common devices for implementing external radiation therapy. Taking into account the fact during the treatment, healthy tissue will inevitably be exposed to ionizing radiation, predicted dose in each radiotherapy case should be delivered with the greatest possible accuracy. Medical requirement for quality treatment achieving means as mach as possible dose into volume of interest and the greatest possible healthy tissue protection. From radiation protection point of view, occupational exposure of the staff involved in radiotherapy process should be minimized. To be able to reach it, consistent adherence to the Quality Assurance Programme is necessary. It should be in accordance with higher national and international protocols, because they give guidelines on the necessary standards, procedures, processes, resources and responsibilities that should be defined in structuring the overall radiotherapy quality management. As a part of this Master thesis, quality management as well as Quality Assurance Programme that is necessary to be applied in each radiotherapy center have been prepared. Mandatory dosimetry measurements included in the internal recommendations are also emphasized. Measurement results and external audit by IAEA indicated high accuracy and quality radiotherapy dose delivering in Macedonia. Based on the measurements and analysis, the aim of this Master thesis is offering a Quality Assurance Protocol for external beam radiotherapy that can be used on the national level in Republic of Macedonia. (Author)

Benign painful shoulder syndrome. Initial results of a single-center prospective randomized radiotherapy dose-optimization trial

International Nuclear Information System (INIS)

Ott, O.J.; Hertel, S.; Gaipl, U.S.; Frey, B.; Schmidt, M.; Fietkau, R.

2012-01-01

Background and purpose: To compare the efficacy of two different dose-fractionation schedules for radiotherapy of patients with benign painful shoulder syndrome. Patients and methods: Between February 2006 and February 2010, 312 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received radiotherapy with an orthovoltage technique. One radiotherapy course consisted of 6 single fractions in 3 weeks. In case of insufficient remission of pain after 6 weeks, a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. The endpoint was pain reduction. Pain was measured before, right after, and 6 weeks after radiotherapy using a visual analogue scale (VAS) and a comprehensive pain score (CPS). Results: The overall response rate for all patients was 83% directly after and 85% 6 weeks after radiotherapy. The mean VAS values before, directly after, and 6 weeks after treatment for the 0.5 and 1.0 Gy groups were 56.8 ± 23.7 and 53.2 ± 21.8 (p = 0.158), 38.2 ± 26.1 and 34.0 ± 24.5 (p = 0.189), and 33.0 ± 27.2 and 23.7 ± 22.7 (p = 0.044), respectively. The mean CPS before, directly after, and 6 weeks after treatment was 9.7 ± 3.0 and 9.5 ± 2.7 (p = 0.309), 6.1 ± 3.6 and 5.4 ± 3.6 (p = 0.096), 5.3 ± 3.7 and 4.1 ± 3.7 (p = 0.052), respectively. Despite a slight advantage in the VAS analysis for the 1.0 Gy group for delayed response, the CPS analysis revealed no statistically significant differences between the two single-dose trial arms for early (p = 0.652) and delayed response quality (p = 0.380). Conclusion: Radiotherapy is an effective treatment option for the management of benign painful shoulder syndrome. Concerning radiation protection, the dose for a radiotherapy series is recommended not to exceed 3-6 Gy. (orig.)

Greenhouse Gas and Ammonia Emissions from Different Stages of Liquid Manure Management Chains: Abatement Options and Emission Interactions.

Science.gov (United States)

Mohankumar Sajeev, Erangu Purath; Winiwarter, Wilfried; Amon, Barbara

2018-01-01

Farm livestock manure is an important source of ammonia and greenhouse gases. Concerns over the environmental impact of emissions from manure management have resulted in research efforts focusing on emission abatement. However, questions regarding the successful abatement of manure-related emissions remain. This study uses a meta-analytical approach comprising 89 peer-reviewed studies to quantify emission reduction potentials of abatement options for liquid manure management chains from cattle and pigs. Analyses of emission reductions highlight the importance of accounting for interactions between emissions. Only three out of the eight abatement options considered (frequent removal of manure, anaerobic digesters, and manure acidification) reduced ammonia (3-60%), nitrous oxide (21-55%), and methane (29-74%) emissions simultaneously, whereas in all other cases, tradeoffs were identified. The results demonstrate that a shift from single-stage emission abatement options towards a whole-chain perspective is vital in reducing overall emissions along the manure management chain. The study also identifies some key elements like proper clustering, reporting of influencing factors, and explicitly describing assumptions associated with abatement options that can reduce variability in emission reduction estimates. Prioritization of abatement options according to their functioning can help to determine low-risk emission reduction options, specifically options that alter manure characteristics (e.g., reduced protein diets, anaerobic digestion, or slurry acidification). These insights supported by comprehensive emission measurement studies can help improve the effectiveness of emission abatement and harmonize strategies aimed at reducing air pollution and climate change simultaneously. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Preliminary Analysis on the Management Options of IRT-DPRK Research Reactor

Energy Technology Data Exchange (ETDEWEB)

Lee, Jung-Hyun; Kim, Minsoo; Hwang, Yongsoo [Korea Institute of Nuclear Nonproliferation and Control, Daejeon (Korea, Republic of)

2015-05-15

Although IRT-DPRK was upgraded several times, operation lifetime was already exhausted and thus management policy is needed to deal with the aging of IRT-DPRK. For example, IRT- 2000 type nuclear reactors in Georgia and Bulgaria had been shut down to refurbish or decommissioned to establish new low power facilities. However, the existing negotiations and agreements related to the nuclear issues on North Korea have been focused on the 'denuclearization', and thus the issues on the IRTDPRK were not handled. In recent, a group of USA scientists has suggested that IRT-DPRK should be refurbished to establish the 'Scientific cent for excellence' like the Cooperative Threat Reduction program applied in Russia and the former Soviet Union (FSU). In this paper, we examined the several options to manage the IRT-DPRK through the study of similar foreign cases. Due to the lack of the detailed and standardized information, it is impossible to suggest the best option at this moment. In order to do that, the further research on the detailed procedures, radioactive wastes, the standards of safety and security are needed.

Integrated weed management for sustainable rice production: concepts, perspectives and options

International Nuclear Information System (INIS)

Amartalingam Rajan

2002-01-01

Weed management has always been in some way integrated with cultural and biological methods, probably occurring more fortuitously than purposefully. Experience has shown that repeated use of any weed control technique especially in monocultures production systems results in rapid emergence of weeds more adapted to the new practice. In intensive high input farming systems, heavy selection pressure for herbicide tolerant weeds and the environmental impacts of these inputs are important tissues that require a good understanding of agroecosystem for successful integration of available options. Rice culture, in particular flooded rice culture has always employed integration through an evolution of management practices over the generations. However, a vast majority office farmers in Asia have yet to achieve the high returns realised by farmers elsewhere, where a near optimum combination of high inputs are being effectively integrated for maximum productivity. In addition to technological and management limitations, farmers in developing countries are faced with social, economic and policy constraints. On the other hand, farmers who had achieved considerable increases in productivity through labour replacing technologies, in particular direct seeding with the aid of herbicides, are now faced with issues related to environmental concerns due to high levels of these inputs. The issues facing weed scientists and farmers alike in managing weeds effectively and in a manner to ensure sustainability have become more challenging than ever before. In the last two decades, no issue has been discussed so. intensively as Sustainable Farming, Sustainable Agriculture or Alternative Agriculture within the broader global concept of Sustainable Development. To address these challenges a clear perspective of sustainable farming is essential. This paper addresses these concepts, perspectives and options for choices in weed management for sustainable rice production. (Author)

Option Strike Price and Managerial Investment Decisions

Institute of Scientific and Technical Information of China (English)

刘鸿雁; 张维

2003-01-01

The manager′s investment decisions is modeled when the manager is risk-averse and has stock options as compensation. It is found that the strike price of options is crucial to the investment incentives of managers, and that the correct value, or interval of values, of managerial stock option strike price can bring stockholder and manager interests in agreement.

Changing Climate, Challenging Choices: Identifying and Evaluating Climate Change Adaptation Options for Protected Areas Management in Ontario, Canada

Science.gov (United States)

Lemieux, Christopher J.; Scott, Daniel J.

2011-10-01

Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

Stage report of the national radiotherapy survey committee May 2009

International Nuclear Information System (INIS)

2009-01-01

This report proposes an assessment of the impact of the national radiotherapy measures present in the road map (November 2007 - March 2009) and describes the creation of a national support unit to manage the operating difficulties of 27 radiotherapy centres. It comments how a transition period between 2009 and 2011 must accompany radiotherapy before the implementation of opposable agreement criteria in 2011, notably through an improvement of recruitment, a support to cooperation between radiotherapy centres, the implementation of a radio-vigilance unit. Finally, it briefly discusses how to prepare the 2011-2013 period

Management options for recycling radioactive scrap metals

Energy Technology Data Exchange (ETDEWEB)

Dehmel, J.C.; MacKinney, J.; Bartlett, J.

1997-02-01

The feasibility and advantages of recycling radioactive scrap metals (RSM) have yet to be assessed, given the unique technical, regulatory, safety, and cost-benefit issues that have already been raised by a concerned recycling industry. As is known, this industry has been repeatedly involved with the accidental recycling of radioactive sources and, in some cases, with costly consequences. If recycling were deemed to be a viable option, it might have to be implemented with regulatory monitoring and controls. Its implementation may have to consider various and complex issues and address the requirements and concerns of distinctly different industries. There are three basic options for the recycling of such scraps. They are: (1) recycling through the existing network of metal-scrap dealers and brokers, (2) recycling directly and only with specific steelmills, or (3) recycling through regional processing centers. Under the first option, scrap dealers and brokers would receive material from RSM generators and determine at which steelmills such scraps would be recycled. For the second option, RSM generators would deal directly with selected steelmills under specific agreements. For the third option, generators would ship scraps only to regional centers for processing and shipment to participating steelmills. This paper addresses the potential advantages of each option, identifies the types of arrangements that would need to be secured among all parties, and attempts to assess the receptivity of the recycling industry to each option.

Management options of varicoceles

Directory of Open Access Journals (Sweden)

Peter Chan

2011-01-01

Full Text Available Varicocele is one of the most common causes of male infertility. Treatment options for varicoceles includes open varicocelectomy performed at various anatomical levels. Laparoscopic varicocelectomy has been established to be a safe and effective treatment for varicoceles. Robotic surgery has been introduced recently as an alternative surgical option for varicocelectomy. Microsurgical varicocelectomy has gained increasing popularity among experts in male reproductive medicine as the treatment of choice for varicocele because of its superior surgical outcomes. There is a growing volume of literature in the recent years on minimal invasive varicocele treatment with percutaneous retrograde and anterograde venous embolization/sclerotherapy. In this review, we will discuss the advantages and limitations associated with each treatment modality for varicoceles. Employment of these advanced techniques of varicocelectomy can provide a safe and effective approach aiming to eliminate varicocele, preserve testicular function and, in a substantial number of men, increase semen quality and the likelihood of pregnancy.

Effect of bleomycin-radiotherapy combination in management of head and neck squamous cell carcinoma

International Nuclear Information System (INIS)

Shah, P.M.; Shukla, S.N.; Patel, K.M.; Patel, N.L.; Baboo, H.A.; Patel, D.D.

1981-01-01

Twenty-five patients with head and neck squamous cell carcinoma were treated with bleomycin-radiotherapy protocol, 15 mg bleomycin I.V. on alternate days followed by radiation within half an hour. The average total dose of bleomycin was 150 mg. Radiotherapy was given daily. Two patients were lost to follow-up very early in the course of the treatment and were removed from the study for statistical purposes. Thirty-six patients with head and neck squamous cell carcinoma who were treated with radiotherapy alone during the same period were used as controls. The patients were followed for two years. The incidence of response rate did not differ significantly between regimens; however, the incidence of side effects with bleomycin-radiotherapy, 82.61%, is significantly more than that of radiotherapy alone (52.78%). Median survial time (MST) of those responding to bleomycin-radiotherapy protocol was seven months and 12 days and for radiotherapy responders was six months. Neither the response rate nor the MST improve significantly after pretreatment with bleomycin. On the contrary, the incidence of side effects increased significantly

23 CFR 500.104 - State option.

Science.gov (United States)

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false State option. 500.104 Section 500.104 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.104 State option. Except as specified in § 500.105 (a...

Improved management of radiotherapy departments through accurate cost data

International Nuclear Information System (INIS)

Kesteloot, K.; Lievens, Y.; Schueren, E. van der

2000-01-01

Escalating health care expenses urge Governments towards cost containment. More accurate data on the precise costs of health care interventions are needed. We performed an aggregate cost calculation of radiation therapy departments and treatments and discussed the different cost components. The costs of a radiotherapy department were estimated, based on accreditation norms for radiotherapy departments set forth in the Belgian legislation. The major cost components of radiotherapy are the cost of buildings and facilities, equipment, medical and non-medical staff, materials and overhead. They respectively represent around 3, 30, 50, 4 and 13% of the total costs, irrespective of the department size. The average cost per patient lowers with increasing department size and optimal utilization of resources. Radiotherapy treatment costs vary in a stepwise fashion: minor variations of patient load do not affect the cost picture significantly due to a small impact of variable costs. With larger increases in patient load however, additional equipment and/or staff will become necessary, resulting in additional semi-fixed costs and an important increase in costs. A sensitivity analysis of these two major cost inputs shows that a decrease in total costs of 12-13% can be obtained by assuming a 20% less than full time availability of personnel; that due to evolving seniority levels, the annual increase in wage costs is estimated to be more than 1%; that by changing the clinical life-time of buildings and equipment with unchanged interest rate, a 5% reduction of total costs and cost per patient can be calculated. More sophisticated equipment will not have a very large impact on the cost (±4000 BEF/patient), provided that the additional equipment is adapted to the size of the department. That the recommendations we used, based on the Belgian legislation, are not outrageous is shown by replacing them by the USA Blue book recommendations. Depending on the department size, costs in

Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy.

Science.gov (United States)

Ota, Takayo; Makihara, Masaru; Tsukuda, Hiroshi; Kajikawa, Ryuji; Inamori, Masayuki; Miyatake, Nozomi; Tanaka, Noriko; Tokunaga, Masahiro; Hasegawa, Yoshikazu; Tada, Takuhito; Fukuoka, Masahiro

2017-06-01

Malignant psoas syndrome is a rare malignant condition presenting as lumbosacral plexopathy and painful fixed flexion of the hip. Metastasis to the psoas muscle is observed, which damages the nerve bundles in the lumbosacral plexuses. The syndrome presents as refractory lower back pain with several other neurological symptoms. The pain is difficult to control because it is a mixture of nociceptive and neuropathic pain, which indicates that treatment requires a versatile approach. The authors report a case of severe back pain caused by metastasis to the psoas muscle of advanced gastric cancer in a patient who underwent palliative radiotherapy under epidural analgesia. Despite conventional analgesics and subcutaneous oxycodone, he had difficulties in maintaining supine position because of the back pain and had a problem to receive radiotherapy, which required him to stay still in the same position during the treatment. By epidural analgesia, he could remain in supine position and complete radiotherapy without increasing opioid administration. His back pain was improved after the radiotherapy. Epidural analgesia is an effective treatment choice for a patient who is unable to keep the position during palliative radiotherapy.

Oligometastases. The new paradigm and options for radiotherapy. A critical review

Energy Technology Data Exchange (ETDEWEB)

Badakhshi, H.; Gruen, A.; Stromberger, C.; Budach, V.; Boehmer, D. [Charite Universitaetsmedizin Berlin (Germany). Dept. for Radiation Oncology

2013-05-15

Traditional oncology distinguishes between two separate and incommensurable states in the evolution of solid malignancies: the localized disease, which is curable; and the disseminated status, which is per se palliative. Recently, a huge body of evidence suggests a fundamental change in the understanding of cancer, indicating an intermediate state in the trajectory of solid malignancies: the oligometastatic state. The following review will critically analyse existing hypotheses and facts from the basic sciences and try to contextualize it in regard to the clinical evidence available to date. Consecutively, it will try to draw possible clinical consequences for application of radiotherapy in this specific clinical scenario. (orig.)

Women's experiences of three early miscarriage management options a qualitative study

Science.gov (United States)

Smith, Lindsay F; Frost, Julia; Levitas, Ruth; Bradley, Harriet; Garcia, Jo

2006-01-01

Background Miscarriage affects around one in six pregnancies. Much research has taken place identifying the consequences of this for parents but is mainly quantitative. Of the limited qualitative studies, none have explored women's experiences of the methods of miscarriage management received. Aim To assess the social and personal impact of different management methods (expectant, medical and surgical) on women's experience of first trimester miscarriage. Design of study Qualitative interviews using a topic guide with a purposive cohort of four categories of women (each management method plus non-participants) 6 months to 1 year after first trimester miscarriage. Focus groups with both research participants and health workers. Setting Women from three hospitals in the South West of England that participated in the Miscarriage Treatment (MIST) trial. Method Seventy-two interviews were undertaken between September 1999 and June 2000. There were also five focus groups (47 participants) and two feedback sessions (8 participants) with written feedback from 12 women. Interviews lasted 0.5–2.5 hours generating over 2000 A4 pages of transcripts. The transcripts were analysed for common themes, using standard proformas, which were filled in by individual team members and then discussed by the whole research team. Iterative readings in the light of new emerging issues ensured that new themes could be identified throughout the analytical process. All transcripts were then encoded for the identified themes using NUDIST. Results Common themes emerged across all management options although some were specific to just one or two management options. The five major themes arising out of the data analysis were: intervention; experiences of care; finality; the ‘baby’; and pain and bleeding. Conclusions Women's experiences and beliefs vary widely and their preferences need to be considered in their early miscarriage management. The three methods have different benefits and

Radiotherapy for esthesioneuroblastoma: is elective nodal irradiation warranted in the multimodality treatment approach?

Science.gov (United States)

Noh, O Kyu; Lee, Sang-wook; Yoon, Sang Min; Kim, Sung Bae; Kim, Sang Yoon; Kim, Chang Jin; Jo, Kyung Ja; Choi, Eun Kyung; Song, Si Yeol; Kim, Jong Hoon; Ahn, Seung Do

2011-02-01

The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy. Copyright © 2011 Elsevier Inc. All rights reserved.

Radiotherapy for Esthesioneuroblastoma: Is Elective Nodal Irradiation Warranted in the Multimodality Treatment Approach?

International Nuclear Information System (INIS)

Noh, O Kyu; Lee, Sang-wook; Yoon, Sang Min; Kim, Sung Bae; Kim, Sang Yoon; Kim, Chang Jin; Jo, Kyung Ja; Choi, Eun Kyung; Song, Si Yeol; Kim, Jong Hoon; Ahn, Seung Do

2011-01-01

Purpose: The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. Methods and Materials: Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. Results: Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. Conclusions: ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy.

A programmable motion phantom for quality assurance of motion management in radiotherapy

International Nuclear Information System (INIS)

Dunn, L.; Franich, R.D.; Kron, T.; Taylor, M.L.; Johnston, P.N.; McDermott, L.N.; Callahan, J.

2012-01-01

A commercially available motion phantom (QUASAR, Modus Medical) was modified for programmable motion control with the aim of reproducing patient respiratory motion in one dimension in both the anterior–posterior and superior–inferior directions, as well as, providing controllable breath-hold and sinusoidal patterns for the testing of radiotherapy gating systems. In order to simulate realistic patient motion, the DC motor was replaced by a stepper motor. A separate 'chest-wall' motion platform was also designed to accommodate a variety of surrogate marker systems. The platform employs a second stepper motor that allows for the decoupling of the chest-wall and insert motion. The platform's accuracy was tested by replicating patient traces recorded with the Varian real-time position management (RPM) system and comparing the motion platform's recorded motion trace with the original patient data. Six lung cancer patient traces recorded with the RPM system were uploaded to the motion platform's in-house control software and subsequently replicated through the phantom motion platform. The phantom's motion profile was recorded with the RPM system and compared to the original patient data. Sinusoidal and breath-hold patterns were simulated with the motion platform and recorded with the RPM system to verify the systems potential for routine quality assurance of commercial radiotherapy gating systems. There was good correlation between replicated and actual patient data (P 0.003). Mean differences between the location of maxima in replicated and patient data-sets for six patients amounted to 0.034 cm with the corresponding minima mean equal to 0.010 cm. The upgraded motion phantom was found to replicate patient motion accurately as well as provide useful test patterns to aid in the quality assurance of motion management methods and technologies.

Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes.

Science.gov (United States)

Matzkin, Elizabeth

2018-05-01

There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Quality Audits In Radiotherapy. Chapter 20

International Nuclear Information System (INIS)

Izewska, J.

2017-01-01

It is widely recognized that quality audits constitute a vital component of quality management in radiotherapy [20.1–20.3]. The main reason why quality audits are considered an important activity is that they help to review the quality of radiotherapy services and improve them. Quality audits check whether radiotherapy practices are adequate, i.e. that what should be done is being done; and in case it is not, audits provide recommendations to encourage improvements to be made. Without some form of auditing, it would be difficult to determine whether radiotherapy services are safe and effective for cancer treatment. In other words, a quality audit in radiotherapy is a method of reviewing whether the quality of activities in a radiotherapy department adheres to the standards of good practices to ensure that the treatment to the cancer patient is optimal. Overall, audits lead to improvements of professional practices and the general quality of services delivered. There are many recommendations regarding quality in radiotherapy practice, both national and international. Practices vary depending on the economic level of States, including specific procedures, equipment and facilities, as well as available resources. Good practices evolve with research developments, including new clinical trial results, progress in evidence based medicine and developments in radiotherapy technology. Quality audits involve the process of fact finding and comparing the findings against criteria for good practices in radiotherapy. Various issues and gaps may be identified by the auditors in the audit process, for example insufficiencies in structure, inadequacies in technology or deviations in procedures. This way the weak points or areas of concern are documented and recommendations for the audited centre are formulated that address these areas with the purpose of improving quality.

Environmental review of options for managing radioactively contaminated carbon steel

International Nuclear Information System (INIS)

1996-10-01

The U.S. Department of Energy (DOE) is proposing to develop a strategy for the management of radioactively contaminated carbon steel (RCCS). Currently, most of this material either is placed in special containers and disposed of by shallow land burial in facilities designed for low-level radioactive waste (LLW) or is stored indefinitely pending sufficient funding to support alternative disposition. The growing amount of RCCS with which DOE will have to deal in the foreseeable future, coupled with the continued need to protect the human and natural environment, has led the Department to evaluate other approaches for managing this material. This environmental review (ER) describes the options that could be used for RCCS management and examines the potential environmental consequences of implementing each. Because much of the analysis underlying this document is available from previous studies, wherever possible the ER relies on incorporating the conclusions of those studies as summaries or by reference

A System Dynamics Approach for the Selection of Contaminated Land Management Options

Science.gov (United States)

McKnight, U. S.; Kuebert, M.; Finkel, M.; Bieg, M.

2006-12-01

Large-scale contaminated land and groundwater is a widespread problem that can severely impact human health, the environment and the economy at many urban sites all over the world. Usually a considerable number of potential management solutions exist at each of these sites. A detailed investigation of all these options, however, is not economically feasible which makes streamlining of the planning and decision process a mandatory requirement. Decisions to be taken should be made as early as possible in order to reduce expenditures on site investigation. Therefore, a tiered decision-making procedure is required, including (i) identification and prioritization of focal areas of risks, (ii) feasibility screening of remediation targets and available management alternatives to narrow the range of possible options for (iii) subsequent detailed investigations of only a select group of preferable options. For each of these elements, tailored decision and investigation concepts are required. These concepts and applied methods should be specifically adapted to the type and scale of the particular decision to be taken- more target-oriented, cost-efficient investigation programs, as well as model-based assessment methods are needed (Ruegner et al. 2006). A gap exists within this framework with respect to preliminary assessment methodologies representing the first decision level. To fill this gap, a new system dynamics approach has been developed that represents the system of source- pathway-receptor sequences by means of a mass flux model. The dynamics are governed by the effects of possible remedial actions, which are described as mass flux change over time (Serapiglia et al. 2005). This approach has been implemented in the preliminary evaluation tool CARO-plus (Cost-efficiency Assessment of Remediation Options) that models the effects of potential remedial actions, including tackling the contaminant source and managing the groundwater plume. The model represents the causal

Who risk profile in radiotherapy

International Nuclear Information System (INIS)

Barton, M.; Sharfiq, J.; Nobleet, D.; Lemer, C.

2009-01-01

The different steps of a treatment in radiotherapy are: patient evaluation, decision to treat, prescription of the treatment protocol, positioning and immobilization, simulation, imaging and volume determination, planning and implementation of materials and software, transfer of treatment data, patient positioning, treatment realisation, treatment checking and follow-up. It exist processes of safety for any step of a radiotherapy realisation: patient identification, accreditation of equipment and processes, evaluation of the personnel competencies, quality assurance of equipment and management of the processes quality, redundancy during the data transfer, control of processes, errors reports and quality improvement, external controls, appropriateness of the workforce. (N.C.)

137Cs radioactive check device for quality and stability control of dosimeters used in radiotherapy

International Nuclear Information System (INIS)

Alves, C.F.E.; Mondaini, C.V.; Leite, S.P.; Pires, E.J.; Magalhaes, L.A.G.; Daivd, M.G.; Almeida, C.E. de

2015-01-01

This paper describes the design and construction of a shielded container to store a used brachytherapy 137 Cs source. This system proposes a new option to check the periodical consistency and proper functioning of ionization chambers and electrometers used in radiotherapy. Since there is no similar equipment being produced in the Brazilian market and the chambers stability control is part of a licensing requirement this device was built to meet the needs of several radiotherapy centers without access to it. (author)

Distributed Energy Implementation Options

Energy Technology Data Exchange (ETDEWEB)

Shah, Chandralata N [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2017-09-13

This presentation covers the options for implementing distributed energy projects. It distinguishes between options available for distributed energy that is government owned versus privately owned, with a focus on the privately owned options including Energy Savings Performance Contract Energy Sales Agreements (ESPC ESAs). The presentation covers the new ESPC ESA Toolkit and other Federal Energy Management Program resources.

Radiotherapy in prostate cancer. Innovative techniques and current controversies

International Nuclear Information System (INIS)

Geinitz, Hans

2015-01-01

Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

Curative radiotherapy of supraglottic cancer

International Nuclear Information System (INIS)

Kim, Yong Ho; Chai, Gyu Young

1998-01-01

The purpose of this study was to evaluate the efficacy of curative radiotherapy in the management of supraglottic cancer. Twenty-one patients with squamous cell carcinoma of the supraglottis were treated with radiotherapy at Gyeongsang National University Hospital between 1990 and 1994. Median follow-up period was 36 months and 95% were observed for at least 2 years. Actuarial survival rate at 5 years was 39.3% for 21 patients. The 5-year actuarial survival rate was 75.0% in Stage I, 42.9% in Stage II, 33.3% in Stage III, and 28.6% in Stage IV(p=0.54). The 5-year local control rate was 52.0% for 21 patients. The 5-year local control rate was 75.0% in Stage I, 57.1% in Stage II, 66.7% in Stage III, and 28.6% in Stage IV(p=0.33). Double primary cancer was developed in 3 patients and those were all esophageal cancers. In early stage(Stage I and II) supraglottic cancer, curative radiotherapy would be a treatment of choice and surgery would be better to be reserved for salvage of radiotherapy failure. In advanced stage(Stage III and IV), radiotherapy alone is inadequate for curative therapy and combination with surgery should be done in operable patients. This report emphasizes the importance of esophagoscopy and esophagogram at the follow-up of patients with supraglottic cancer

Adjuvant radiotherapy for stage I endometrial cancer.

Science.gov (United States)

Kong, A; Johnson, N; Cornes, P; Simera, I; Collingwood, M; Williams, C; Kitchener, H

2007-04-18

The role of adjuvant radiotherapy (both pelvic external beam radiotherapy and vaginal intracavity brachytherapy) in stage I endometrial cancer following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) remains unclear. To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CancerLit, Physician Data Query (PDQ) of National Cancer Institute. Handsearching was also carried out where appropriate. Randomised controlled trials (RCTs) which compared adjuvant radiotherapy versus no radiotherapy following surgery for patients with stage I endometrial cancer were included. Quality of the studies was assessed and data collected using a predefined data collection form. The primary endpoint was overall survival. Secondary endpoints were locoregional recurrence, distant recurrence and endometrial cancer death. Data on quality of life (QOL) and morbidity were also collected. A meta-analysis on included trials was performed using the Cochrane Collaboration Review Manager Software 4.2. The meta-analysis was performed on four trials (1770 patients). The addition of pelvic external beam radiotherapy to surgery reduced locoregional recurrence, a relative risk (RR) of 0.28 (95% confidence interval (CI) 0.17 to 0.44, p ASTEC; Lukka) are awaited. External beam radiotherapy carries a risk of toxicity and should be avoided in stage 1 endometrial cancer patients with no high risk factors.

A Multi-Criteria Decision Analysis of Waste Treatment Options for Food and Biodegradable Waste Management in Japan

Directory of Open Access Journals (Sweden)

Micky A. Babalola

2015-10-01

Full Text Available Dealing with large-scale Food and Biodegradable Waste (FBW often results in many logistical problems and environmental impacts to be considered. These can become great hindrances when the integration of solid waste management is concerned. Extra care is needed to plan such waste disposal or treatment services and facilities, especially with respect to the ecological impact. Decision-making with regards to the sustainable use of these facilities also involves tradeoffs between a number of conflicting objectives, since increasing one benefit may decrease the others. In this study a Multi-Criteria Decision Analysis (MCDA is presented to evaluate different waste management options and their applicability in Japan. The analytical process aims at selecting the most suitable waste treatment option, using pairwise comparisons conducted within a decision hierarchy that was developed through the Analytical Hierarchy Process (AHP. The results of this study show that anaerobic digestion should be chosen as the best FBW treatment option with regards to resource recovery. The study also presents some conditions and recommendations that can enhance the suitability of other options like incineration and composting.

Erythropoietin and radiotherapy; Erythropoietine et radiotherapie

Energy Technology Data Exchange (ETDEWEB)

Le Fur, E.; Albarghach, M.N.; Pradier, O. [CHU de Morvan, Dept. de radiotherapie, 29 - Brest (France)

2010-01-15

Erythropoietin (E.P.O.) is a glycoprotein hormone. This hormone is a growth factor for red blood cells precursors in the bone marrow. The decrease of oxygen partial pressure, a reduced number of erythrocytes caused by bleeding or excessive destruction, or increased tissues oxygen requirements lead to increased secretion of E.P.O.. Its action takes place on bone marrow erythroblastic cells through specific receptors. E.P.O. stimulates the proliferation of red cell precursors stem cells in the bone marrow, thus increasing their production in one to two weeks. The effectiveness of E.P.O. at increasing haemoglobin and improving patients quality of life has been demonstrated by several studies. However, its use in radiotherapy remains controversial. While tumour hypoxia caused by anaemia is a factor of radio resistance and thus a source of local failure, tumour expression of E.P.O. receptors presents a significant risk for tumour progression and neo-angiogenesis, which would be increased during the administration of E.P.O.. The purpose of this article is to answer the question: is there a place for E.P.O. in combination with radiotherapy in the management of cancer?

Toxicity of oral radiotherapy in patients with acquired immunodeficiency syndrome

International Nuclear Information System (INIS)

Cooper, J.S.; Fried, P.R.

1987-01-01

Although radiotherapy is a standard form of management of head and neck tumors, treatment of the oral cavity in patients who have the acquired immunodeficiency syndrome has produced unacceptable toxicity. Five such patients are described as a warning of enhanced toxicity of oral radiotherapy in this patient population

Conventional external beam radiotherapy for central nervous system malignancies

International Nuclear Information System (INIS)

Halperin, E.C.; Burger, P.C.

1985-01-01

Fractionated external beam photon radiotherapy is an important component of the clinical management of malignant disease of the central nervous system. The practicing neurologist or neurosurgeon frequently relies on the consultative and treatment skills of a radiotherapist. This article provides a review for the nonradiotherapist of the place of conventional external beam radiotherapy in neuro-oncology. 23 references

The manipulator occupation in electro radiology: a challenge and an opportunity to improve the safety and the patients management in oncological radiotherapy

International Nuclear Information System (INIS)

Brusadin, G.

2009-01-01

The evolutions in oncology radiotherapy need a strategic management of financial and human means, that are limited, in order to guarantee the safety and the quality of the treatments for patients suffering of cancers and the presence of motivated personnel and highly qualified at any system level. The shortage of skilled labour on the labour market in some countries could be solved by clarifying the content and the social status of the profession of manipulators in radiotherapy and by offering an initial and continuous quality training, perspective of interesting carrier and opportunities in term of specialization and research. The harmonization of the radiotherapy technicians training in Europe can be got only by standardizing the different cultures and working procedures existing in the various services of radio-oncology, with the help of a procedures and functions clarification. For that, the representatives of the every team of oncology radiotherapy should cooperate at the European level, everyone coming and exchanging on the practices of his national organisation and on his own experience. (N.C.)

Radiotherapy in Cancer Care: Facing the Global Challenge

International Nuclear Information System (INIS)

Rosenblatt, Eduardo; Zubizarreta, Eduardo

2017-06-01

Cancer treatment is complex and calls for a diverse set of services. Radiotherapy is recognized as an essential tool in the cure and palliation of cancer. Currently, access to radiation treatment is limited in many countries and non-existent in some. This lack of radiotherapy resources exacerbates the burden of disease and underscores the continuing health care disparity among States. Closing this gap represents an essential measure in addressing this global health equity problem. This publication presents a comprehensive overview of the major topics and issues to be taken into consideration when planning a strategy to address this problem, in particular in low and middle income countries. With contributions from leaders in the field, it provides an introduction to the achievements and issues of radiation therapy as a cancer treatment modality around the world. Dedicated chapters focus on proton therapy, carbon ion radiotherapy, intraoperative radiotherapy, radiotherapy for children, HIV/AIDS related malignancies, and costing and quality management issues.

Arterial occlusive disease after radiotherapy

International Nuclear Information System (INIS)

Piedbois, P.; Mazeron, J.J.; Le Bourgeois, J.P.; Becquemin, J.P.; Blanc, I.; Lange, F.; Melliere, D.

1990-01-01

Fourteen cases of arterial occlusion or severe narrowing following radiotherapy are studied in order to assess the possible etiological role of such therapy in arterial lesion. Surgical results are also discussed in terms of long-term efficacy. The average time of occurrence after radiotherapy was 8 years post-radiotherapy. This series includes 7 supra-aortic trunk stenoses and 7 abdominal aorta trunk stenoses. The doses received in the volumes iradiated ranged from 47 to 70 Gy with standard fractionation. Association of atherosclerotic risk factors was present in 12 patients, but stenoses were usually confined to irradiated areas, and at imes occurred in uncommon sites. Surgical management included 11 by-passes, 2 endarterectomies and one percutaneous transluminal angioplasty. All patients experienced immediate and satisfactory functional improvements. Three patients were re-operated on because of the re-occlusion of the by-pass and graft infection. On the whole, stenoses in previously irradiated areas showed no particular difficulties for surgical treatment. It was concluded that radiotherapy seems to be a definite risk factor for arterial occlusion or narrowing, especially in association in association with atherosclerotic risk factors. (author). 45 refs.; 3 figs.; 2 tabs

Stereotactic radiotherapy in oligometastatic cancer.

Science.gov (United States)

Kennedy, Thomas A C; Corkum, Mark T; Louie, Alexander V

2017-09-01

Oligometastatic cancer describes a disease state somewhere between localized and metastatic cancer. Proposed definitions of oligometastatic disease have typically used a cut-off of five or fewer sites of disease. Treatment of oligometastatic disease should have the goal of long-term local control, and in selected cases, disease remission. While several retrospective cohorts argue for surgical excision of limited metastases (metastasectomy) as the preferred treatment option for several clinical indications, limited randomized data exists for treating oligometastases. Alternatively, stereotactic ablative radiotherapy (SABR) is a radiotherapy technique that combines high radiation doses per fraction with precision targeting with the goal of achieving long-term local control of treated sites. Published cohort studies of SABR have demonstrated excellent local control rates of 70-90% in oligometastatic disease, with long-term survival in some series approaching 20-40%. A recent randomized phase 2 clinical trial by Gomez et al. demonstrated significantly improved progression free survival with aggressive consolidative therapy (surgery, radiotherapy ± chemotherapy or SABR) in oli-gometastatic non-small cell lung cancer (NSCLC). As additional randomized controlled trials are ongoing to determine the efficacy of SABR in oligometastatic disease, SABR is increasingly being used within routine clinical practice. This review article aims to sum-marize the history and current paradigm of the oligometastatic state, review recently pub-lished literature of SABR in oligometastatic cancer and discuss ongoing trials and future directions in this context.

Available evidence on re-irradiation with stereotactic ablative radiotherapy following high-dose previous thoracic radiotherapy for lung malignancies.

Science.gov (United States)

De Bari, Berardino; Filippi, Andrea Riccardo; Mazzola, Rosario; Bonomo, Pierluigi; Trovò, Marco; Livi, Lorenzo; Alongi, Filippo

2015-06-01

Patients affected with intra-thoracic recurrences of primary or secondary lung malignancies after a first course of definitive radiotherapy have limited therapeutic options, and they are often treated with a palliative intent. Re-irradiation with stereotactic ablative radiotherapy (SABR) represents an appealing approach, due to the optimized dose distribution that allows for high-dose delivery with better sparing of organs at risk. This strategy has the goal of long-term control and even cure. Aim of this review is to report and discuss published data on re-irradiation with SABR in terms of efficacy and toxicity. Results indicate that thoracic re-irradiation may offer satisfactory disease control, however the data on outcome and toxicity are derived from low quality retrospective studies, and results should be cautiously interpreted. As SABR may be associated with serious toxicity, attention should be paid for an accurate patients' selection. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pelvic radiation disease: Updates on treatment options

Science.gov (United States)

Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

2015-01-01

Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

Radiotherapy for a cystadenolymphoma of the parotid gland (Warthin's tumor)

International Nuclear Information System (INIS)

Stallmann, C.; Vacha, P.; Vesely, H.; Richter, E.; Feyerabend, T.

2001-01-01

Background: With 17.6% of all primary parotid neoformations the benign Warthin's tumor (cystadenolymphoma) is the second common parotid gland tumor. Males > 50 years are affected predominantly. After surgery the recurrence rate is less than 5%. Histomorphologically the tumor is characterized by cystoid ducts lined by epithelial cells as well as lymphoid stroma. The lymphoid component has been described as radioresponsive whereas the epithelial parts are less radiosensitive. Since 1960 only one patient treated by primary radiotherapy has been published. Case report: A 77-year-old woman suffered from cystadenolymphoma (maximal diameter 7 cm). Because of its extension and the reduced performance status of the patient surgery was no option. Radiotherapy was performed with a total dose of 50 Gy. Clinically, the tumor regressed completely after 30 Gy, which was confirmed by CT at 6 weeks after completion of radiotherapy. After 6 and 12 months the patient stayed free of tumor. Epicrisis: In our case the cystadenolymphoma was unusually large (7 cm). Radiotherapy with 50 Gy induced complete tumor regression. The good clinical response after 30 Gy suggests that the necessary dose may be lower for less extended cystadenolymphomas. Conclusion: We present a case of cystadenolymphoma treated by radiotherapy with 50 Gy resulting in a complete remission. Due to missing published experiences no common recommendation for the total dose can be given. In the following situations radiotherapy should be considered: 1. high surgical risk of damage to the facial nerve, 2. unfavorable cosmetic outcome after surgery, 3. inoperability for internal risks, 4. refusal of operation. (orig.) [de

Target migration from re-inflation of adjacent atelectasis during lung stereotactic body radiotherapy.

Science.gov (United States)

Mao, Bijing; Verma, Vivek; Zheng, Dandan; Zhu, Xiaofeng; Bennion, Nathan R; Bhirud, Abhijeet R; Poole, Maria A; Zhen, Weining

2017-06-10

Stereotactic body radiotherapy (SBRT) is a widely accepted option for the treatment of medically inoperable early-stage non-small cell lung cancer (NSCLC). Herein, we highlight the importance of interfraction image guidance during SBRT. We describe a case of early-stage NSCLC associated with segmental atelectasis that translocated 15 mm anteroinferiorly due to re-expansion of the adjacent segmental atelectasis following the first fraction. The case exemplifies the importance of cross-sectional image-guided radiotherapy that shows the intended target, as opposed to aligning based on rigid anatomy alone, especially in cases associated with potentially "volatile" anatomic areas.

Options for the management of Chernobyl-restricted areas in England and Wales

International Nuclear Information System (INIS)

Nisbet, Anne; Woodman, Rona

2000-01-01

Areas in England and Wales are still subject to restrictions on the movement, sale and slaughter of sheep because activity concentrations of 137 Cs in sheepmeat may exceed the 1000 Bq kg -1 limit imposed after the Chernobyl nuclear power plant accident. The operation of various monitoring programmes has enabled lamb production to be sustained in restricted areas. Under present circumstances, it is predicted that some restrictions will remain until at least 2003. This paper describes an assessment of the practicability and cost-effectiveness of five alternative management options: utilisation of existing improved land for the purposes of clean feeding; improvement of unimproved upland grazing for the purposes of clean feeding; provision of housing and clean feed; administration of boli containing ammonium ferric hexacyanoferrate; and monitoring at the market place. The practicability of each option, which encompasses technical feasibility, capacity, cost, impact and acceptability, was assessed through a series of case studies carried out on farms in the restricted area of north Wales, and through consultation with a range of organisations with interests in farming and/or the environment. Recommendations are made for the future management of the restricted areas

Applicability of the cost-effectiveness approach for comparison of waste management options

International Nuclear Information System (INIS)

Vuori, S.; Peltonen, E.; Vieno, T.; Vira, J.

1984-01-01

There is an obvious need to consider the achievable level of safety of waste management in view of the costs involved. The feasibility of the cost-effectiveness approach for this purpose is discussed in the framework of practical case studies. The analysis indicates that such an approach has clear benefits, but it also reveals several issues and ambiguities in its application. The waste management alternatives considered include various concepts for the disposal of low- and intermediate-level reactor wastes as well as of the unreprocessed spent fuel. The employed impact indicators describe both the individual and collective risks. In addition, indicators simultaneously giving a perspective into other risks in the society and a means to make a rank ordering of the alternative options are proposed. The cost-effectiveness ratios for collective risks vary in the range of ten to hundreds of millions US $ per man.Sv. The examples considered also indicate that increased costs do not necessarily improve safety. Furthermore, the comparison of the safety of different options requires more sophisticated and realistic models than those employed in the present analyses, because an unbalanced degree of conservatism could result in misleading conclusions. (author)

Climate change adaptation and mitigation options a guide for natural resource managers in southern forest ecosystems

Science.gov (United States)

James M. Vose; Kier D. Klepzig

2014-01-01

The rapid pace of climate change and its direct and indirect effects on forest ecosystems present a pressing need for better scientific understanding and the development of new science-management partnerships. Understanding the effects of stressors and disturbances (including climatic variability), and developing and testing science-based management options to deal...

Radiotherapy in Cancer Management at Ahmadu Bello University ...

African Journals Online (AJOL)

A new Co-60 Teletherapy Machine was commission at the Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, in April 2000. A total of three hundred and fifty seven patients, with histologically confirmed malignant tumours, were treated with external beam radiation ...

Management options for cholestatic liver disease in children.

Science.gov (United States)

Catzola, Andrea; Vajro, Pietro

2017-11-01

Due to a peculiar age-dependent increased susceptibility, neonatal cholestasis affects the liver of approximately 1 in every 2500 term infants. A high index of suspicion is the key to an early diagnosis, and to implement timely, often life-saving treatments. Even when specific treatment is not available or curative, prompt medical management and optimization of nutrition are of paramount importance to survival and avoidance of complications. Areas covered: The present article will prominently focus on a series of newer diagnostic and therapeutic options of cholestasis in neonates and infants blended with consolidated established paradigms. The overview of strategies for the management reported here is based on a systematic literature search published in English using accessible databases (PubMed, MEDLINE) with the keywords biliary atresia, choleretics and neonatal cholestasis. References lists from retrieved articles were also reviewed. Expert commentary: A large number of uncommon and rare hepatobiliary disorders may present with cholestasis during the neonatal and infantile period. Potentially life-saving disease-specific pharmacological and surgical therapeutic approaches are currently available. Advances in hepatobiliary transport mechanisms have started clarifying fundamental aspects of inherited and acquired cholestasis, laying the foundation for the development of possibly more effective specific therapies.

Radiotherapy of invasive breast cancer: French national guidelines

International Nuclear Information System (INIS)

Besnard, S.; Mazeau-Woynar, V.; Verdoni, L.; Cutuli, B.; Fourquet, A.; Giard, S.; Hennequin, C.; Leblanc-Onfroy, M.

2012-01-01

The French National Cancer Institute (INCa) and Societe francaise de senologie et pathologie mammaire (SFSPM), in collaboration with a multidisciplinary experts group, have published the French national clinical practice guidelines on a selection of 11 currently debated questions regarding the management of invasive breast cancer. Those guidelines are based on a comprehensive analysis of the current published evidence dealing with those issues, secondly reviewed by 100 reviewers. Radiotherapy was concerned by five of the 11 questions: indications for the boost after whole gland irradiation; hypo-fractionated radiotherapy; partial breast irradiation; indications for mammary internal nodes irradiation, and indications of radiotherapy after neo-adjuvant chemotherapy. (authors)

Consideration of safety of implant-based breast reconstruction with postreconstruction radiotherapy for breast cancer

International Nuclear Information System (INIS)

Aomatsu, Naoki; Tei, Seika; Haraoka, Goichi

2016-01-01

There is controversy as to whether immediate autologous breast reconstruction followed by postoperative radiotherapy has acceptable complications and aesthetic outcomes. To evaluate the interval between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy and immediate expander-implant reconstruction, and to evaluate locoregional and distant control and cosmesis in these patients. Between 2011 and 2015, 9 patients with breast cancer were treated at our institution with definitive mastectomy and axillary lymph node dissection followed by immediate tissue expander placement and postreconstruction radiotherapy. We reviewed the complications of implant-based breast reconstruction followed by postreconstruction radiotherapy. The timing of irradiation was after implant insertion for 8 patients and after tissue expander insertion for 1 patient. The mean follow-up was 601 days. There were no unacceptable complications or local recurrences. For the majority of patients, overall symmetry, aesthetic results, and patient satisfaction were high. Breast reconstruction using tissue expansion and implants is an acceptable option for the subset of patients who may undergo postreconstruction radiotherapy. (author)

The unique entity of nodular lymphocyte-predominant Hodgkin lymphoma: current approaches to diagnosis and management.

Science.gov (United States)

Hawkes, Eliza A; Wotherspoon, Andrew; Cunningham, David

2012-03-01

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare disease constituting only 3-8% of all Hodgkin lymphoma. It has a distinct histological and clinical presentation as well as significantly different natural history compared to the classical form of Hodgkin lymphoma. Presenting most often as early-stage disease, NLPHL is characterized by frequent relapses, but paradoxically an overall good prognosis. The approach to management should therefore reflect this pattern and focus on attaining prolonged remissions, with long-term follow-up paramount. Due to the rarity of the disease, few prospective data exist. Options for treatment include radiotherapy, chemotherapy or combined chemotherapy plus radiotherapy and targeted anti-CD20 antibody therapy, as well as observation in selected patients.

A case of gastric endocrine cell carcinoma which was significantly reduced in size by radiotherapy

International Nuclear Information System (INIS)

Azakami, Kiyoshi; Nishida, Kouji; Tanikawa, Ken

2016-01-01

In 2010, the World Health Organization classified gastric neuroendocrine tumors (NETs) into three types: NET grade (G) 1, NET G2 and neuroendocrine carcinoma (NEC). NECs are associated with a very poor prognosis. The patient was an 84-year-old female who was initially diagnosed by gastrointestinal endoscope with type 3 advanced gastric cancer with stenosis of the gastric cardia. Her overall status and performance status did not allow for operations or intensive chemotherapy. Palliative radiotherapy was performed and resulted in a significant reduction in the size of the tumor as well as the improvement of the obstructive symptoms. She died 9 months after radiotherapy. An autopsy provided a definitive diagnosis of gastric endocrine cell carcinoma, and the effectiveness of radiotherapy was pathologically-confirmed. Palliative radiotherapy may be a useful treatment option for providing symptom relief, especially for old patients with unresectable advanced gastric neuroendocrine carcinoma. (author)

A case of Bowen’s disease responding well to radiotherapy

Directory of Open Access Journals (Sweden)

Goknur Kalkan

2013-08-01

Full Text Available Bowen’s disease is a form of intraepidermal squamous cell carcinoma which is known as carsinoma in situ. The head, neck, and extremities are the most commonly affected anatomic locations. Treatment options for Bowen’s disease include observation, surgery, cryotherapy, electrodesiccation and curettage, topical application of 5-fluorouracil or imiquimod, Moh’s micrographic surgery, photodynamic therapy, and radiotherapy. Radiation therapy is advantageous in patients who refuse surgery, for large or multiple lesions, for lesions in cosmetically sensitive areas, and in patients who are predisposed to formation of keloids, with a high cure rate cited in the literature. Here we report a 70-year-old man who was diagnosed as Bowen’s disease and completely healed with the treatment of radiotherapy. By means of this case report, we will review the current literature and empasize that radiotherapy is an effective treatment alternative for Bowen's disease in the suitable lesions. [Cukurova Med J 2013; 38(4.000: 813-817

R and D options for demand side management in Japanese electric utilities

International Nuclear Information System (INIS)

Yamamoto, Takahiko

1996-01-01

Japanese electric demand has been steadily increasing in accordance with the economic growth. However, Japanese electric utilities are facing several problems; increasing construction cost of power facilities, siting constraints and the environmental issue of greenhouse gas emissions. To overcome these problems, electric utilities have been promoting demand-side-management (DSM) activities as well as supplier-side measures, with some presently being carried out through promoting energy conservation technologies and introducing electric tariff options of specific contracts for residential/commercial and industrial consumers. Japanese electric utilities have been carrying out R and D for the future, in particular, energy storage and heat storage which contribute to the improvement of load factor. In this paper, I would like to outline the R and D options for DSM in Japan. (author)

Lethal trap trees: a potential option for emerald ash borer (Agrilus planipennis Fairmaire) management

Science.gov (United States)

Deborah G McCullough; Therese M. Poland; Phillip A. Lewis

2015-01-01

BACKGROUND: Economic and ecological impacts of ash (Fraxinus spp.) mortality resulting from emerald ash borer (EAB) (Agrilus planipennis Fairmaire) invasion are severe in forested, residential and urban areas. Management options include girdling ash trees to attract ovipositing adult beetles and then destroying infested trees...

Radiotherapy in prostate cancer. Innovative techniques and current controversies

Energy Technology Data Exchange (ETDEWEB)

Geinitz, Hans [Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Dept. of Radiation Oncology; Linz Univ. (Austria). Medical Faculty; Roach, Mack III [California Univ., San Francisco, CA (United States). Dept. of Radiation Oncology; Van As, Nicholas (ed.) [The Institute of Cancer Research, Sutton Surrey (United Kingdom)

2015-04-01

Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

Radiotherapy

Directory of Open Access Journals (Sweden)

Rema Jyothirmayi

1999-01-01

Full Text Available Purpose. Conservative treatment in the form of limited surgery and post-operative radiotherapy is controversial in hand and foot sarcomas, both due to poor radiation tolerance of the palm and sole, and due to technical difficulties in achieving adequate margins.This paper describes the local control and survival of 41 patients with soft tissue sarcoma of the hand or foot treated with conservative surgery and radiotherapy. The acute and late toxicity of megavoltage radiotherapy to the hand and foot are described. The technical issues and details of treatment delivery are discussed. The factors influencing local control after radiotherapy are analysed.

Impact assessment of waste management options in Singapore.

Science.gov (United States)

Tan, Reginald B H; Khoo, Hsien H

2006-03-01

This paper describes the application of life cycle assessment for evaluating various waste management options in Singapore, a small-island city state. The impact assessment method by SimaPro is carried out for comparing the potential environmental impacts of waste treatment options including landfilling, incineration, recycling, and composting. The inventory data include gases and leachate from landfills, air emissions and energy recovery from incinerators, energy (and emission) savings from recycling, composting gases, and transport pollution. The impact assessment results for climate change, acidification, and ecotoxicity show that the incineration of materials imposes considerable harm to both human health and the environment, especially for the burning of plastics, paper/cardboard, and ferrous metals. The results also show that, although some amount of energy can be derived from the incineration of wastes, these benefits are outweighed by the air pollution (heavy metals and dioxins/furans) that incinerators produce. For Singapore, landfill gases and leachate generate minimal environmental damage because of the nation's policy to landfill only 10% of the total disposed wastes. Land transportation and separation of waste materials also pose minimal environmental damage. However, sea transportation to the landfill could contribute significantly to acidification because of the emissions of sulfur oxides and nitrogen oxides from barges. The composting of horticultural wastes hardly imposes any environmental damage. Out of all the waste strategies, the recycling of wastes offers the best solution for environmental protection and improved human health for the nation. Significant emission savings can be realized through recycling.

41 CFR 101-39.004 - Optional operations.

Science.gov (United States)

2010-07-01

...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Optional operations. 101...

Primary lung sarcoma treated with stereotactic ablative radiotherapy: a case report

Directory of Open Access Journals (Sweden)

Yeo SG

2017-07-01

Full Text Available Seung-Gu Yeo Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea Abstract: Primary lung sarcoma (PLS is an extremely rare, very aggressive malignancy. Surgical removal is considered the treatment of choice, and patients who have been given conventional radiotherapy have had inferior outcomes. This study is the first describing a case of PLS treated with stereotactic ablative radiotherapy (SABR, which precisely targets a small tumor with a markedly higher biologically effective dose than conventional radiotherapy. The patient was an 82-year-old man who was diagnosed with primary lung leiomyosarcoma based on radiology, pathology, and immunohistochemical examinations. The PLS was located in the right lower lobe and measured 2.5 cm. No regional nodal or distant organ metastasis was observed. He was inoperable medically. The SABR was performed using volumetric modulated arc therapy and a dose of 56 Gy in four fractions. Follow-up computed tomography 2 months after SABR revealed a complete tumor response. The toxicity was limited to mild respiratory symptoms. The patient is alive and has had no evidence of disease for 2 years. This study suggests that SABR can be a safe and effective treatment option for PLS. Keywords: primary lung sarcoma, leiomyosarcoma, stereotactic ablative radiotherapy, stereotactic body radiotherapy, radiation therapy, sarcoma 

Planning National Radiotherapy Services: A Practical Tool (Russian Edition)

International Nuclear Information System (INIS)

2015-01-01

The current and future burden of cancer incidence in developing countries requires the planning, establishment and upgrading of radiotherapy services at the national level. This publication is a practical guide outlining the main issues at stake when planning national radiotherapy services. It provides an assessment of the cancer burden, evaluates the existing resources, and determines what is needed and how to cover the gap in a resource oriented rational way. The publication will be of practical value to decision makers and programme managers in public health facing the organization or reorganization of radiotherapy services in their countries.

Development and application of the computer information administration system in radiotherapy

International Nuclear Information System (INIS)

Zhao Yufei; Zhang Hongyan; Ma Jun; Wu Weiwei; Cheng Guangyuan; Liu Yezheng

2004-01-01

Objective: To develop the system of computer information processing for radiotherapy. Methods: Visual Foxpro 5.0 was used to program the system through the model of client-server machine. SQL-server was used as the database-server. Results: The main function of this system was management of the case data for radiotherapy and make plans for radiotherapy. Conclusion: This system operates steadily with the data safe and reliable. It can be used extensively in clinical practice

Herbal Medicine Offered as an Initiative Therapeutic Option for the Management of Hepatocellular Carcinoma.

Science.gov (United States)

Chen, Shao-Ru; Qiu, Hong-Cong; Hu, Yang; Wang, Ying; Wang, Yi-Tao

2016-06-01

Hepatocellular carcinoma (HCC) is a common malignant cancer and is the third leading cause of death worldwide. Effective treatment of this disease is limited by the complicated molecular mechanism underlying HCC pathogenesis. Thus, therapeutic options for HCC management are urgently needed. Targeting the Wnt/β-catenin, Hedgehog, Notch, and Hippo-YAP signaling pathways in cancer stem cell development has been extensively investigated as an alternative treatment. Herbal medicine has emerged as an initiative therapeutic option for HCC management because of its multi-level, multi-target, and coordinated intervention effects. In this article, we summarized the recent progress and clinical benefits of targeting the above mentioned signaling pathways and using natural products such as herbal medicine formulas to treat HCC. Proving the clinical success of herbal medicine is expected to deepen the knowledge on herbal medicine efficiency and hasten the adoption of new therapies. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Radiotherapy in complex management of Ewing sarcoma

International Nuclear Information System (INIS)

Ruseva, Tz.; Marinova, L.; Hristozova, I.; Sokolov, T.

1996-01-01

Over the period 1981-1995, 32 patients with non-metastatic Ewing sarcoma, aged 2 to 22 years, underwent treatment and follow-up study. A locally advanced tumor is found in 85% of patients. Complex radio- and chemotherapy is carried out in all patients, and additional radical surgery - in eight. 60 Co-radiotherapy with gradual radiation field reduction is applied, applying a local dose of 60 - 64 Gy in the tumor area. Chemotherapy is performed according to the VACA protocol. Local tumor control is achieved in all patients with primary tumor located in long bones, and only in 1 of 5 patients with pelvic localization. The overall survival established is as follows: 1 year survival - 100 %, 2 years - 50 %, 3 years - 40 % and 5 years - 34 %. Local recurrence is recorded in 2 cases (6.2%). The distant metastases observed involve the lungs (13), bones (4), lung and bones (2) and soft tissues (3). The Ewing sarcoma is sensible to chemo- and radiotherapy, but the conventional methods do not improve survival. Based on the analysis of the clinical results, emphasis is laid on the necessity of complex treatment with a special reference to alternative therapeutic approaches. 13 refs., 4 figs., 2 tabs

Life-cycle assessment of selected management options for air pollution control residues from waste incineration.

Science.gov (United States)

Fruergaard, Thilde; Hyks, Jiri; Astrup, Thomas

2010-09-15

Based on available technology and emission data seven selected management options for air-pollution-control (APC) residues from waste incineration were evaluated by life-cycle assessment (LCA) using the EASEWASTE model. Scenarios were evaluated with respect to both non-toxicity impact categories (e.g. global warming) and toxicity related impact categories (e.g. ecotoxicity and human toxicity). The assessment addressed treatment and final placement of 1 tonne of APC residue in seven scenarios: 1) direct landfilling without treatment (baseline), 2) backfilling in salt mines, 3) neutralization of waste acid, 4) filler material in asphalt, 5) Ferrox stabilization, 6) vitrification, and 7) melting with automobile shredder residues (ASR). The management scenarios were selected as examples of the wide range of different technologies available worldwide while at the same time using realistic technology data. Results from the LCA were discussed with respect to importance of: energy consumption/substitution, material substitution, leaching, air emissions, time horizon aspects for the assessment, and transportation distances. The LCA modeling showed that thermal processes were associated with the highest loads in the non-toxicity categories (energy consumption), while differences between the remaining alternatives were small and generally considered insignificant. In the toxicity categories, all treatment/utilization options were significantly better than direct landfilling without treatment (lower leaching), although the thermal processes had somewhat higher impacts than the others options (air emissions). Transportation distances did not affect the overall ranking of the management alternatives. Copyright 2010 Elsevier B.V. All rights reserved.

Partitioning and transmutation: Radioactive waste management option

International Nuclear Information System (INIS)

Stanculescu, A.

2005-01-01

Growing world population with increasing energy needs, especially in the developing countries, Threat of global warming due to CO 2 emissions demands non-fossil electricity production. Nuclear will have to be part of a sustainable mix of energy production options Figures show that 350 GWe worldwide capacity is 'nuclear'. Present worldwide spent fuel (containing high Pu inventory) and HLW would need large repositories. In view of the previous facts this lecture deals Partitioning and transmutation as radioactive waste management option. Partitioning and transmutation (P and T) is a complex technology i.e. advanced reprocessing, and demand transuranics fuel fabrication plants, as well as innovative and/or dedicated transmutation reactors. In addition to U, Pu, and 129 I, 'partitioning' extracts from the liquid high level waste the minor actinides (MA) and the long-lived fission products (LLFP) 99-Tc, 93-Zr, 135-Cs, 107-Pd, and 79-Se). 'Transmutation' requires fully new fuel fabrication plants and reactor technologies to be developed and implemented on industrial scale. Present LWRs are not suited for MA and LLFP transmutation (safety consideration, plant operation, poor incineration capability). Only specially licensed LWRs can cope with MOX fuel; for increased Pu loadings (up to 100%), special reactor designs (e.g., ABB80+) are required; a combination of these reactor types could allow Pu inventory stabilization. Long-term waste radiotoxicity can be effectively reduced only if transuranics are 'incinerated' through fission with very hard neutron spectra. New reactor concepts (dedicated fast reactors, Accelerator Driven Systems (ADS), fusion/fission hybrid reactors) have been proposed as transmuters/incinerators. Significant Pu+MAs incineration rates can be achieved in symbiotic scenarios: LWR-MOX and dedicated fast reactors; fast neutron spectrum ADS mainly for MA incineration; very high thermal flux ADS concepts could also provide a significant transuranics

An Agent-Based Approach for Evaluating Basic Design Options of Management Accounting Systems

Directory of Open Access Journals (Sweden)

Friederike Wall

2013-12-01

Full Text Available This paper investigates the effectiveness of reducing errors in management accounting systems with respect to organizational performance. In particular, different basic design options of management accounting systems of how to improve the information base by measurements of actual values are analyzed in different organizational contexts. The paper applies an agent-based simulation based on the idea of NK fitness landscapes. The results provide broad, but no universal support for conventional wisdom that lower inaccuracies of accounting information lead to more effective adaptation processes. Furthermore, results indicate that the effectiveness of improving the management accounting system subtly interferes with the complexity of the interactions within the organization and the coordination mode applied

A survey of the practice and management of radiotherapy linear accelerator quality control in the UK.

Science.gov (United States)

Palmer, A; Kearton, J; Hayman, O

2012-11-01

The objective of this study was to determine current radiotherapy linear accelerator quality control (QC) practice in the UK, as a comparative benchmark and indicator of development needs, and to raise awareness of QC as a key performance indicator. All UK radiotherapy centres were invited to complete an online questionnaire regarding their local QC processes, and submit their QC schedules. The range of QC tests, frequency of measurements and acceptable tolerances in use across the UK were analysed, and consensus and range statistics determined. 72% of the UK's 62 radiotherapy centres completed the questionnaire and 40% provided their QC schedules. 60 separate QC tests were identified from the returned schedules. There was a large variation in the total time devoted to QC between centres: interquartile range from 13 to 26 h per linear accelerator per month. There has been a move from weekly to monthly testing of output calibration in the last decade, with reliance on daily constancy testing equipment. 33% of centres thought their schedules were in need of an update and only 30% used risk-assessment approaches to determine local QC schedule content. Less than 30% of centres regularly complete all planned QC tests each month, although 96% achieve over 80% of tests. A comprehensive "snapshot" of linear accelerator QC testing practice in the UK has been collated, which demonstrates reasonable agreement between centres in their stated QC test frequencies. However, intelligent design of QC schedules and management is necessary to ensure efficiency and appropriateness.

Management of stage IV rectal cancer: Palliative options

Science.gov (United States)

Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-01-01

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

Current options for palliative treatment in patients with pancreatic cancer.

Science.gov (United States)

Ridwelski, K; Meyer, F

2001-01-01

Palliative treatment is often the only remaining option in the management of pancreatic carcinoma, but its efficacy is poor due to low tumor sensitivity and inadequate treatment protocols. There are several options of palliative treatment with antitumor or supportive intention. Classical end points of palliative treatment are survival, tumor response, and quality of life. A decade ago, palliative chemotherapy consisted mainly of 5-fluorouracil as the standard agent in combination with either other agents and/or radiotherapy. Only the new antineoplastic drug gemcitabine, which was introduced simultaneously with the definition of novel end points of chemotherapy such as clinical benefit, allowed to achieve some progress. However, while gemcitabine monotherapy appeared to be superior to 5-fluorouracil and improved important parameters of quality of life, it could not provide a significant improvement of survival. A novel concept, therefore, is to improve this beneficial cytostatic response in pancreatic carcinoma using a gemcitabine-based protocol by combining it with antineoplastic drugs such as taxanes or platin analogs. This strategy may have the potential to improve the outcome in palliative chemotherapy of pancreatic carcinoma patients with advanced tumor growth or metastases. Best supportive care in pancreatic cancer consists of the treatment of symptoms, such as pain, jaundice, duodenal obstruction, weight loss, exocrine pancreatic insufficiency, and tumor-associated depression. Copyright 2001 S. Karger AG, Basel

NEOADJUVANT RADIOTHERAPY FOR BLADDER CARCINOMA IN ...

African Journals Online (AJOL)

Objective To evaluate the impact of preoperative accelerated hyperfractionated radiotherapy in the management of bladder carcinoma in Egyptian patients. Patients and Methods Between December 1996 and February 2000, 104 Egyptian patients with pathologically proven infiltrative bladder carcinoma were enrolled in ...

All delays before radiotherapy risk progression of Merkel cell carcinoma

International Nuclear Information System (INIS)

Tsang, G.; O'Brien, P.; Robertson, R.; Hamilton, C.; Wratten, C.; Denham, J.

2004-01-01

Prolonged waiting times for radiotherapy have resulted in many centres assigning priorities to various patient or diagnostic groups. A high risk of progression on a waiting list is one factor that would reasonably influence the priority. The present descriptive study of 27 patients with Merkel cell carcinoma (MCC) found that a median wait of 24 days for radiotherapy is associated with a high risk of progression. Eleven (41%) of 27 patients developed progressive disease, including five (45%) of 11 patients waiting for adjuvant radiotherapy. Patients treated adjuvantly also had longer waiting times prior to their initial radiotherapy consultation (median 41 days), which may have contributed to the rate of progression. Merkel cell carcinoma is an aggressive but curable malignancy and appropriate management should include efforts to minimize all potential delays prior to the commencement of radiotherapy. Copyright (2004) Blackwell Science Pty Ltd

Management Options For Reducing The Release Of Antibiotics And Antibiotic Resistance Genes To The Environment

Science.gov (United States)

Background: There is growing concern worldwide about the role of polluted soil and water - 77 environments in the development and dissemination of antibiotic resistance. 78 Objective: To identify management options for reducing the spread of antibiotics and 79 antibiotic resist...

Radiotherapy options for localized prostate cancer based upon pretreatment serum prostate-specific antigen levels and biochemical control: A comprehensive review of the literature

International Nuclear Information System (INIS)

Vicini, Frank A.; Horwitz, Eric M.; Kini, Vijay R.; Stromberg, Jannifer S.; Martinez, Alvaro A.

1998-01-01

Purpose: To review all the available radiotherapy (RT) literature on localized prostate cancer treatment where serum prostate-specific antigen (PSA) levels were used to both stratify patients and evaluate outcome and determine if any conclusions can be reached regarding an optimal radiotherapeutic management for this disease. Methods and Materials: A MEDLINE search was conducted to obtain all articles in English on prostate cancer treatment employing RT from 1986-1997. Studies were considered eligible for review only if they met all the following criteria: 1) pretreatment PSA values were recorded and grouped for subsequent evaluation, 2) posttreatment PSA values were continuously monitored, 3) definitions of biochemical control were stated, and 4) the median follow-up was given. Results: Of the 246 articles identified, only 20 met the inclusion criteria; 4 using conformal external beam RT, 8 using conventional external beam RT, and 8 using interstitial brachytherapy (4 using a permanent implant alone, 3 combining external beam RT with a permanent implant, and 1 combining a conformal temporary interstitial implant boost with external beam RT). No studies using neutrons (with or without external beam RT) or androgen deprivation (combined with external beam RT) were identified where patients were stratified by pretreatment PSA levels. Results for all therapies were extremely variable with the 3-5-year rates of biochemical control for patients with pretreatment PSA levels ≤4 ng/ml ranging from 48 to 100%, for PSA levels >4 and ≤10 ng/ml ranging from 44 to 90%, for PSA levels >10 and ≤20 ng/ml ranging from 27 to 89%, and for PSA levels >20 ranging from 14 to 89%. The median Gleason score, T-stage, definition of biochemical control, and follow-up were substantially different from series to series. No RT option consistently produced superior results. Conclusions: When data are reviewed from studies using serum PSA levels to stratify patients and to evaluate

External beam radiotherapy in the management of ovarian carcinoma

International Nuclear Information System (INIS)

Reinfuss, Marian; Zbigniew, Kojs; Skolyszewski, Jan

1993-01-01

Between 1970 and 1983, 345 patients with ovarian cancer clinical stage I, II and III were irradiated postoperatively. Five-year NED survival was achieved in 41.7% of patients. The most important prognostic factors were histological grade and clinical stage of cancer. Postoperative external beam radiotherapy appeared to be highly efficient for the patients with microscopic residual disease, giving 70% 5-year survival, and moderately efficient for patients with small, i.e. ≤3 cm in diameter residual disease, giving 40% 5-year survival. The optimal technique of irradiation appeared to be the irradiation given to the entire abdominal cavity with additional irradiation coned down to the pelvis. External beam radiotherapy was ineffective in patients with gross residual disease, i.e. >3 cm in diameter, and useless as palliative treatment given to patients with inoperable cancer of the ovary. (author). tabs., figs

The Three-Dimensional Approach of Total Quality Management, an Essential Strategic Option for Business Excellence

Directory of Open Access Journals (Sweden)

Armenia Androniceanu

2017-02-01

Full Text Available In a complex and dynamic business environment, managers widely appeal to modern methods and techniques that would help them cope with the competition and offer their customers new, attractive, good quality products and services and at competitive prices. In this context, total quality management is a viable and sustainable option that can systematically contribute to the consolidation of the capacity of organizations. The aim of this paper was to put forth a three-dimensional approach of total quality management and provide some concrete action ways through which organizations in Romania that implement total or partial quality management integrated systems would produce significant competitive advantages. The main research methods used were: the questionnaire, document analysis, applications offered by Word and Excel and the Statistical Package for Social Sciences, one of the most complete software packages with which we calculated means and standard deviations and determined and analysed correlations between variables and various quality parameters. In this research, have been identified the main key success factors, the vulnerabilities and weaknesses of the systems, their causes and the necessary changes through which the threedimensional approach of total quality management could become a preferred strategic option with a major positive impact upon business excellence. The most important results obtained are a three-dimensional approach of the Total Quality Management and a substantial number of certain proposals for the Romanian firms in order to achieve business excellence.

Dementia post-radiotherapy: improvement with acetylcholinesterase inhibitor A case report

Directory of Open Access Journals (Sweden)

Antonio Eduardo Damin

Full Text Available Abstract Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment.

Organizational, technical, physical and clinical quality standards for radiotherapy

Science.gov (United States)

Bogusz-Czerniewicz, Marta; Kaźmierczak, Daniel

2012-01-01

Background Indisputably, radiotherapy has become an entirely interdisciplinary specialty. This situation requires efficient planning, verification, monitoring, quality control and constant improvement of all aspects of service delivery, referring both to patients’ (including diagnosis, prescription and method of treatment, its justification, realization and follow up) and organizational, technical and physics matters. Aim The aim of this work was to develop technical, physics and clinical quality standards for radiotherapy. This paper presents chosen standards for each of the aforementioned category. Materials and methods For the development of quality standards the comparison analysis of EU and Polish acts of law passed between 1980 and 2010 was conducted, the universal industrial ISO norm 9001:2008 referring to quality management system was reviewed. Recommendations of this norm were completed with detailed quality standards based on the author's 11 year work experience and the review of articles on quality assurance and quality control standards for radiotherapy published between 1984 and 2009 and the review of current recommendations and guidelines of American, International, European and National bodies (associations, societies, agencies such as AAPM, ESTRO, IAEA, and OECI) for quality assurance and quality management in radiotherapy. Results As a result 352 quality standards for radiotherapy were developed and categorized into the following three groups: (1) organizational standards, (2) physics and technical standards and (3) clinical standards. Conclusions Proposed quality standards for radiotherapy, can be used by any institution using ionizing radiation for medical procedures. Nevertheless standards are only of value if they are implemented, reviewed, audited and improved and if there is a clear mechanism in place to monitor and address failure to meet agreed standards. PMID:24377023

Sentinel lymph node mapping for defining site and extent of elective radiotherapy management of regional modes in Merkel cell carcinoma: a pilot case series

International Nuclear Information System (INIS)

Naehrig, Diana; Uren, Roger F.; Emmett, Louise; Ioannou, Kim; Hong, Angela; Wratten, Chris; Thompson, John F.; Hruby, George

2014-01-01

Merkel cell carcinoma is a rare and aggressive skin malignancy. We discuss sentinel lymph node mapping which is a valuable decision aid for radiotherapy management and planning of treatment volumes as illustrated by four cases.

The Dynamics of Social Capital in Influencing Use of Soil Management Options in the Chinyanja Triangle of Southern Africa

Directory of Open Access Journals (Sweden)

Jemimah M. Njuki

2008-12-01

Full Text Available Social capital has become a critical issue in agricultural development as it plays an important role in collective action, such as, management of common resources and collective marketing. Whilst literature exists on the role of social capital in the use and adoption of improved agricultural technology, such literature is fraught with issues of the measurement of social capital beyond membership of farmers in groups. We hypothesized that different types of social capital influence the adoption of soil management options differently. This study looked at the measurement of social capital, differentiating between the main types of social capital and employed factor analysis to aggregate indicators of social capital into bonding, bridging, and linking social capital. Using logit analysis, the role of these types of capitals on influencing use of different soil management options was analyzed. The study found that bonding, bridging, and linking social capital all influence the adoption and use of different soil management options differently, a trend that might be similar for other agricultural technologies as well. The study recommends more research investments in understanding the differentiated outcomes of these forms of social capital on use and adoption of technologies to further guide agricultural interventions.

Traffic Light Options

DEFF Research Database (Denmark)

Jørgensen, Peter Løchte

This paper introduces, prices, and analyzes traffic light options. The traffic light option is an innovative structured OTC derivative developed independently by several London-based investment banks to suit the needs of Danish life and pension (L&P) companies, which must comply with the traffic...... 2006, and supervisory authorities in many other European countries have implemented similar regulation. Traffic light options are therefore likely to attract the attention of a wider audience of pension fund managers in the future. Focusing on the valuation of the traffic light option we set up a Black...... light scenarios. These stress scenarios entail drops in interest rates as well as in stock prices, and traffic light options are thus designed to pay off and preserve sufficient capital when interest rates and stock prices fall simultaneously. Sweden's FSA implemented a traffic light system in January...

Traffic Light Options

DEFF Research Database (Denmark)

Jørgensen, Peter Løchte

2007-01-01

This paper introduces, prices, and analyzes traffic light options. The traffic light option is an innovative structured OTC derivative developed independently by several London-based investment banks to suit the needs of Danish life and pension (L&P) companies, which must comply with the traffic...... 2006, and supervisory authorities in many other European countries have implemented similar regulation. Traffic light options are therefore likely to attract the attention of a wider audience of pension fund managers in the future. Focusing on the valuation of the traffic light option we set up a Black...... light scenarios. These stress scenarios entail drops in interest rates as well as in stock prices, and traffic light options are thus designed to pay off and preserve sufficient capital when interest rates and stock prices fall simultaneously. Sweden's FSA implemented a traffic light system in January...

Radiotherapy Treatment Planning for Testicular Seminoma

International Nuclear Information System (INIS)

Wilder, Richard B.; Buyyounouski, Mark K.; Efstathiou, Jason A.; Beard, Clair J.

2012-01-01

Virtually all patients with Stage I testicular seminoma are cured regardless of postorchiectomy management. For patients treated with adjuvant radiotherapy, late toxicity is a major concern. However, toxicity may be limited by radiotherapy techniques that minimize radiation exposure of healthy normal tissues. This article is an evidence-based review that provides radiotherapy treatment planning recommendations for testicular seminoma. The minority of Stage I patients who choose adjuvant treatment over surveillance may be considered for (1) para-aortic irradiation to 20 Gy in 10 fractions, or (2) carboplatin chemotherapy consisting of area under the curve, AUC = 7 × 1−2 cycles. Two-dimensional radiotherapy based on bony anatomy is a simple and effective treatment for Stage IIA or IIB testicular seminoma. Centers with expertise in vascular and nodal anatomy may consider use of anteroposterior–posteroanterior fields based on three-dimensional conformal radiotherapy instead. For modified dog-leg fields delivering 20 Gy in 10 fractions, clinical studies support placement of the inferior border at the top of the acetabulum. Clinical and nodal mapping studies support placement of the superior border of all radiotherapy fields at the top of the T12 vertebral body. For Stage IIA and IIB patients, an anteroposterior–posteroanterior boost is then delivered to the adenopathy with a 2-cm margin to the block edge. The boost dose consists of 10 Gy in 5 fractions for Stage IIA and 16 Gy in 8 fractions for Stage IIB. Alternatively, bleomycin, etoposide, and cisplatin chemotherapy for 3 cycles or etoposide and cisplatin chemotherapy for 4 cycles may be delivered to Stage IIA or IIB patients (e.g., if they have a horseshoe kidney, inflammatory bowel disease, or a history of radiotherapy).

Radiotherapy Treatment Planning for Testicular Seminoma

Energy Technology Data Exchange (ETDEWEB)

Wilder, Richard B., E-mail: richardbwilder@yahoo.com [Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL (United States); Buyyounouski, Mark K. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Efstathiou, Jason A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Beard, Clair J. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States)

2012-07-15

Virtually all patients with Stage I testicular seminoma are cured regardless of postorchiectomy management. For patients treated with adjuvant radiotherapy, late toxicity is a major concern. However, toxicity may be limited by radiotherapy techniques that minimize radiation exposure of healthy normal tissues. This article is an evidence-based review that provides radiotherapy treatment planning recommendations for testicular seminoma. The minority of Stage I patients who choose adjuvant treatment over surveillance may be considered for (1) para-aortic irradiation to 20 Gy in 10 fractions, or (2) carboplatin chemotherapy consisting of area under the curve, AUC = 7 Multiplication-Sign 1-2 cycles. Two-dimensional radiotherapy based on bony anatomy is a simple and effective treatment for Stage IIA or IIB testicular seminoma. Centers with expertise in vascular and nodal anatomy may consider use of anteroposterior-posteroanterior fields based on three-dimensional conformal radiotherapy instead. For modified dog-leg fields delivering 20 Gy in 10 fractions, clinical studies support placement of the inferior border at the top of the acetabulum. Clinical and nodal mapping studies support placement of the superior border of all radiotherapy fields at the top of the T12 vertebral body. For Stage IIA and IIB patients, an anteroposterior-posteroanterior boost is then delivered to the adenopathy with a 2-cm margin to the block edge. The boost dose consists of 10 Gy in 5 fractions for Stage IIA and 16 Gy in 8 fractions for Stage IIB. Alternatively, bleomycin, etoposide, and cisplatin chemotherapy for 3 cycles or etoposide and cisplatin chemotherapy for 4 cycles may be delivered to Stage IIA or IIB patients (e.g., if they have a horseshoe kidney, inflammatory bowel disease, or a history of radiotherapy).

Electronic database of patients in radiotherapy: Amedatos

International Nuclear Information System (INIS)

Perez Guevara, Adrian; Rodriguez Zayas, Michael; Gonzalez Perez, Yelina; Sola Rodriguez, Yeline; Reyes Gonzalez, Tommy; Caballero, Roberto

2009-01-01

Registration and monitoring of patients in the departments of radiotherapy in our country are taken manually, which is difficult when very large number of patients and treatment units in service. Due to these problems in the Department of Radiotherapy 'Hospital Hermanos Ameijeiras' AMEDATOS program was designed in Microsoft Excel. The main program relates different books, macros are used to improve visualization and facilitate the management of data on different sheets (dosimetry, Team, Daily Record, Record monitoring, patient data, dosimetry data, not treated and four sheets of Report). (Author)

Big Data Analytics for Prostate Radiotherapy.

Science.gov (United States)

Coates, James; Souhami, Luis; El Naqa, Issam

2016-01-01

Radiation therapy is a first-line treatment option for localized prostate cancer and radiation-induced normal tissue damage are often the main limiting factor for modern radiotherapy regimens. Conversely, under-dosing of target volumes in an attempt to spare adjacent healthy tissues limits the likelihood of achieving local, long-term control. Thus, the ability to generate personalized data-driven risk profiles for radiotherapy outcomes would provide valuable prognostic information to help guide both clinicians and patients alike. Big data applied to radiation oncology promises to deliver better understanding of outcomes by harvesting and integrating heterogeneous data types, including patient-specific clinical parameters, treatment-related dose-volume metrics, and biological risk factors. When taken together, such variables make up the basis for a multi-dimensional space (the "RadoncSpace") in which the presented modeling techniques search in order to identify significant predictors. Herein, we review outcome modeling and big data-mining techniques for both tumor control and radiotherapy-induced normal tissue effects. We apply many of the presented modeling approaches onto a cohort of hypofractionated prostate cancer patients taking into account different data types and a large heterogeneous mix of physical and biological parameters. Cross-validation techniques are also reviewed for the refinement of the proposed framework architecture and checking individual model performance. We conclude by considering advanced modeling techniques that borrow concepts from big data analytics, such as machine learning and artificial intelligence, before discussing the potential future impact of systems radiobiology approaches.

Long-term local control with radiofrequency ablation or radiotherapy for second, third, and fourth lung tumors after lobectomy for primary lung cancer

International Nuclear Information System (INIS)

Yokouchi, Hideoki; Murata, Kohei; Miyazaki, Masaki; Miyamoto, Takeaki; Minami, Takafumi; Tsuji, Fumio; Mikami, Koji

2016-01-01

A 78-year-old woman developed second, third, and fourth lung tumors at intervals of 1-3 years after left upper lobectomy for primary lung cancer. The tumors were controlled with radiofrequency ablation (RFA) or conventional conformal radiotherapy for 9 years postoperatively. For the treatment of second primary lung cancer or lung metastasis after surgical resection of the primary lung cancer, reoperation is not recommended because of the impaired respiratory reserve. Thus, local therapy such as radiotherapy or RFA is applied in some cases. Among these, stereotactic body radiotherapy (SBRT) is a feasible option because of its good local control and safety, which is comparable with surgery. On the other hand, for cases of multiple lesions that are not suitable for radiotherapy or combination therapy, RFA could be an option because of its short-term local control, easiness, safety, and repeatability. After surgery for primary lung cancer, a second lung tumor could be controlled with highly effective and minimally invasive local therapy if it is recognized as a local disease but is medically inoperable. Therefore, long-term postoperative follow-up for primary lung cancer is beneficial. (author)

Participatory groundwater management in Jordan: Development and analysis of options

Science.gov (United States)

Chebaane, Mohamed; El-Naser, Hazim; Fitch, Jim; Hijazi, Amal; Jabbarin, Amer

Groundwater over-exploitation has been on the rise in Jordan. Competing demands have grown in the face of perennial water shortages, a situation which has been exacerbated by drought conditions in the past decade. This paper reports findings of a project in which management options to address over-exploitation were developed for one of Jordan's principal aquifer systems, the Amman-Zarqa Basin. Options for addressing the situation were developed through a participatory approach that involved government officials and various public and private sector interest groups. Particular efforts were made to involve well irrigators, who are likely to be heavily impacted by the changes required to reduce groundwater pumping to a sustainable level. With information obtained from a rapid appraisal survey as well as from interviews with farmers, community groups, government officials, and technical experts, an extensive set of options was identified for evaluation. Based on integrated hydrogeologic, social, and economic analysis, five complementary management options were recommended for implementation. These included the establishment of an Irrigation Advisory Service, buying out farm wells, placing firm limits on well ion and irrigated crop areas, exchanging treated wastewater for groundwater, and measures to increase the efficiency of municipal and industrial water use. Various combinations and levels of these options were grouped in scenarios, representing possible implementation strategies. The scenarios were designed to assist decision makers, well owners and other stakeholders in moving gradually towards a sustainable ion regime. Social and economic aspects of each option and scenario were analyzed and presented to stakeholders, together with a of legal, institutional and environmental ramifications. Combining scientific analysis with a participatory approach in the Amman Zarqa Basin groundwater management was devised as a prototype to be used in the management of other

Management options for reducing the release of antibiotics and antibiotic resistance genes to the environment

DEFF Research Database (Denmark)

Pruden, Amy; Larsson, D.G. Joakim; Amézquita, Alejandro

2013-01-01

Background: There is growing concern worldwide about the role of polluted soil and water environments in the development and dissemination of antibiotic resistance. Objective: Our aim in this study was to identify management options for reducing the spread of antibiotics and antibiotic resistance...

Analysis of Options Contract, Option Pricing in Agricultural Products

Directory of Open Access Journals (Sweden)

H. Tamidy

2016-03-01

Full Text Available Introduction: Risk is an essential component in the production and sale of agricultural products. Due to the nature of agricultural products, the people who act in this area including farmers and businesspersons encounter unpredictable fluctuations of prices. On the other hand, the firms that process agricultural products also face fluctuation of price of agricultural inputs. Given that the Canola is considered as one of the inputs of product processing factories, control of unpredictable fluctuations of the price of this product would increase the possibility of correct decision making for farmers and managers of food processing industries. The best available tool for control and management of the price risk is the use of future markets and options. It is evident that the pricing is the main pillar in every trade. Therefore, offering a fair price for the options will be very important. In fact, options trading in the options market create cost insurance stopped. In this way, which can reduce the risks of deflation created in the future, if the person entitled to the benefits of the price increase occurs in the future. Unlike the futures, market where the seller had to deliver the product on time, in the options market, there is no such compulsion. In addition, this is one of the strengths of this option contract, because if there is not enough product for delivery to the futures market as result of chilling, in due course, the farmers suffer, but in the options market there will be a loss. In this study, the setup options of rape, as a product, as well as inputs has been paid for industry. Materials and Methods: In this section. The selection criteria of the disposal of asset base for valuation of European put options and call option is been introduced. That for obtain this purpose, some characteristics of the goods must considered: 1-Unpredictable fluctuations price of underlying asset 2 -large underlying asset cash market 3- The possibility

Effect of radiotherapy on immunity function of cancer patients receiving radiotherapy

International Nuclear Information System (INIS)

Li Xinli; Zhu Shentao; Xu Jiuhong

2003-01-01

Objective: In order to observe the effect of radiotherapy on immunity function of cancer patients receiving radiotherapy. Methods: Cellular immunity is determined by APAAP; Humoral immunity is determined by transmission method. Results: The items of cellular immunity is lower than the control after radiotherapy. These items decrease continually. The difference between before and after radiotherapy has statistic significance. Of all Humoral immunity items, IgA, IgM decreased after radiotherapy and the difference has statistic significance. Conclusions: Radiotherapy can damage patients' immunity function

Estimating option values of solar radiation management assuming that climate sensitivity is uncertain.

Science.gov (United States)

Arino, Yosuke; Akimoto, Keigo; Sano, Fuminori; Homma, Takashi; Oda, Junichiro; Tomoda, Toshimasa

2016-05-24

Although solar radiation management (SRM) might play a role as an emergency geoengineering measure, its potential risks remain uncertain, and hence there are ethical and governance issues in the face of SRM's actual deployment. By using an integrated assessment model, we first present one possible methodology for evaluating the value arising from retaining an SRM option given the uncertainty of climate sensitivity, and also examine sensitivities of the option value to SRM's side effects (damages). Reflecting the governance challenges on immediate SRM deployment, we assume scenarios in which SRM could only be deployed with a limited degree of cooling (0.5 °C) only after 2050, when climate sensitivity uncertainty is assumed to be resolved and only when the sensitivity is found to be high (T2x = 4 °C). We conduct a cost-effectiveness analysis with constraining temperature rise as the objective. The SRM option value is originated from its rapid cooling capability that would alleviate the mitigation requirement under climate sensitivity uncertainty and thereby reduce mitigation costs. According to our estimates, the option value during 1990-2049 for a +2.4 °C target (the lowest temperature target level for which there were feasible solutions in this model study) relative to preindustrial levels were in the range between $2.5 and $5.9 trillion, taking into account the maximum level of side effects shown in the existing literature. The result indicates that lower limits of the option values for temperature targets below +2.4 °C would be greater than $2.5 trillion.

Demographic profile, clinical presentation, management options in cranio-cerebral trauma

International Nuclear Information System (INIS)

Bhole, A.M.; Potode, R.; Joharapurkar, S.R.

2007-01-01

Head injury is a common condition that can result in either obvious neurological sequelae or imaging findings. The purpose of this study was to find out the epidemiology, clinical presentation and management options in patients with head injury at a rural centre of central India. In this retrospective study, data of all patients who attended the Department of Surgery, ABMH, Sawangi (Meghe), Wardha for cranio-cerebral trauma were included and a total of 200 patients were reviewed. Epidemiological and clinical details including investigations were noted for all the patients. Management offered to the patients was studied and outcome was analyzed. This study enrolled 200 patients. Male were more common than female. Young patients were commonly affected. Common presenting features were loss of consciousness and vomiting. Mild head injury was most common. Majority of patients were treated conservatively and indications for surgery were compound depressed fractures and significant intracranial haematomas. Cranio-cerebral injury patterns in developing countries particularly in rural area are no different from developed countries and knowledge of its causative factors, management and potential complications will help to plan active interventions that may improve outcome. It will also help in developing preventive measures. (author)

Evaluating radiotherapy patients' need for information: a study using a patient information booklet; Evaluation des besoins en information des patients suivis en radiotherapi: etude effectuee sur la base du livret de la radiotherapie

Energy Technology Data Exchange (ETDEWEB)

Bonnet, V.; Romestaing, P.; Gerard, J.P.; Mornex, F. [Centre Hospitalier Universitaire Lyon-Sud, Dept. d' Oncologie-Radiotherapie, 69 - Pierre-Benite (France); Couvreur, C. [Institut Gustave Roussy, Dept. d' Oncologie-Radiotherapie, 94 - Villejuif (France); Demachy, P. [Centre Hospitalier V. Dupouy, Centre de Radiologie et de Traitement des Tumeurs, 95 - Argenteuil (France); Kimmel, F. [Centre de Radiologie et de Traitement des Tumeurs, 92 - Meudon-la-Foret (France); Milan, H. [Centre Georges-Francois-Leclerc, 21 - Dijon (France); Noel, D. [Hopital Pitie-Salpetriere, Dept. d' Oncologie-Radiotherapie, 75 - Paris (France); Pace, M. [Hopital d' Annecy, Dept. d' Oncologie-Radiotherapie, 74 - Annecy (France); Raison, C. [Centre Catherine-de-Sienne, 44 - Nantes (France); Compagnon, C. [Ligue Nationale Contre le Cancer, 75 -Paris (France); Pigeon, P. [Isis Research, 69 - Lyon (France)

2000-08-01

The French Radiotherapy-Oncology Society (SFRO) and the National Trade of Radiotherapists-Oncologists (SNRO) elaborated and published a patient information booklet on radiotherapy, in 1999. This present study appraises the pertinence of the form and substance of this booklet one year after its release. Eight radiotherapy centers participated in this research which evaluated 162 patients at treatment initiation. The conclusions of this study demonstrated the importance of clearly informing patients of their disease, treatment, and the secondary effects of treatment. It is essential to emphasize that 97% of the patients declared that an information booklet is a real necessity, and that the one provided by the SFRO responds to the majority of their concerns. Obtaining technical and practical knowledge resulted in a reassurance about their treatment. The most revealing result is that 87% requested direct communication about their illness, and that cancer be named by this word and not other, evasive terms. Seventy-two percent of the patients requested more information about their cancer, different treatment options, and quality of life issues in an attempt to psychologically prepare themselves to face an illness for which they have little control. Patients refuse to be passive, and claim the right to become 'partners' of the medical teams, concerning their treatment and recovery. (authors)

Strategic options in using sterile insects for area-wide integrated pest management

International Nuclear Information System (INIS)

Hendrichs, J.; Vreysen, M.J.B.; Enkerlin, W.R.; Cayol, J.P.

2005-01-01

The four strategic options, 'suppression', 'eradication', 'containment' and 'prevention', in which the sterile insect technique (SIT) can be deployed as part of area-wide integrated pest management (AW-IPM) interventions, are defined and described in relation to the contexts in which they are applied against exotic or naturally occurring major insect pests. Advantages and disadvantages of these strategic options are analysed, and examples of successful programmes provided. Considerations of pest status, biology and distribution affecting decision-making in relation to strategy selection are reviewed and discussed in terms of feasibility assessment, and programme planning and implementation. Unrealistic expectations are often associated with applying the SIT, resulting in high political costs to change a strategy during implementation. The choice of strategy needs to be assessed carefully, and considerable baseline data obtained to prepare for the selected strategy, before embarking on an AW-IPM programme with an SIT component. (author)

Stereotactic radiosurgery versus whole-brain radiotherapy after intracranial metastasis resection : A systematic review and meta-analysis

NARCIS (Netherlands)

Lamba, Nayan; Muskens, Ivo S; DiRisio, Aislyn C; Meijer, Louise; Briceno, Vanessa; Edrees, Heba; Aslam, Bilal; Minhas, Sadia; Verhoeff, Joost J.C.; Kleynen, Catharina E.; Smith, Timothy R; Mekary, Rania A; Broekman, Marike L.

2017-01-01

Background: In patients with one to three brain metastases who undergo resection, options for post-operative treatments include whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) of the resection cavity. In this meta-analysis, we sought to compare the efficacy of each post-operative

Long-term issues associated with spent nuclear power fuel management options

International Nuclear Information System (INIS)

Jae-Sol, Lee; Kosaku, Fukuda; Burcl, R.; Bell, M.

2003-01-01

Spent fuel management is perceived as one of the crucial issues to be resolved for sustainable utilisation of nuclear power. In the last decades, spent fuel management policies have shown diverging tendencies among the nuclear power production countries - a group has adhered to reprocessing- recycle and another has turned to direct disposal, while the rest of the countries have not taken decision yet, often with ''wait and see'' position. Both the closed and open fuel cycle options for spent fuel management have been subject to a number of debates with pros and cons on various issues such as proliferation risk, environmental impact, etc. The anticipation for better technical solutions that would mitigate those issues has given rise to the renewal of interest in partitioning and transmutation of harmful nuclides to be disposed of, and in a broader context, the recent initiatives for development of innovative nuclear systems. The current trend toward globalization of market economy, which has already brought important impacts on nuclear industry, might have a stimulating effect on regional-international co-operations for cost-effective efforts to mitigate some of those long-term issues associated with spent fuel management. (author)

Default options and neonatal resuscitation decisions.

Science.gov (United States)

Haward, Marlyse Frieda; Murphy, Ryan O; Lorenz, John M

2012-12-01

To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed using χ(2) tests and multivariate logistic regression. Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, pmanipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy. Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making.

Palliative radiotherapy in developing countries

International Nuclear Information System (INIS)

Allen, B.J.

2010-01-01

Full text: The International Agency for Research on Cancer predicts that cancer incidence in developing countries will increase dramatically in the first two decades of this millennium. Already some 80% of cancer patients in developing countries present with incurable disease. [n many cases pain is a severe problem and palliation is needed to improve quality of life as well as extending survival. This paper will consider the physical and clinical aspects of palliative radiotherapy (PRT), choice of radiation modality, alternative approaches to imaging and therapy and cost-benefit considerations. The potential benefits of a dedicated palliative centre include lower cost and therefore more centres, enabling more patients access to regional palliative care. Whilst there is an obvious need for palliative radiotherapy, simple curative treatments could also be managed. C060 radiotherapy has important advantages in developing countries, because of the higher initial cost of a linear accelerator, as well as the need for reliable power supply and the level of skill required by linac technicians and physicists. The beam characteristics of both C060 units and low energy linacs are compared and both are found to be acceptable for palliation. The concept of telemedicine is also discussed, using mobile phones and internet communication to allow rural clinics to receive support from specialists based in the cities, to send images for remote diagnosis and remote dose planning for radiotherapy. (author)

Using leptospermum honey to manage wounds impaired by radiotherapy: a case series.

Science.gov (United States)

Robson, Val; Cooper, Rose

2009-01-01

Radiation-induced tissue injury and wounds with radiation-impaired healing are traumatic for patients and challenging for their caregivers. Standardized management approaches do not exist. The effect of Leptospermum honey as a primary dressing for managing these wounds was assessed in four patients (age range 63 to 93 years) who had previously undergone radiotherapy that left them with fragile friable areas of damaged skin that did not respond to conventional treatment. Compromised areas involved the neck, cheek, groin/perineum, and chest. In patients 1 and 2, after topical application of honey via hydrofiber rope and nonadhesive foam, respectively, improvements in the size and condition of wound/periwound area and a reduction in pain were noted before death or loss to follow-up. After including honey in the treatment regimen of patients 3 and 4, complete healing was noted in 2.5 weeks (with honey and paraffin) and 6 weeks (with honey-soaked hydrofiber rope), respectively. No adverse events were reported. Honey as an adjunct to conventional wound/skin care post radiation therapy shows promise for less painful healing in these chronic wounds. Prospective, randomized, controlled clinical studies are needed to confirm these observations.

Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma.

Science.gov (United States)

Gómez Sáez, José Manuel; Jiménez-Fonseca, Paula; Santamaría Sandi, Javier; Capdevila Castillón, Jaume; Navarro González, Elena; Zafón Llopis, Carles; Ramón Y Cajal Asensio, Teresa; Riesco Eizaguirre, Garcilaso; Grande Pulido, Enrique; Galofré Ferrater, Juan Carlos

2015-03-01

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumour known and is a rare but highly lethal form of thyroid cancer that requires a multidisciplinary team approach. No Spanish consensus exists for management of patients with ATC. The Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the GETHI (Grupo Español de Enfermedades Huérfanas e Infrecuentes) of the Spanish Society of Oncology, in agreement with the Boards of these Societies, commissioned an independent task force to develop a wide consensus on ATC. The relevant literature was reviewed, including serial PubMed searches supplemented with additional articles. The consensus includes the characteristics, diagnosis, initial evaluation, establishment of treatment goals, approaches to locoregional disease (surgery, radiotherapy, systemic therapy, supportive care during active treatment), approaches to advanced/metastatic disease, palliative care options, monitoring, and long-term follow-up of ATC. For operable disease, a combination of radical surgery with adjuvant radiotherapy or chemotherapy, using agents such as doxorubicin, cisplatin and paclitaxel, is the best treatment strategy. Cytotoxic drugs are poorly effective for advanced/metastatic ATC. On the other hand, targeted agents may represent a viable therapeutic option. Patients with stage IVA/IVB resectable disease have the best prognosis, particularly if a multimodal approach is used, and some stage IVB unresectable patients may respond to aggressive therapy. Patients with stage IVC disease should be considered for clinical trials or for hospice/palliative care depending on their preference. This is the first Spanish consensus for ATC, and provides recommendations for management of this extremely aggressive malignancy. Novel systemic therapies are being tested, and more effective combinations are needed to improve patient outcomes. Although more aggressive radiotherapy has reduced locoregional recurrence, mean

BRAF inhibitors and radiotherapy for melanoma brain metastases: potential advantages and disadvantages of combination therapy

Directory of Open Access Journals (Sweden)

Chowdhary M

2016-12-01

Full Text Available Mudit Chowdhary,1,2 Kirtesh R Patel,1 Hasan H Danish,1 David H Lawson,3 Mohammad K Khan1 1Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 2Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, 3Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA Abstract: Melanoma is an aggressive malignancy that frequently spreads to the brain, resulting in rapid deterioration in both quality and quantity of life. Historically, treatment options for melanoma brain metastases (MBM have predominantly consisted of surgery and radiotherapy. While these options can help provide local control, the majority of patients still develop intracranial progression. Indeed, novel therapeutic options, including molecularly targeted agents and immunotherapy, have improved outcomes and are now changing the role of radiotherapy. Up to 50% of melanomas contain an activating BRAF mutation, resulting in hyperactive cellular proliferation and survival. Drugs that target BRAF have been introduced for the treatment of metastatic melanoma and offer hope in improving disease outcomes; however, many of these trials either excluded or had a limited amount of patients with MBM. Recent studies have revealed that melanoma cell lines become more radiosensitive following BRAF inhibition, thus providing a potential synergistic mechanism when combining BRAF inhibitor (BRAFi and radiotherapy. However, neurotoxicity concerns also exist with this combination. This article reviews the efficacy and limitations of BRAFi therapy for MBM, describes current evidence for combining BRAFis with radiation, discusses the rationale and evidence for combination modalities, and highlights emerging clinical trials specifically investigating this combination in MBM. Keywords: brain metastases, melanoma, radiation, BRAF inhibitors, vemurafenib, dabrafenib

Tadalafil - a therapeutic option in the management of BPH-LUTS.

Science.gov (United States)

Carson, C C; Rosenberg, M; Kissel, J; Wong, D G

2014-01-01

Men with signs of benign prostatic hyperplasia (BPH) may experience lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, intermittence, nocturia, straining, incomplete emptying or a weak urinary stream. The effective management of LUTS suggestive of BPH (BPH-LUTS) requires careful consideration of several factors, including the severity of a patient's symptoms, concurrent or other coexisting medical conditions, the ability to improve symptoms and impact quality of life (QOL), as well as the potential side effects of available treatment options. Several clinical studies have assessed phosphodiesterase type 5 (PDE5) inhibitors in reducing LUTS; however, tadalafil is the only PDE5 inhibitor approved for the treatment of signs and symptoms of BPH, as well as in men with both erectile dysfunction (ED) and the signs and symptoms of BPH. This review examined articles that assessed tadalafil in patients with signs and symptoms of BPH, with or without erectile dysfunction (ED), which led to regulatory approval in the United States and Europe. In dose-ranging and confirmatory studies, results demonstrate that tadalafil significantly improved total International Prostate Symptom Score (IPSS) following 12 weeks of treatment with once daily tadalafil 5 mg. Statistically significant improvements in Benign Prostatic Hyperplasia Impact Index (BII), IPSS subscores, IPSS QOL and International Index of Erectile Function (IIEF) were also observed. Improvement in urinary symptoms occurred regardless of age, previous treatment with an α1 -adrenergic blocker, BPH-LUTS severity at baseline or ED status. While tadalafil is most frequently recognised as a standard treatment option for men with ED, it also represents a well-tolerated and effective treatment option in men with moderate to severe BPH-LUTS. © 2013 John Wiley & Sons Ltd.

Tracheostomy and radiotherapy in the management of laryngeal carcinoma causing airway obstruction

Energy Technology Data Exchange (ETDEWEB)

Dawes, P.J.D. [Sunderland District General Hospital (United Kingdom); Agrawal, R.K.; Dawes, P.J.D.K. [Newcastle General Hospital (United Kingdom); Williams, S. [Otago Univ., Dunedin (New Zealand)

1997-09-01

Between 1977 and 1985, 66 patients presenting with airway obstruction due to laryngeal squamous cell carcinoma were treated by tracheostomy and subsequent radiotherapy. Female survival (64% at 2 years and 35% at 5 years) was significantly better than male survival (19% at 2 years and 10% at 5 years). When four forms of management were compared, it appeared that 40 Gy in ten fractions over 21 days was associated with better survival. Because two of the treatment groups contained few patients, these were excluded from further analysis. When adjustments were made for sex, delay between tracheostomy and treatment, and residual disease, the difference in treatment response between those receiving 60+ Gy in 28-30 fractions over 42 days and those receiving 40 Gy in ten fractions over 21 days was not significant (hazard ratio 1.37; 95% CI 0.64-3.91). (author).

Tracheostomy and radiotherapy in the management of laryngeal carcinoma causing airway obstruction

International Nuclear Information System (INIS)

Dawes, P.J.D.; Agrawal, R.K.; Dawes, P.J.D.K.; Williams, S.

1997-01-01

Between 1977 and 1985, 66 patients presenting with airway obstruction due to laryngeal squamous cell carcinoma were treated by tracheostomy and subsequent radiotherapy. Female survival (64% at 2 years and 35% at 5 years) was significantly better than male survival (19% at 2 years and 10% at 5 years). When four forms of management were compared, it appeared that 40 Gy in ten fractions over 21 days was associated with better survival. Because two of the treatment groups contained few patients, these were excluded from further analysis. When adjustments were made for sex, delay between tracheostomy and treatment, and residual disease, the difference in treatment response between those receiving 60+ Gy in 28-30 fractions over 42 days and those receiving 40 Gy in ten fractions over 21 days was not significant (hazard ratio 1.37; 95% CI 0.64-3.91). (author)

National Option of China's Nuclear Energy Systems for Spent Fuel Management

Energy Technology Data Exchange (ETDEWEB)

Gao, R.X. [University of Science and Technology, Daejeon (Korea, Republic of); Ko, W. I.; Lee, S. H. [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2015-10-15

Along with safety concerns, these long standing environmental challenges are the major factors influencing the public acceptance of nuclear power. Although nuclear power plays an important role in reducing carbon emissions from energy generation, this could not fully prove it as a sustainable energy source unless we find a consensus approach to treat the nuclear wastes. There are currently no countries that have completed a whole nuclear fuel cycle, and the relative comparison of the reprocessing spent fuel options versus direct disposal option is always a controversial issue. Without exception, nowadays, China is implementing many R and D projects on spent fuel management to find a long-term solution for nuclear fuel cycle system transition, such as deep geological repositories for High Level Waste (HLW), Pu Reduction by Solvent Extraction (PUREX) technology, and fast reactor recycling Mixed U-Pu Oxide (MOX) fuels, etc. This paper integrates the current nation's projects of back-end fuel cycle, analyzes the consequences of potential successes, failures and delays in the project development to future nuclear fuel cycle transition up to 2100. We compared the dynamic results of four scenarios and then assessed relative impact on spent fuel management. The result revealed that the fuel cycle transition of reprocessing and recycling of spent fuel would bring advantages to overall nuclear systems by reducing high level waste inventory, saving natural uranium resources, and reducing plutonium management risk.

Knowledge, attitudes and behaviour regarding waste management options in Romania: results from a school questionnaire

Directory of Open Access Journals (Sweden)

Karin KOLBE

2014-12-01

The analysis revealed that knowledge is highly developed in Romania regarding the potential of recycling, while the concepts of waste management technologies are far less known about and understood. Landfill is seen as a problem for human health and the environment. However, recycling behaviour is low - partly as a result of limited possibilities. In general, the treatment hierarchy that is recommended in the "European waste hierarchy" is only partly reflected in students’ attitudes towards waste management options.

Role of palliative radiotherapy in brain metastases

Directory of Open Access Journals (Sweden)

Ramesh S Bilimagga

2009-01-01

Full Text Available Background: Brain metastases are a common manifestation of systemic cancer and exceed primary brain tumors in number and are a significant cause of neurologic problems. They affect 20-40% of all cancer patients. Aggressive management of brain metastases is effective in both symptom palliation and prolonging the life. Radiotherapy has a major role to play in the management of brain metastases. AIM: The aim of the study was to know the outcome of palliative radiotherapy in symptomatic brain metastases in terms of improvement in their performance status. Materials and Methods: This is a retrospective study of 63 patients diagnosed to have brain metastases and treated with palliative whole brain radiotherapy to a dose of 30 Gy in 10 fractions over two weeks between June 1998 and June 2007. Diagnosis was done in most of the cases with computed tomography scan and in a few with magnetic resonance imaging. Improvement in presenting symptoms has been assessed in terms of improvement in their performance status by using the ECOG scale. Results: Fifty-four patients completed the planned treatment. Eight patients received concurrent Temozolamide; 88% of patients had symptom relief at one month follow-up; 39/54 patients had a follow-up of just one to three months. Hence survival could not be assessed in this study. Conclusion: External beam radiotherapy in the dose of 30 Gy over two weeks achieved good palliation in terms improvement in their performance status in 88% of patients. Addition of concurrent and adjuvant Timozolamide may improve the results.

An investigation of anxiety about radiotherapy deploying the radiotherapy categorical anxiety scale

International Nuclear Information System (INIS)

Shimotsu, Sakie; Karasawa, Kumiko; Ito, Kana; Saito, Anneyuko I.; Izawa, Hiromi; Kawase, Eri; Horikawa, Naoshi

2010-01-01

Radiotherapy is one of the major methods for treating cancer, but many patients undergoing radiotherapy have deep concerns about receiving radiation treatment. This problem is not generally appreciated and has not been adequately studied. The objective of this investigation was to empirically investigate the anxieties that cancer patients feel towards radiotherapy by using questionnaires to classify and quantitatively measure their concerns. A preliminary interview to develop a questionnaire was carried out with 48 patients receiving radiotherapy to discover their anxieties about on-going treatments. Subsequently, a main study was performed using a questionnaire with 185 patients to classify their types of anxiety and to ascertain the reliability and validity of the responses. Confirmatory factor analysis was then carried out with a 17-item Radiotherapy Categorical Anxiety Scale. Three anxiety factors were abstracted by factor analysis: adverse effects of radiotherapy, environment of radiotherapy, and treatment effects of radiotherapy. Reliability, content validity, and concurrent validity were obtained. The adequacy of the three-factor model of anxiety concerning radiotherapy was confirmed. A 17-item Radiotherapy Categorical Anxiety Scale was formulated to quantitatively measure the specific types of anxiety among cancer patients receiving radiotherapy. (author)

Radiotherapy of Graves' ophthalmopathy. State of the art and review of the literature; Radiotherapie der endokrinen Orbitopathie. State of the Art und Literaturuebersicht

Energy Technology Data Exchange (ETDEWEB)

Eich, H.T. [Klinikum der Univ. Koeln (Germany). Klinik und Poliklinik fuer Strahlentherapie; Micke, O. [Franziskus-Hospital Bielefeld (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Seegenschmiedt, M.H. [Alfried-Krupp Krankenhaus Essen (Germany). Klinik fuer Radioonkologie und Strahlentherapie

2007-07-01

Graves' ophthalmopathy (GO), the most frequent extrathyroidal manifestation of Graves' disease, is a disorder of autoimmune origin, the pathogenic mechanisms of which are still incompletely understood. Although GO is severe in only 3-5% of affected individuals, quality of life is severely impaired even in patients with mild GO. The role of radiotherapy in the management of GO is discussed controversially. However, recent randomized clinical trials have, with one exception, confirmed that orbital radiotherapy is an effective and safe therapeutic procedure for GO. This article describes the sequences, dosages and fractionation schemes as well as the risks and side effects of the radiotherapy. (orig.)

Analysis of radwaste material management options for experimental DUPIC fuel fabrication process

Energy Technology Data Exchange (ETDEWEB)

Lee, H. H.; Park, J. J.; Yang, M. S.; Kim, K. H.; Shin, J. M.; Lee, H. S.; Ko, W. I.; Lee, J. W.; Yim, S. P.; Hong, D. H.; Lee, J. Y.; Baik, S. Y.; Song, W. S.; Yoo, B. O.; Lee, E. P.; Kang, I. S. [Korea Atomic Energy Research Institute, Taejeon (Korea)

2000-03-01

This report is desirable to review management options in advance for radioactive waste generated from manufacturing experiment of DUPIC nuclear fuel as well as residual nuclear material and dismantled equipment. This report was written for helping researchers working in related facilities to DUPIC project understanding management of DUPIC radioactive waste as well as fellows in DUPIC project. Also, it will be used as basic material to prove transparency and safeguardability of DUPIC fuel cycle. In order to meet these purposes, this report includes basic experiment plan for manufacturing DUPIC nuclear fuel, outlines for DUPIC manufacturing facility and equipment, arising source and estimated amount of radioactive waste, waste classification and packing, transport cask, transport procedures. 15 refs., 31 figs., 11 tabs. (Author)

Management Of Carcinoma Of The Bronchus By Radiotherapy In ...

African Journals Online (AJOL)

Tissue biopsy and cytology and chest radiograph accounted for 63.2% of the methods of diagnosis while the rest was based on clinical impression and chest radiograph. All cases were advanced and therefore inoperable on presentation but 89% had good symptomatic control following radiotherapy. Less than 7% were ...

Feasibility of an interactive ICT-platform for early assessment and management of patient-reported symptoms during radiotherapy for prostate cancer.

Science.gov (United States)

Sundberg, Kay; Eklöf, Ann Langius; Blomberg, Karin; Isaksson, Ann-Kristin; Wengström, Yvonne

2015-10-01

The aim of this study was to test the feasibility and acceptability of an Information and Communication Technology platform for assessing and managing patient reported symptoms during radiotherapy for prostate cancer. In cooperation with a health management company, using a patient experience co-design, we developed the platform operated by an interactive application for reporting and managing symptoms in real time. Nine patients diagnosed with prostate cancer and receiving radiotherapy were recruited from two university hospitals in Sweden. Evidence-based symptoms and related self-care advice specific to prostate cancer were implemented in the application based on a literature review and interviews with patients and health care professionals. In the test of the platform the patients reported symptoms, via a mobile phone, daily for two weeks and were afterwards interviewed about their experiences. Overall, the patients found the symptom questionnaire and the self-care advice relevant and the application user friendly. The alert system was activated on several occasions when the symptoms were severe leading to a nurse contact and support so the patients felt safe and well cared for. The platform enabled increased patient involvement and facilitated symptom assessment and communication between the patient and the health care provider. The study's results support further development of the platform, as well as tests in full-scale studies and in other populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical practice guidelines: 2004 standards, options and recommendations for the management of patient with adenocarcinoma of the stomach - radiotherapy

International Nuclear Information System (INIS)

Ychou, M.; Duffour, J.; Lemanski, C.; Masson, B.; Gory-Delabaere, G.; Bosquet, L.; Blanc, P.; Giovannini, M.; Monge, G.; Guillemin, F.; Marchal, F.; Conroy, T.; Merrouche, Y.; Adenis, A.; Bosset, J.F.; Bouche, O.; Pezet, D.; Triboulet, J.P.

2004-01-01

Context. - The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French regional cancer centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. Objectives. - To elaborate clinical practice guidelines for patients with stomach adenocarcinoma. These recommendations cover the diagnosis, treatment and follow-up of these tumors. Methods. - The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. The Standards, Options and Recommendations are thus based on the best available evidence and expert agreement. Results. - Adjuvant radiation therapy alone is not a standard treatment for patients with stomach adenocarcinoma. Adjuvant concomitant chemoradiotherapy is not a standard treatment for patients with stage II or III stomach adenocarcinoma R0, with D1 or D2 lymphadenectomy who have undergone surgery. Following surgical resection, adjuvant concomitant chemoradiotherapy should be proposed to patients without de-nutrition with a lymphadenectomy < D1 (fewer than 15 lymph nodes examined) and those with T3 and/or N+ tumours following the protocol used in the MacDonald trials (SWOG-9008) (Level of evidence B1). Adjuvant concomitant chemoradiotherapy can be administered to patients without de-nutrition with D1 or D2 lymphadenectomy and with involvement of regional lymph nodes (N2 or N3). (authors)

SU-F-T-251: The Quality Assurance for the Heavy Patient Load Department in the Developing Country: The Primary Experience of An Entire Workflow QA Process Management in Radiotherapy

International Nuclear Information System (INIS)

Xie, J; Wang, J; Peng, J; Chen, J; Hu, W

2016-01-01

Purpose: To implement an entire workflow quality assurance (QA) process in the radiotherapy department and to reduce the error rates of radiotherapy based on the entire workflow management in the developing country. Methods: The entire workflow QA process management starts from patient registration to the end of last treatment including all steps through the entire radiotherapy process. Error rate of chartcheck is used to evaluate the the entire workflow QA process. Two to three qualified senior medical physicists checked the documents before the first treatment fraction of every patient. Random check of the treatment history during treatment was also performed. A total of around 6000 patients treatment data before and after implementing the entire workflow QA process were compared from May, 2014 to December, 2015. Results: A systemic checklist was established. It mainly includes patient’s registration, treatment plan QA, information exporting to OIS(Oncology Information System), documents of treatment QAand QA of the treatment history. The error rate derived from the chart check decreases from 1.7% to 0.9% after our the entire workflow QA process. All checked errors before the first treatment fraction were corrected as soon as oncologist re-confirmed them and reinforce staff training was accordingly followed to prevent those errors. Conclusion: The entire workflow QA process improved the safety, quality of radiotherapy in our department and we consider that our QA experience can be applicable for the heavily-loaded radiotherapy departments in developing country.

SU-F-T-251: The Quality Assurance for the Heavy Patient Load Department in the Developing Country: The Primary Experience of An Entire Workflow QA Process Management in Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Xie, J; Wang, J; Peng, J; Chen, J; Hu, W [Fudan University Shanghai Cancer Center, Shanghai, Shanghai (China)

2016-06-15

Purpose: To implement an entire workflow quality assurance (QA) process in the radiotherapy department and to reduce the error rates of radiotherapy based on the entire workflow management in the developing country. Methods: The entire workflow QA process management starts from patient registration to the end of last treatment including all steps through the entire radiotherapy process. Error rate of chartcheck is used to evaluate the the entire workflow QA process. Two to three qualified senior medical physicists checked the documents before the first treatment fraction of every patient. Random check of the treatment history during treatment was also performed. A total of around 6000 patients treatment data before and after implementing the entire workflow QA process were compared from May, 2014 to December, 2015. Results: A systemic checklist was established. It mainly includes patient’s registration, treatment plan QA, information exporting to OIS(Oncology Information System), documents of treatment QAand QA of the treatment history. The error rate derived from the chart check decreases from 1.7% to 0.9% after our the entire workflow QA process. All checked errors before the first treatment fraction were corrected as soon as oncologist re-confirmed them and reinforce staff training was accordingly followed to prevent those errors. Conclusion: The entire workflow QA process improved the safety, quality of radiotherapy in our department and we consider that our QA experience can be applicable for the heavily-loaded radiotherapy departments in developing country.

Radiotherapy of bronchogenic carcinoma

International Nuclear Information System (INIS)

Heilmann, H.P.

1982-01-01

Radiotherapy of branchogenic carcinoma comprises; palliative treatment, postoperative or pre-operative radiotherapy, radiotherapy as part of a combination of chemotherapy and radiotherapy of small cell carcinoma and curative radiotherapy of non-operable non-small cell carcinoma. Atelectasis and obstruction are indications for palliative radiotherapy. Postoperative radiotherapy is given only in cases of incomplete resection or mediastinal metastases. In the treatment of small cell carcinoma by combined irradiation and chemotherapy the mediastinum and primary tumour are irradiated, generally after chemotherapy, and the C.N.S. receives prophylactic radiotherapy. Curative radiotherapy is indicated in cases of non-operable small cell carcinoma. Irradiation with doses of 60-70 Gy produced 5-years-survival rates of 10-14% in cases classified as T 1 -T 2 N 0 M 0 . (orig.) [de

Sustainability as a challenge to radiotherapy in Nigeria

International Nuclear Information System (INIS)

Elegba, S.B.

2005-01-01

In Nigeria there are 5 radiotherapy centres for a population of 140 million, i.e. 1 machine to 28 million. About 100,000 new cases are diagnosed/yr. The cancer register was not updated since 1999, the services are poor and serve poor patients. Affluent patients seek treatment abroad. The legislative and regulatory infrastructure comprise the Medical and Dental Practitioners Act Cap 2221 of 1990 amended by Decree 78 of 1992, the Radiographers Registration Board of Nigeria Decree 1987, the Nuclear Safety and Radiation Protection Act 1995, the Nigerian Nuclear Regulatory Authority 2001, the Nigerian Basic Ionising Radiation Regulations 2003 and the Guidance on Radiation Protection. Audit report of radiotherapy practice revealed inadequate number of oncologists, medical physicist and radiographers as well as inadequate level of competence but high patient-to-expert ratio in radiotherapy. The equipment and machines are obsolete, second hand, without manuals or parts, poorly maintained, unaccredited maintenance group and lack of accessories as against spare parts. Concerning premises there is little or no shielding materials, re-configuration without drawings and lack of records. There is no operational manual, radiation protection programme, quality assurance manual and radiological emergency plan. There is no structured communication channel between management and the operating unit, no programme for equipment maintenance and replacement, no financial plan budget for the operation and maintenance of the facilities, no commitment from management to radiation protection and safety and inadequate communication between management and facility owners. Sustainability means meeting the needs of the present generation without compromising the needs of future generations. The triple bottom line is economic, social and environmental sustainability. There will be a National Policy of Integrating Radiotherapy into the National Cancer Control Programme in 2005 and the International

Radiotherapy for Locoregional Recurrent Cervix Cancer after Surgery

International Nuclear Information System (INIS)

Yang, Mi Gyoung

1994-01-01

Purpose: The role of radiotherapy in the management of patients with locoregional recurrent cervix cancer after radical surgery were retrospectively analyzed. Methods and materials: Twenty-eight patients treated with radiotherapy for locoregional recurrence after primary surgery for carcinoma of the cervix between 1989 and 1993 were analyzed. The median follow-up of survivors was 15 months (ranged 7-43 months). Eight patients had their disease confined to the vagina and 19 patients(68%) had pelvic mass as part of their locoregional recurrent disease. Within 24 months after the initial surgery, 82% of recurrences manifested themselves. All patients had whole pelvic irradiation with or without intracavitary radiotherapy(ICR). Results: Complete response(CR) was achieved in 18 patients(64%). Five of eighteen patients(28%) with initial CR developed second locoregional recurrence. Response to radiotherapy correlated strongly with tumor volume, site of recurrence and total radiation dose. The overall 2 year survival rate was 43% and the disease free survival was 31%. Survival rate was significantly influenced by the factors of interval from operation to recurrence, size and site of recurrent tumor, radiation dose, response of radiotherapy, lymph node status as initial presentation. The principal cause of death was lung metastasis(36%). Conclusion: Radiotherapy is an excellent modality for control of locoregional recurrent cervix cancer. To improve local control and survival rate, whole pelvic external radiotherapy in addition to ICR with more than 75.0Gy at the depth of 1.0cm from vaginal mucosa is needed and frequent follow up and early detection of recurrence is suggested as well

Radiotherapy physics

International Nuclear Information System (INIS)

Chen, G.T.Y.; Collier, J.M.; Lyman, J.T.; Pitluck, S.

1982-01-01

The Radiotherapy Physics Group works on the physical and biophysical aspects of charged particle radiotherapy. Our activities include the development of isosurvival beams (beams of uniform biological effect), computerized treatment planning development for charged particle radiotherapy, design of compensation to shape dose distributions, and development of dosimetry techniques to verify planned irradiations in both phantoms and patients

Supportive care for head and neck cancer patients receiving radiotherapy

International Nuclear Information System (INIS)

Zenda, Sadamoto

2015-01-01

Recently (chemo-)radiotherapy has been widely used in head and neck cancer with definite evidence. As long survivor has increased, social problems associated with late toxicity have become more. Late toxicities induced by radiotherapy for head and neck lesion are often severe. Xerostomia is one of the severe late toxicities conventionally and dysphagia after chemoradiotherapy is a new topic. Some industrial development (ex. Intensity Modulated Radiotherapy: IMRT) play a great role in toxicity management. Multidisciplinary approach (cooperation between not only physicians but also nurses and dentists) is necessary to control toxicities. The research of supportive care will be needed same as definitive treatment in the future. (author)

The Management of Keloids by Radiotherapy in Nigeria | Ketiku ...

African Journals Online (AJOL)

A new method of treatment of keloid was compared with an old technique in five hundred and twenty eight Nigerian patients with 617 keloid lesions seen at the Department of Radiation Biology and Radiotherapy, Lagos University Teaching Hospital, between 1969 and 1981. The etiological factors were identified. A total of ...

An Evaluation of Feral Cat Management Options Using a Decision Analysis Network

Directory of Open Access Journals (Sweden)

Kerrie Anne T. Loyd

2010-12-01

Full Text Available The feral domestic cat (Felis catus is a predatory invasive species with documented negative effects on native wildlife. The issue of appropriate and acceptable feral cat management is a matter of contentious debate in cities and states across the United States due to concerns for wildlife conservation, cat welfare, and public health. Common management strategies include: Trap-Neuter-Release, Trap-Neuter-Release with removal of kittens for adoption and Trap-Euthanize. Very little empirical evidence exists relevant to the efficacy of alternative options and a model-based approach is needed to predict population response and extend calculations to impact on wildlife. We have created a structured decision support model representing multiple stakeholder groups to facilitate the coordinated management of feral cats. We used a probabilistic graphical model (a Bayesian Belief Network to evaluate and rank alternative management decisions according to efficacy, societal preferences, and cost. Our model predicts that Trap-Neuter-Release strategies would be optimal management decisions for small local populations of less than fifty cats while Trap-Euthanize would be the optimal management decision for populations greater than 50 cats. Removal is predicted to reduce feral cat populations quickly and prevent cats from taking a large number of wildlife prey.

Survey on changes of breast cancer radiotherapy in four hospitals within southeast coastal region of China

International Nuclear Information System (INIS)

Ji Yongling; Liu Jingjie; Tian Ye; Li Xianming; Zhu Yaqun; Yu De; Du Xianghui

2010-01-01

Objective: to explore the changes and the tendency of breast cancer radiotherapy in China within the past decade. Methods: A survey on breast cancer radiotherapy in 1999 and 2006 was conducted in 4 hospitals located within the southeast coastal region of China, including patients' clinical characteristics, the purpose of radiotherapy and its techniques. Results: The percentage of breast conservative treatment (BCT) increased from 3% in 1999 to 13% in 2006. For radiotherapy techniques in 2066 compared with 1999, the growth trend was found in use of breast immobilization devices (80% vs. 46%), treatment planning system (70% vs. 23%), and CT simulation (14% vs. 0). The frequency was increased in the chest wall irradiation after mastectomy (90% vs. 67%), but decreased in internal mammary region (30% vs. 76%) and axilla (37% vs. 69%) treatment. There were no differences in total dose and fractionation prescription. Conclusions: BCT was performed more frequently, but post-mastectomy radiotherapy was still essential option in China at present. Although some advanced techniques were applied frequently in clinical practice. Simulation, treatment planning, and irradiation target design were urgent for improvement and standardization. (authors)

Management of anemia in patients undergoing curative radiotherapy. Erythropoietin, transfusions, or better nothing?

International Nuclear Information System (INIS)

Dunst, J.

2004-01-01

Background and results: anemia is a well-known risk factor for decreased local control and survival in patients undergoing curative radiotherapy. There is clear evidence from recent clinical investigations that anemia is an independent risk factor and hemoglobin (Hb) levels during radiotherapy are important (and not pretreatment Hb levels). The most likely explanation for the prognostic impact is the association with tumor hypoxia. An ''optimal'' Hb range with regard to tumor oxygenation seems to exist, and Hb levels ∝15 g/dl impair tumor oxygenation but have (over a broader range) no significant impact on normal tissue oxygenation. There is some evidence from retrospective and prospective studies that the response to radiotherapy and the prognosis, especially in cervical cancers, might be improved if the Hb levels during radiotherapy can be maintained in the optimal range, either by transfusions or by erythropoietin. The effect of any antianemic therapy should be analyzed according to whether or not treatment was successful with regard to achieving optimal Hb levels during irradiation. Erythropoietin is probably more effective in steadily increasing and stabilizing Hb levels, but bears the risk of overcorrection of Hb levels. The clinical relevance of erythropoietin receptors on tumor cells remains questionable. Conclusions: treatment of anemia with the objective of improving local control and survival in radiotherapy patients is probably more difficult and sophisticated than coping with symptoms of anemia or improving quality of life. Nevertheless, the potential of antianemic treatment is high on the basis of experimental and clinical data, and further clinical trials are warranted. (orig.)

Security option file - Exploitation (DOS-Expl)

International Nuclear Information System (INIS)

2016-01-01

This document aims at presenting functions performed by Cigeo during its exploitation phase, its main technical and security options which are envisaged with respect to different types of internal or external risks, and a first assessment of its impact on mankind and on the environment during its exploitation in normal operation as well as in incidental or accidental situations. A first volume addresses security principles, approach and management in relationship with the legal and regulatory framework. The second volume presents input data related to waste parcels and used for the installation sizing and operation, the main site characteristics, the main technical options regarding structures and equipment, and the main options regarding exploitation (parcel management, organisational and human aspects, and effluent management). The third volume describes how parcel are processed from their arrival to their setting in storage compartment, an inventory of internal and external risks, and a first assessment of consequences of scenarios on mankind and on the environment. The fourth volume presents options and operations which are envisaged regarding Cigeo closure, and inventory of associated risks

Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180.

Science.gov (United States)

Ding, George X; Alaei, Parham; Curran, Bruce; Flynn, Ryan; Gossman, Michael; Mackie, T Rock; Miften, Moyed; Morin, Richard; Xu, X George; Zhu, Timothy C

2018-05-01

With radiotherapy having entered the era of image guidance, or image-guided radiation therapy (IGRT), imaging procedures are routinely performed for patient positioning and target localization. The imaging dose delivered may result in excessive dose to sensitive organs and potentially increase the chance of secondary cancers and, therefore, needs to be managed. This task group was charged with: a) providing an overview on imaging dose, including megavoltage electronic portal imaging (MV EPI), kilovoltage digital radiography (kV DR), Tomotherapy MV-CT, megavoltage cone-beam CT (MV-CBCT) and kilovoltage cone-beam CT (kV-CBCT), and b) providing general guidelines for commissioning dose calculation methods and managing imaging dose to patients. We briefly review the dose to radiotherapy (RT) patients resulting from different image guidance procedures and list typical organ doses resulting from MV and kV image acquisition procedures. We provide recommendations for managing the imaging dose, including different methods for its calculation, and techniques for reducing it. The recommended threshold beyond which imaging dose should be considered in the treatment planning process is 5% of the therapeutic target dose. Although the imaging dose resulting from current kV acquisition procedures is generally below this threshold, the ALARA principle should always be applied in practice. Medical physicists should make radiation oncologists aware of the imaging doses delivered to patients under their care. Balancing ALARA with the requirement for effective target localization requires that imaging dose be managed based on the consideration of weighing risks and benefits to the patient. © 2018 American Association of Physicists in Medicine.

[Radiotherapy for head and neck squamous cell carcinoma: State of the art and future directions].

Science.gov (United States)

Schick, U; Huguet, F; Pointreau, Y; Pradier, O

2017-10-01

Therapeutic principles of radiation therapy in head and neck carcinomas will be discussed in this review. Intensity-modulated radiotherapy with concomitant cisplatin should be standard. In case of contraindication to chemotherapy, cetuximab is an option, while hyperfractionation should be considered in patients unfit for concomitant treatment. Concomitant chemotherapy should be administered in the presence of extracapsular extensions and positive margins in the postoperative setting. Current research areas such as desescalation in human papillomavirus-positive tumours, adaptive radiotherapy, radiomics and immunotherapy will also be addressed. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

Radiotherapy of chondrosarcoma of bone

International Nuclear Information System (INIS)

Harwood, A.R.; Krajbich, J.I.; Fornasier, V.L.

1980-01-01

A retrospective analysis of 31 cases of chondrosarcoma of bone treated by radiotherapy is presented. In comparison with other large series, our group of patients were found to have been unfavourably selected with respect to the known prognostic factors: histology site, adequacy of operative treatment, and presenting symptoms. Twelve patients with primary chondrosarcoma were radically irradiated; 6 of these 12 have been alive and well without tumor for periods ranging from three and a half to 16 years and 3 of these are alive and well for 15 years or more following radiotherapy. The other 6 patients responded or desease stabilized following radiotherapy for periods ranging from 16 months to eight years. One poorly differentiated tumor was radically irradiated and did not respond. Eleven patients were irradiated palliatively, generally with low doses of irradiation, and only 4 responded transiently for periods ranging from three to 12 months. Seven patients with mesenchymal and dedifferentiated tumors were radically irradiated. Four responded or disease stabilized, and 1 of these patients was alive and well at 3 years; 3 did not respond. Six died with distant metastasis. It is concluded that chondrosarcoma of bone is a radioresponsive tumor and the place of radiotherapy in the treatment of this disease and the reason for its being labelled a radioresistant tumor are discussed. The problems of assessing response of chondrosarcoma to therapy are also discussed. It is suggested that chemotherapy may have a role in the management of mesenchymal and dedifferentiated chondrosarcoma

Non-deposit system option for waste management on small islands.

Science.gov (United States)

Vilms, Monica; Voronova, Viktoria

2016-08-01

This paper analyses waste management on small islands (on a global scale these are micro-islands). In the context of the paper, small islands are islands that have an area less than 50 km(2) The study presents an overview of the problems connected with waste transport from islands to the mainland. Waste generation on islands is very much related to tourists. If tourists do not handle waste properly, it will cause problems. Four small Estonian islands in the range of 3-19 km(2) are studied in detail. For these and other small islands, the main problem is the waste produced by tourists, or related to tourists and waste transport to the mainland. Currently, the local municipality has to arrange and finance waste transport. In fact, and based on the polluter-pays principle, the tourists should bear the cost of waste management. There are different tax options available in order to collect the money from tourists - waste tax, harbour tax, tourist tax, donations, environmental tax and others. The study results revealed that the best possible solution for Estonian islands may be a non-deposit system - including an additional charge on ferry ticket prices. The extra money should cover the costs of waste management and waste shipping. The tourists arriving in their own boats should pay a harbour tax, which includes a waste tax to compensate for the cost of waste management. © The Author(s) 2016.

Patient Radiation Protection in Radiotherapy

International Nuclear Information System (INIS)

Hegazy, M.

2010-01-01

The Role of Radiotherapy is treatment modalities for cancer which is generally assumed that 50 to 60% of cancer patients will benefit from radiotherapy. It constitutes a peaceful application of ionizing radiation and an essential part of cancer management. The two aims of radiation protection Prevention is of deterministic effect and Reduction of the probability of stochastic effects. The Shielding fundamentals is to limit radiation exposure of staff, patients, visitors and the public to acceptable levels it also optimize protection of patients, staff and the public. Diagnosis is important for target design and the dose required for cure or palliation while Simulator is often used twice in the radiotherapy process where Patient data acquisition - target localization, contours, outlines and Verification. The Prescription is the responsibility of individual clinicians, depending on the patient’s condition, equipment available, experience and training. An ultimate check of the actual treatment given can only be made by using in vivo dosimetry. Treatment records must be kept of all relevant aspects of the treatment – including Session and Summary Record information, Records all treatment parameters, Dose Calculations and Dose Measurements

The future demand for and structural problems of Japanese Radiotherapy

International Nuclear Information System (INIS)

Imai, Atsushi; Inoue, Toshihiko; Teshima, Teruki; Ohno, Yuko; Yamashita, Takashi; Mitsuhashi, Norio; Hiraoka, Masahiro; Sumi, Minako

2001-01-01

Recently, as the number of elderly people in Japan is growing, so is the number of new cancer cases. The number of patients treated with radiotherapy is therefore also on the increase, so that it is important to estimate the future demand for radiotherapy and to make preparations for it. All the surveys were conducted for 106 facilities selected randomly out of 556 radiotherapy facilities in Japan. To obtain trends in the number of new cancer patients treated with radiotherapy in Japan, we conducted a survey with a self-administered mail questionnaire designed to obtain the number of new patients treated with radiotherapy for each year of the past decade (1990-99). The future number of new patients treated with radiotherapy was estimated from the data thus obtained. To investigate structural problems of Japanese radiotherapy, surveys about the number of treatment machines and full-time equivalent (FTE) radiation oncologists were conducted according to data from the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) structure survey and the Patterns of Care Study (PCS). We also compared the structure of Japanese radiotherapy with that in the USA. The number of patients treated with radiotherapy has increased for every institutional stratum, with an overall increase of 1.4-fold over the past 10 years in Japan. It is estimated that the number of cancer patients treated with radiotherapy will reach 190000 in 2015. In Japanese non-academic institutions, less than one FTE radiation oncologist has been managing many of these patients. In both equipment and manpower, academic institutions exceed non-academic institutions. The future demand for Japanese radiotherapy will grow substantially, so that it is of vital importance to prepare for it. Specifically, the number of FTE radiation oncologists must be increased. (author)

Radiotherapy

International Nuclear Information System (INIS)

Zedgenidze, G.A.; Kulikov, V.A.; Mardynskij, Yu.S.

1984-01-01

The technique for roentgenotopometric and medicamentous preparation of patients for radiotherapy has been reported in detail. The features of planning and performing of remote, intracavitary and combined therapy in urinary bladder cancer are considered. The more effective methods of radiotherapy have been proposed taking into account own experience as well as literature data. The comparative evaluation of treatment results and prognosis are given. Radiation pathomorphism of tumors and tissues of urinary bladder is considered in detail. The problems of diagnosis, prophylaxis and treatment of complications following radiodiagnosis and radiotherapy in patients with urinary bladder cancer are illustrated widely

Olfactory neural tumours - the role of external beam radiotherapy

International Nuclear Information System (INIS)

Slevin, N.J.; Irwin, C.J.R.; Banerjee, S.S.; Path, F.R.C.; Gupta, N.K.; Farrington, W.T.

1996-01-01

Olfactory neuroblastoma is an uncommon tumour arising in the nasal cavity or paranasal sinuses. We report the management of nine cases treated with external beam radiotherapy subsequent to surgery, either attempted definitive removal or biopsy only. Recent refinements in pathological evaluation of these tumours are discussed. Seven cases were deemed classical olfactory neuroblastoma whilst two were classified as neuroendocrine carcinoma. The clinical features, radiotherapy technique and variable natural history are presented. Seven of eight patients treated radically were controlled locally, with a minimum follow-up of two years. Three patients developed cervical lymph node disease and three patients died of systemic metastatic disease. Suggestions are made as to which patients should have en-bloc resection rather than definitive radiotherapy. (author)

Retrospective study on therapy options of brain metastases: surgery versus stereotactic radiotherapy with the linear accelerator

International Nuclear Information System (INIS)

Fortunati, M.K.S.

2001-04-01

Background: in the therapy of brain metastases there has been a great progress in the last years. It was shown, that more aggressive therapies can not only extend the survival of the patients, but also improve quality of life. The major question of this study was, whether surgery or stereotactic radiotherapy with the linear accelerator show better results in behalf of the survival. Beside this major question many parameters regarding the patient or his primary cancer were examined. Methods: from the 1st of January 1995 until the 30th of June 2000 233 patients with one or more brain metastases have been treated in the Wagner Jauregg Landesnervenkrankenhaus Oberoesterreich (WJ LNKH OeO). The LINAC has been established on the 1st of July 1997. The patients have been distributed in three groups: 1. LINAC-group: 81 patients have been treated from the 1st of July 1997 until the 30th of June 2000 with the LINAC. 2. Surgery-group: 81 patients have been operated from the 1st of July 1997 until the 30th June 2000. 3 Control-group: 71 patients have been operated from the 1st of January 1995 until the 30th of June 1997, before the LINAC has been established on the 1st of July 1997. Results: There are shown the mean survival times. Therapy options (0,05): LINAC-group: 377 days. Surgery-group: 195 days. Control-group: 285 days. Primary cancer (0,05): unknown primary: 203 days. Cancer of the colon tract: 218 days. Breast cancer: 314 days. Melanoma: 162 days. Kidney: 466 days. Lung 261 days. Others: 439 days. Metastases in one/in both hemispheres (0,05): in one hemisphere 310 days, in both 184 days. All the other parameters (age, sex, Karnofsky-Index, period between diagnose of the primary and the brain metastases, primary cancer therapy, extra cerebral metastases, number of metastases, localization of metastases supra- or infratentoriell, dose/effect relationship in the LINAC-group, whole brain radiotherapy) showed interesting differences, but the results were not statistically

Pelvic haemophilic pseudotumour: management of a patient with high level of inhibitors

International Nuclear Information System (INIS)

Keller, A.; Terrier, F.; Schneider, P.A.; Bianchi, S.; Howarth, N.; De Moerloose, P.

2002-01-01

Haemophilic pseudotumour (HP) is a rare but very serious complication of haemophilia. HP affects mainly patients with severe haemophilia and those who have developed antibodies to factor VIII or factor IX. We report on a 45-year-old man with haemophilia A and high titres of inhibitors who developed an extensive HP with progressive destruction of the right ilium over a period of 12 years. The different therapeutic options (conservative management by replacement therapy, surgical approach, radiotherapy, percutaneous evacuation with secondary refilled cavity and transcatheter arterial embolization) are reviewed. (orig.)

Volume reduction options for the management of low-level radioactive wastes

International Nuclear Information System (INIS)

Clark, D.E.; Lerch, R.E.

1979-01-01

Volume reduction options that are now or soon will be available for low-level wastes are examined. These wastes generally are in the form of combustible solids, noncombustible solids, and wet wastes (solid/liquid). Initially, the wastes are collected and stored onsite. Preconditioning may be required, e.g., sorting, shredding, and classifying the solids into combustible and noncombustible fractions. The volume of combustible solids can be reduced by compaction, incineration/pyrolysis, acid digestion, or molten salt combustion. Options for reducing the volume of noncombustible solids include compaction, size reduction and decontamination, meltdown-casting, dissolution and electropolishing. Burnable wet wastes (e.g., organic wastes) can be evaporated or combusted; nonburnable wet wastes can be treated by various evaporative or nonevaporative processes. All radioactive waste processing operations result in some equipment contamination and the production of additional radioactively contaminated wastes (secondary wastes). The additional waste quantities must be considered in evaluating performance and overall volume reduction factors for the various systems. In the selection of an optimum waste management plan for a given facility, other important factors (e.g., relative stability of the waste product form) should be considered along with the savings accrued due to volume reduction

Radiotherapy for pituitary adenomas: an endocrinologist`s perspective

Energy Technology Data Exchange (ETDEWEB)

O`Halloran, D.J.; Shalet, S.M. [Christie Hospital and Holt Radium Inst., Manchester (United Kingdom)

1996-10-01

A brief review is given of the clinical management of patients with pituitary adenomas such as prolactinomas, adenomasin acromegoly and Leushin`s disease, and non-functioning pituitary adenomas. In particular the complications of radiotherapy are explored. (UK).

Application of a hydrogel spacer for postoperative salvage radiotherapy of prostate cancer

International Nuclear Information System (INIS)

Pinkawa, Michael; Schubert, Carolin; Escobar-Corral, Nuria; Holy, Richard; Eble, Michael J.

2015-01-01

In contrast to primary radiotherapy, no reports are available for a hydrogel spacer application in postoperative salvage radiotherapy for prostate cancer. A 77-year-old patient presented 20 years after radical prostatectomy with a digitally palpable local recurrence at the urethrovesical anastomosis (PSA 5.5 ng/ml). The hydrogel spacer (10 ml, SpaceOAR trademark) was injected between the local recurrence and rectal wall under transrectal ultrasound guidance. Treatment planning was performed with an intensity-modulated technique up to a total dose of 76 Gy in 2-Gy fractions. The same planning was performed based on computed tomography before spacer injection for comparison. The local recurrence, initially directly on the rectal wall, could be displaced more than 1 cm from the rectal wall after hydrogel injection. With a mean total dose of 76 Gy to the planning target volume, rectal wall volumes included in the 70 Gy, 60 Gy, 50 Gy isodoses were 0 cm 3 , 0 cm 3 , and 0.4 cm 3 with a spacer and 2.9 cm 3 , 4.5 cm 3 , and 6.2 cm 3 without a spacer, respectively. The patient reported rectal urgency during radiotherapy, completely resolving after the end of treatment. The PSA level was 5.4 ng/ml a week before the end of radiotherapy and dropped to 0.9 ng/ml 5 months after radiotherapy. A hydrogel spacer was successfully applied for dose-escalated radiotherapy in a patient with macroscopic local prostate cancer recurrence at the urethrovesical anastomosis to decrease the dose at the rectal wall. This option can be considered in specifically selected patients. (orig.) [de

Efficient Trajectory Options Allocation for the Collaborative Trajectory Options Program

Science.gov (United States)

Rodionova, Olga; Arneson, Heather; Sridhar, Banavar; Evans, Antony

2017-01-01

The Collaborative Trajectory Options Program (CTOP) is a Traffic Management Initiative (TMI) intended to control the air traffic flow rates at multiple specified Flow Constrained Areas (FCAs), where demand exceeds capacity. CTOP allows flight operators to submit the desired Trajectory Options Set (TOS) for each affected flight with associated Relative Trajectory Cost (RTC) for each option. CTOP then creates a feasible schedule that complies with capacity constraints by assigning affected flights with routes and departure delays in such a way as to minimize the total cost while maintaining equity across flight operators. The current version of CTOP implements a Ration-by-Schedule (RBS) scheme, which assigns the best available options to flights based on a First-Scheduled-First-Served heuristic. In the present study, an alternative flight scheduling approach is developed based on linear optimization. Results suggest that such an approach can significantly reduce flight delays, in the deterministic case, while maintaining equity as defined using a Max-Min fairness scheme.

Exclusive radiotherapy and concurrent endocrine therapy for the management of elderly breast cancer patients: Case study and review of hypo-fractionated schemes; Hormonoradiotherapie exclusive dans la prise en charge du cancer du sein de la personne agee: cas clinique et revue de la litterature des schemas hypofractionnes

Energy Technology Data Exchange (ETDEWEB)

Auberdiac, P.; Cartier, L.; Malkoun, N.; Chauleur, C.; De Laroche, G.; Magne, N. [Departement de radiotherapie, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France); Chargari, C. [Service d' oncologie radiotherapie, hopital d' instruction des armees du Val-de-Grace, 74, boulevard de Port-Royal, 75230 Paris cedex 5 (France); Melis, A.; Jacquin, J.P. [Departement d' oncologie medicale, institut de cancerologie de la Loire, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex (France)

2011-12-15

Normo-fractionated radiotherapy is standard for adjuvant management of patients treated with breast conservative surgery for breast cancer. However, many elderly patients are not eligible to such strategy, either because of concurrent diseases, or because the tumor is inoperable. Several protocols of exclusive radiotherapy have been reported in the literature, frequently using hypo-fractionated radiotherapy and endocrine therapy. We report a case of a patient treated with exclusive endocrine and radiotherapy and address the state of the art on hypo-fractionated schemes for the management of elderly breast cancer patients. While hypo-fractionated radiotherapy does not compromise the oncologic or cosmetic outcome, there is no prospective data that assesses the place of radiotherapy for the exclusive treatment of elderly patients. This strategy should be further assessed in clinical randomized trial. (authors)

The IAEA quality audits in radiotherapy

International Nuclear Information System (INIS)

Izewska, J.; Vatnitsky, S.T.; Salminen, E.

2009-01-01

The quality audits are considered as an essential component of management systems of quality in radiotherapy. this method consists in checking that the quality of activities of a radiotherapy center is consistent with the rules of correct practices. The principal objective of the quality audit is to contribute to an improvement of the quality. IAEA developed a method of complete audit in the framework of the quality assurance team in radio-oncology (Q.U.A.T.R.O.). The Q.U.A.T.R.O. missions consist in an evaluation of the radiotherapy infrastructure, including the aspects related to the patient and equipment and where appropriate, an assessment of the safety of using ionizing radiation and radiation protection of the patients. The assessment also covers the staffing and training programs for radiation oncologists and medical radiation physicists. These missions allow to identify the insufficiencies in term of infrastructures, material, human resources and procedures and to enlighten the points to improve. Their results proved useful to improve the dosimetry practices at the worldwide level. (N.C.)

Definition of stereotactic body radiotherapy. Principles and practice for the treatment of stage I non-small cell lung cancer

International Nuclear Information System (INIS)

Guckenberger, M.; Sauer, O.; Andratschke, N.; Alheit, H.; Holy, R.; Moustakis, C.; Nestle, U.

2014-01-01

This report from the Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (Deutschen Gesellschaft fuer Radioonkologie, DEGRO) provides a definition of stereotactic body radiotherapy (SBRT) that agrees with that of other international societies. SBRT is defined as a method of external beam radiotherapy (EBRT) that accurately delivers a high irradiation dose to an extracranial target in one or few treatment fractions. Detailed recommendations concerning the principles and practice of SBRT for early stage non-small cell lung cancer (NSCLC) are given. These cover the entire treatment process; from patient selection, staging, treatment planning and delivery to follow-up. SBRT was identified as the method of choice when compared to best supportive care (BSC), conventionally fractionated radiotherapy and radiofrequency ablation. Based on current evidence, SBRT appears to be on a par with sublobar resection and is an effective treatment option in operable patients who refuse lobectomy. (orig.) [de

R and D options for demand side management in Japanese electric utilities

International Nuclear Information System (INIS)

Yamamoto, T.

1995-01-01

Japanese electric utilities are facing several problems: increasing construction cost of power facilities, siting constraints and the environmental issue of greenhouse gas emissions. To overcome these problems, electric utilities have been promoting demand-side-management (DSM) activities as well as supplier-side measures, with some presently being carried out through promoting energy conservation technologies and introducing tariff options for residential/commercial and industrial consumers. R and D works have been carried out on various fields such as energy storage and heat storage which contribute to the improvement of the load factor. 5 figs., 2 tabs

External quality audits in radiotherapy in Poland

International Nuclear Information System (INIS)

Bulski, W.; Rostkowska, J.; Kania, M.; Gwiazdowska, B.

2002-01-01

The Secondary Standard Dosimetry Laboratory (SSDL) of the Medical Physics Department of the Centre of Oncology in Warsaw is a continuation of the Radiation Measurements Laboratory created in 1937, following the suggestions of Marie Curie, the founder of the Institute. The present SSDL is a member of the WHO/IAEA international network and is periodically audited by the International Atomic Energy Agency. The SSDL is in charge of the calibration of all radiotherapy dosimeters in Poland, and it also co-ordinates all activities carried out in radiotherapy quality assurance programmes nation-wide. The External Audit Group (EAG) was set-up according to the recommendations of the IAEA, as a part of the SSDL. The EAG is in charge of the management of the project and organization of the TLD measurements. The SSDL takes the responsibilities of the metrological aspects of the programme. The results of the efforts, aimed at the development of a quality audit programme and methodology in radiotherapy, are presented

National arrangements for radiotherapy

International Nuclear Information System (INIS)

2007-01-01

After a presentation of several letters exchanged between the French health ministry and public agencies in charge of public health or nuclear safety after a radiotherapy accident in Epinal, this report comments the evolution of needs in cancerology care and the place given to radiotherapy. It outlines the technological and organisational evolution of radiotherapy and presents the distribution of radiotherapy equipment, of radio-therapists and other radiotherapy professionals in France. Within the context of radiotherapy accidents which occurred in 2007, it presents the regulatory arrangements which aimed at improving the safety, short term and middle term arrangements which are needed to support and structure radiotherapy practice quality. It stresses the fact that the system will deeply evolve by implementing a radiotherapy vigilance arrangement and a permanent follow-on and adaptation plan based on surveys and the creation of a national committee

Whither radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Ross, W M

1987-03-01

The 1986 Glyn Evans Memorial Lecture, given at the Joint Provincial Meeting of the Royal College of Radiologists, Sheffield, September 1986, sketches an outline of the history of radiotherapy and discusses the future development of the art. Topics included are siting of centres, training needs, the relationship of radiotherapy to other medical specialities, and the advantages and disadvantages of radiotherapy practitioners forming a separate medical College. (U.K.)

Radiotherapy facilities: Master planning and concept design considerations

Energy Technology Data Exchange (ETDEWEB)

NONE

2014-08-15

This publication provides guidelines on how to plan a radiotherapy facility in terms of the strategic master planning process including the legal, technical and infrastructure requirements. It outlines a risk assessment methodology, a typical project work plan and describes the professional expertise required for the implementation of such a project. Generic templates for a block design are suggested, which include possibilities for future expansion. These templates can be overlaid onto the designated site such that the most efficient workflow between the main functional areas can be ensured. A sample checklist is attached to act as a guideline for project management and to indicate the critical stages in the process where technical expert assistance may be needed. The publication is aimed at professionals and administrators involved in infrastructure development, planning and facility management, as well as engineers, building contractors and radiotherapy professionals.

Radiotherapy facilities: Master planning and concept design considerations

International Nuclear Information System (INIS)

2014-01-01

This publication provides guidelines on how to plan a radiotherapy facility in terms of the strategic master planning process including the legal, technical and infrastructure requirements. It outlines a risk assessment methodology, a typical project work plan and describes the professional expertise required for the implementation of such a project. Generic templates for a block design are suggested, which include possibilities for future expansion. These templates can be overlaid onto the designated site such that the most efficient workflow between the main functional areas can be ensured. A sample checklist is attached to act as a guideline for project management and to indicate the critical stages in the process where technical expert assistance may be needed. The publication is aimed at professionals and administrators involved in infrastructure development, planning and facility management, as well as engineers, building contractors and radiotherapy professionals

Clinical Impact of Re-irradiation with Carbon-ion Radiotherapy for Lymph Node Recurrence of Gynecological Cancers.

Science.gov (United States)

Shiba, Shintaro; Okonogi, Noriyuki; Kato, Shingo; Wakatsuki, Masaru; Kobayashi, Daijiro; Kiyohara, Hiroki; Ohno, Tatsuya; Karasawa, Kumiko; Nakano, Takashi; Kamada, Tadashi

2017-10-01

To evaluate the safety and efficacy of re-irradiation with carbon-ion radiotherapy (C-ion RT) for lymph node recurrence of gynecological cancers after definitive radiotherapy. Data regarding patients with unresectable and isolated recurrent lymph node from gynecological cancer after definitive radiotherapy were analyzed. Total dose of C-ion RT was 48-57.6 Gy (RBE) in 12 or 16 fractions. Sixteen patients received re-irradiation by C-ion RT were analyzed. Median follow-up was 37 months. Median tumor size was 27 mm. None developed Grade 1 or higher acute toxicities and Grade 3 or higher late toxicities. The 3-year overall survival, local control and disease-free survival rates after C-ion RT were 74%, 94% and 55%, respectively. Re-irradiation with C-ion RT for lymph node recurrence of gynecological cancers after definitive radiotherapy can be safe and effective. This result suggested that C-ion RT could be a curative treatment option for conventionally difficult-to-cure patients. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Radiotherapy in bladder cancer

International Nuclear Information System (INIS)

Rozan, R.

1992-01-01

In 1992, the problem of the vesical radiotherapy is not resolved. The author presents the situation and the different techniques of radiotherapy in bladder cancers: external radiotherapy, only and associated with surgery, interstitial curietherapy and non-classical techniques as per operative radiotherapy, neutron therapy and concurrent radiotherapy with chemotherapy. In order to compare their efficiency, the five-year survival are given in all cases.(10 tabs)

Current opinions on radiotherapy of pediatric central nervous system tumors

International Nuclear Information System (INIS)

Chojnacka, M.; Skowronska-Gardas, A.

2006-01-01

Primary central nervous system (CNS) neoplasms are the most frequent solid tumors in childhood accounting for 20% of all pediatric malignancies. Despite developments in neurosurgery, radiotherapy and chemotherapy, a significant proportion of these patients suffer progressive disease. A good treatment management strategy should consider not only survival but also the quality of life of the child. Irradiation is ann essential part of the management of the majority of CNS tumors. During then last decade, there significant advances in the technology of planning and delivery of radiation treatment. These new radiotherapy techniques such as conformal, intensity modulated photon beam and stereotactic methods allow a high homogenous dose to the tumor region with minimal doses to normal tissue. This is particularly important in children with localized low-grade tumors, whose prognosis of long-term survival is often excellent and should be accompanied by smallest risk of treatment toxicity. For small tumors fractionated radiotherapy stereotactic radiotherapy using multiple fixed non-coplanar beams is an appropriate treatment. Modification of craniospinal technique, lowering of the total craniospinal dose with adjuvant chemotherapy, new radiotherapy modalities to treat the posterior fossa may be employed to possibly decrease the late rectifies of radiation therapy. For malignant glioma and brain stem tumors we need new approaches, as chemo sensitization, angiogenesis inhibitors and gene therapies. These new methods in therapy of pediatric brain tumors and our experience in treatment of children with medulloblastoma, low-grade astrocytoma, craniopharyngioma and brain stem tumors are presented. We summarize therapeutic aspects of most childhood brain tumors. (author)

Dosimetric al confirmation of a software for the design of radiotherapy treatments

International Nuclear Information System (INIS)

Alfonso, Rodolfo; Huerta, Ubaldo; Torres, Miguel; Alonso, Jose L.

1995-01-01

A software for the planning of treatments of Radiotherapy was developed recently by medical physics of the Hospital Clinicoquirurgico Hermanos Ameijeiras, to evaluate the dependability of the results of the dose distributions calculated in the patients, localizations were chosen in the region of the head and the neck and I take like reference the results of measurement dosimetric with powder TLD-700 in a human phantoms. The different options are explained for the entrance of data of the patient's contours. A comparison of the results of the mensurations is shown with those calculated. The causes of the discrepancies are analyzed and recommendations are made regarding the utility of the different options of acquisition of the patient's data

Optical spectroscopy of radiotherapy and photodynamic therapy responses in normal rat skin shows vascular breakdown products

Science.gov (United States)

Teles de Andrade, Cintia; Nogueira, Marcelo S.; Kanick, Stephen C.; Marra, Kayla; Gunn, Jason; Andreozzi, Jacqueline; Samkoe, Kimberley S.; Kurachi, Cristina; Pogue, Brian W.

2016-03-01

Photodynamic therapy (PDT) and radiotherapy are non-systemic cancer treatment options with different mechanisms of damage. So combining these techniques has been shown to have some synergy, and can mitigate their limitations such as low PDT light penetration or radiotherapy side effects. The present study monitored the induced tissue changes after PDT, radiotherapy, and a combination protocol in normal rat skin, using an optical spectroscopy system to track the observed biophysical changes. The Wistar rats were treated with one of the protocols: PDT followed by radiotherapy, PDT, radiotherapy and radiotherapy followed by PDT. Reflectance spectra were collected in order to observe the effects of these combined therapies, especially targeting vascular response. From the reflectance, information about oxygen saturation, met-hemoglobin and bilirubin concentration, blood volume fraction (BVF) and vessel radius were extracted from model fitting of the spectra. The rats were monitored for 24 hours after treatment. Results showed that there was no significant variation in the vessel size or BVF after the treatments. However, the PDT caused a significant increase in the met-hemoglobin and bilirubin concentrations, indicating an important blood breakdown. These results may provide an important clue on how the damage establishment takes place, helping to understand the effect of the combination of those techniques in order to verify the existence of a known synergistic effect.

Study of Agricultural Product Options Pricing

Science.gov (United States)

HONG, Qiu

2017-09-01

China is a large agricultural country, and the healthy development of agriculture is related to the stability of the whole society. The agricultural production and management of agricultural products are confronted with many risks, especially the market risks. Option contract is the object of option market transaction, so it is very important to study the option contract of agricultural products. Option trading separates the risk and profit, so that the trader can avoid the risk while retaining the opportunity to obtain income. The option has the characteristics of low transaction cost, simple and efficient, so it is suitable for small and medium investors.

National arrangements for radiotherapy; Mesures nationales pour la radiotherapie. Travail collectif des missions

Energy Technology Data Exchange (ETDEWEB)

NONE

2007-07-01

After a presentation of several letters exchanged between the French health ministry and public agencies in charge of public health or nuclear safety after a radiotherapy accident in Epinal, this report comments the evolution of needs in cancerology care and the place given to radiotherapy. It outlines the technological and organisational evolution of radiotherapy and presents the distribution of radiotherapy equipment, of radio-therapists and other radiotherapy professionals in France. Within the context of radiotherapy accidents which occurred in 2007, it presents the regulatory arrangements which aimed at improving the safety, short term and middle term arrangements which are needed to support and structure radiotherapy practice quality. It stresses the fact that the system will deeply evolve by implementing a radiotherapy vigilance arrangement and a permanent follow-on and adaptation plan based on surveys and the creation of a national committee.

Proceedings of the International Conference on Modern Radiotherapy. Advances and Challenges in Radiation Protection of Patients; Actes de la conference internationale sur la radiotherapie moderne. Defis et progres dans le domaine de la radioprotection des patients

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-12-15

The use of ionizing radiation in medicine has led to major improvements in the diagnosis and treatment of human diseases. While bringing new benefits for cancer treatment, modern radiotherapy also poses new challenges in terms of radiation protection of patients. Prevention of radiotherapy incidents and accidents is a major issue in this area. In December 2009, the French Nuclear Safety Authority (ASN) organised the 1. international conference on radiation protection of patients in radiotherapy. The major objective of the conference was to provide a platform for exchanging experience, and reviewing the actions implemented to improve the radiation safety in radiotherapy both at national and international level. The expected result was: - to reach a consensus about the necessity to strengthen existing international actions for prevention of incidents and accidents, - to set up an international cooperation to improve management for overexposed patients, - to outline a strategy for strengthening regulation, - to contribute to the elaboration of an international scale to rate patient related events for communication and reporting purpose. 360 delegates from 50 countries across the world participated at the 3-day conference. 41 presentations were made and 67 posters were displayed. The conference brought together a broad spectrum of expertise: scientists, health professionals, medical devices manufacturers, risk management specialists, radiation protection experts, representatives from Radiation Protection and Health Authorities as well as patient's associations. The programme covered both scientific and medical issues, such as patient sensitivity to ionising radiation and the treatment of complications. It also provided scope to discuss the benefits and risks of modern radiotherapy and to explore treatment safety issues from various perspectives, including human resources, expertise, education and training along with control and prevention strategies. The

The strategy of therapy of the axilla in early cancer. Surgery or radiotherapy

International Nuclear Information System (INIS)

Izuo, Masaru

1998-01-01

The therapy of the axillary lymph node in early breast cancer was assessed perspectively. Recently, axillary irradiation was carried out and compared with surgery. Radiotherapy was not evaluated more successful. To carry out in accordance with the present guide line, so called ''modern technique'' or ''modern dosage schedule'', radiotherapy of the axilla is effective as well as surgery. We have many agreements that the rate of incidence of complication associated with irradiation was decreased in accordance with ''modern technique''. It is reasonable to radiate additionally after the selection by the ''node sampling'' in the sense of decreasing unnecessary irradiation. But it is not sufficient in their reliability, it is hard to expect this method getting more popular than now. We cannot find any difference in the effect of the treatment itself between present dissection and radiotherapy. However we have many agreements that axillary dissection may give the information about n-stage, and the contribution to the suitable selection to the prognosis factor and adjuvant chemotherapy was not so less even in early cancer. Some early cancers (non-invasive carcinoma or micro carcinoma) will not need the axillary therapy. It is one of the options ''to combine mastectomy under local anesthesia and radiotherapy'' in close cooperation with the skilled radiologist. (K.H.) 120 refs

Indications and interventional options for non-resectable tracheal stenosis

Science.gov (United States)

Bacon, Jenny Louise; Patterson, Caroline Marie

2014-01-01

Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management. PMID:24624290

Stock Option Compensation and Managerial Turnover

OpenAIRE

Raluca Georgiana NASTASESCU

2009-01-01

This study examines the association between managerial turnover and equity-based compensation. I investigate whether stock options act to bond executives to their firms and whether retention of managers is a motivation of companies in designing CEO incentive contracts. The results show that stock options do negatively influence the probability of a CEO leaving the company. The monetary cost of losing the value of equity-based compensation package keeps the manager with his company. I also fin...

A Comparison of In-Room Computerized Tomography Options for Detection of Fiducial Markers in Prostate Cancer Radiotherapy

International Nuclear Information System (INIS)

Owen, Rebecca; Foroudi, Farshad; Kron, Tomas; Milner, Alvin; Cox, Jennifer; Cramb, Jim; Zhu Li; Duchesne, Gillian

2010-01-01

Purpose: To compare volumetric in-room computed tomography (CT) and kilovoltage (kV) cone-beam CT (CBCT) to planar imaging with respect to their ability to localize fiducial markers (FMs) for radiotherapy of prostate cancer. Methods and Materials: Image guidance options from two linear accelerators were compared in terms of identifying the center of gravity (COG) of FMs from the isocenter: a Siemens Primatom, where the couch is rotated 180 degrees from the treatment isocenter to the in-room CT vs. electronic portal imaging (EPI); and a Varian OBI system, where kV CBCT, EPI, and planar kV radiographs were compared. In all, 387 image pairs (CBCT = 133; CT = 254) from 18 patients were analyzed. A clinical tolerance of 3 mm was predefined as the acceptable threshold for agreement. Results: COG location on in-room CT and EPI was in agreement 96.9%, 85.8%, and 89.0% of the time in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions, respectively, vs. 99.2%, 91.7%, and 93.2% for the CBCT and EPI analysis. The CBCT vs. kV radiographs were in agreement 100% (LR), 85.4% (SI), and 88.5% (AP), and EPI vs. kV radiographs were in agreement 100% (LR), 94.6% (SI), and 91.5% (AP) of the time. Conclusion: Identification of FMs on volumetric or planar images was found to be not equivalent (±3 mm) using either linear accelerator. Intrafraction prostate motion, interpretation of FM location, and spatial properties of images are contributing factors. Although in-room CT has superior image quality, the process of realigning the treatment couch to acquire a CT introduces an error, highlighting the benefits of a single isocentric system.

Federal Employees Health Benefits Program: Enrollment Options Following the Termination of a Plan or Plan Option. Final rule.

Science.gov (United States)

2015-10-28

The U.S. Office of Personnel Management (OPM) is issuing a final rule to amend the Federal Employees Health Benefits (FEHB) Program regulations regarding enrollment options following the termination of a plan or plan option.

To understand radiotherapy

International Nuclear Information System (INIS)

2009-01-01

Dealing with the use of radiotherapy for adults, this guide indicates when a radiotherapy is suggested, how it acts, how the treatment is chosen, which are the professionals involved. It describes how an external radiotherapy takes place and its various techniques, the different types of side effects (general, specific to the treated zone, late effects). It indicates which organs can be treated by curie-therapy, the different curie-therapy treatment modalities, how a curie-therapy takes place and which are its side effects. It outlines how to better cope with radiotherapy (how to be supported, the important role of relatives, everyday life questions, rights). It indicates and comments the different measures adopted for the safety and quality of radiotherapy

External radiotherapy in thyroid cancer

International Nuclear Information System (INIS)

Samuel, A.M.; Shah, D.H.

1999-01-01

In the management of thyroid carcinoma (TC) of any histological type, surgery is the primary mode of treatment. The second modality for the management is treatment with radioactive iodine ( 131 I), especially, when the tumor has the ability to concentrate 131 I. External radiotherapy has a limited use in differentiated thyroid carcinoma (DTC). It is useful in the management of bulky residual tissue which is not completely resected, metastatic disease which does not concentrated radioiodine and as a palliative treatment for reliving pain in patients with distant metastases. The ER as an adjuvant treatment in both anaplastic and medullary carcinoma has a significant role to play and should be used more frequently than is presently being advocated and practiced

The role of dentistry other than oral care in patients undergoing radiotherapy for head and neck cancer

Directory of Open Access Journals (Sweden)

Hidenobu Matsuzaki

2017-05-01

Full Text Available The usefulness of dental approaches, such as oral management, has gained recognition among patients treated for head and neck cancer. In particular, oral management plays a very important role before, during, and after treatment in patients undergoing radiotherapy, chemotherapy, or a combination of both. However, specialized dentistry knowledge and techniques that are useful for patients undergoing radiotherapy for head and neck cancer have yet to be reported. Therefore, in this review article, our aim is to introduce dental approaches in radiotherapy for patients with head and neck cancer that have been developed and are currently being used at our institute.

Radiotherapy for Metastatic Merkel Cell Carcinoma: A Review of the Literature

International Nuclear Information System (INIS)

Khan, L.; Barnes, E. A.

2012-01-01

Merkel cell carcinoma is a rare form of non-melanoma skin cancer of neuroendocrine origin. Optimal management of patients is controversial and the role of radiotherapy is unclear. Purpose. The purpose of this study was to review the efficacy of RT in the treatment of both local and distant metastatic disease from MCC. Methods. A literature search was conducted in MEDLINE (1946-January Week 1 2012) and Embase (1980-2012 Week 2). Articles of interest analyze the efficacy of radiotherapy for treatment of metastatic MCC and did not exclude case reports. Results. All articles except one focusing on the role of radiotherapy were of retrospective origin or case series. Significant limitations applied in all studies due to limited sample sizes and the retrospective nature of these studies. Radiotherapy improves locoregional control in the adjuvant setting, and many series suggest an improvement in overall survival. In cases where surgery is not possible, definitive radiotherapy may be an as-efficacious alternative. The radiosensitive nature of MCC coupled with existing reports suggests that treatment via current protocols for other primary tumors is adequate. Conclusion. Further studies should be conducted prospectively to clarify the true role of radiotherapy in metastatic MCC.

Radiotherapy in the management of high-grade gliomas diagnosed in Western Australia: a patterns of care study

International Nuclear Information System (INIS)

Jackson, Melanie; Taylor, Mandy; Bydder, Sean; Maujean, Eric; Nowak, Anna

2012-01-01

Radiotherapy (RT) plays an integral role in the management of high-grade glioma (HGG). However, there is little information on the patterns of care in unselected Australian patients with HGG. This prospective cohort study collected information on patients with a diagnosis of HGG managed in Western Australia over a 25-month period from 2006 to 2008. RT treatment and survival data were analysed. 86% of Western Australian patients with HGG were treated at the study site over this period. Of these, 80% were reviewed by a radiation oncologist with RT recommended in 88% of cases. One hundred eighty-seven patients proceeded to have RT, with most receiving 60 Gy in 30 fractions with limited field external beam radiotherapy (LFRT). Median survival from diagnosis was 13.6 months for all patients and 15.4 months for those planned for treatment with 60 Gy in 30 fractions. The median time from surgery to the start of RT was 41 days. Longer waiting times were not predictors of poor survival. Failure to receive all planned treatment (13% of patients) predicted for poor survival (hazard ratio 0.38). Dose and fractionation practices show concordance with published data and guidelines. Survival is also consistent with clinical trial data for patients planned for aggressive therapy. Nevertheless, a substantial number of patients are not suited to aggressive therapy or fail to complete planned therapy, and these patients have poor outcomes. Treatment delays did not affect survival outcomes but are confounded by earlier treatment of those unsuited to LFRT.

Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience

Directory of Open Access Journals (Sweden)

Heba G. El-Sheredy

2016-01-01

Full Text Available Background: Breast cancer is the most frequent malignant tumor in women worldwide. In recent years, defined reconstruction principles along with numerous surgical techniques with volume replacement have been published. Autologous breast reconstruction is more natural but leaves donor site morbidity. It provides the opportunity to restore the breast mound without the need for scars. This study aims to evaluate the complications of radiotherapy after immediate breast reconstruction with implants in breast cancer patients who submitted to skin sparing mastectomy and nipple sparing mastectomy by taking into consideration the risk factors and management at our institution. Methods: The current study prospectively included patients with invasive breast cancer admitted between January and June 2012 who were scheduled for skin sparing mastectomy or nipple sparing mastectomy and axillary dissection followed by immediate breast reconstruction with implant. Patients received adjuvant chemotherapy followed by conventional fractionated radiation. Complications were classified as either minor or major. The minor complications included capsular contracture (Baker 1-2, seroma, minor skin infection and skin dehiscence without exposure of the implant. Major complications included capsular contracture (Baker 3-4, severe infection and major wound dehiscence with implant exposure. Capsular contracture was scored according to the modified Baker classification. Results: The study included 38 patients. Of these, 28 had skin sparing mastectomy while 10 underwent nipple sparing mastectomy. The overall complication rate was 71%. We observed minor complications in 18 patients while 9 patients had major complications. Complications occurred with a median time of 13 months following radiotherapy completion. All minor complications were managed conservatively whereas all major complications required repeat surgery. No loco-regional recurrences occurred during the follow up

Depleted uranium disposal options evaluation

International Nuclear Information System (INIS)

Hertzler, T.J.; Nishimoto, D.D.; Otis, M.D.

1994-05-01

The Department of Energy (DOE), Office of Environmental Restoration and Waste Management, has chartered a study to evaluate alternative management strategies for depleted uranium (DU) currently stored throughout the DOE complex. Historically, DU has been maintained as a strategic resource because of uses for DU metal and potential uses for further enrichment or for uranium oxide as breeder reactor blanket fuel. This study has focused on evaluating the disposal options for DU if it were considered a waste. This report is in no way declaring these DU reserves a ''waste,'' but is intended to provide baseline data for comparison with other management options for use of DU. To PICS considered in this report include: Retrievable disposal; permanent disposal; health hazards; radiation toxicity and chemical toxicity

Technological options for the management of biosolids.

Science.gov (United States)

Wang, Hailong; Brown, Sally L; Magesan, Guna N; Slade, Alison H; Quintern, Michael; Clinton, Peter W; Payn, Tim W

2008-06-01

provide a complete management for biosolids. A number of advanced thermal conversion technologies (e.g., supercritical water oxidation process and pyrolysis) are under development for biosolids management with a goal to generate useful products, such as higher quality fuels and recovery of phosphorus. With an ever-increasing demand for renewable energy, growing bioenergy crops and forests using biosolids as a fertilizer and soil amendment can not only contribute to the low-carbon economy but also maximize the nutrient and carbon value of the biosolids. Land application of biosolids achieves a complete reuse of its nutrients and organic carbon at a relatively low cost. Therefore, land application should become a preferred management option where there is available land, the quality of biosolids meet regulatory requirements, and it is socially acceptable. Intensive energy cropping and forest production using biosolids can help us meet the ever-increasing demand for renewable energy, which can eliminate the contamination potential for food sources, a common social concern about land application of biosolids. In recent years, increasing numbers of national and local governments have adopted more stringent regulations toward biosolid management. Under such a political climate, biosolids producers will have to develop multireuse strategies for biosolids to avoid being caught because a single route management practice might be under pressure at a short notice. Conventional incineration systems for biosolids management generally consume more energy than they produce and, although by-products may be used in manufacturing, this process cannot be regarded as a beneficial use of biosolids. However, biosolids are likely to become a source of renewable energy and produce 'carbon credits' under the increasingly popular, low-carbon economy policy. To manage biosolids in a sustainable manner, there is a need for further research in the following areas: achieving a higher degree of public

Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 2: Design options

Science.gov (United States)

1985-01-01

The primary objective of Task 2 is the development of an information base that will support the conduct of trade studies and provide sufficient data to make key design/programmatic decisions. This includes: (1) the establishment of option categories that are most likely to influence Space Station Data System (SSDS) definition; (2) the identification of preferred options in each category; and (3) the characterization of these options with respect to performance attributes, constraints, cost and risk. This volume contains the options development for the design category. This category comprises alternative structures, configurations and techniques that can be used to develop designs that are responsive to the SSDS requirements. The specific areas discussed are software, including data base management and distributed operating systems; system architecture, including fault tolerance and system growth/automation/autonomy and system interfaces; time management; and system security/privacy. Also discussed are space communications and local area networking.

A Study on Optimized Management Options for the Wolsong Low- and Intermediate - Level Waste Disposal Center in Korea - 13479

Energy Technology Data Exchange (ETDEWEB)

Park, JooWan; Kim, DongSun; Choi, DongEun [Korea Radioactive Waste Management Corporation, Korea 89, Bukseongno, Gyeongju, 780-050 (Korea, Republic of)

2013-07-01

The safe and effective management of radioactive waste is a national task required for sustainable generation of nuclear power and for energy self-reliance in Korea. Currently, for permanent disposal of low- and intermediate-level waste (LILW), the Wolsong LILW Disposal Center (WLDC) is under construction. It will accommodate a total of 800,000 drums at the final stage after stepwise expansion. As an implementing strategy for cost-effective development of the WLDC, various disposal options suitable for waste classification schemes would be considered. It is also needed an optimized management of the WLDC by taking a countermeasure of volume reduction treatment. In this study, various management options to be applied to each waste class are analyzed in terms of its inventory and disposal cost. For the volume reduction and stabilization of waste, the vitrification and plasma melting methods are considered for combustible and incombustible waste, respectively. (authors)

Can or must the patient participate to risk management in radiotherapy?

International Nuclear Information System (INIS)

Mollo, V.; Pernet, A.; Moutel, G.; Duchange, N.; Giraud, P.

2011-01-01

Purpose. - The present study aimed at analyzing if patient participation constitutes a promising way of improvement of patient safety, or not. The hypothesis is that patient participation is a means to develop a safety culture based on the cooperation between patients and health care providers, to improve patients' satisfaction and to reduce the costs associated to adverse events. Patients and methods. - A half-day session was organized on this theme during a training of radiotherapy professionals on risk management. Professionals were first distributed in three subgroups according to their specialty (radiation oncologists, radiation physicists and medical technicians), and had to work on four main questions relating to participation, among which the collection of real situations in which patients effectively contributed (positively or negatively) to patient safety. Results were then collectively discussed. Results. - Patient participation allows not only to detect and recover some mistakes or errors made by the professionals (error of identity), but also to decrease patients' risk behaviors (purposely taking the place of another patient in order to be treated faster). However, it must be seen as a possibility offered to patients, and not as an obligation. Conclusion. - Patient participation to patient safety is a field of study, which requires to be developed in order to define the conditions enhancing such participation and to implement a set of actions to improve health care safety by a cooperative management of this one. (authors)

A comparison of costs associated with utility management options for dry active waste

Energy Technology Data Exchange (ETDEWEB)

Hornibrook, C. [EPRI, Palo Alto, CA (United States)

1995-12-31

The economics of low level waste management is receiving more attention today than ever before. This is due to four factors: (1) the increases in the cost of processing of these wastes; (2) increases in the cost of disposal; (3) the addition of storage costs for those without access to disposal; and (4) the increasing competitive nature of the electric generation industry. These pressures are forcing the industry to update it`s evaluation of the mix of processing that will afford it the best long term economics and minimize it`s risks for unforeseen costs. Whether disposal is available or not, all utilities face the same challenge of minimizing the costs associated with the management of these wastes. There are a number of variables that will impact how a utility manages their wastes but the problem is the uncertainty of what will actually happen, i.e., will disposal be available, when and at what cost. Using the EPRI-developed WASTECOST: DAW code, this paper explores a variety of LLW management options available to utilities. Along with providing the costs and benefits, other technical considerations which play an important part in the management of these wastes are also addressed.

The economics of nuclear decontamination: assessing policy options for the management of land around Fukushima dai-ichi

International Nuclear Information System (INIS)

Munro, Alistair

2013-01-01

Highlights: • Assesses land management options after the Fukushima accident. • Builds a model for exploring intervention and decontaminations options in areas affected by radioactive contamination. • Findings suggest delaying decontamination efforts by 3–10 years is optimal with a central figure of 8.75 years. • Results are sensitive to estimates of the benefits of resettlement. • Poor state of knowledge about some variables that are key for policy actions, such as psychological benefits and costs of resettlement. -- Abstract: In the light of the Japanese government's intensive efforts to decontaminate areas affected by radioactive Caesium from Fukushima dai-ichi nuclear power plant, I create a framework for assessing the merits of management options. In particular I consider delayed intervention as a possible policy. Delay can be optimal because allowing the natural decay of radiation can lower significantly the costs of achieving targets for exposure. Using some benchmark data for Japan I estimate that optimal delay is positive for most reasonable parameter values. Optimal delay generally lies in the range of 3–10 years with a central figure of 8.8 years. There is however considerable uncertainty over some of the key parameter values, particularly with regard to the behaviour of currently evacuated inhabitants

Radiation therapy technology innovations applied to the treatment of head and neck patients: - Clinical results of Intensity Modulated Radiotherapy (IMRT), - Contribution of Image Guided Radiotherapy (IGRT) in the management of head and neck patients treated with IMRT

International Nuclear Information System (INIS)

Graff-Cailleaud, Pierre

2011-01-01

Numerous and exciting technological innovations were recently developed in radiotherapy. We aimed to assess benefits in two specific fields. 1) Clinical results of Intensity Modulated Radiotherapy (IMRT) applied to the treatment of Head and Neck (H and N) patients. The first study was a long-term mono-centric prospective registration of all H and N patients treated with IMRT in our institution. Locoregional control was excellent and toxicities limited. Recurrences were in-field. Dosimetric recommendations (parotids mean dose) were established. The second study assessed the impact of IMRT on health-related quality of life for H and N patients through a multicentric matched-pair comparison with conventional radiotherapy. Outstanding benefits were observed particularly in the fields of salivary dysfunction and oral discomfort. 2) Contribution of Image Guided Radiotherapy (IGRT) in the management of H and N patients treated with IMRT. The first study was a monitoring of delivered dose, using 3D dose recalculation from Megavoltage Cone-Beam CT (CBCT), as a quality assurance measure of a panel of H and N IMRT patients aligned with IGRT. Dosimetric consequences of anatomical changes were assessed. Contribution of color-coded MVCBCT dose-difference maps was studied. The aim of the second study was to quantify the inherent relative mobility between anatomic regions of the H and N area and to assess the dosimetric impact of several different matching procedures. Recommendations for the use of CBCT images in a daily practice were established. (author) [fr

[Experience feed back committee in radiotherapy (CREx): a compulsory tool for security management evaluation at two years].

Science.gov (United States)

Lartigau, E; Coche-Dequeant, B; Dumortier, V; Giscard, S; Lacornerie, T; Lasue, A; Cheval, V; Martel, V; Malfait, B; Fuchs, A; Pestel, M; Damman, M; Forrest, M

2008-11-01

After working on treatment organisation in radiotherapy (bonne pratiques organisationnelles en radiothérapie - action pilote MEAH 2003), the development of a security policy has become crucial. With the help of Air France Consulting and the MEAH, three cancer centers in Angers, Lille and Villejuif worked together on the implantation of experience feed back committees (CREx) dedicated to the registration, analysis and correction of precursor events. After two years, we report the centre Oscar-Lambret experience in Lille and try to get the recommendations for generalisation of the process. This seems now to be compulsory for security management in oncology.

The value of radiotherapy for the treatment of meningeal melanocytoma

International Nuclear Information System (INIS)

Rades, D.; Karstens, J.H.; Tatagiba, M.; Brandis, A.; Dubben, H.H.

2002-01-01

Background: Meningeal melanocytoma is described as rare benign lesion with a high risk of recurrence. There are no well-substantiated treatment recommendations in the literature. Only case reports have been published by now. Patients and Methods: In 1997 a patient was irradiated for a recurrent spinal meningeal melanocytoma and 2 years later for brain metastases indicating malignant transformation. This case gave rise to a literature review for therapeutic options. All sufficiently documented cases published since 1972, when the term meningeal melanocytoma was established, were evaluated. Based on published and on original data recurrence and overall survival rates up to 5 years were calculated for three different therapeutic approaches, namely complete tumor resection, incomplete resection with subsequent radiotherapy, and incomplete resection alone. Statistical evaluation was performed using the χ 2 test and Kaplan-Meier-analysis. Results: 53 patients (including our patient) met selection criteria. Complete tumor resection was superior to incomplete resection alone with lower recurrence (4-38% versus 50-92%) and better overall survival rates (86-95% versus 30-58%). After incomplete resection radiotherapy seemed to improve prognosis (recurrence 15-45%; overall survival 91-92%). Between complete resection and incomplete resection plus radiotherapy no significant differences were observed. Conclusions: For meningeal melanocytoma complete resection must be regarded as the best of the modalities compared. After incomplete resection radiotherapy should be considered, although a specific radiotherapeutic regimen cannot be recommended at present. However, for multiple cranial or spinal lesions total cranial irradiation or craniospinal irradiation is indicated. (orig.) [de

PLANNING NATIONAL RADIOTHERAPY SERVICES

Directory of Open Access Journals (Sweden)

Eduardo eRosenblatt

2014-11-01

Full Text Available Countries, states and island nations often need forward planning of their radiotherapy services driven by different motives. Countries without radiotherapy services sponsor patients to receive radiotherapy abroad. They often engage professionals for a feasibility study in order to establish whether it would be more cost-beneficial to establish a radiotherapy facility. Countries where radiotherapy services have developed without any central planning, find themselves in situations where many of the available centres are private and thus inaccessible for a majority of patients with limited resources. Government may decide to plan ahead when a significant exodus of cancer patients travel to another country for treatment, thus exposing the failure of the country to provide this medical service for its citizens. In developed countries the trigger has been the existence of highly visible waiting lists for radiotherapy revealing a shortage of radiotherapy equipment.This paper suggests that there should be a systematic and comprehensive process of long-term planning of radiotherapy services at the national level, taking into account the regulatory infrastructure for radiation protection, planning of centres, equipment, staff, education pr

41 CFR 101-39.4901 - Obtaining standard and optional forms.

Science.gov (United States)

2010-07-01

... VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.49-Forms § 101-39.4901 Obtaining standard and optional... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Obtaining standard and optional forms. 101-39.4901 Section 101-39.4901 Public Contracts and Property Management Federal Property...

Repeated diffusion MRI reveals earliest time point for stratification of radiotherapy response in brain metastases

DEFF Research Database (Denmark)

Mahmood, Faisal; Johannesen, Helle H; Geertsen, Poul

2017-01-01

An imaging biomarker for early prediction of treatment response potentially provides a non-invasive tool for better prognostics and individualized management of the disease. Radiotherapy (RT) response is generally related to changes in gross tumor volume manifesting months later. In this prospect......An imaging biomarker for early prediction of treatment response potentially provides a non-invasive tool for better prognostics and individualized management of the disease. Radiotherapy (RT) response is generally related to changes in gross tumor volume manifesting months later....... In this prospective study we investigated the apparent diffusion coefficient (ADC), perfusion fraction and pseudo diffusion coefficient derived from diffusion weighted MRI as potential early biomarkers for radiotherapy response of brain metastases. It was a particular aim to assess the optimal time point...

The otological status of patients with nasopharyngeal carcinoma after megavoltage radiotherapy

International Nuclear Information System (INIS)

Tang, N.L.S.; Choy, A.T.K.; John, D.G.; Hassalt, C.A. van

1992-01-01

A middle ear effusion is a common complication of nasopharyngeal carcinoma both before and after radiotherapy. An effusion was found in 38 per cent of patients before radiotherapy and 9 per cent developed an effusion after the start of radiotherapy. Surgical treatment by myringotomy with or without grommet insertion was associated with a high incidence of otorrhoea (26 per cent) which was often refractory to treatment. In view of the frequency of this complication and the fact that a middle ear effusion may not be of concern to an adult patient with nasopharyngeal carcinoma, a wait and see policy may be appropriate in the management of a middle ear effusion in these patients. (Author)

Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer

DEFF Research Database (Denmark)

Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max

2014-01-01

The TARGIT-A trial compared risk-adapted radiotherapy using single-dose targeted intraoperative radiotherapy (TARGIT) versus fractionated external beam radiotherapy (EBRT) for breast cancer. We report 5-year results for local recurrence and the first analysis of overall survival....

Development of a model for recording and evaluating incidents in radiotherapy

International Nuclear Information System (INIS)

Ribeiro, A.L.C.; Paiva, E. de; Teixeira, F.C.S.

2017-01-01

Radiotherapy has been constantly improving to become increasingly effective, thus contributing to increase the chances of healing patients. In this sense, incident learning gained prominence during successive approaches to patient safety. The objective is to develop a tool for recording and analyzing incidents in radiotherapy and applying it to clinics in Rio de Janeiro in order to implement the policy of quality management and safety culture. Steps were taken that involved the analysis of the process maps for the enrichment of the system (called the Standardized System of Incidents in Radiotherapy - SPIRad) that already has a version in physical form. The proposal is the conversion of this form to a digital tool to be used through the intranet. The next step is to apply it to radiotherapy clinics in Rio de Janeiro and evaluate the results obtained with the objective of possible improvements through feedback from users

Treatment outcome in patients with vulvar cancer: comparison of concurrent radiotherapy to postoperative radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Lee, Ja Young; Kim, Sung Hwan; Kim, Ki Won; Park, Dong Choon; Yoon, Joo Hee; Yoon, Sei Chul [St. Vincent' s Hospital, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of); Yu, Mina [St. Mary' s Hospital, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of)

2012-03-15

To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

Mainstreaming Disaster Risk Management for Finance: Application of Real Options Method for Disaster Risk Sensitive Project

Directory of Open Access Journals (Sweden)

KUSDHIANTO SETIAWAN

Full Text Available This paper discusses the application of real options analysis for a project that is in the process of construction and was affected by a natural disaster. The use of the analytical method has become a way of thinking in making decisions that should be taught to business school students. The case in this paper is based on an MBA thesis at the University of Gadjah Mada that was intended as a showcase for application of real options to address real business problems. It shows one of the strategies in mainstreaming disaster risk management in the business school that also answers the needs of businesses in the disaster-prone country.

Erythropoietin and radiotherapy

International Nuclear Information System (INIS)

Le Fur, E.; Albarghach, M.N.; Pradier, O.

2010-01-01

Erythropoietin (E.P.O.) is a glycoprotein hormone. This hormone is a growth factor for red blood cells precursors in the bone marrow. The decrease of oxygen partial pressure, a reduced number of erythrocytes caused by bleeding or excessive destruction, or increased tissues oxygen requirements lead to increased secretion of E.P.O.. Its action takes place on bone marrow erythroblastic cells through specific receptors. E.P.O. stimulates the proliferation of red cell precursors stem cells in the bone marrow, thus increasing their production in one to two weeks. The effectiveness of E.P.O. at increasing haemoglobin and improving patients quality of life has been demonstrated by several studies. However, its use in radiotherapy remains controversial. While tumour hypoxia caused by anaemia is a factor of radio resistance and thus a source of local failure, tumour expression of E.P.O. receptors presents a significant risk for tumour progression and neo-angiogenesis, which would be increased during the administration of E.P.O.. The purpose of this article is to answer the question: is there a place for E.P.O. in combination with radiotherapy in the management of cancer?

Dosimetric confirmation of a software for the design of radiotherapy

International Nuclear Information System (INIS)

Alfonso, R.; Huerta, U.; Torres, M.; Alonso, J.L.

1995-01-01

A software for radiotherapy treatment has been recently designed by specialists in medical physics form Hermanos Ameijeiras Clinical and Surgical Hospital. Several locations in the distributions of dose calculations. The results of dosimetric measurements with TLD-700 powder in a human-like manikin were taken as reference. The different options available for the entry of patients shape data are explained. A comparison of the results of measurements with calculations, is presented. Causes of discrepancies are analyzed and recommendations regarding the usefulness of the different for the collection of data from patients are made

A review on technological options of waste to energy for effective management of municipal solid waste.

Science.gov (United States)

Kumar, Atul; Samadder, S R

2017-11-01

Approximately one-fourth population across the world rely on traditional fuels (kerosene, natural gas, biomass residue, firewood, coal, animal dung, etc.) for domestic use despite significant socioeconomic and technological development. Fossil fuel reserves are being exploited at a very fast rate to meet the increasing energy demands, so there is a need to find alternative sources of energy before all the fossil fuel reserves are depleted. Waste to energy (WTE) can be considered as a potential alternative source of energy, which is economically viable and environmentally sustainable. The present study reviewed the current global scenario of WTE technological options (incineration, pyrolysis, gasification, anaerobic digestion, and landfilling with gas recovery) for effective energy recovery and the challenges faced by developed and developing countries. This review will provide a framework for evaluating WTE technological options based on case studies of developed and developing countries. Unsanitary landfilling is the most commonly practiced waste disposal option in the developing countries. However, developed countries have realised the potential of WTE technologies for effective municipal solid waste management (MSWM). This review will help the policy makers and the implementing authorities involved in MSWM to understand the current status, challenges and barriers for effective management of municipal solid waste. This review concluded WTE as a potential renewable source of energy, which will partly meet the energy demand and ensure effective MSWM. Copyright © 2017 Elsevier Ltd. All rights reserved.

Audit on dose delivery by using TLD in Radiotherapy Centers in Malaysia

International Nuclear Information System (INIS)

Md Saion Salikin; Taiman Kadni; Husaini Salleh; Asmaliza Hashim; Hasrul Husham Hussain

2004-01-01

The External Audit Group (EAQ) is established and supported by IAEA. Its main objective is to audit the accuracy of dose delivery to patients in radiotherapy centres or hospitals in developing countries in IAEA member states. At MINT the operation of EAG is managed by Medical Physics Group and supported by Secondary Standard Dosimetry Laboratory (SSDL), MINT. The selected radiotherapy centers are supplied with TLD powder in capsule form, to be irradiated with the required radiation doses, by their physicists. The irradiated TLD is analysed at SSDL. The result of the audit for a few radiotherapy centres in Malaysia, is presented in brief in this paper. (Author)

Radiotherapy in small countries.

Science.gov (United States)

Barton, Michael B; Zubizarreta, Eduardo H; Polo Rubio, J Alfredo

2017-10-01

To examine the availability of radiotherapy in small countries. A small country was defined as a country with a population less than one million persons. The economic status of each country was defined using the World Bank Classification. The number of cancers in each country was obtained from GLOBOCAN 2012. The number of cancer cases with an indication or radiotherapy was calculated using the CCORE model. There were 41 countries with a population of under 1 million; 15 were classified as High Income, 15 Upper Middle Income, 10 Lower Middle Income and one Low Income. 28 countries were islands. Populations ranged from 799 (Holy See) to 886450 (Fiji) and the total number of cancer cases occurring in small countries was 21,043 (range by country from 4 to 2476). Overall the total number of radiotherapy cases in small countries was 10982 (range by country from 2 to 1239). Radiotherapy was available in all HIC islands with 80 or more new cases of cancer in 2012 but was not available in any LMIC island. Fiji was the only LMIC island with a large radiotherapy caseload. Similar caseloads in non-island LMIC all had radiotherapy services. Most non-island HIC did not have radiotherapy services presumably because of the easy access to radiotherapy in neighbouring countries. There are no radiotherapy services in any LMIC islands. Copyright © 2017. Published by Elsevier Ltd.

Prophylactic and therapeutic management of oral complications related to chemotherapy and radiotherapy: role of dental oncology in cancer patient supportive therapy

International Nuclear Information System (INIS)

Buffarah, Henry Bittar

2008-01-01

Cancer patients under treatment of head and neck tumors as well as those under chemotherapy for hematologic cancers, such as lymphoma and leukemia, and those about to receive bone marrow grafts, do require preventive oral and dental care (prior to cancer treatment), as well as oral care during and after oncological treatment. Furthermore, chemo and radiotherapy-related adverse effects are also common in patients with other types of cancer, with an estimated frequency of 10 per cent in adjuvant chemotherapy (QT), 40 per cent in primary QT, 80 per cent in bone marrow transplantation, in which myeloablative regimens are introduced, and 100 per cent in head and neck radiotherapy, in which the targeted fields are those of the oral cavity. The dentist, specialized in dental oncology, works within the multidisciplinary team at the great centers of cancer treatment, contributing to improve the quality of life of these patients. The present review of literature and of the Guidelines for Management of Oral Complications of Chemotherapy and Head and Neck Radiation (US National Cancer Institute) aims to inform the clinical oncologist, the radio therapist, and other professionals about the resources available in Oral Supportive Therapy in both the prevention and managements of such complications. (author)

Novel Technological and Management Options for Accelerating Transformational Changes in Rice and Livestock Systems

Directory of Open Access Journals (Sweden)

Ngonidzashe Chirinda

2017-10-01

Full Text Available Agricultural producers grapple with low farm yields and declining ecosystem services within their landscapes. In several instances, agricultural production systems may be considered largely unsustainable in socioeconomic and ecological (resource conservation and use and impact on nature terms. Novel technological and management options that can serve as vehicles to promote the provision of multiple benefits, including the improvement of smallholder livelihoods, are needed. We call for a paradigm shift to allow designing and implementing agricultural systems that are not only efficient (serving as a means to promote development based on the concept of creating more goods and services while using fewer resources and creating less waste but can also be considered synergistic (symbiotic relationship between socio-ecological systems by simultaneously contributing to major objectives of economic, ecological, and social (equity improvement of agro-ecosystems. These transformations require strategic approaches that are supported by participatory system-level research, experimentation, and innovation. Using data from several studies, we here provide evidence for technological and management options that could be optimized, promoted, and adopted to enable agricultural systems to be efficient, effective, and, indeed, sustainable. Specifically, we present results from a study conducted in Colombia, which demonstrated that, in rice systems, improved water management practices such as Alternate Wetting and Drying (AWD reduce methane emissions (~70%. We also show how women can play a key role in AWD adoption. For livestock systems, we present in vitro evidence showing that the use of alternative feed options such as cassava leaves contributes to livestock feed supplementation and could represent a cost-effective approach for reducing enteric methane emissions (22% to 55%. We argue that to design and benefit from sustainable agricultural systems, there is a

Status of Radiotherapy around the World: Radiotherapy in China. Chapter 25.6

International Nuclear Information System (INIS)

Zhu, Ci; Yin, Wei Bo; Chen, Bo; Zhang, Chun Li; Zhang, Hong Zhi; Li, Ye Xiong

2017-01-01

China’s experience of using radiotherapy to treat cancer began with the installation of the first superficial X ray machine at Peking Union Medical College Hospital in early 1920, followed by the first 200 kV deep X ray machine installed at the French Hospital in Shanghai in 1923, and the first Chinese radiotherapy department established at the Affiliated Hospital of Peking University in 1932. However, the field of radiotherapy in China was still in its infancy between the 1930s and 1960s, as all operating machines were imported from foreign countries, making radiotherapy very difficult to access for cancer patients. Progress was slow until the mid-1970s, when the first batch of megavoltage machines (cobalt-60 machines and linacs) was produced by Chinese manufacturers. Owing to the efforts of radiotherapy pioneers such as Wu Huanxing, Gu Xianzhi, Liu Taifu, and Yin Weibo, who brought radiotherapy to China and shaped how Chinese patients would be treated today, radiotherapy was installed as one of the mainstream modalities of cancer treatment. In 1986, the China Society for Radiation Oncology (CSTRO) was founded, indicating that a network advancing radiation oncology practice in China was taking shape. One year later, the first issue of the Chinese Journal of Radiation Oncology was published, offering a platform for the timely exchange and sharing of laboratory and clinical research outcomes among radiation oncology professions across the country. During the past two decades, with the introduction of the gamma knife and stereotactic radiotherapy, 3-D conformal radiotherapy, IMRT, IGRT and other advanced techniques, China experienced not only a big jump in its radiotherapy equipment and facilities, but also a dramatic growth in the excellence of radiation oncology specialist staff nationwide

Radiotherapy for Metastatic Merkel Cell Carcinoma: A Review of the Literature

Directory of Open Access Journals (Sweden)

Luluel Khan

2012-01-01

Full Text Available Introduction. Merkel cell carcinoma is a rare form of non-melanoma skin cancer of neuroendocrine origin. Optimal management of patients is controversial and the role of radiotherapy is unclear. Purpose. The purpose of this study was to review the efficacy of RT in the treatment of both local and distant metastatic disease from MCC. Methods. A literature search was conducted in MEDLINE (1946—January Week 1 2012 and Embase (1980–2012 Week 2. Articles of interest analyze the efficacy of radiotherapy for treatment of metastatic MCC and did not exclude case reports. Results. All articles except one focusing on the role of radiotherapy were of retrospective origin or case series. Significant limitations applied in all studies due to limited sample sizes and the retrospective nature of these studies. Radiotherapy improves locoregional control in the adjuvant setting, and many series suggest an improvement in overall survival. In cases where surgery is not possible, definitive radiotherapy may be an as-efficacious alternative. The radiosensitive nature of MCC coupled with existing reports suggests that treatment via current protocols for other primary tumors is adequate. Conclusion. Further studies should be conducted prospectively to clarify the true role of radiotherapy in metastatic MCC.

Poster — Thur Eve — 52: A Web-based Platform for Collaborative Document Management in Radiotherapy

International Nuclear Information System (INIS)

Kildea, J.; Joseph, A.

2014-01-01

We describe DepDocs, a web-based platform that we have developed to manage the committee meetings, policies, procedures and other documents within our otherwise paperless radiotherapy clinic. DepDocs is essentially a document management system based on the popular Drupal content management software. For security and confidentiality, it is hosted on a linux server internal to our hospital network such that documents are never sent to the cloud or outside of the hospital firewall. We used Drupal's in-built role-based user rights management system to assign a role, and associated document editing rights, to each user. Documents are accessed for viewing using either a simple Google-like search or by generating a list of related documents from a taxonomy of categorization terms. Our system provides document revision tracking and an document review and approval mechanism for all official policies and procedures. Committee meeting schedules, agendas and minutes are maintained by committee chairs and are restricted to committee members. DepDocs has been operational within our department for over six months and has already 45 unique users and an archive of over 1000 documents, mostly policies and procedures. Documents are easily retrievable from the system using any web browser within our hospital's network

Poster — Thur Eve — 52: A Web-based Platform for Collaborative Document Management in Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Kildea, J.; Joseph, A. [Dept. of Medical Physics, McGill University Health Centre, Montreal, QC (Canada)

2014-08-15

We describe DepDocs, a web-based platform that we have developed to manage the committee meetings, policies, procedures and other documents within our otherwise paperless radiotherapy clinic. DepDocs is essentially a document management system based on the popular Drupal content management software. For security and confidentiality, it is hosted on a linux server internal to our hospital network such that documents are never sent to the cloud or outside of the hospital firewall. We used Drupal's in-built role-based user rights management system to assign a role, and associated document editing rights, to each user. Documents are accessed for viewing using either a simple Google-like search or by generating a list of related documents from a taxonomy of categorization terms. Our system provides document revision tracking and an document review and approval mechanism for all official policies and procedures. Committee meeting schedules, agendas and minutes are maintained by committee chairs and are restricted to committee members. DepDocs has been operational within our department for over six months and has already 45 unique users and an archive of over 1000 documents, mostly policies and procedures. Documents are easily retrievable from the system using any web browser within our hospital's network.

Complete remission of a lymphoma-associated chylothorax by radiotherapy of the celiac trunk and thoracic duct

International Nuclear Information System (INIS)

Gerstein, J.; Fruehauf, J.; Bremer, M.; Kofahl-Krause, D.

2008-01-01

Background: a chylothorax is a rare complication of mostly advanced malignant lymphomas. A case of a refractory chylothorax unresponsive to chemotherapy and successfully treated with radiotherapy is reported. Case report: a 45-year-old woman with recurrent stage IV low-grade follicular non-Hodgkin's lymphoma and a progressive chylothorax is described. The CT scans showed bulky lymphadenopathy at the thoracic trunk but no detectable enlargement of mediastinal lymph nodes. After ineffective pretreatment including chemotherapy and chest drainage, fractionated radiotherapy to the celiac trunk (20.4 Gy) and the thoracic duct (15 Gy) was performed. Result: already after 7.5 Gy a rapid decline of chylothorax was noted and the chest drain could be removed. A complete remission of the chylothorax could be achieved after 20.4 Gy. During a follow-up of 16 months no recurrence of chylothorax occurred. CT scans showed nearly complete remission of the lymphadenopathy of the celiac trunk 12 months after radiotherapy. Conclusion: radiotherapy with limited total doses is an effective treatment option for lymphoma-associated chylothorax and should always be taken into consideration, especially in cases unresponsive to chemotherapy. (orig.)

Hyperthermia and radiotherapy

International Nuclear Information System (INIS)

Fitspatrick, C.

1990-01-01

Hyperthermia and radiotherapy have for long been used to assist in the control of tumours, either as separate entities, or, in a combined treatment scheme. This paper outlines why hyperthermia works, thermal dose and the considerations required in the timing when hyperthermia is combined with radiotherapy. Previously reported results for hyperthermia and radiotherapy used together are also presented. 8 refs., 8 tabs

Radiotherapy

International Nuclear Information System (INIS)

Wannenmacher, M.; Debus, J.; Wenz, F.

2006-01-01

The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy

Outcome of post-prostatectomy radiotherapy in one institution

International Nuclear Information System (INIS)

Borg, M.; Buxton, S.; Heilbornn, C.; Wong, H. Z.; Sutherland, P.; Bolt, J.; Steele, D.; Stapleton, A.; Porter, A.; Landers, B.

2006-01-01

We present a retrospective study to evaluate the outcome of postoperative radiotherapy for biochemical or clinical recurrent prostate cancer. Twenty-six patients (median age 60 years) underwent radiotherapy after radical prostatectomy between January 1997 and January 2004. Seven patients received adjuvant radiotherapy and 19 received salvage radiotherapy. The median prostate-specific antigen at diagnosis was 8.6 (0.9-89) and most (23 patients) presented with T 3N 0 disease. The median follow up was 19.5 months (5-84 months). All patients received a dose of 61.2 Gy at 1.8 Gy per fraction, 20 initially receiving 45 Gy to the lesser pelvis. The median dose to the bladder, rectum and left femoral head were 55.6, 57.5 and 33.8 Gy, respectively. All patients were managed radiotherapeutically by the first author. Twenty-four patients are alive. Two patients have died, one from oesophageal cancer and the second from metastatic prostate cancer. Two other patients also developed metastatic disease. Four asymptomatic patients with a rising prostate-specific antigen are under observation. None of the 26 patients has developed a local recurrence. Seven patients have developed grade 1 late bowel effects and three a grade 2 late effect. Eight patients suffer from grade 1 late genitourinary effects and two from grade 2 effects. One patient developed impotence, whereas 23 patients were rendered impotent postoperatively. There were no grade 3/4 late effects. Postoperative radiotherapy is well tolerated and provides effective local control

Stereotactic body radiotherapy: current strategies and future development

Science.gov (United States)

2016-01-01

Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

Optimization of the primary collimator settings for fractionated IMRT stereotactic radiotherapy

International Nuclear Information System (INIS)

Tobler, Matt; Leavitt, Dennis D.; Watson, Gordon

2004-01-01

Advances in field-shaping techniques for stereotactic radiosurgery/radiotherapy have allowed dynamic adjustment of field shape with gantry rotation (dynamic conformal arc) in an effort to minimize dose to critical structures. Recent work evaluated the potential for increased sparing of dose to normal tissues when the primary collimator setting is optimized to only the size necessary to cover the largest shape of the dynamic micro multi leaf field. Intensity-modulated radiotherapy (IMRT) is now a treatment option for patients receiving stereotactic radiotherapy treatments. This multisegmentation of the dose delivered through multiple fixed treatment fields provides for delivery of uniform dose to the tumor volume while allowing sparing of critical structures, particularly for patients whose tumor volumes are less suited for rotational treatment. For these segmented fields, the total number of monitor units (MUs) delivered may be much greater than the number of MUs required if dose delivery occurred through an unmodulated treatment field. As a result, undesired dose delivered, as leakage through the leaves to tissues outside the area of interest, will be proportionally increased. This work will evaluate the role of optimization of the primary collimator setting for these IMRT treatment fields, and compare these results to treatment fields where the primary collimator settings have not been optimized

Athabasca caribou landscape management options report : executive summary

Energy Technology Data Exchange (ETDEWEB)

NONE

2009-05-15

The woodland caribou are listed as threatened under Alberta's Wildlife Act and the federal Species at Risk Act. The key factors that directly or indirectly affect the population size and distribution of woodland caribou population include habitat change due to wildfire or human land-use activities, predation and hunting. The Alberta Woodland Caribou Recovery Plan outlines a time line to progressively improve conditions for caribou in Alberta. The 2 main goals are to achieve self-sustaining woodland caribou populations and maintain the distribution of caribou in Alberta; and ensure that long-term habitat requirements for woodland caribou are met within Alberta's caribou range. The Athabasca Landscape Team conducted 2 analyses from which it developed management options. The first was a rating or relative risk to caribou persistence within 4 Athabasca ranges based on a series of 8 risk criteria, including both biological and land use factors. The second analysis conducted for each planning area involved simulation modeling using ALCES to forecast likely caribou populations and habitat conditions under 3 scenarios, including non-industrial, business and usual, and alternative futures. 1 tab.

Natural options for management of melasma, a review.

Science.gov (United States)

Nomakhosi, Mpofana; Heidi, Abrahamse

2018-02-20

A blemish free, even-toned skin is universally associated with healthy skin. This reasoning makes people desire to have a flawless skin. Melanin is a naturally occurring pigment in humans. This pigment is responsible for skin, hair, and eye color, therefore determines our race and phenotypic appearance. On darker skin types, it is common that melanin production processes malfunctions. These malfunctions often lead to overproduction and secretion of melanin. As a result, unwanted pigmentary problems such melasma occur. Due to unknown etiology and its recurrence in nature, melasma is challenging to treat. The current available melasma treatment options often produce undesired side effects and suboptimum results. First-line topical treatments usually involve hydroquinone or topical steroids. Apart from the irritant reactions, this treatment mode is not suitable for all skin types. Skin care specialists are in search of an effective long-term cosmetics and cosmeceuticals to address hypermelanosis problems. Understanding of naturally occurring depigmenting agents provides an opportunity for more effective ways to manage melasma in all skin types. This review considers the benefits of naturally occurring ingredients which could help address skin pigmentation problems and broaden the choice for skin-lightening treatments.